When is Total Knee Replacement Necessary?

Knee Pain and Total Knee Replacement

Osteoarthritis is the most common cause of chronic pain and reduced knee function. While many types of osteoarthritis exist, those most often causing knee pain include:

• Chronic senile osteoarthritis;
• Osteoarthritis secondary to rheumatoid arthritis (an autoimmune inflammatory disease);
• Post-traumatic osteoarthritis (resulting from fractures);
• Osteonecrosis (bone infarction);

The decision to undergo total knee replacement should be made jointly by you, your family, your family doctor, and the orthopedic surgeon. Your family doctor can refer you to an orthopedic surgeon for a thorough evaluation to determine if you are a candidate for this type of surgery.

Indications for Knee Replacement

When to Consider a Knee Replacement?

Several reasons may lead your doctor to recommend knee replacement surgery. Individuals who benefit from a knee replacement generally experience:

• Severe knee pain or stiffness limiting daily activities, including walking, climbing stairs, rising from or sitting in a chair;
• Chronic inflammation and swelling of the knee that doesn't improve with rest, ice, injections, or medication;
• Knee deformities: a bent knee that no longer extends (a result of severe osteoarthritis). In these cases, prosthetic surgery can realign the limbs;

There is no absolute age or weight restriction for knee replacement surgery. However, these implants do not last forever (15 years on average), and excessive body weight can reduce the longevity of your prosthesis. When a prosthesis is worn out and no longer functional, it must be replaced. This revision knee surgery is more complex and riskier than the initial placement of the knee prosthesis.

When to Proceed with Total Knee Replacement

The indication for total knee replacement is based on the patient's pain and degree of disability, not age. Most patients undergoing total knee replacement are between 50 and 80 years old, but orthopedic surgeons evaluate patients individually. Total knee replacements are successfully performed at any age, from young adolescents with juvenile arthritis to elderly patients with degenerative arthritis.

What Does Total Knee Replacement Surgery Involve?

During total knee replacement surgery, the orthopedic surgeon removes the damaged cartilage and bone, then implants the new metal and plastic knee to restore the alignment and function of your knee. The surgical procedure takes an average of 1 to 2 hours.

In total knee replacement, the damaged cartilage surfaces and a small amount of underlying bone at the ends of the femur and tibia of the entire knee are replaced with metal components. The metal parts are usually cemented to the bone with special cement. A very strong special plastic insert is inserted between the metal parts to create a smooth gliding surface. The underside of the kneecap is cut away and replaced with a plastic button that is also cemented in place. Some surgeons do not do patellar resurfacing or do it on a case-by-case basis, others always do it. There is no scientific evidence in the literature demonstrating the superiority of one choice over the other, so the choice of whether or not to do patellar resurfacing will essentially depend on the experience of each surgeon.

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What to Expect After Total Knee Replacement

You should not undergo total knee arthroplasty if you do not fully understand all the information relating to the operation, including the risks and complications. An important factor in deciding whether or not to have knee arthroplasty is understanding what this procedure can and cannot do.

More than 90% of people who have undergone knee arthroplasty have seen a significant reduction in knee pain and a noticeable improvement in their ability to perform common daily living activities. But total knee replacement will not allow you to do more than you did before you started suffering from osteoarthritis. With normal use and activity, the plastic spacer in any knee prosthesis begins to wear out. Excessive activity or overloading can accelerate this wear and lead you to revise your prosthesis too early because it has loosened or become painful.

Expected Results of Total Knee Replacement

One goal of total knee replacement is to improve movement, but total recovery of movement is rare. The movement your knee will have after surgery can be predicted based on the movement you had before surgery. Most people experience some numbness of the skin around the wound. You may also experience some stiffness, especially when bending.

Most people feel metallic and plastic clicks when the knee bends or when they walk. This is normal. These differences compared to a non-prosthetic knee often lessen with time, and most patients find them tolerable compared to the pain and functional limitations they had before surgery.

Your new knee may set off the metal detectors required for security at airports and in certain buildings. Tell the security officer about your knee prosthesis if it sets off the alarm.

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