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Knee’d to know?

by Barbara Taylor MCSP

Why do I need a new knee?

Knee replacement surgery is a treatment predominantly for painful arthritis of the knee. The most common form of arthritis is osteoarthritis. In this condition joint surfaces become increasingly worn. Initially the cartilage that covers the surfaces is affected. As the arthritis progresses the bone underneath becomes damaged.

A knee replacement is considered for:

1. Increasing knee pain.
2. Pain and stiffness in your knee, affecting your everyday activities so that you are becoming less independent.
3. Reduced mobility and problems getting around.
4. Athritis that is not responding to other forms of treatment.

What is a knee replacement?

The knee works as a hinge joint between the thigh bone (femur) and the shin bone (tibia). In a normal knee joint the ends of the femur and tibia are covered with a smooth layer of articular cartilage that allows the bones to move over each other. In an arthritic knee the surfaces become roughened. Therefore the knee movements are restricted and painful.

In knee replacement surgery the worn ends of the bones are removed and are replaced with a combination of metal and plastic. In a total knee replacement both the femoral and tibial articular surfaces are replaced and usually cemented in place. If only one side (compartment) of the knee is affected by arthritis it may be possible to have half a knee replacement. Replacement of the kneecap (patella) can be undertaken if the joint between the kneecap and the thigh bone is affected by arthritis.

Current advances in knee replacement surgery include computer assisted surgery, minimally invasive surgery and robotic assisted surgery. Many of these techniques are still in their infancy and are still being evaluated. Other types of knee surgery that may be offered include:

• Arthroscopy (keyhole) where the joint can be examined using small incisions, damaged areas can be repaired or cleared to stop the knee from hurting, giving way or locking.
• Osteotomy to shift the weight bearing from one worn area to another less affected area. In this operation the bone is cut, repositioned and allowed to heal in the new position.
• Recent improvements in cell biology allow the surgeon to take a small piece of articular cartilage from your knee, multiply the cells so that they can then be reattached to cover cartilage defects in the knee.

Please discuss any of these surgical options with your orthopaedic surgeon.

How can I best prepare for surgery?

Stop smoking, and if you are overweight try to reduce your weight. This will lower the risks of an anaesthetic and improve the beneficial effects of the surgery.

Attend any pre-operative clinics as these will ensure you are fit for surgery as well as answering any questions you or your family may have. Check around your home to make sure that loose rugs and mats are removed, electrical cords moved safely out of the way and small objects are removed from the floor.

What can I expect after my knee operation?

After surgery you will be visited by the physiotherapist who will show you deep breathing exercises and exercises to tighten your thighs and buttocks. It is important to keep your feet and ankles moving to maintain a good circulation in your legs.

On the day after the operation knee exercises are started. It is important to do your exercises regularly both in hospital and at home. These will need to be reviewed and progressed as your strength and mobility improve.

Usually the day after surgery you will be encouraged to mobilise. Initially you will take a few steps with a walking frame which will be progressed to crutches or sticks.

A total knee replacement operation is considered major surgery and it may take 3 months before you feel back to normal. As with all major surgery there are risks involved. Please discuss these fully with your Surgeon/GP beforehand.

General advice

1. Once home go for regular walks. You will probably need a walking aid for at least 6 weeks.
2. Try to keep your weight within normal limits as being overweight puts extra strain on your new knee.
3. Most people are allowed to drive between 4-6 weeks after surgery.
4. If you have a sedentary job you will need approximately 6 weeks off work. For manual jobs it may be 12 weeks.

Please follow the advice of your consultant as to specific precautions and time scales that they recommend, as these may vary depending on the type of surgery performed and your medical condition.

What If I don’t want a new knee?

There are various things you can do to help yourself:

1. Keep active. Regular exercise such as walking or swimming can reduce the pain and help to keep you mobile.
2. Keep your weight within normal limits as extra weight puts increased strain on your arthritic knee.
3. Physiotherapy can strengthen your muscles, maintain knee mobility and improve gait.
4. A walking aid, such as a stick, reduces the strain on your knee as well as keeping you active and mobile.
5. Painkillers and NSAIDs (non-steroidal anti-inflammatory drugs) help with pain management.

Time in hospital following joint replacement surgery in both the private sector and NHS is normally 5 days. This limits the amount of physiotherapy treatment received in hospital. Home based physiotherapy is a way of continuing your rehabilitation, improving the range of movement in your knee and your mobilisation in the important 1-4 weeks following your surgery.

Physio2go is a home-based physiotherapy service, our experienced Specialist Physiotherapists offer advice and treatment to patients before and after surgery as well as those who wish to manage the symptoms of arthritis without surgical intervention.