In patients who have severe progressive knee arthritis, which limits their function, the main form of treatment may be a total knee arthroplasty—also known as total knee replacement surgery. With a total knee arthroplasty, a saw, chisel and other instruments are used to remove the ends of the bones at the knee and to replace them with metal and plastic. This procedure has been found to be very effective at improving a patient’s function. However, it does have some limitations.
First, total knee replacements are felt to last up to 15 years. The amount of time that they last can be dependent upon a patient’s size, alignment, and their age. Heavier and younger patients tend to wear out their replacements sooner. Thus, this has to be factored in when total knee replacement is recommended for a patient.
Studies in Europe have indicated that 20% of patients who have a total knee arthroplasty wish they had never had it in the first place. Thus, it is very important to try to exhaust all forms of non-operative treatment, including exercising, anti-inflammatories as needed, injections, un-loader knee bracing, as well as arthroscopic or realignment surgeries prior to performing a total knee arthroplasty in younger patients.
In general, in patients that are less than 60 years old, we recommend that they try to live with their symptoms and deal without a total knee replacement surgery if they can still walk distances without severe pain, do not have to use a cane, and can go up and down stairs by tandem stepping (that is not going up and down stairs one at a time). In addition, it is very important to evaluate the X-rays in these patients and to correlate them with the clinical symptoms. There are oftentimes where patients may have “bad-looking X-rays,” but in fact they are still functioning quite well to the point where a total knee replacement surgery would not be indicated.
Overall, the results of total knee arthroplasty are effective in a vast majority of patients. However, patients need to be carefully selected for this procedure because it is a very extensive surgery, can be very painful, and can involve a long period of rehabilitation to recover. In addition, it is one of those surgeries that one cannot back from, so indications for surgery must be carefully monitored and followed.
Knee replacement surgery will require physical therapy and rehabilitation so that the knee joint can regain strength, motion, and overall mobility. It is important to follow the prescribed protocol and follow the instructions provided by your therapist closely. Initial therapy focuses on safe motion with certain restrictions for 6 weeks. After a recovery period of 2-3 months, patients typically are painless and performing well with their normal activities.