Total Knee Replacement
Total knee replacement (TKR) in an orthopedic surgical procedure where the articular surface of the knee, the femoral condyles & tibia plateau are replaced. In 50% of the cases the patella is also replaced. The aim of the patella reconstruction is to restore the extensor mechanism. It depends on the level of bone loss, which kind of patella prosthesis is placed. The main clinical reason for the operation is osteoarthritis with the goal of reducing an individual’s pain & increasing function. Other reason can be trauma or other rare destructive diseases of the joint. Regardless of the cause of the damage to the joint, the resulting progressively increasing pain and stiffness and decreasing daily function lead the patient to consider total knee replacement. Decision regarding whether or when to undergo knee replacement surgery are usually not easy for the patient.
Implants are made of metal allays, ceramic material or strong plastic parts up to three bone surfaces may be replaced in a total knee replacement.
Ø The lower end of the femur.
Ø The top surface of the tibia.
Ø The surface of the patella.
Current implant deigns recognize the complexity of the joint & more closely mimic the motion of the normal knee. Some implant design preserve the patient’s own ligaments while other substitute for them. Several manufacturers make knee implants and there are more than 150 designs on the market today.
A major reason for putting off knee replacement can be summed up in the word ‘fear’. Fear of the unknown. Fear of the pain. Fear of recovery. Fear of being vulnerable. For some this fear can be crippling causing additional stress & anxiety in the months, weeks and days leading up to the procedure. What joint replacement candidates often don’t realize is that this untempered fear or anxiety can actually negatively affect the outcome of surgery. Studies have shown that patients going into surgery.
We have to make patient believe that they will get through their joint replacement and live richer life because of it. Training mind to stay in the moment & not wander to anxiety and fear driven thoughts will keep anxiety and stress at bay. Practicing mindfulness has the ability to improve the way one interpret & overcome negative experiences.
Quacks in the field of medical lines are very common. So one need to be aware from quack physio’s who are just diploma holders or some technicians. They don’t know the ethics, principles& don’t have proper knowledge.
And in case of TKR they worsen the case. Improper exercises, delay in treatment, late mobilization all these activities put the patient under trouble.
So one must always refer to a skilled physio pre & post operatively for the best results after the surgery.
Myth: One should wait as long as possible to undergo knee replacement surgery.
Fact: It is incorrect. It is not required to wait for the surgery until the pain become intolerable. However, longer life of joint replacement enables people to consider surgery even at a younger age. Unnecessarily waiting for surgery and delaying it, is technically more challenging for the surgeon & it causes patient’s health to Detroiter overtime and increase complications.
Myth: Alternative therapies such as acupressure, ozone treatment, massage beds, oils, laser therapy, and braces will cure advanced arthritis and knee pain.
Fact: There is no scientifically proven permanent non surgical cure for advanced knee arthritis till date. These modalities provide temporary relief in easily to moderate arthritis for some duration and are not curative.
Myth: Knee replacement is a very painful surgery. There is lot of pain in post- operative period.
Fact: Modern day pain management, such as in multimodal approach, ensures that patient does not feel any pain during surgery or post operative.
Myth: After knee replacement, one have to give up some activities and sport.
Fact: Patient have a high probability of getting back to activities like brisk walking or cycling in 6 to 12 weeks however it is better to avoid contact games. Squatting & sitting cross legged in possible but should be kept to minimal in order to have longer life of implant.
Myth: After knee replacement, it takes months to recover.
Fact: After 24-48 hour of surgery, patient become independent for toilet activities weight bearing is tolerated & knee bending is permitted. At around 3 weeks patient can participate in outdoor social activity. Majority of patient can resume their job at 6 weeks.
Myth: New knee last for 15-20 years only.
Fact: With modern day precision including computer assisted knee replacement and advancement in biomaterials, it last for 20-25 years or longer 8 in many people for lifetime.
Myth: Diabetic, hypertensive or patient with heart ailment, cannot undergo TKR.
Fact: To access cardiac function of patient several test are done prior to surgery. These diseases do not affect the outcome of surgery despite that caution is required. In fact one can gain better health & better control of diabetes, hypertension or heart disease after knee replacement as one is able to walk without pain, can go for long walks if required.
Myth: expensive implants are always better & Patient can get good results getting a costly knee implanted.
Fact: Not always true. Result of surgery depend on the implant, not cost and its technique. The other important role of physiotherapist, who keep the patient moving.
When rehabilitating from total knee replacement, a physiotherapist will be your ‘best friend’. He or she will play the role of personal trainer, cheerleader, counselor, offering you tough love all along the way. They know when to push you, when to ease up and when it’s time for you to ‘fly the nest’ cease physiotherapy. They have role both pre-operatively and past-operatively.
Pre-operatively: Physiotherapist choose to teach the patient the exercises before surgery in order that the patient might understand the procedure & after surgery be ready to practice a correct version of appropriate exercises in this way recovery begin rapidly. Physiotherapist trains the patient postural control, gait need to perform functional exercises & develop strength of lower extremities as well as bowel & bladder control.
Post- operatively: studies have shown the importance of physiotherapy post-operatively as it keep the patients moving. Physiotherapist as it keeps the patient moving. Physiotherapist target strengthening of quadriceps & hamstring to improve outcomes from TKR. Physiotherapist protocol includes strengthening and intensive functional exercises given through land based on aquatic programs that are progressed as the patient meets clinical & strength milestones. Due to highly individualized characteristics of these exercises the therapy should be under supervision of a trained physical therapist. Usually the steps followed are mobilization then static strength followed by dynamic strength & stabilization. Important role of physiotherapy in the management of TKR patient is facilitating mobilization within 48 hours of surgery, as part of an accelerated pathway. Physiotherapy in the hospital in patient rehab setting following TKR should be focused on activity based interventions.