Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down. When conservative management like physiotherapy, hydrotherapy and gait aids, are no longer keeping your pain levels under control, you may want to consider total knee replacement surgery. Over the next 2 weeks, we are going to look at the two most common joint replacements – knee and hip. Today’s blog looks at knee replacements: what they are, why they are done, and how physiotherapy is involved in your recovery.
What is a joint replacement?
A joint replacement (arthroplasty), is a surgical procedure to replace the weight-bearing surfaces of a joint. This procedure is performed to relieve pain and disability. It is most commonly performed for osteoarthritis, and also for other knee diseases such as rheumatoid arthritis and psoriatic arthritis.
Knee replacement surgery can be performed as a partial or a total knee replacement. In general, the surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components, shaped to allow continued motion of the knee.
Image credit: PhysioWorks
Risks of knee replacement surgery include:
- persistent instability and knee pain
- knee stiffness
- difficulty returning to your previous level of activity
The good news is that more than 90% of patients have no complications post-surgery!
Why does my knee wear out?
Knee arthritis (inflammation of your knee joint) is a major cause of knee ‘wearing out’ or degeneration. The most common arthritis is osteoarthritis (OA), which is inflammation related to wear and tear of the knee joint. Degeneration of your knee joint is a common problem as we get older. Other risk factors include:
- previous injuries or traumas
- previous surgeries
- muscle weakness
- increased body weight
- rheumatoid disease
- knee infections
Fact: If you lose just 10 kilograms of weight you can reduce the load on your knees by half!
What are the symptoms of knee arthritis?
- pain++, sharp or achy sensations
- deformity may begin to appear (knock kneed or bow legged)
- stiffness, especially difficult locking knee out straight
How is Knee Arthritis Diagnosed?
Your physiotherapist or doctor can assess your knee, looking for signs of limited knee movement causing pain, deformity, and swelling. In most cases, an X-ray will be sufficient to show the degree of wear and tear.
Image credit: AAOS
Can physiotherapy help?
The answer to that question is a loud and resounding YES! More research continues to come out suggesting physiotherapy should be your first line in arthritis management and is most effective in reducing mild or moderate arthritic pain. Massage, stretches, strengthening, Pilates and Hydrotherapy can all reduce your joint pain and slow its progression. Surgery should only be used as a last resort when all other treatments are no longer effective.
If surgery is planned and you haven’t previously seen a physio, you can still benefit from starting physio before your replacement. Studies show that the better your muscle strength and knee range of movement before surgery, then the better and quicker you recover! This might mean an earlier, pain-free return to the activities you love.
What does physiotherapy involve after surgery?
A joint replacement surgery is just that – the replacement of a joint through surgery. Your joint pain should disappear but unfortunately, the strength and stiffness of your knee won’t magically return post-surgery – it’s going to take some work!
Post-surgery, you will normally experience pain and swelling. This can take some time to settle. In the meantime, this unfortunately means your knee will continue to weaken and stiffen whilst you recover. Your physio in the hospital will show you exercises to address this and get you back on your feet, normally the next day! By the time you are ready to go home, you should be able to:
- get in and out of bed, perform transfers with the least amount of help possible, using your gait aid
- walk at least 5-10 metres and go up and down stairs using crutches
- achieve a 90-degree bend of your knee, so you can perform sit-to-stand transfers
- perform your home exercises without assistance
Most patients are in hospital for 3-5 days (those with more complex care needs may spend a week or two in rehab prior to discharge home). Once you are cleared to go home by your surgeon, the hard work begins!
Will I need more physio once I am back home?
For most people the answer is definitely “yes”. Two weeks post-surgery, most patients will still have a stiff, swollen knee, with a healing scar across the front of your knee.
Post-operative physiotherapy will help you achieve full knee motion, strength and day to day function. Therapies include:
Your physio treatment goals include:
- reducing knee pain and inflammation
- reducing scar tissue
- restoring full knee joint range of motion
- strengthening your knee muscles: quadriceps (esp. VMO) and hamstrings
- strengthening your lower limb: calves, hip and pelvis muscles
- improving your proprioception, agility and balance
- improving your technique and function e.g. walking, stair climbing, squatting and bending
How long will it be before I feel normal?
You should be able to stop using your crutches or walking frame and resume normal leisure activities by six weeks after surgery. However, it may take up to three months for pain and swelling to settle down. It can take up to a year for the swelling to totally disappear. Your new knee will continue to recover for up to two years after your operation. During this time, scar tissue will heal and muscles will be restored by exercise.
Even after you have recovered, it’s best to avoid extreme movements or sports where there’s a risk of falling, such as running, skiing or mountain biking. Low impact sports such as golf, bowls or swimming are recommended.
At Revive Physiotherapy and Pilates, we have years of experience working with patients suffering arthritic knee pain or those recovering post knee replacement surgery. Feel free to call us on 9391 2600 to discuss your issues or to make an appointment with one of our Physiotherapists today.