Total Knee Replacement

General

The most common reason for total knee replacement in patients is osteoarthritis. There are many type of “arthritis” but osteoarthritis is by far the most common. Other reasonably well-know causes include rheumatoid arthritis and avascular necrosis (osteonecrosis).

In severe cases, arthritis causes pain, stiffness and marked limitation of an individual’s quality of life. When this point has been reached and other non-operative treatments are not successful in controlling the pain, then knee replacement is a definite surgical option.

There are seven indications that suggest a patient may need knee replacement surgery:

  • Pain that disturbs sleep at night;
  • Pain that occurs at rest;
  • Pain that is not controlled by analgesics, anti-inflammatories or steroid injections;
  • Pain that causes restriction at work;
  • Pain that interferes with activities of daily living;
  • The natural history of osteoarthritis of a joint is for patients to experience episodes of pain followed by episodes of relief. When there are no longer significant episodes of relief, then the time is coming to consider surgery;
  • When an individual feels that their quality of life has become so compromised that surgery offers the best long-term solution.

Realistic expectations of knee replacement surgery

Knee replacement surgery has revolutionised the treatment of osteoarthritis, initially in the elderly, but now in the middle-aged population, and occasionally even in young patients where no other alternative is available. Most people over the age of 65 with severe pain in their knees may well remember their grand-parents being immobilised, as they had no alternative other than walking aids or remaining in a chair for the rest of their days as they were so limited in what they could do.

Although revolutionary, it is important to remember that knee replacements do not give an individual a normal knee, but rather a functioning artificial one. Over 90% of individuals who undergo knee replacement surgery experience substantial reduction in their knee pain, and dramatic improvement in their quality of life. In most cases, a knee replacement will not make patients able to do more things than they could have done before the onset of arthritis, but after experiencing the effects of severe arthritis, patients find that knee replacement surgery significantly restores their quality of life.

Patients can look forward to returning to their pre-existing level of activity after knee replacement surgery. While high-impact sports and running are discouraged, a return to activities such as golf, bowls, tennis, gardening and bush walking is encouraged. With normal use and activity all knee replacements will develop some wear, however currently around 90% of knee replacements are lasting 20 years and beyond.

Returning to work can happen in as short a period as a few weeks. For those who do office work, or who are able to work from home, work may resume as soon as comfort allows, provided that regular visits to the Physiotherapist are maintained.

The average time to return to work if travel is involved is six weeks. If heavy manual work is involved, then this period will be closer to three months, however it may be possible to return to lighter duties at around the six-week period following surgery.