A Total Knee Replacement (TKR) or Total Knee Arthroplasty is a surgery that replaces the knee joint with artificial metal or plastic replacement parts called the ‘prostheses’. The procedure is recommended for patients who have failed conservative treatment, such as physiotherapy and injections, or those who suffer from pain and loss of function of the knee joint. The operation itself has become common mainly due to arthritis of the knee, as well as trauma, inflammation caused by rheumatoid arthritis, increased stress to the knee or inactive lifestyle.
As osteoarthritis develops in the knee joint, the normal, protective cartilage in the joint is destroyed, leading to uneven and rough joint surfaces in the knee. As a result, the knee joint cannot move smoothly, can become stiff, the joint space narrowed or excessive bone build up can occur. A combination of these factors results in a stiff knee, and can cause pain or fatigue in the joint.
The diagnosis of osteoarthritis is made by your history, physical examination & X-rays. There is no blood test to diagnose Osteoarthritis (wear & tear arthritis).
A TKR depends on your symptoms, and the conservative therapies you have already trialed. A TKR aims to relieve the symptoms of arthritis in the knee; most commonly these symptoms present as pain waking you at night, severe pain which limits daily activities, stiffness or locking of the knee or a deformity of the joint.
Once you have decided to go ahead with surgery, the below gives an example of what may happen before your procedure:
- You will be provided with an instruction pack with hospital forms and a list of all of your pre-operative appointments
- You may require routine blood tests and other investigations prior to your surgery, to ensure you are fit and able to have a general anaesthetic
- You may require a pre-operative check with a physician to assess your general health and medications
- You will be asked to stop smoking as long as possible pre-surgery, to improve your surgical outcome and rehabilitation.
Day of Your Surgery
On the day of your surgery you will be admitted to the hospital. Your anaesthetist will meet with you and discuss the anaesthetic options with you, as well as post-operative pain management, including the pain medication you will take home with you from hospital.
Immediately prior to being transferred to the operating room, your operation site will be shaved and cleaned, and you will be asked to change into a gown. From there you will be transferred to the operating room, and put under a general anaesthetic.
Immediately After Your Operation
You will wake up in the recovery room with intravenous drips in your arm, and your vital signs will be monitored. Staff will assess how stable you are, and once ready, you will be transferred to the ward.
There are a number of risks post-surgery, and these risks will be discussed with Mr. Blackmore during your appointment, and pre-surgery. A common risk is blood clotting in your legs (Deep Vein Thrombosis), therefore you may wake up from surgery with leg coverings or stockings to help minimize this risk.
Once on the ward, we encourage patients to get up and start walking as soon as possible, with assistance. Your rehabilitation in hospital will be under the guidance of occupational therapists and physiotherapists.
Usually, you will remain in hospital for 3-5 days. Depending on your needs, you will either return home or move to a rehabilitation facility.
You will be discharged on a walker or crutches and usually progress to a cane at six weeks.
At Home Following Surgery
After you have returned home from hospital or from a rehabilitation facility, we ask that you take precaution and take care around the house, ensuring it is safe for your new joint. You may need rails in your bathroom, and modify your sleeping arrangements at home, especially if they are up a lot of stairs as some patients find it difficult to climb stairs initially.
Once the wound is healed, you may shower. We recommend leaving the crepe bandages on for at least 1 week, and leaving the sterile bandage on until you see Mr. Blackmore at your first post-operative appointment. Mr. Blackmore will see you approximately 2-3 weeks post operatively for an initial check-up, and you will have regular reviews for approximately 18 months. Additionally, Mr. Blackmore will request you have X-rays each time you see him, to ensure there are no problems with the knee.
If you ever have any unexplained pain, swelling or redness or if you feel generally poor, you should contact Mr. Blackmore’s room as soon as possible.
You will discuss your individual rehabilitation with Mr. Blackmore depending on your situation, however achieving positive long term results depends on how much work you put into it following your operation, so we will always recommend seeing a physiotherapist. Physiotherapy is an important part of rehabilitation and ensuring you get the most out of your new knee joint. Mr. Blackmore has preferred physiotherapists who we can suggest if you do not currently see a physiotherapist.
Risks and Complications
As with any major surgery, there are potential risks involved, which can be general and specific to total knee replacements.
These include general health and anaesthetic risks including allergic reaction to medications or general anaesthetic, complications with nerve blocks and nerve damage. General medical risks include heart attack and stroke, kidney failure, blood loss, prolonged hospitalization and rarely death.
Other complications directly relating to knee replacement can include:
Wear and tear
Blood Clots (Deep Vein Thrombosis)
Fracture and Dislocation
Leg Length Discrepancy
Wound Irritation or Breakdown
The general and specific risks of surgery will be discussed with you prior to your surgery, and we will ensure you are fully informed prior to your decision to go ahead with surgery. Although the majority of our patients are complication-free, it does not mean that everyone will have the same outcome, and you must be aware of these risks prior to making a decision.
A Total Knee Replacement is one of the most successful operations available today, returning function and reducing the pain of knee arthritis in many patients. For most, the knee replacement will last the remainder of their lives, with some prosthesis lasting longer than 25 years.
Surgery is only offered once conservative treatment has been trialed. The decision to have surgery is important, and we recommend patients take the time, and discuss all aspects of surgery with Mr. Blackmore, their family and general practitioner prior to making a decision.
We welcome any enquiries regarding total knee replacement surgery, please call (03) 9928-6188, or via our online web form or email.