Knee Replacement Surgery: Types, Procedures, Risks and Recovery

Millions of people worldwide struggle with daily activities like climbing stairs or moving out of bed due to severe knee pain. When conservative treatments are unable to give relief, knee replacement surgery offers a solution that helps patients return to active lifestyles.

Knee replacement surgery involves clearing damaged joint surfaces & replacing them with artificial components. This procedure comes in different types, from total knee replacement to partial knee replacement, each suited to specific patient needs. While the surgery has become increasingly common and successful, patients need to understand the procedure, preparation requirements, and recovery process to make informed decisions about their treatment.

This comprehensive guide explains everything patients need to know about knee replacement surgery, from recognising when surgery might be necessary to understanding the recovery journey. Readers will learn about the surgical procedure, various types of knee replacements, potential risks, and what to expect during recovery.

Understanding When You Need Knee Surgery

Recognising when knee replacement surgery becomes necessary involves understanding specific signs and medical conditions. Patients often reach this point when their quality of life significantly diminishes due to knee problems.

Signs your knee needs replacement

The decision to undergo knee replacement surgery typically comes after experiencing persistent symptoms. Key indicators include:

• Constant, severe pain that persists during rest
• Visible swelling and inflammation unresponsive to medication
• Difficulty performing daily activities like climbing stairs
• Stiffness and limited mobility in the knee
• Pain that disrupts sleep
• Need for daily painkillers to reduce knee pain 
• Bowing of the leg
• Changes in knee appearance

Medical conditions leading to surgery

Osteoarthritis stands as the most common condition necessitating knee replacement surgery. This condition causes the breakdown of joint cartilage, leading to pain and limited movement. Other medical conditions that might require surgery include rheumatoid arthritis and post-injury arthritis. These conditions may translate into irreversible damage to the knee joint, making daily activities increasingly difficult.

Johnson & Johnson Vely's robot for knee replacement

The VELYS™ Robotic-Assisted Solution by DePuy Synthes is a part of Johnson & Johnson MedTech. This represents a significant advancement in knee replacement surgery through the application of robotic technology. This innovative, table-mounted system is designed to integrate seamlessly into the surgeon's existing workflow, eliminating the need for pre-operative imaging and reducing the system's footprint in the operating room. 

The VELYS system provides real-time insights into joint stability and soft tissue balance, enabling precise alignment. It works exclusively with the ATTUNE® Knee System, which has been shown to improve patient-reported outcomes by harmonizing with the patient's anatomy to deliver both stability and motion. This combination aims to set a new standard for patient performance and elevate the overall knee replacement experience.

Types of Knee Replacement Surgeries

There are four types of knee replacement surgeries commonly known. 

• Total Knee Replacement (TKR) involves replacing the entire joint. 
• Partial Knee Replacement focuses on replacing only the damaged part. 
• Kneecap Replacement targets the undersurface of the kneecap. 
• Complex (Revision) Knee Replacement is performed on patients who have had previous knee replacements.

Getting Ready for Your Surgery

Proper preparation is vital for ensuring successful knee replacement surgery outcomes. The preparation phase typically begins several weeks before the scheduled surgery date, involving various medical evaluations and lifestyle adjustments.

Medical tests and evaluations

A thorough pre-operative evaluation helps determine if patients are fit for surgery. The orthopaedic surgeon will coordinate with a team of doctors to conduct comprehensive assessments. These evaluations include:

• Physical examination to assess knee strength and stability
• Complete blood count and metabolic panel
• Chest X-ray and electrocardiogram (EKG)
• Urinalysis to check for infections
• Review of current medications
• Dental examination to rule out infections

Lifestyle changes before surgery

Patients must make several necessary lifestyle modifications in the weeks of surgery. Smoking cessation becomes crucial as nicotine can impede healing and increase infection risks. Those with diabetes should work closely with their healthcare team to control blood sugar. Weight management also plays a significant role, as losing one pound can reduce four pounds of pressure on the knees.

Home preparation tips

Creating a safe & comfortable environment is a must for post-surgery recovery. Patients should prepare their homes well in advance of the procedure. Key preparations include:

• Removing trip hazards like loose rugs and electrical cords
• Setting up a recovery area with essential items within reach
• Arranging for help with daily tasks for the first few weeks
• Western toilets for the initial 3 months 
• Organising transportation for follow-up appointments

These preparations help ensure a smoother recovery process and reduce the risk of complications after knee replacement surgery.

What Happens During Surgery

The surgical process for knee replacement begins in the operating room, where a skilled team of doctors works together to ensure a successful procedure. 

Types of anaesthesia

The choice of anaesthesia significantly impacts the surgery experience. Patients typically receive either regional or general anaesthesia. Regional anaesthesia numbs only the lower part of the body while keeping the patient conscious but sedated. This includes spinal blocks and epidural blocks, which are used in over 90% of knee replacement surgeries. General anaesthesia, which makes the patient completely unconscious, serves as an alternative when regional anaesthesia isn't suitable. Epidural blocks also help in post operative pain reduction.

Step-by-step surgical process

The knee replacement procedure follows a precise sequence of steps that typically takes 1-3 hours. After anaesthesia induction, the surgeon:

• Makes an incision across the front of the knee (8-10 inches for traditional surgery, 4-6 inches for minimally invasive)
• Rotates the kneecap outside the knee area for better access
• Removes damaged bone & cartilage from the thighbone and shinbone
• Shape the remaining bone so that it can fit the artificial components
• Attaches titanium components to the thighbone and shinbone using surgical cement
• Inserts a medical-grade plastic component between the metal parts
• Tests the knee's movement and alignment before closing the incision

Duration and hospital stay

After surgery, patients spend 1-2 hours in the recovery room while the anaesthesia wears off. The typical hospital stay ranges from 1-3 days, though some patients may go home on the same day of surgery. During this time, medical staff monitors vital signs, manages pain, and helps patients begin their recovery journey.

Recovery Journey

Your recovery journey after knee replacement surgery begins as soon as patients return home. While each person's healing process varies, following a structured rehabilitation plan helps ensure optimal results.

The first few weeks after surgery

The initial recovery phase focuses on managing pain and swelling while gradually increasing mobility. Patients typically experience moderate to severe swelling in the first few weeks. To manage this, they should:

• Elevate the leg above the heart level
• Apply ice packs for 20 minutes multiple times daily
• Take prescribed pain medications as directed
• Keep the incision clean and dry
• Move feet and ankles regularly to improve circulation

Physical therapy and exercises

Physiotherapy starts within 24 hours of surgery, marking the beginning of a structured rehabilitation programme. By week three, most patients no longer need prescription pain medication. The exercise programme typically includes:

• Early Phase (1-3 weeks):
  • Knee bending and straightening exercises
  • Walking with assistive devices
  • Ankle pumps for circulation
• Progressive Phase (4 weeks):
  • Stationary cycling
  • Strength training exercises
  • Balance activities

Getting back to normal activities

Patients gradually return to daily activities as their strength improves. Most people can drive after 4-6 weeks. By month three, patients typically achieve about 95% recovery. Work return varies: desk jobs usually resume within 4 weeks, while physical jobs may require up to 3 months.

With new implants swimming becomes possible once the incision fully heals, while activities like golf and cycling can resume after proper consultation with doctors. Patients can start high-impact activities such as running & jumping also.

Risks of Knee Replacement Surgery

Generally, knee replacement surgery is a safe procedure, but there are some risks to consider:

• Persistent pain in the knee 
• Unexpected bleeding at the incision site
• Infection at the incision site or deeper in the joint- requiring additional surgery
• Blood clot formation 
• Surrounding nerve or tissue damage
• Damage to ligament or blood vessels
• Joint instability
• Implant failure

Conclusion

Knee replacement surgery stands as a reliable solution for people experiencing severe knee pain and limited mobility. Modern surgical techniques, proper preparation, and dedicated recovery efforts help patients return to their active lives. Success rates remain high, with most artificial joints functioning well even after twenty years.

Patients who follow their doctor's guidelines, commit to physical therapy and maintain realistic expectations achieve the best outcomes. Though recovery requires patience and dedication, most people return to their regular activities within 2 months after surgery. 

FAQs

1. What is knee replacement surgery?

Arthroplasty or knee replacement surgery involves the replacement of damaged knee joint surfaces to alleviate pain and improve function. It's commonly performed for patients suffering from osteoarthritis & other knee diseases, such as rheumatoid arthritis.

2. When is it recommended?

Pain or stiffness significantly limits daily activities, when there's chronic inflammation unresponsive to rest or medication, in cases of knee deformity, or when other treatments like medications, injections, and physical therapy have failed to provide relief are few indications of knee replacement surgery.

3. How long is the recovery period?

The recovery timeline varies among patients. Typically, hospital stays last 1-3 days. Most patients can resume driving after 4-6 weeks and return to normal activities within one and a half months. Full recovery usually takes 2-4 months.

4. How long do knee replacements last? 

The longevity of knee replacements is impressive, with 80-90% lasting 20-30 years. However, this may depend on the patient's activity level, weight, and overall health.

5. Are there alternatives to knee replacement surgery?

Before opting for surgery, several alternatives may be considered. These include physical therapy, weight loss, anti-inflammatory medications, cortisone or lubricating injections, bracing, and acupuncture. Patients should avoid therapies such as stem cell as there is no proven benefit.