All about Inside Knee Pain
Knee Replacement

Typically, knee replacement surgeries are done for individuals who have debilitating knee pain and who have exhausted all other forms of treatment, including cortisone (steroid) injections and arthroscopic surgery. Osteoarthritis (the natural wear and tear of the knee which causes knee joint pain) and other knee diseases are the most common reasons for knee replacements. However, certain types of injury (or repeated knee injuries) may also require knee replacement surgery to alleviate pain.

If knee pain is so severe that it starts preventing a person from simple tasks, such as walking, then knee replacement surgery may be the best option. In severe cases, the knee may ache even when sitting or laying down. Your doctor will discuss if and when is the best time to have surgery as well as which type of knee replacement may be best for your situation.

Types of Knee Replacement

Total Knee Replacement - The majority of knee replacement surgeries are total knee replacements (TKR). Usually by the time pain is so severe that surgery is suggested, enough of the knee is damaged that multiple parts of the joint must be replaced. The good news is, knee replacement surgeries are one of the most routine and safest surgeries performed.

Partial Knee Replacement - In some instances where only one area of the knee is damaged, an orthopedic surgeon may perform a partial knee replacement surgery (PKR) in just one area of the knee. For example, if only the patella is damaged, the doctor may suggest knee cap replacement.

Minimally Invasive Knee Replacements - Your orthopedic surgeon may also discuss whether traditional knee replacement or minimally invasive knee replacement is best for you. Minimally invasive knee replacement does the same thing as traditional knee replacements, just through a smaller opening in the knee. The kneecap is moved to the side during this procedure. Since the incision is smaller, it usually decreases healing and recovery time. However, doctors are not certain whether the outcome of minimally invasive procedures are as good as traditional knee replacements, as studies have shown a higher incidence of complications with minimally invasive methods. Researchers are consistently trying new techniques for opening the knee and knee replacements have vastly improved over the past few decades.

Knee Replacement Alternatives - Again, typically your physician will only look at knee replacement surgeries after all other options have been exhausted. Here are some non-traditional treatments for knee pain that may be an alternative to knee replacement to try before going under the knife:

  • Weight loss
  • Acupuncture
  • Physical therapy
  • Arthritis knee braces
  • Knee injections (there are varying types of injections - speak with your doctor about your options)

There are also medical companies that are starting newer procedures of their own as knee replacement alternatives. These include knee stem cell therapy and alternate procedures which you may research. It's important to weigh all your options before deciding to do knee replacement surgery.

Knee Replacement Surgery

After making the incision, there are typically four stages to knee replacement surgery.

Step 1 - The existing structures of the knee joint are prepared for the artificial parts by removing unhealthy cartilage and/or bone.

Step 2 - The new implants are positioned into the areas they are replacing in the knee.

Step 3 - The kneecap (patella) is adjusted to fit with the new components. It may be resurfaced or cemented. This step may be skipped, depending on your surgeon and on your situation.

Step 4 - A spacer is inserted to ensure that the joint glides smoothly. The surgeon will also flex and bend the knee to ensure that it is working properly. The incision is then closed up (usually with staples or stitches) and the patient is prepped for recovery.

Be aware that knee replacement complications may occur. As with any surgery, there is risk of blood clots and infection. There is also a small chance that knee stability and knee pain are not improved after surgery. Rarely, the knee replacement implant may fail - meaning that it comes loose or is not aligned well. In those cases, the surgeon will need to perform additional surgery to fix the issue.

Knee Replacement Recovery

After knee replacement surgery, a patient will typically spend between 1 and 7 days in the hospital. During this time, nurses will help you manage your pain and you will be encouraged to move your foot and ankle to increase blood flow to your legs. This helps reduce the chances of blood clots and decreases swelling. Patients are usually discharged from the hospital once they are able to get in and out of bed and walk short distances with help from a walker or other non-human devices.

Some questions you may want to ask your doctor about knee replacement recovery may include:

  • When can I take a shower?
  • What changes in diet may I need to make?
  • What exercises can I perform?
  • Can I drive?

Physical therapy is a key portion of the knee replacement recovery process. The goals during this time are to perform exercises that increase your strength and range of motion. Your therapist will also show you exercises to do on your own at home.

The total time for knee replacement recovery varies from patient to patient, as there are many factors such as age, type of knee replacement, etc. that may affect the recovery time. Most patients are able to walk without assistance from a walker or cane by 12 weeks. However, full recovery (which means that the patient feels normal) may take about 6 months. The patient's involvement and adherence to physical therapy and other instructions from the doctor may help reduce knee replacement recovery time.