Total knee replacement surgery involves the replacement of an arthritic knee joint with prosthetic components. It is generally successful, with 90-95% of prostheses lasting 15 years.
As the knee is a complex load-bearing joint, it is a common area of injury and chronic pain and mobility issues in patients of all ages. Total knee replacement surgery by a knee surgeon on the Gold Coast is typically recommended for older patients. This is because the prosthetic replacement is not generally designed for high-impact activities such as contact sports – and is not generally intended as a treatment for sports injuries.
Total knee replacement surgery, also known as knee arthroplasty, refers to the replacement of the end of the thigh and shin bones (femur and tibia) and the insertion of plastic cartilage and kneecap (patella) substitutes by a knee surgeon.
When is surgery necessary?
Total knee replacement surgery is recommended when pain and loss of function can no longer be effectively managed by other non-surgical treatments (e.g. rest, physiotherapy and medication).
Surgery is typically deemed as necessary when you are suffering from severe or chronic symptoms, such as:
- Persistent swelling around the knee capsule
- Thinned or absent cartilage lining
- Narrow or irregular joint space
- Bone spurs or thickening around the joint edges
The decision to operate
Dr. Letchford – a knee surgeon on the Gold Coast, will perform a physical examination and refer to recent scans and your medical history to assess whether or not surgery is the best option for your particular knee condition.
Throughout the decision-making process, Dr. Letchford will make every effort to help you understand your options and make an informed choice based on the potential risks and benefits of surgery.
Helping you understand your options
Before making the decision to proceed with surgical treatment, Dr. Letchford will discuss the following with you:
- Your preferred outcome
- The possible benefits and risks of surgical treatment
- What kind of results you can anticipate
Dr. Letchford will only make the choice to recommend a surgical procedure if you both reach the consensus that surgery will provide the most positive outcome, in terms of improving your mobility and assisting with your pain-related issues.
About the procedure
What it involves
Every operation is different, just as every patient is different. Depending on the severity of the damage, additional bone implants or extended prostheses may be needed. In general however, most total knee replacement surgeries follow the same procedure and take around two hours.
- Based on the anaesthetist’s recommendation, you will be given either general or spinal anaesthesia (put to sleep or numbed from the waist down).
- A tourniquet is place on your thigh to limit blood loss.
- An incision is made over the knee, exposing the joint.
- The damaged areas of your femur and tibia (thigh and shin bone) are removed and levelled to a specific angle to prepare for the prostheses.
- The prostheses are test-fit a number of times to ensure perfect surface adhesion.
- The patella (knee cap) may also be replaced if deemed necessary.
- The prostheses are affixed or cemented into place, and their fit confirmed.
- Dr. Letchford will again test the physical motion of the new knee.
- The incision is closed. A drain may be inserted to remove fluid build-up.
Hospital stay and recovery time
In-patient stay: Average 5-7 days
Walk (frame): Up to 6 weeks
Walk (stick): By 6 weeks
Driving: By 6 weeks
Sports: Up to 3 months
Possible risks and complications
Please note that all surgery brings with it risks and possible complications. Fortunately, total knee replacement surgery has a relatively low incidence of complications; however it is important that you are fully aware of any dangers before proceeding.
Some examples of possible complications, in descending order of likelihood, include cosmetic changes in the knee, blood clots, infection, wound or scar irritation, unequal leg length, nerve damage, increased pain, dislocation, failure of the joint, heart attack, stroke or death.
Dr. Letchford and his team will do everything they can to prevent the likelihood of complications or side effects developing.
Prior to arriving at the practice for your surgery, there are several considerations and actions that need to be taken by both you and your knee surgeon, Dr. Letchford. These will ensure the best preoperative and postoperative experience possible.
- Use of medications
You should stop taking any anti-inflammatories or blood-thinning drugs – as well as any natural or herbal medication – at least 10 days prior to surgical treatment.
- Routine medical examination
You will undertake a standard medical evaluation, ensuring that your general health is at a good enough level for the operation. This will also work to determine any potential factors that may indicate problems in the future, including existing skin conditions, infections and body weight-related health concerns.
- Dental-related concerns
Any kind of every-day dental work can result in the introduction of bacteria into your bloodstream. As this can result in the possibility of developing an infection post-surgery, it is wise to have any dental work carried out well prior or after any surgical treatment. Additionally, you may be required to regularly take preventative antibiotic medication for a few months or years after surgical treatment, to counter the risk of developing an infection.
- Additional blood work and testing
Routine blood work will be carried out to ensure that you have an adequate level of health for surgical treatment. If required, our team may also carry out heart checks or miscellaneous scans.
- Preparation of your home environment
It’s wise to carry out preparations at home prior to your surgical treatment, as this will compensate for the limited level of mobility you will have while recovering. Some ideas for these preparations include planning for people close to you to assist you with day-to-day tasks, as well as the rearranging of furniture to make it easier for you to move around the home.
We strongly recommend that all patients cease smoking for as long as they can prior to their surgery. Smoking can encourage the formation of clots, while lessening the ability of the blood to oxygenate and circulate – which is vital for healing.
Recovery, rehabilitation and precautions
- Physiotherapy and exercise precautions
With physical therapy, you should be able to bend your knee to at least 90 degrees by 6 weeks. However, while your physiotherapist will recommend light exercises, be careful not to over-exert your knee in the weeks following surgery. If you are unsure of what activities you can and can’t do, talk to your physio or Dr. Letchford.
- Preventing infection
Make sure you change your dressing as instructed, and keep an eye out for any changes, including fever, chills, tenderness, excessive fluid, or increased pain, as these can indicate infection.
- Blood clot prevention
Our team will prescribe you a combination of bandages and anti-clotting medication to assist in the prevention of clot formation. If you notice any unexplained pain or shortness of breath post-treatment, get in touch with a doctor immediately.
- Maintaining nutrition
It’s possible that your appetite may diminish following surgical treatment. To help speed up your recovery and give your body the best chance to mend, it’s a good idea to eat a balanced, healthy diet – and drink plenty of fluids.
If you require any more information on what you can expect from complete knee replacement surgical treatment on the Gold Coast, feel free to take a look at the resources found at the American Academy of Orthopaedic Surgeons website.