Knee Replacement Surgery Who Needs It, When to Get It, and What to Expect

Introduction

The knee joint is one of the most important joints in the human body and plays a crucial role in weight-bearing and movement. Damage to the knee joint can cause symptoms ranging from stiffness to severe knee pain, significantly affecting daily activities such as walking, climbing stairs, and getting in and out of a chair. Knee replacement surgery (also known as total knee arthroplasty) is one of the most common orthopedic surgeries performed in the geriatric population to relieve pain and restore function.

How to Decide if Knee Replacement is Needed

Who Needs a Knee Replacement Surgery?

Most cases requiring knee replacement stem from progressive joint degeneration due to osteoarthritis, rheumatoid arthritis, or other degenerative conditions. Patients should consult an orthopedic surgeon if they experience:

• Severe knee pain preventing routine activities like climbing stairs or standing up.
• Persistent knee pain even during rest or sleep.
• Chronic knee swelling unresponsive to medications.
• Noticeable knee deformity affecting posture and mobility.

When is Knee Replacement Surgery Recommended?

Not every patient with knee arthritis or pain will require surgery. Treatment options before surgery may include:

• Pain management: NSAIDs, opioids (in severe cases), and topical analgesics.
• Physiotherapy and exercise: Strengthening muscles around the joint to reduce strain.
• Weight loss programs: Reducing stress on the knee joint for arthritis management.
• Injection therapies: Corticosteroid injections, platelet-rich plasma (PRP) therapy, or Visco supplementation (hyaluronic acid injections).
• Nerve block therapy: Temporary pain relief by blocking nerve signals.

When these non-surgical interventions fail and joint degeneration reaches an advanced stage, knee replacement surgery is advised.

How is Knee Replacement Surgery Performed?

Pre-operative Phase

Preparation starts 2-3 weeks before surgery and includes:

• Consultations with an orthopedic surgeon, anesthetist, physiotherapist, and treating physician.
• Medical clearance for patients with conditions like hypertension, diabetes, asthma, or heart disease.
• Pre-surgical counseling to discuss implant options, total knee replacement (TKR) vs. partial knee replacement (PKR), and post-op expectations.

During Surgery

• Types of anesthesia: Spinal anesthesia, epidural anesthesia, or general anesthesia.
• Surgical duration: Typically 1.5-2 hours.
• Hospital stay: Usually 2-3 days, including post-operative monitoring and early physical therapy.

Post-operative Recovery

• Pain management: Anesthetist-guided medications, nerve blocks, or epidural catheters.
• Physiotherapy begins the next day to regain mobility and prevent complications.
• Home recovery: Full recovery takes 3-4 months, with basic activities resuming in 4-6 weeks.

Life After Knee Replacement Surgery

The success of knee replacement surgery depends largely on post-operative care. Patients must strictly follow guidelines on:

• Physiotherapy exercises to improve flexibility and strength.
• Proper wound care to prevent infections.
• Diet modifications to support healing and avoid weight gain.

Possible Post-Surgical Complications

While knee replacement is generally safe, complications can occur, including:

• Infection at the surgical site.
• Fractures during or after the procedure.
• Blood clots (Deep Vein Thrombosis, Pulmonary Embolism).
• Nerve damage, leading to temporary or permanent numbness.
• Chronic pain or stiffness in the knee joint.

Important Questions to Ask Your Doctor Before Surgery

Patients should have a detailed discussion with their orthopedic surgeon regarding:

• Severity of symptoms and necessity of surgery.
• Alternative treatments before considering knee replacement.
• Types of knee replacement surgeries and the best option for their condition.
• Other medical conditions that need attention before surgery.
• Surgeon's experience and expertise in knee replacement procedures.
• Anesthesia options and associated risks.
• Post-surgical pain management and expected hospital stay.
• Total cost of surgery and insurance coverage.
• Timeframe for full recovery and rehabilitation.
• Longevity of knee implants and potential revision surgery needs.

Conclusion

Knee replacement surgery is a major medical procedure requiring careful evaluation, pre-operative preparation, and post-operative rehabilitation. A multidisciplinary approach involving orthopedic surgeons, anesthetists, physiotherapists, and dietitians ensures a smooth recovery. Asking the right questions before surgery helps patients and their families make well-informed decisions for a successful outcome.

Healthy Wrinkles is devoted to better healthcare of senior citizens. We hope that Healthy Wrinkles YouTube channel, blogs and healthcare service databases will help senior citizens and also their family members to ensure better health. Knowledge, discussions and demonstrations over here are for the purpose of information only and shall NOT be construed as medical advice. You should contact your health care professional with respect to any specific problem or issue.

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About the Author

Dr. Brishnik Bhattacharya

MBBS. DA. DNB (anaestheology)

Consultant Anesthesia & Acute Pain Management