Knee pain
Knee pain can arise from the knee as a result of the wearing of the lining or cartilage within the knee joint. This knee pain is generally described as developing gradually over time, aggravated by activity and the pain is usually worse at nights or during cold weather. Knee pain, however, can also be referred from the ipsilateral hip and therefore your doctor should always evaluate the ipsilateral hip. Knee pain is the most common symptom associated with a knee replacement but there are additional symptoms commonly observed with patients who undergo knee replacement
Other symptoms are knee stiffness, loss of the normal range of motion of the knee joint both in full extension (straightening) and flexion (bending), repeated slipping out of the knee joint or instability of the knee joint, locking of the knee and swelling of the knee.
Knee pain can also originate from the ligaments, meniscus, muscle, tendon and skin associated with the knee, therefore, a thorough assessment must be done to determine if a knee replacement is right for you.
If you are experiencing any of the above symptoms, your doctor will take a detailed history and do a thorough physical examination. Your doctor will also do investigations such as Blood tests, X-rays, CT scan, MRI, etc. to confirm the diagnosis or underlying cause for your symptoms.
The most common underlying cause for the aforementioned symptoms is arthritis of the knee of which there are many types. Osteoarthritis and rheumatoid arthritis however, are the most common. Arthritis is also the most common underlying reason for a total knee replacement.
Other indication for total knee replacement (TKR) include post traumatic degenerative joint disease or joint collapse with cartilage destruction.
Other causes of knee pain however may be ligamentous injury, miniscus injury and referred pain from the hips.
Individuals experiencing ongoing knee pain which limits your daily activities and is associated with arthritis should first undergo pharmacotherapy and physiotherapy. If overweight then weight loss may help to reduce symptoms. If the aforementioned measures have been exhausted and there are no improvements, then a Total Knee Replacement (TKR) may be warranted.
You may not be a candidate for knee replacement if you have extensor mechanism dysfunction, poor blood supply to the knee, an ongoing septic arthritis or if you are deemed high risk for general or spinal anesthesia. Those issues must be addressed prior to your surgery. Pre-surgery and post-surgery preparations are highly important as well. Before proceeding with surgery, patients must demonstrate a willingness to participate in physiotherapy and to learn how to walk with their new joint.
Most patients who undergo a total knee replacement are able to stand and walk the day after surgery and return home 3-5 days later. Artificial knee joints have an expected life span of over 20 years in about 85-90% of patients, albeit the actual lifespan of the artificial joint does depend on each individual.
The complication rates for a TKR are very small and patients can do their part to keep complications rates low by following their doctor’s instructions before and after surgery. Possible risks or complications associated with anaesthesia, include respiratory or cardiac malfunction. There are also risks associated to the surgical procedure itself and these include:
- Infection requiring antibiotics and in some cases hospitalization. Infection can sometimes occur around the knee joint years after the surgery.
- Blood clots in the legs (deep vein thrombosis), which can dislodge and move to the lungs (pulmonary embolism).
- Injury to nerves or blood vessels.
Fracture or dislocation of the new knee joint may necessitate additional surgeries. With time - sometimes as long as 15 years - the artificial joint will loosen and revision surgery will become necessary.