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What is a Total Knee Replacement (TKR)?

A total knee replacement (TKR) is a surgical procedure wherein some parts of the knee are removed and replaced with artificial parts. 

When is total knee replacement required?

It is a surgical procedure. Therefore, it should be a last resort for an individual: 

  • when all conservative management, including walking aids, painkillers and lifestyle modifications, is no longer helpful, 
  • when there is functional impairment with unbearable knee pain, 
  • when there is reduced joint range of motion,
  • when there is flexion deformity that compromises quality of life, 
  • when there is radiological evidence that there are significant arthritic changes in the knee. 

For which conditions is a total knee replacement not advisable?

  • Joint infections, 
  • Other systemic infection or sepsis, 
  • Neurological pain, 
  • Bones in normal condition. 

 

If other conditions are present: 

  • when general anaesthesia cannot be tolerated, such as for an individual with a poor heart, 
  • general poor health, 
  • failed extensor mechanism in the knee, 
  • significant peripheral vascular disease.

What are the benefits of a total knee replacement?

  • Improved range of motion, 
  • Reduced pain, 
  • Improved functional abilities, 
  • Improved quality of life.

What functions can be improved after a total knee replacement?

  • Transfers such as sit-to-stand,
  • Bed transfers, 
  • Toilet transfers,
  • Getting in and out of a car, 
  • Improved mobility and reduced use of walking aids, 
  • Ability to go up and down stairs, 
  • Mobility without pain, both indoors and outdoors, 
  • Engaging in enjoyable activities. 

How long will a total knee replacement last?

Most clinicians tend to agree that a total knee replacement lasts for 10 to 15 years. However, it is possible for individuals to experience no issues for 30 years or more. The key to maintaining the replaced knee is an active lifestyle. 

 

What does total knee replacement rehabilitation consist of?

TKR rehabilitation consists of:

  • pre-operative care, 
  • post-operative care, 
  • long term maintenance.

 

Pre Operative: It is good practice to: 

  • learn how to apply ice to the surgical site, 
  • learn the post-surgery exercises,
  • gain knowledge on 

☆ pain,

☆ stiffness, 

☆ swelling and its management.

Post Operative: It is crucial that this is approached wholeheartedly, with maximum effort. Do not be deterred by: 

  • pain, 
  • stiffness, 
  • swelling.

Physiotherapy starts on the Day 1. A physiotherapist will begin with:

  • exercises, 
  • mobility using a frame, 
  • cryotherapy for pain. 

Between Days 3 and 5, patients should be able to: 

  • get in and out of bed independently, 
  • sit to stand from bed/chair independently, 
  • progress mobility from frame to elbow crutches, 
  • mobilise with one or two elbow crutches independently, 
  • navigate stairs with physiotherapy technique, 
  • get in and out of a car, 
  • be discharged from hospital and return home.

 

Long term maintenance: After coming home, it is important to do the following: 

  • home exercises, 
  • begin outdoor mobility, 
  • gradually increase the distance every day. 

A physiotherapist will review the exercises and increase the intensity to a mutually agreed level.

 

What precautions do I need to take following total knee replacement surgery?

Falling: Remove all rugs and mats from the floor. Always be cautious while changing clothes. Have the lights on in the hallway and toilets, particularly during the night. Use walking aids to get to the toilet during the night.

Infection: Avoid long periods of inactivity. Do not overdo the exercise, and slowly wean from painkillers.

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