If your knee joint is significantly affected by arthritis or injury, this may limit your physical activity, such as walking or walking up stairs. You may even experience pain at rest.
If medications, decreased physical activity, and use of additional support when walking no longer help, total knee replacement may be considered. As a result of this operation, pain may go away, the deformity of the limb will be corrected, and normal physical activity will return.
One of the most significant advances in orthopedics of the 20th century, total knee replacement was first performed in 1968. Improvements in surgical materials and techniques have since greatly increased the effectiveness of this operation. In the United States, approximately 300,000 such operations are performed annually.
What will change after total knee replacement?
When deciding whether to undergo surgery, it is important to understand what awaits you without surgery and what surgical treatment can give you.
More than 90 percent of those who undergo this operation expect complete disappearance of pain and a significant increase in mobility for the possibility of a normal, active life. However, total knee replacement cannot do more than you could before you developed arthritis.
After surgery, you should be careful about certain movements and sports, including running and contact sports.
Even with normal use of the endoprosthesis, its components, especially the polymer spacer, will wear out. If you experience increased stress on the joint or are overweight, the wear and tear process may accelerate and cause instability of the prosthesis and renewed pain. If used properly, a knee replacement can last for many years.
Hazardous activities after surgery: running, jumping, contact sports, aerobics.
Activity that exceeds the usual recommendations after surgery: too long or tiring walks, tennis, lifting weights over 25 kg.
Allowed activities after surgery: non-tiring walks, swimming, golf, driving, “non-extreme” tourism, ballroom dancing, climbing short stairs.
Recommendations for the home
The following are some recommendations that will make your return home easier during the rehabilitation process.
- Firmly fixed grab bars in the bathroom or shower.
- Strong handrails along all stairs.
- A stable chair with a durable, high seat, a strong back, two armrests, and a footrest.
- High toilet seat.
- A stable bench in the shower or a chair in the bathroom.
- Removing loose carpets and electrical wires from areas where you walk.
Operation
You will arrive at the clinic some time before the operation. Next, you will be examined by an anesthesiologist. The most common types of pain relief for total arthroplasty are endotracheal anesthesia (you will sleep during the operation and the ventilator will breathe for you), spinal or epidural anesthesia (in which you will be able to breathe on your own, but your legs will not feel anything. Anesthesiologist will discuss with you the advantages and disadvantages of these methods and help you choose the most suitable type of anesthesia.
The operation lasts on average about two hours. The surgeon will remove the damaged cartilage and some bone and then install new metal and polymer joint surfaces to restore the axis of the limb and the function of the knee joint.
Many different types of prostheses are currently used in total knee replacement. Almost all of them consist of three components: the femoral component (made of a highly polished, durable metal), the tibial component (consisting of a strong polymer, often located on a metal platform), and the patella (also polymer).
After the operation, once you are fully awake, you will be transferred to your room.
You will be in the clinic for several days. After the operation, you will feel pain in the operated joint. You will receive painkillers to relieve pain.
Walking and gentle exercise of the operated joint are essential for recovery and should begin soon after surgery.
To prevent pulmonary complications, you should breathe deeper and cough more often.
The surgeon will take certain measures to prevent thrombosis and prevent swelling, such as elastic bandages, stockings, and the use of anticoagulants.
Foot and ankle exercises should also be done immediately after surgery and will help increase blood flow to the extremities, reducing swelling and the risk of blood clots. Many patients begin knee exercises the day after surgery. Your physical therapist will teach you specific exercises to strengthen your knee joint and restore the movements needed for walking and normal daily activities shortly after surgery.
The patient's condition after knee replacement
The condition after knee replacement almost directly depends on the general health of the patient, the severity of the injury for which the operation was performed, as well as other factors. In any case, the patient will feel pain in the knee area for some time. This is due to the fact that after an injury the joint becomes damaged. But if it is replaced during surgery, then the muscles and ligaments located nearby. retain their original condition. And since the knee was practically immobilized before the operation, the muscles atrophied a little. You can return them to full functionality with the help of special physical exercises. But before that, you first need to deal with the pain that occurs after knee replacement.
Possible complications after surgery
The risk of complications after this operation is low.
Serious complications, such as infection of the operated joint, occur in less than two percent of cases. Such serious complications as myocardial infarction or stroke are even less common. However, chronic diseases can increase the risk of complications. Although they are rare, these complications may prolong your recovery period.
Vein thrombosis of the femur or pelvis is the most common complication of total hip arthroplasty. Your podiatrist will take steps to prevent blood clots from forming in the veins of your legs and pelvis. These measures include special elastic bandages or stockings, exercises and anticoagulants.
Despite the fact that the biocompatibility of implants and surgical techniques are constantly progressing, over time the endoprosthesis may wear out or its fixation in the bone may weaken. In rare cases, important vessels or nerves in the knee joint may be damaged during surgery.
What is knee arthroscopy?
Overload and injury to the knee joint are the most common causes of knee dysfunction. People who actively and professionally engage in sports such as skiing, running, basketball, volleyball and football are considered especially vulnerable. Some injuries can be treated with joint immobilization, physical therapy, and painkillers and anti-inflammatory medications. However, there are some lesions that may require surgery.
In addition to imaging tests such as X-rays, knee ultrasound, or magnetic resonance imaging, orthopedists often perform diagnostic arthroscopy. Thanks to this examination, it is possible to accurately assess the condition of intra-articular structures: muscles, ligaments, articular cartilage, meniscus and synovium. The arthroscope is inserted into the joint through a small incision. Saline solution is injected inside to make it easier to view the pond through the camera. The device allows you to reach hard-to-reach places without the need to make large incisions. As a result, the patient recovers faster and less burdensome. If treatment is required, surgical instruments may be inserted into the joint. This procedure is known as operative arthroscopy.
Homecoming
The success of the operation largely depends on how well you follow your orthopedist's recommendations at home during the first few weeks after surgery.
Careful attitude to the postoperative wound. Stitches or special staples will be placed along your wound along the front surface of the knee joint, or it will be closed with a subcutaneous suture. The staples or stitches will be removed approximately two weeks after surgery. The subcutaneous suture does not require removal.
You must be careful not to get water on the wound until it is completely sealed. You may want to place a bandage over the wound to prevent clothing or elastic stockings from irritating the wound.
Diet. A slight decrease in appetite often occurs for several weeks after surgery. A balanced diet rich in iron is essential to help promote tissue healing and restore muscle strength. Of course, you need to consume enough liquid.
Activity. Exercise is a crucial component of your home rehabilitation, especially during the first weeks after surgery. You should return to normal activities and daily life within 3 to 6 weeks after surgery. During this time, you will experience slight discomfort during active movements and at night.
Your activation program should include:
- Gradually increasing duration of walking, first at home and then on the street.
- Training of necessary movements, such as sitting down, getting up from a chair, walking up the stairs.
- Return to necessary household chores.
- Special exercises a few minutes a day to develop movements in the knee joint.
- Special exercises a few minutes a day to strengthen the knee joint.
- It is possible to carry out physiotherapeutic activities at home.
Driving a car is possible when you develop movements in the operated joint so that you can get into the car without difficulty and when your muscles can provide an adequate reaction when pressing the pedals. This most often occurs 4 to 6 weeks after surgery.
How to prepare for knee arthroscopy? How is the procedure done?
Before undergoing an arthroscopy procedure, the patient should undergo an orthopedic consultation, as well as a series of imaging studies (ultrasound, magnetic resonance imaging) and laboratory blood tests (including morphology, blood type, glucose levels, coagulation system, liver tests). In addition, the patient should be vaccinated against hepatitis B. To do this, it is advisable to consult a family doctor. All concomitant diseases, as well as the fact of taking medications, must be discussed in advance with the attending physician.
The arthroscopy itself does not last long and is usually performed under spinal anesthesia, less often under local or general anesthesia. During the procedure, after an incision is made, specialized cameras and instruments are inserted into the joint, thanks to which the orthopedist will be able to assess the intra-articular structures and the extent of possible damage, and then carry out treatment. The most common treatments include treatment of the meniscus, synovium, and treatment of articular cartilage and ligaments.
Prevention of complications after surgery.
Prevention of thrombosis. Follow your doctor's instructions carefully to reduce the potential risk of blood clots. These problems may especially occur in the first few weeks after surgery.
The following signs indicate the formation of blood clots:
- Pain in the leg, in the calf muscles, not associated with the incision.
- Pain, swelling, redness along the back of the leg.
- Swelling of the thigh, leg, ankle, or foot.
Indications for thromboembolism:
- Sudden difficulty breathing.
- Sudden pain in the chest, aggravated by deep breathing and coughing.
Contact your doctor immediately if these signs occur!
Prevention of infection.
The most common routes of infection after endoprosthetics are the introduction of bacteria into the bloodstream during dental procedures, urinary tract infections, and skin infections. These bacteria can infect the area around the denture.
For two years after surgery, you may need to take prophylactic antibiotics before dental procedures, including enamel cleaning, or other surgical procedures that may introduce bacteria into the bloodstream.
Be alert for the following signs of an early infection:
- Continued fever (temperature above 37°).
- Fever or chills
- Increasing redness, swelling, pain in the area of the postoperative wound.
- Discharge from a wound.
- Increased pain with exercise and at rest.
Contact your doctor immediately if these signs occur!
Prevention of falls.
A fall during the first weeks after surgery can damage the endoprosthesis and lead to the need for another operation. You need to be especially careful when walking on stairs. You should use a cane, crutches, walker, handrails or other assistive devices until the joint becomes stronger and the mobility or strength of the muscles in it is restored.
Your surgeon or physical therapist will advise you on what assistive devices you need after surgery and when you can safely stop using these devices.
When the surgical wound suppurates, body temperature.
Main complications of the postoperative period. Suppuration of a surgical wound is most often caused by aerobic flora, but often the causative agent is anaerobic non-clostridial microflora. The complication usually appears on the 5-8th day of the postoperative period; it can occur after discharge from the hospital, but rapid development of suppuration is also possible already on the 2-3rd day. When the surgical wound suppurates, the body temperature, as a rule, rises again and is usually febrile. Moderate leukocytosis is noted, with anaerobic non-clostridial flora - severe lymphopenia, toxic granularity of neutrophils. Diuresis, as a rule, is not impaired.
What is special about your new knee joint?
After surgery, you may feel numbness in the skin around the scar. You may also feel some difficulty bending your knee joint. Restoring movement in the joint is one of the goals of total arthroplasty, but complete restoration is not always possible.
The metal components of the joint may be detected by metal detectors at airports and other facilities. In such cases, inform the security staff that you had an operation with metal implantation. You can ask the surgeon for a certificate stating that you have had an endoprosthesis implanted.
After surgery, be sure to do the following:
- Participate in training programs to maintain stability and mobility of the new joint
- Follow specific guidelines to prevent falls and injuries. Patients who have suffered a fracture after total joint replacement may require new surgery.
- Let your dentist know that you have undergone total endoprosthetics. It is necessary to take antibiotics before dental procedures for two years after surgery, possibly more, depending on the course of the postoperative period. Antibiotic guidelines for the surgeon and dentist are available on the AAOS and ADA websites.
- Periodically see the surgeon for examination and x-ray control, even if you do not experience any problems with the joint.
Possible consequences after arthroscopy
Arthroscopy is considered a modern method for diagnosing and treating joints. This technique is one of the few where the risks of complications are reduced to almost a minimum. But still, like any operation, surgery on the knee joint has certain risks: Infectious complications. Damage to articular cartilage. Thrombosis of blood vessels. Bleeding Such consequences occur infrequently, in approximately 0.1% of cases. To avoid complications, we strongly advise you to contact only trusted medical centers where real specialists work. Monitor your health carefully after surgery. If severe pain, increasing swelling, shortness of breath and other worrying signs appear, consult a doctor immediately.
Exercises.
For a complete recovery and a gradual return to normal life, regular exercise is necessary to help restore normal joint movements and muscle strength. Your orthopedist and physical therapy doctor may recommend exercising for 20-30 minutes two to three times a day, and also walking for half an hour 2-3 times a day. They may suggest some of the exercises below. The brochure will help you understand how to do these exercises.
Exercises in the early postoperative period.
Begin the following exercises as soon after surgery as possible. You can start them already in the recovery room. You may experience discomfort at first, but they will speed up your recovery.
- Contraction of the quadriceps muscle. Contract your quadriceps muscle. At the same time, try to straighten your knee and lift your leg, holding it for 5 - 10 seconds. Repeat this exercise 10 times for 2 times. minute period, rest for a minute, then repeat. Continue until you feel tired in your hip.
- You can also raise your leg while sitting. Try to straighten your knee more. Continue this exercise until you can straighten your knee completely.
- Flexion - extension of the foot. Slowly bend and straighten your foot at the ankle joint. Do this exercise several times every 5 to 10 minutes. You can start this exercise immediately after surgery and continue until you have fully recovered.
- Exercise to straighten the knee. Place a small bolster under your ankle so that your foot does not touch the bed. Contract your quadriceps muscle. Exercise until your knee is straight, then place your leg on the bed. Keep your knee fully extended for 5 to 10 seconds. Repeat until you get tired.
- Bending the knee while resting on the bed. Slide your heel toward your buttock, bending your knee as much as possible. Keep your knee bent as much as possible for 5 - 10 seconds, then straighten it. Repeat until you become tired or cannot fully bend your knee.
Walking in the early postoperative period.
Soon after surgery, you will begin to walk short distances within the room and begin to care for yourself. Early activation will strengthen the muscles, restore range of motion in the joint and speed up recovery.
Walking with a walker/walking with full weight bearing on the operated leg. Stand up straight and balance your weight on crutches or a walker. Move your crutches or walker forward a short distance. After this, move forward yourself, raising your operated leg so that you can feel the floor, touching it. As you move, your knee and ankle will be flexed. To rest, lower your leg to the floor. When you take a step, it is permissible to lift your foot off the floor. Move the walker forward again and move your foot forward again for the next step. Remember, first you need to touch the floor with your heel, then straighten your leg, then lift your leg off the floor. You are allowed to walk as much as you can. Do not hurry. As your muscle strength and exercise tolerance increases, you will be able to walk more and more. Gradually you will increase the weight load on the operated leg.
Walking with a stick or crutches. A walker is often used for the first few weeks to help with balance and prevent falls. A cane or crutches are then used until strength and range of motion are fully restored. Hold the cane in the hand opposite the operated joint. You will be ready to transition to a cane or crutches when you can balance and stand without a walker, when you can fully distribute your weight on both legs, and when the walker becomes uncomfortable to hold.
Climbing and descending stairs. The ability to navigate stairs requires a certain range of motion and muscle strength. First, you will need handrails for balance and additional support, and at first you will only be able to step on one step at a time. Always ascend stairs on your healthy leg and descend on your operated leg. Remember “ascent with a healthy person” and “descent with a sick one.” At first, you may need help. Climbing stairs is a very good exercise for training muscles and developing joints. Do not climb steps that are more than 7 inches (18 cm) high and always use handrails.
Useful information about the condition after reconstruction (plasty) of the anterior cruciate ligament.
One of the most common plastic surgeries on the knee joint among skiers is arthroscopic reconstruction of the anterior cruciate ligament. There are several options for performing this operation. Here are the most common ones:
1. Type of graft: own tissue (autoplasty) from the hamstring tendon, patellar ligament or quadriceps tendon; donor tissue (alloplasty); synthetic materials.
2. Type of retainers: metal retainers (titanium alloy), absorbable (polymer).
So, It happened. The operation went well, and the rehabilitation period began.
In the modern understanding, the recovery process is divided into several stages, where each new stage is carried out only if the goals set at the previous stage are achieved.
Rehabilitation after reconstruction of the anterior cruciate ligament.
Stage one
The first stage will require patience and skill from you.
1-2 weeks.
Objectives: Reduce pain and swelling.
During the first 24 hours, ice is applied around the knee joint and on the area of postoperative wounds. For the next few days after the operation, bed rest is prescribed, so the “need” will have to be relieved in a duck or bedpan. The position of the leg is full extension, walking only on crutches, and leaning on the leg is impossible or undesirable. In order to fix the lower limb, a plaster cast, splint or orthosis is used, fixed in a position of full extension. At night, it is allowed to slightly loosen the fixation in order to reduce discomfort. In the area of the knee joint, as a rule, there is swelling (this is fluid that accumulates in the joint capsules and periarticular tissues). She's not dangerous. The bulk of the work is performed by doctors: dressing wounds with antiseptics, puncturing a joint (often, but not always). If you are in the hospital before the sutures are removed, then for the first few days prophylactic antibiotics are injected into the gluteal muscle (painkillers are also injected there). If you are on an outpatient basis, then all medications are prescribed, as a rule, in tablets. Sometimes, at the discretion of the attending physician, anti-inflammatory and decongestant physiotherapy “on the spot” (magnet, UHF) is prescribed. From the second to third day, the leg hurts less, and you can begin to perform isometric contractions of the quadriceps femoris muscle in a position of full extension, flexion-extension at the ankle joint, lifting and holding the leg. Duration of exercises is several minutes throughout the day, depending on the pain. On days 10-14, the sutures are usually removed. And remember - postoperative wounds should not be wetted with water until the sutures are removed. So, you will have to take a shower in the “Z” position or tightly wrap your leg with improvised means.
! Frequent problems at this stage are awkwardness and, as a result, falls on crutches. For example, when, after lying for a long time, you decide to go to the toilet, where the wet floor has not yet dried (well, or you just feel dizzy). So before you get up and go, sit on the edge of the bed for a while and calm down. When using crutches, try to take your time and adjust their height so that it is comfortable for you.
Stage two
3-4 week
Objectives: combat muscle weakness, control hip muscles and smooth transition from walking with crutches to walking without additional support. For this purpose, rigid fixation is replaced with an orthosis (semi-rigid or, preferably, “frame type”) with a small angle of flexion. They refuse to use crutches to the best of their ability by gradually putting pressure on the operated limb. A gradual transition option is possible: crutches – cane – walking without support. The main thing is that you feel confident. At this stage, gradual flexion and extension in the knee joint also begin. Exercises for the thigh muscles are performed to a greater extent in a lying or sitting position. It is possible to use electrical myostimulation of the thigh muscles and massage. General strengthening daily exercises are required at home or in the gym.
! Frequent problems at this stage are excessive load on the leg after giving up crutches and, as a result, the appearance of swelling and pain. It is necessary to reduce the load and consult your doctor. Local use of ointments based on heparin and diclofenac is allowed.
This stage is characterized by the beginning of normal life. The leg no longer hurts, crutches are not needed, all the unpleasant attributes of treatment are already behind us. But there is a nuance...
5-8 week
Objectives: restoration of the full range of motion in the knee joint, increasing the strength of the thigh muscles. Restoring correct gait. The lesson is conducted by an instructor-methodologist. This is not always necessary, but it is advisable. It is very important at this stage to achieve a full range of motion. This is the key task of the entire recovery process and requires willpower. This is achieved by constant flexion and extension of the knee joint and, if necessary, by performing physical procedures (thermal procedures, massage, hydromassage, electrical myostimulation, electrical neurostimulation). Moderate strength loads are carried out daily on all muscle groups of the thigh and lower leg (in a sitting or lying position, using weights).
! Common problems at this stage: Many people notice the still weak quadriceps muscle and turn their attention to its recovery. However, this is not true. This muscle tends to quickly atrophy, but its complete restoration (with the formation of the appropriate “relief” and volume) does not occur in one month.
9-12 week
Objectives: improve proprioception (deep sensitivity, sense of the position of a limb in space), restoration of precise movements and static muscle strength. At this stage, the best place for recovery is the gym, with its numerous strength training equipment for all thigh muscle groups, as well as gyms with sports equipment. All exercises are performed in a lying or sitting position. Classes are held at least 3 times a week. The orthosis is usually replaced with a “soft” elastic knee pad.
! Frequent problems at this stage: The desire to start running and jumping. Beware of these wrong desires.
Stage three
This stage is characterized as a “muscle holiday.”
13-16 week
Objectives: improving muscle strength and endurance. At this stage, long-term exercise on an exercise bike or rowing machine is possible. Complex coordinated exercises and balance exercises, lunges, and squats are used. General physical training is increased, classes are held in the pool. Classes are held 3-4 times a week for 2 hours.
! Frequent problems at this stage: Give up everything and wait for everything to recover on its own.
Stage four
Expansion and complication of physical activity.
17 – 24 weeks
The main task is to prepare the muscles for long-term static and dynamic loads. The load is carried out on strength, endurance and coordination in an upright position with a gradual complication of locomotor reactions: walking backwards, in a half-squat, running with acceleration and deceleration on a flat surface, jumping rope, cycling.
! Frequent problems at this stage are muscle and extra-articular pain. They often arise due to an unbalanced approach to training. It is important to pay due attention to warm-up and stretching-relaxation exercises at the end of each session.
Stage five
Up to 36 weeks
Professional preparation for a specific physical or sports activity. This stage involves the restoration of special motor reflexes and skills. The program is compiled individually and is limited only to rehabilitation doctors. To assess the effectiveness, electrophysiological and biomechanical studies are carried out. At all stages of recovery, it is necessary to consult a doctor and a methodologist, do not forget about injury prevention (have good and comfortable shoes and clothes), and warm up well.
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