Is total knee replacement in your future?

SUSAN LOCKE writes that total knee replacement can ease or eliminate knee pain . . .

Susan Locke

Total knee replacement (TKR), also known as total knee arthroplasty, is a surgical procedure in which artificial parts are used to replace parts of the knee joint.

The surfaces where knee bones meet can become worn out over time, usually due to arthritis or prior trauma. American doctors perform about 700,000 knee replacements annually with the goal of relieving pain, improving knee function, and boosting quality of life.

The most common reason for TKR is that other treatments have failed to relieve knee pain. Other treatments include weight loss, exercise, physical therapy, anti-inflammatory medications, knee bracing or shoe inserts, and injections with either cortisone or a hyaluronic acid derivative.

Other surgical procedures that may be considered instead of TKR include osteotomy, a procedure where the leg bone is cut and realigned. This is usually not recommended for patients over 60 or in patients who have an inflammatory type of arthritis like rheumatoid arthritis. Another option: partial knee replacement where only one part of the knee joint is replaced.

What to expect with TKR. Surgery is usually performed under epidural anesthesia and takes 1.5 to 2 hours. The hospital stay is usually two to four days. Patients wear compression boots when lying down, and once they can walk, anti-embolism stockings should be worn.  Potential complications include blood clot, infection, stiffness and early failure of the implant, which may require revision surgery.

Rehabilitation. Physical therapy (PT) is crucial for recovery. It’s common to begin PT one day after surgery while still in the hospital. After discharge, some people have PT in their home and some patients opt to go to a rehabilitation facility for a few days. PT includes exercises to improve range of motion and to strengthen leg muscles. After several months of rehab, you should be able to have a more active lifestyle.

Dr. Steven Haas

I spoke to Steven Haas, chief of the knee service at Hospital for Special Surgery in New York.

What are the pros and cons of doing both knees at once?

The pros are that there is one surgical procedure and one rehabilitation period. The con is that it’s a larger operation with much greater physiologic stress. The rehab is slower and initially more difficult. Patients must be medically very healthy and not obese. Age is also a factor and is taken into consideration. I rarely perform bilateral TKR in patients over 75 years old.

When do you opt for osteotomy or partial knee replacement?

Osteotomy in active younger patients generally in their 30s and 40s. Partial knee replacement are used in patients who have arthritis, which is very localized to only one compartment and symptoms isolated to that compartment. While this procedure has very good results, the durability may not as good as total knee replacement so patients should be selected with this in mind.

What type of patient is not a good candidate for TKR?

Patients who have history of frequent infection or ulcers of the legs are not good candidates. Patients have to be able to tolerate an epidural, spinal or general anesthetic. Most of our patients receive an epidural.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: [email protected]