Many people fear the idea of "joint replacement" even though it can be life-changing!

Knee replacement surgery is one of the most effective surgeries today, which can restore normal daily activities for those suffering from severe knee pain. Many people find that this surgery significantly improves their quality of life by reducing pain, enhancing mobility, and restoring functionality. (1)‍

What is Knee Replacement Surgery?

Knee replacement involves replacing the damaged part of the knee joint with an artificial one, either partial or total replacement, which makes it easier to walk and do everyday activities without pain or discomfort. (1)

In partial knee replacement, only the damaged parts are replaced, while preserving as much of the healthy joint as possible. Total knee replacement, on the other hand, replaces the entire joint. (1)

Indications

The most common indication for knee replacement is advanced osteoarthritis (grade 4), a condition characterized by severe wear and tear of the knee cartilage, where other treatments such as medications, injections, or physical therapy no longer provide relief. This may result in: (1)(2)

• Severe knee pain and stiffness, limiting everyday activities like walking short distances or even standing up from a chair.
• Moderate to severe pain even when at rest.
• Persistent knee inflammation that doesn’t improve with rest or medication.
• Knee deformities, such as bowing or bending.

Knee replacement surgery can also be done for other types of arthritis and severe knee injuries.

Outcomes

Knee replacement surgery has been one of the most successful procedures over the last 30 years, with a ten-year success rate exceeding 90%, which means that most patients enjoy their lives painlessly for a long time. (3)

About 90% of artificial joints last over 15 years, and some may last up to 25 years before needing replacement. (4)

Risks

As with all surgeries, there is a small risk of complications in knee replacement surgery, which may include: (3)

• Infection inside the joint or at the surgical site.
• Nerve damage that causes issues like numbness, weakness, and tingling.
• DVT (deep vein thrombosis).
• Persistent stiffness and knee pain may also occur in a few cases, accompanied by limited mobility.
• Severe reaction to general anesthesia.

Preparations

• Your surgeon may ask you to stop certain medications before surgery, including blood thinners, and immunosuppressants - such as methotrexate.
• The surgeon will order some tests to ensure that you are eligible for the surgery.
•  If you smoke, it's important to quit as it can delay the healing process.
• Inform your doctor if you have any symptoms of a cold or flu, as surgery may be postponed.
• To ensure a smooth recovery, prepare your home by rearranging furniture to create a safe space and consider using safety tools to prevent slipping or bending. 
• Practice using crutches or a walker.
• You will need to fast for 8 to 12 hours before surgery. (4)

Surgery Steps

Knee replacement surgery typically lasts around two hours, depending on the extent of joint damage. The steps of the surgery generally include: (4)

• General or regional anesthesia; meaning there is no pain during the procedure.
• A vertical incision in the knee, about 20-25 cm long, is made.
• The kneecap is shifted to the side, so the doctor can reach the joint.
• Both the ends of the femur bone and the lower leg bone are reshaped to fit the new joint.
• The new joint is then secured with the underlying bone using screws or bone cement.
• The new joint is then attached to the inner surface of the kneecap.
• Muscles and tendons are attached to the joint, and the incision is closed.

Book an appointment with the Orthopedics Department at Dr. Soliman Fakeeh Hospital, where we use the highest quality joint implants and the latest surgical techniques.

Recovery

Most patients can walk without crutches or a walker within 3 to 6 weeks after knee replacement surgery. However, full recovery may take several months to a year, particularly for more strenuous activities. (4)

Pain:

Expect significant pain during the first two days post-surgery, but strong pain relievers will be provided. (5)

Walking and Movement:

• You can walk on the same day of the surgery or the next day with the help of crutches or a walker, and you will be advised to gradually increase the distance over the next few days.
• Most patients can resume normal daily activities within 3-6 weeks.
• Although it takes 6 months or more before you can regain complete strength and mobility, most patients find that their movement is considerably better within 1-2 months than what was before the surgery. (1)

Physical Therapy:

During your hospital stay, a physical therapist will teach you exercises to help regain movement and make daily activities easier. (2)

Recovery Tips:

• Use crutches or a walker at first and then reduce to one crutch as you gain strength.
• Take a 5-minute walk every hour to reduce the risk of blood clots.
• Keep your leg elevated to reduce swelling.
• Avoid kneeling on your new knee until your doctor says it is okay.
• Avoid twisting, bending, or climbing as much as possible.
• Avoid standing for long periods.
• Avoid heavy lifting for at least 3 months.
• Avoid sitting crossed-legged for at least 6 weeks.
• Practice exercises recommended by your physical therapist regularly.
• Return to work when you feel ready, this is usually 6-12 weeks depending on the types of your work. (5)

Frequently Asked Questions

At what age can knee replacement surgery be performed?

There is no specific age requirement for this surgery. It is based on pain severity and mobility limitations. While most patients are between 50 and 80 years old, the surgery can be performed on younger or older individuals depending on their knee condition. (2)

What will my new knee feel like?

Your movement will improve significantly, though it won’t feel exactly like a natural knee. You’ll be able to walk, bend, and climb stairs comfortably. Kneeling may be uncomfortable initially, but many patients can manage it with time. (2)

References

1. HSS - Knee Replacement
2. OrthoInfo - Total Knee Replacement
3. University of Washington - Total Knee Replacement: A Patient's Guide
4. MedlinePlus - Knee joint replacement‍
5. NHS - Recovering from a knee replacement