Knee replacement Surgery in 2020- Advances, expectations and recovery
Knee replacements have been constantly evolving over the last half a century. Initial designs used a simple hinge mechanism which went through many modification with current modern designs boasting ultra-congruent designs and medial pivots that attempt to mimic the natural knee closely as much as possible. Biomaterial advances have led to better metal compositions and finishes as well as improvements in the polyethylene insert, the artificial cartilage substitute, to make it more resilient. Other advances such as patient specific (custom instrumentation) and Robotic Assisted Knee replacements are discussed below.
Expectation of a successful knee replacement is a pain free knee that allows a patient to function in their day to day life. Remember, the patient that has a knee replacement is often unable to attend to day to day activity due to pain prior to their operation. As such, expectations must be realistic. This is not as good as the knee we are born with and whilst the aim is to get as close to what the knee was like prior to the disease set in, it will never be what the natural knee was like. IT WILL HAVE SOME LIMITATIONS. We all hope that we don’t find these limits during the course of our activities! Having said that, we do have patients that have climbed Mt Kilimanjaro after their knee replacement but for most, the disabling pin of arthritis is gone, they are much more mobile, agile and functional.
Recovery is influenced by a multitude of factors but initial functional recovery is expected to be fairly quick. Patients are usually up walking with a frame or crutches a few hours after their operation. They may leave hospital as soon as they are safe on crutches / stairs and this is usually anywhere between 1-4 days, often a couple of days.
One of the most important factors in determining outcomes is how motivated and proactive the rehabilitation is. This is directed by the patient. Going to a rehab facility and spending a week or two there after the hospital or going straight home or to an outpatient facility a few times a week or the local physio are all options and there is no right or wrong as long as the patient is motivated and proactive with their exercises (within what has been prescribed). This is to recover the movement before scar tissue forms and stiffens the knee which can negatively affect the outcome.
Patients are expected to have some discomfort or even pain for a couple of months that continues to improve every day. The ‘healing process’ though, may continue for a couple of years. Sometimes this can manifest itself by a feeling of discomfort or tightness in the knee.
‘Clicking’ in a knee replacement is quite normal. Often patients get used to it and it becomes less noticeable. Very occasionally, it may be a problem such as new onset clicking.
The following videos are aimed at showing you what most patients mobility is like at different times after their operation.