Total Knee Replacement

A total knee replacement is usually a very successful treatment option for a “worn out knee” which is giving the patient daily pain and making mobility difficult. It can improve quality of life and provide an opportunity to get mobile again with comfort.
If you have been told that you are likely to need a knee replacement soon, you may be interested to know more about the surgery, what’s new and what you can do to get the best result.

A lot has changed since the first total knee replacement which was around 1890. The early knee replacements were made of Ivory, held into the bone with plaster and were designed like a hinge. A hinge doesn’t tolerate twisting forces but the knees we are born with do. It wasn’t until the 1970’s that the hinge design was replaced with components that had some resemblance to the normal contours of the knee joint that we see today. This does allow for some twist.

Over time, new knee components and surgical technique have and continue to evolve.  The ultimate aim is to provide a new knee that feels and works much more like a normal knee.  Each person that needs a new knee will be different.  Their functional needs, their health status and the actual problem and shape of the knee is different.  Good surgeons will spend time planning and discussing the proposed surgery with you to maximise the chance of success and satisfaction you will have with your new knee.

In the last 5 -10 years, MRI and 3D CT scans has meant that surgeons can accurately measure what size “parts” they need to put in the knee. Some surgeons use the images to get cutting templates made up for specific patients. They use the templates as a guide to cut the bone accurately which allows the new knee to fit well.

This procedure is known as ”Patient Specific Instrumentation”. This does not mean that you get a new knee specifically made for you. It just applies to the cutting templates that are made up specifically for you. There are a wide range of “off the shelf knees” available. The new technology allows the surgeon to choose one that fits well for your size.

Orthopaedic surgeon Dr Nick Pourgiezis from Active Orthopaedics Adelaide, is using this technology. He reports that the cutting guide templates reduces the surgery time, reduces the size of the cut to the knee, reduces bleeding and aims to improve alignment of the new knee. This helps the knee last longer.

From the surgeons perspective, Dr Pourgiezis states “preparing for surgery is very important and the patients that have the best results are those that have started exercise with range of movement and strengthening exercises pre-operatively.

After surgery physio exercises are very important focussing on achieving a fully straight knee and at least 90 degrees of flexion in the first week.  Gaining confidence in walking is also important. After their post op consultation to confirm healing of the incision, they can start hydrotherapy which is very helpful”.

• Losing a few kilos if you are overweight and seeking help for your arthritis early.  Exercise programs like GLA:D can delay or sometimes prevent surgery.
• Keep up your pain relief after surgery.  Some people hate taking painkillers because they want to know when it hurts.   Pain killers will make it easier to do the exercises so you can get the knee movement back quickly.

If you need help with your knee to prepare for surgery, or are struggling to get going after surgery, our experienced physios are here to help.

Post by Physiotherapist Sandy Woolman with comments from Orthopaedic Surgeon, Dr Nick Pourgiezis.