Total Knee Replacement

Candidates for TKA typically have severe arthritis or a significant knee injury that interferes with daily activities and significantly impacts quality of life. Symptoms may include chronic knee pain, difficulty walking or climbing stairs, moderate to severe knee pain even at rest, and significant stiffness or instability in the knee. This surgery is generally considered after non-surgical treatments, such as physical therapy and medications, have proven ineffective.

TKA is performed under general anesthesia or spinal anesthesia. The procedure generally involves:

• Preparing the bone: The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
• Positioning the metal implants: The removed cartilage and bone are replaced with metal components that recreate the surface of the joint. These metal parts are either cemented or “press-fit” into the bone.
• Resurfacing the patella: The undersurface of the patella (kneecap) is sometimes cut and resurfaced with a plastic button.
• Inserting a spacer: A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

After surgery, you’ll likely experience some pain, but this will be managed with pain medication. Physical therapy usually begins the day after surgery to help restore knee movement and strength. You’ll also be educated on how to use walking aids and how to manage activities of daily living during your recovery at home. Many patients are able to go home the same day of surgery.

Physical therapy is a crucial part of the recovery process after TKA. Your knee surgeon Dr. Mayo and the physical therapy team will design a tailored rehabilitation program for you. This will usually include:

• Early Stage (Weeks 1-3): The initial focus is on wound care, pain management, and regaining range of motion. You’ll also start light exercises to strengthen your leg muscles.
• Middle Stage (Weeks 4-8): As your knee heals, the focus will shift towards strengthening exercises, improving flexibility, balance training, and walking without assistance.
• Late Stage (Weeks 9 and beyond): The final stage involves gait training, and low-impact cardiovascular exercises like cycling or swimming. The goal is to restore your knee’s function and strength.

Like any surgery, TKA comes with potential risks. These may include:

• Infection: Occurs in about 1-2% of cases. Antibiotics are administered to reduce this risk.
• Blood clots: DVT or PE can occur but are relatively rare. You will take an aspirin or other blood thinning medication daily to minimize this risk.
• Nerve damage: While rare, there can be injury to the nerves near the knee causing permanent or temporary weakness and numbness.
• Prosthesis complications: Over time, the knee prosthesis may wear out or loosen, necessitating a revision surgery.

Most patients can start moving and walking with the aid of a walker or crutches within a day of surgery. Full recovery and return to regular activities, including light sports, typically takes about three to six months, although it can vary depending on the individual’s general health, age, and commitment to rehabilitation.

If your knee surgeon Dr. Mayo recommends TKA and you opt not to undergo the procedure, potential risks include:

• Worsening pain and mobility issues: Your knee pain and mobility issues will likely continue and may worsen over time.
• Decreased quality of life: Without surgery, you may face ongoing pain, limited mobility, and reduced ability to perform daily activities, impacting your overall quality of life.
• Worsening arthritis and deformity: If surgery is delayed for a long time, the arthritis may continue to progress and lead to a worse deformity which may make the surgery more difficult.