What is Knee Arthritis?

The bones in a normal knee are lined with a smooth layer of cartilage. This cartilage allows the adjacent surfaces in the knee to glide smoothly and painlessly against each other.

In the process of arthritis, the cartilage is worn away (degenerates) with the end result of “bone rubbing on bone”. This process is painful and can result in inflammation of the knee joint. With progression of the disease the knee becomes increasingly painful, stiff and swollen, and may result in a deformity.

What is a Total Knee Replacement?

A total knee replacement is a prosthesis that is used to replace a knee joint that is affected by arthritis. It consists of several components:

• An upper metal femoral component that is shaped and sized to fit to the contour of the end of the femur bone.
• A metal tibial component which is flat and has a small stem attached to its undersurface.
• The femoral and tibial components are made of cobalt-chrome or titanium. They are both fixed to the bone with a polymer referred to as “bone cement”.
• A plastic insert locks into the upper surface of the tibial component. This insert acts as the bearing surface onto which the femoral component moves against. The plastic is made of polyethylene which has been carefully manufactured to allow it to last a long time without wearing out.

When is a Total Knee Replacement helpful?

The most important indication for surgery is pain that is interfering with your quality of life and is not adequately controlled by other means (medication, injections, physiotherapy, or activity modification).

How long will it take to recover?

Most patients are allowed to walk with assistance within 2-4 hours of surgery. Prior to discharge, extensive physiotherapy instructions will be provided and the patient will be able to climb stairs and get into and out of a car. Post-op stay is usually 1-2 nights.

Crutches are recommended for the first week after surgery. Many people will use a single crutch or cane in the opposite hand for a few weeks longer. Depending on your occupation, one will require 2-8 weeks off work. One can be driven in a car as a passenger immediately on discharge. Patients can drive a car ten days to two weeks after their procedure as long as they are no longer taking narcotics. Airplane travel of less than 6 hours in duration can be undertaken immediately after discharge.

How to prepare for surgery?

Good preparation for surgery lowers risk of complications and expedites the recovery process. Some useful tips include:

• pre-surgery exercise program (“pre-hab”) as shown by a physiotherapist
• smoking sessation
• Weight loss
• Close monitoring of blood glucose levels in diabetic patients
• Well balanced diet and reduced alcohol consumption

Here is a very helpful link with instructions on how to get ready for your knee replacement surgery. https://precare.ca/knee-surgery/

What medications do I stop before knee replacement surgery?

Continue all usual medications, with the exception of blood thinning agents or medications that may increase the risk of clot formation. Please note that many over the counter (non prescription) herbal preparations and supplements may also have strong blood thinning effects.

Some medications to consider include:

• Certain Anticoagulants
• Fish Oil / Omega 3 (cease 3 weeks prior)
• Supplements – Ginko, Ginsing, Garlic (cease 3 weeks prior)
• Hormone Replacement Therapy (cease 3 weeks prior)
• Oral Contraceptive Pill (cease 3 weeks prior)
• Some immune modulating medications may need to be discontinued prior to surgery (please discuss with us during your visit)

Is rehabilitation available after the surgery?

As mentioned, physiotherapy will be initiated immediately after surgery and throughout your stay with us. Upon returning home, we will have the local CLSC arrange for home physiotherapy to help supervise your progress. For international patients or out of province patients, we will provide you with the information needed so a physiotherapist of your choice can continue the required care in your area. For Quebec patients, the CLSC will be contacted by us before the surgery and they will be in touch with you to fulfill any needs you may have after the procedure.

What are the risks of knee replacement?

Knee replacement surgery is very safe, and serious complications are uncommon. Serious wound infection occurs in less than 1% of cases. Clots can form in the veins of the leg (deep venous thrombosis), which on rare occasions may dislodge and travel to the lungs causing breathing difficulty. We will discuss the risks of the procedure with you in detail prior to the operation.

Longer term, what activities can I perform after knee replacement?

Once you have recovered, there are some restrictions on activity after knee replacement. Activities such as walking, cycling, skiing, & tennis may be conducted without limitation. Running for long distances is generally discouraged after knee replacement surgery due to the damage this may cause to the implant.

Is long term surveillance required?

I usually recommend life-time surveillance of your knee replacement with intermittent X-Ray evaluations and clinical reviews. A standard surveillance program typically involves clinical assessment at one year and every 2-3 years after that.