By John Voelz – Exercise Specialist
Total knee arthroplasty (TKA), otherwise known as total knee replacement, is becoming more common with the increasing number of seniors wishing to remain active walking, climbing steps, etc. Osteoarthritis of the knee can become debilitating, especially for those with extra body weight and weakness in the legs. Surgeons and physical therapists often recommend knee replacement when other options have been exhausted and arthritic pain is affecting the life of the patient.
|A Normal Healthy Knee Joint||An Arthritic Knee Joint|
Osteoarthritis occurs when the articular cartilage wears away until eventually the cartilage is completely gone and the bony surfaces of the upper and lower leg meet…..”bone on bone.” The first X-ray below shows a healthy joint with space between the two bone surfaces (cartilage does not show up on X-rays, so that explains the “space” in the joint). In the second X-ray, the cartilage has disappeared allowing the bones to come into contact. This is the stage of arthritis which is the most painful.
Since cartilage cannot grow back, the arthritic condition is not reversible. The best ways to slow the progression of arthritis is to maintain a healthy body weight (to take the pressure off the knee joints) and to perform the right kinds of exercises in order to keep the knees stable and strong. Some people report improved joint symptoms by using glucosamine/chondroitin supplements, but there is very little scientific evidence of reduced pain, and absolutely no evidence of cartilage regrowth.
As a last resort, surgery is an option. Below is a picture of an exposed knee joint before replacement and also following replacement:
Here is a video of a total knee replacement procedure:
Here is a picture of an actual total knee procedure. Notice the two titanium surfaces covering the bones and the plastic splint in between. The arthritic surfaces have been replaced with durable metal. Pushed to the side is the new knee cap (patella).
Post Op and Rehabilitation
Often the same day as the surgery, physical therapy will have the patient try to stand and take a few steps. Walking with a walker is typically possible very soon after the procedure. The therapist also helps the patient with exercises that strengthen the hip and thigh muscles. Bending of the knee to reestablish range-of-motion (ROM) is the difficult part of rehabilitation. While this is the most painful part of the rehab process, adequate knee flexion (bending) is required for efficient walking and climbing stairs. The most intense rehabilitation occurs in the first month following surgery. After 4 to 5 months, most patients report little or no soreness and full strength and mobility. Patients are generally very happy with their new knee despite a difficult initial rehab process.
If you are planning to undergo total knee replacement, stop in and we can talk about it. It is always a good idea to perform some strengthening and balance exercises weeks prior to surgery — this makes the rehabilitation much easier. Also, after your post-op rehab is finished, we can help you continue with strengthening, balance, and mobility.