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Total Knee Replacement

Introduction

Two million Australians have arthritis of the knee and 60,000 undergo knee replacement surgery every year.

Total Knee Replacement (TKR) or Total Knee Arthroplasty is indicated in end stage arthritis. The most common cause of this is osteoarthritis, which is in turn caused by the wearing away of the cartilage tissue in the knee joint. Other possible knee problems requiring TKR include:

  • Rheumatoid arthritis.
  • Haemophilia.
  • Gout (leading to arthritis due to excess uric acid in the bloodstream).
  • Osteonecrosis (avascular necrosis) - death of bone tissue caused by lack of blood supply.
  • Bone growth disorders such as bone ‘dysplasia’.
  • Sequelae of infection.

TKR is one of the most successful surgeries in orthopaedics, after Total hip replacements to improve mobility, function and quality of life. 85-90% of patients who undergo total knee replacement are happy with the results of surgery, with a considerable reduction in pain and a significant improvement in quality of life.

The goals of knee replacement surgery are restoration of limb alignment, appropriate ligament balance and a well tracking extensor mechanism (patella and its tendon attachments). New technologies are increasingly being used to achieve these goals. Computer assisted surgery (CAS) in Total knee arthroplasty, abbreviated to CAS-TKA and Robotic-Assisted TKA are some of such technologies.

Prof Jegan Krishnan and Dr Sunil Reddy specialise in Total Joint replacement surgery of Knee, hip and shoulder.  We strive to achieve the best possible outcomes and improve the quality of life of our patients. Towards this objective, we use computer navigation for all Total knee replacement surgeries and also offer Robotic-assisted Total knee arthroplasty.

Make an appointment with the JRC to discuss your knee problems and the best way to manage it. We believe in optimising non-operative management of knee arthritis and will work with you to keep you away from the operating theatre as much as possible. When arthritis is end stage and very symptomatic we offer the most up to date and evidence-based technology to achieve the best possible outcomes in knee joint replacement surgery.

X-ray showing advanced osteoarthritis of both knees

Computer navigation allows for reliable and reproducible restoration of limb alignment in total knee replacements. It helps achieve precision and accuracy especially in patients with a large body habitus and in post-traumatic bone deformities (two images at bottom).

Procedure

A total knee replacement procedure, as the name implies, involves the replacement of the entire knee joint with an artificial joint, or 'prosthesis'. It takes around an hour and a half and is conducted under general anaesthetic or an epidural (spinal) anaesthetic.

The procedure itself involves an incision to the front of the knee joint and the removal of damaged cartilage and bone from the thigh bone ('distal femur') and shin bone ('proximal tibia'). The artificial joint components are then inserted and fixated to the bones using bone cement or uncemented press-fit techniques.

We have special interest in multi-modality pain management and blood loss minimisation strategies in TKR surgery and utilise these for all patients.

Postoperative Instructions

After a total knee replacement most patients need to stay in hospital for a few days (most are out of hospital within three days). The evening of surgery (or the following morning) you will be encouraged to get up and do simple physiotherapy exercises and/or walk around a little.

Discharge home is criterion based and depends on your recovery and independence in toileting, leg control, and mobilisation.

Please see our section on Total Knee Replacement Rehabilitation Protocol to learn more about your recovery and rehabilitation.

Wound Management

When you are discharged the surgical incisions, which are closed with absorbable sutures, will be covered with a waterproof dressing, which you can wear in the shower. This dressing should stay on until your appointment with your surgeon at the 12-14 day mark.

During this period ensure the wound site remains dry and clean. If at any point there is any severe pain, any discharge or redness, or if you feel unwell, you should contact us.

Risks

As with all surgical procedures there are some risks associated with total knee replacement. These are...

  • Infection (about 1% risk).
  • Bleeding.
  • Nerve injury causing numbness/weakness in affected leg.
  • Blood clots (DVT or embolism).

Risks specific to this procedure include...

  • Post-operative stiffness in the knee.
  • Wearing / loosening of artificial joint - many artificial joints last a lifetime, however over time wearing and/or loosening may occur, in which case a revision procedure may be required.

In most cases of symptomatic advanced arthritis of the knee, the benefits of undergoing the procedure significantly outweigh the potential risks. Your surgeon will run through the details of the benefits as well as the potential risks and complications related to the procedure at your first consultation.