Osteoarthritis is the underlying disease leading to a patient needing a knee replacement in over 95% of cases.
Osteoarthritis is a disease of joints that leads to the cartilage in the joint deteriorating (wearing out) and the usual cushioning effect of the cartilage is lost. The process is gradual but at times pain can develop quite quickly.
The number one symptom of arthritis is pain. The most common site of knee pain is around the knee itself. Often pain is felt at the back of the knee and many patients believe that their pain is from a Baker’s cyst. This is almost never the case.
Knee pain is common with exercise and with standing for long periods particularly on hard surfaces. With an arthritic knee people can also complain of stiffness and instability. Kneeling and squatting are often difficult.
Underlying conditions that can lead to the knee needing to be replaced include osteonecrosis (where some of the bone around the knee has died), post trauma, rheumatoid arthritis, or other types of inflammatory knee disease. All conditions lead to the cartilage wearing out and the treatment is generally very similar no matter what the underlying diagnosis.
There are no medications that can cure arthritis. Drugs such as anti-inflammatory medications and simple analgesics such as paracetamol can help to control the pain. Exercise is to be encouraged to help with weight loss and to maintain a level of fitness. Swimming and cycling are often less painful than walking. Hiking poles can help decrease the load through your knee when walking and are recommended. Increased weight can put more load on your arthritic joint and increased weight is also a risk factor for failure of your knee if you undergo surgery. It is very important to try to keep your weight down.
Nearly all knee arthritis is treated by a knee replacement of some kind. The most common operation is a total knee replacement (TKR). Other alternatives include partial knee replacement either of the inside half of the knee or the patella-femoral joint. All of these operations are dependent on where your pain and disease are, your age and your expectations. The alternative operations will be discussed at your visit. TKR is a very successful operation and has excellent results in people of almost any age but particularly over 65. Knee replacement tends to be better the older you are, and it is important to maximise your non-operative treatment prior to surgery. Most people can return to near normal activity following a TKR.
Usually patients are admitted on the same day of the operation and are walking that day or the next. Patients usually leave hospital 2-4 days after the surgery. At discharge you will be mobile on crutches, able to get in and out of bed and shower. You will go home with pain relief. Physiotherapy can usually be arranged at your house.
Admission to a rehabilitation facility is possible but being used less and less. Your dressing is removed at 10 days This can be done by you or a family member. There are usually no stitches to be removed. Mobility improves gradually. Generally you can expect to be walking short distances unaided by 1-2 weeks.
By 4 weeks it is usually safe to drive and by 6 weeks you should be able to perform most activities. Improvement can occur for up to 3 months. Your expected individual journey will be discussed in further detail with you at your consultation.
Following a TKR it is important to work on both the straightening and bending of the knee. Usually you will be bending your knee to 90 degrees prior to discharge from hospital and it is important to try to maintain and improve this bend. Your hospital physiotherapist will explain this to you in more detail during your hospital stay and it is important to see a physiotherapist after you are at home.
Robotic assistance (Mako) during joint replacement surgery is becoming more common. The operation is still very similar and is performed using the same surgery and implants. The robot can assist in accurate preparation of the bone following balancing of the knee in an attempt to put the implants in the most suitable alignment. I currently perform all my knee replacements (both total and partial) using robotic technology and the risks and benefits will be discussed at your consultation.
All surgery carries risks. There are the general risks of the operation and specific complications. Specific risks of TKR include infection, dislocation, and long-term loosening. All of these are rare, and it is worth noting that over 80% of knees are still working 20 years post-surgery. Once you have decided to consider surgery these risks will be discussed in more detail at your consultation.
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Prince Charles Hospital
Rode Rd, Chermside, Brisbane 4032
Monday – Friday 8.30am to 5.00pm
Ph: 07 3139 4481
Fax: 07 3139 4043
CAR PARKING FACILITIES
A multi-storey public car park is located at the western end of the main hospital building. Visitors should enter The Prince Charles Hospital via the Rode Rd entrance (please refer to the map of the hospital), and follow the signs to the public car parking facility.