Should I Consider A Total Knee Replacement?

Q: My left knee is very painful and prevents me from walking very far. Should I consider a total knee replacement?

A: The knee is the most commonly replaced joint in the body. The decision to have knee replacement surgery is one that you should make in consultation with your orthopedic surgeon and your physical therapist. Usually, total knee replacement (TKR) surgery is performed when people have:

Knee joint damage due to osteoarthritis, rheumatoid arthritis, other bone diseases or fracture.

Knee pain or alignment problems in the leg that cause difficulty with walking, performing daily activities or life tasks.

Q: What exactly is a total knee replacement (TKR)?

A: A total knee replacement (TKR) involves removing the ends of the bones at the knee joint (the tibia, sometimes called “shin bone”) and the femur (thigh bone) and replacing them with artificial parts. Replacement parts consist of a metal cap placed on the end of the femur and a plastic cap placed on the top of the shin bone. Sometimes, a plastic insert is used to replace the kneecap.

Q: How can a physical therapist help before and after surgery?

A: The better physical shape you are in before TKR surgery, the better your results will be, especially in the short term. Before surgery, your physical therapist will teach you exercises and show you how you will walk with assistance after your operation. Your therapist also will discuss precautions and home adaptations, such as removing loose rugs or strategically placing a chair so that you can sit instead of squatting to get something out of a low cabinet. It’s always easier to make these modifications before you have TKR surgery.

If you smoke, quit. That may help improve your healing after surgery. If you are overweight, focus on weight loss prior to surgery. Losing excess body weight may help you recover more quickly, and help improve your function and overall results following surgery.

Proper rehabilitation after a TKR is essential to your recovery. Your physical therapist will help you regain much of your knee range of motion as soon as possible. At this point, you might be walking with a cane or with one crutch.

Your physical therapist can speed up your return to activity and help make your new knee better than the old one. Your therapist will tailor range-of-motion exercises, progressive muscle-strengthening exercises, body awareness and balance training, and activity-specific training to your specific needs.

Occasional swelling of the knee joint and lower leg can occur for up to three months after surgery. To relieve swelling, you can wear support stockings, apply a cold pack, and elevate your lower leg on a pillow when sitting or lying down.

Range-of-motion exercises. Swelling and pain can make you move your knee less. Your physical therapist can teach you safe and effective exercises to restore the range of motion to your knee so that you can perform your daily activities.

Strengthening exercises. Weakness of the muscles of the thigh and lower leg could make you need to use a cane when walking. Your physical therapist can determine which strengthening exercises are right for you, with the goal of no longer needing to use a cane to walk.

Source: www.moveforwardpt.com American Physical Therapy Association

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