KNEE

Total Knee Replacement

If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities such as walking or climbing stairs. You may even begin to feel pain while you're sitting or lying down.

If medications, changing your activity level, and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. By resurfacing your knee's damaged and worn surfaces, total knee replacement surgery can relieve your pain, correct your leg deformity, and help you resume your normal activities.

An important factor in deciding whether to have total knee replacement surgery is understanding what the procedure can and can't do. More than 90 percent of individuals who undergo total knee replacement experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement won't make you a super-athlete or allow you to do more than you could before you developed arthritis.

Following surgery, you will be advised to avoid some types of activity, including jogging and high impact sports, for the rest of your life.

Causes

The most common cause of chronic knee pain and disability is arthritis with osteoarthritis, rheumatoid arthritis, and traumatic arthritis being the most common forms.

Osteoarthritis usually occurs after the age of 50 and often in an individual with a family history of arthritis. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.

Rheumatoid arthritis is a disease in which the synovial membrane becomes thickened and inflamed, producing too much synovial fluid that over-fills the joint space. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness.

Traumatic arthritis can follow a serious knee injury. A knee fracture or severe tears of the knee's ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

Symptoms

Typical symptoms include:

  • Severe knee pain that limits your everyday activities, including walking, going up and down stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain, and you may need to use a cane or walker.
  • Moderate or severe knee pain while resting, either day or night.
  • Chronic knee inflammation and swelling that doesn't improve with rest or medications.
  • Knee deformity: a bowing in or out of your knee.
  • Knee stiffness: inability to bend and straighten your knee.
  • Failure to obtain pain relief from non-steroidal anti-inflammatory drugs. These medications, including aspirin and ibuprofen, often are most effective in the early stages of arthritis. Their effectiveness in controlling knee pain varies greatly from person to person.
  • Inability to tolerate or complications from pain medications.
  • Failure to substantially improve with other treatments such as cortisone injections, physical therapy, or other surgeries.

Treatment

The orthopedic evaluation consists of several components:

  • A medical history, in which your orthopedic surgeon gathers information about your general health and asks you about the extent of your knee pain and your ability to function.
  • A physical examination to assess your knee motion, stability, strength, and overall leg alignment.
  • X-rays to determine the extent of damage and deformity in your knee.
  • Occasionally blood tests, a Magnetic Resonance Image (MRI), or a bone scan may be needed to determine the condition of the bone and soft tissues of your knee.
  • Your orthopedic surgeon will review the results of your evaluation with you and discuss whether total knee replacement would be the best method to relieve your pain and improve your function. Other treatment options – including medications, injections, physical therapy, or other types of surgery – also will be discussed and considered.