So now you’ve read about knee replacements and made a decision as to whether or not you need a knee replacement. If the answer is yes, before you go ahead and schedule one you should know what you can expect after a knee replacement and how successful it is likely to be.
Despite what anyone tells you, undergoing a knee replacement is a big ordeal. It involves cutting out the whole knee joint and hammering a new one into place, often under a general anaesthetic. There are many problems and complications that can occur both during and after the operation and you should have all these risks explained to you before you decide to go ahead.
What are the main complications specifically associated with a knee replacement?
When it comes to judging the success of a knee replacement there are two specific periods to consider. Immediately after the operation and then the following years. In the days and weeks following a knee replacement the most common serious complication is infection. The rate is low, about 0.5-1%, but if it happens the results can be devastating and can lead to significant long term disability. It is important that your operation is carried out in a reputable institution with a good record for cleanliness and low infection rates. Infection can complicate a knee replacement at any time during its life but it most commonly occurs within the first year.
The biggest long term complication to consider when undertaking a knee replacement is failure of the implant to treat the condition it was indicated for. Despite what Surgeons may tell you we are unable to accurately predict how long a knee replacement may last. New implants are being developed and marketed all the time, but until we have waited 15 or 20 years to see how it performs there is not really any way of knowing. Failure of the implant is usually due to excessive wear and loosening. As well as the implant there are several factors that can contribute to the success of the operation, including surgical expertise and aftercare, so make sure you ask a Surgeon about his success rate before you choose them.
The older a person is before they have a knee replacement, the less chance there is that they will undergo a revision. Those undergoing a knee replacement before the age of 50 can have up to a 4x higher risk of needing revision within the first 10 years than someone who had the procedure at the age of 70. There is also a much higher chance you will need a revision if you undergo a partial knee replacement so be well informed before deciding to have one of these.
How quickly can you expect to recover from the operation?
Although a knee replacement is a big surgical procedure, the recovery time if all goes well is remarkably quick. You will be on your feet very quickly and can be out of hospital the same week. Understandably there can be considerable pain and swelling after the operation, but rest assured that this will subside. The swelling is the bodies natural response to the trauma and will eventually resolve. As soon as your surgeon has given you the go ahead, don’t be scared to get up and use your knee. Believe it or not the worst thing you can do is sit there and keep it still.
Physiotherapy and exercises in the weeks following a knee replacement are the most important aspect governing your long term satisfaction with the replacement. The movement you regain in this time will be the movement you will have for the life of the implant. You will never get the full range of motion you had with your native knee but it is possible to get relatively close. Don’t be shy to take pain relief. You are not taking analgesia because you can’t stand the pain but instead because you need it to allow you to carry out the all important exercises. If you know you aren’t going to be committed to an intense rehabilitation program you should seriously reconsider having the operation as you may not achieve the results you want.
Knee replacements are an amazing surgical innovation. If the operation goes well and you are religious in carrying out your rehabilitation the results of a knee replacement can be truly amazing. It can change people’s lives and relieve crippling pain. They can last for decades and allow people to return to healthy active lives. There is always the risk of complications however and these should be taken into account whether a person requires the procedure. The younger someone is when they have a knee replacement the higher the risk that their prosthetic knee will require revision (replacement of a knee replacement!) in the future.
There is always a risk of complications with any surgery, but you can take steps to make sure you achieve the best outcome possible.
- Make sure you are in good physical shape before undergoing the procedure. If you are overweight make the effort to lose weight before the operation and you will reap the rewards in a better outcome.
- Do your research and choose a Surgeon with a good record. Ask them for their operation figures if in doubt. The same goes for the hospital you choose. Make sure it has a low rate of infection and a good reputation.
- Be wary about trying new and untested implants, even if they are recommended by your surgeon (sometimes they may be offered financial incentives to sell particular models). If you are unsure ask for something tried and tested.
Be religious with your rehabilitation exercises. What you achieve in the first few weeks to months is often what you will be left with forever.