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What are the long term effects of having knee replacement surgery?

29th March 2018

Knee replacement surgery, also known as arthroplasty, involves replacing a damaged, diseased or worn knee joint with an artificial joint. It is an increasingly common surgery, with the majority of patients aged between 60 and 80. There are an increasing number of younger patients undergoing this surgical procedure, however, meaning that more and more people are dealing with the long-term effects.

Who is offered knee replacement surgery?

Knee replacement surgery is usually given to people who are suffering from severe pain and stiffness in their knee joint or joints. If the pain, stiffness and swelling are severe enough to make movement difficult, interfere with everyday tasks and make it hard to sleep, knee replacement is usually the surgical solution. Very severe knee pain can cause depression and prevent people working or socialising; in addition, it can lead to further health problems such as obesity and related issues, as it becomes impossible to exercise. Long-term use of painkillers can also cause problems; therefore, if a doctor suggests knee replacement surgery, patients should give this serious consideration.

This kind of severe damage to the knee joint can have several causes. The most common reason for undergoing knee replacement surgery is osteoarthritis, which is a medical condition caused by wear and tear to the joints. This is usually seen in older patients. Osteoarthritis is not curable; however, it can be treated and surgery is usually the last option. There are a range of other conditions that could lead to the need for knee replacement surgery, including rheumatoid arthritis, haemophilia or gout. Conditions that cause unusual bone growth can also necessitate surgery, as can bone death due to blood supply problems. Injury is another reason people opt for knee replacement surgery.

Knee replacement surgery is a major surgery; therefore, it is usually considered after other treatments have failed. A patient needs to be able to withstand major surgery and to undergo a period of rehabilitation after the surgery.

Types of knee replacement surgery

There are two main types of knee replacement surgery: total knee replacement (TKR), in which both sides of the knee joint are replaced, and partial knee replacement (PKR), in which only one side of the knee joint is replaced. PKR surgery obviously requires less time in hospital and a shorter period of rehabilitation, but both types of surgery will have long-term effects on patients.

There are alternatives to knee replacement surgery; however, these are often less effective, especially in the long run.

Short-term effects

The immediate recovery period for knee replacements is variable, but most people will spend from three to five days in hospital. This obviously depends on the kind of knee replacement surgery being carried out and on the individual patient’s health and circumstances.

Most knee replacement surgery goes smoothly; however, complications are possible with any kind of surgery and knee replacements are no exception. Unexpected bleeding or infections can delay the healing process, while a deep infection may even require further surgery. If the knee is stiff after surgery or the patient has persistent pain, there may be a problem. Occasionally, the surgery can cause ligament, artery or nerve damage around the knee joint. It is even possible for the bone to fracture around the new joint.

Once a patient is discharged from hospital, the recovery begins in full. To begin with, patients will need help with walking, from either crutches or a frame, and will need physiotherapy to build up strength in the knee again.

Most people can do without walking aids after six to eight weeks and can drive again after eight to 12 weeks; however, this is not always the case. It can take up to three months for the pain and swelling to go away, and anything up to a year for the swelling to go completely.

Mid-term effects

There are a lot of activities that are put on hold when a knee problem becomes severe, with not all of these advisable after knee replacement surgery. It can take up to two years for scar tissue to heal and muscle to be restored. Exercise is a good idea during this time - but not all exercise!

Extreme sports are best avoided, as are activities that put a strain on the knee joints or carry a high risk of falling or hitting the knee. Swimming is obviously a great activity; downhill mountain biking, skiing or climbing are not. Patients are usually advised to ask their doctors if they are unsure whether they should try an activity. Using a good sports brace - one that is supportive, lightweight and waterproof - can increase the range of activities you can safely do.

Working and everyday jobs will also be affected by knee replacement surgery. Most people will need at least six weeks before returning to work, although realistically you should expect to be away from your work for longer - anything up to six months. This depends on your job, to a certain extent, and on your healing rate and general health. Even if you have a job that you can do from home, or sitting down, you will be dealing with the effects of major surgery, medication and pain relief. You will also need to be taking regular time to do physiotherapy exercises; if you rush back to work too quickly, you can undo a lot of the benefits of the surgery!

Even housework should be approached carefully. Standing for long periods is not a good idea, nor is lifting heavy weights. You should avoid hoovering and changing beds for at least three months, and should not kneel on your replacement joint until your doctor says you can.

Long-term effects

There are several long-term effects of knee surgery. Patients may have to change aspects of their lifestyles to ensure they do not damage the joint; for example, some patients may have to give up certain sports or activities. It is also advisable for people who have had knee replacements to keep their weight down, as heavier people put more stress on the joints in their legs and this can wear the replacement joint down. Patients should be able to drive and work normally.

As more and more younger people have knee replacement surgery, and as we are living longer and longer, there is a distinct possibility that you your knee problems will come back after 10 or 15 years or have been replaced by equally troublesome knee problems. It is possible to have a second knee replacement surgery, and even a third or a fourth. Patients need to be aware that if they have another knee replacement procedure, they will be out of action for another six months - recovery times do not get any shorter! It is also likely that each subsequent knee replacement will be less effective.

Overall, it is important to bear in mind that this is a major surgical procedure and one that can have life-changing effects, both good and bad. Preparing for surgery by strengthening muscles, following the doctor’s advice about recovery times and exercises, and treating the new knee with respect will go a long way towards ensuring that the results of the knee replacement are beneficial and long-lasting.

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