June 14, 2018
For the ordinary patient, knee replacement surgery can allow them to return to a comfortable lifestyle; However, many patients who still compete athletically at an advanced age may question their post-surgery abilities.
Surgery of any kind is a major event, and for athletes it can be particularly daunting. How long until I can return to competing? Will I be able to return to my original level of performance? How long will the artificial knee joint last? These questions, of course, are in addition to all of the typical questions that any patient would ask prior to knee replacement surgery.
Fortunately, knee replacement surgery is not only a highly effective treatment but also one that has become routine, especially for treating severe knee arthritis and other conditions that would otherwise end an athlete’s career. While surgery is not appropriate for every patient, it can be extremely beneficial for those who are suitable candidates.
To ensure that you receive the best long-term outcomes, it is important that you ask the right questions about both the surgery and your surgeon. The type of surgery you receive, as well who and where you receive treatment, are all factors that will determine your return to competition.
This article contains a list of questions that athletes should ask their physician regarding knee replacement.
What are the benefits of a knee replacement in terms of pain relief, function and mobility?
First and foremost, the purpose of knee replacement surgery, which is also called knee arthroplasty, is to relieve chronic, debilitating joint pain and restore essential joint function. During the procedure, the surgeon removes painful, diseased tissue with an artificial joint called a prosthetic. The artificial joint relieves pain, restores the patient’s mobility, and provides better shock absorption during movement. All of these benefits contribute to an overall improvement in the patient’s quality of life.
Patients who would benefit the most from a knee replacement have significant or irreversible joint damage caused by end-stage osteoarthritis, rheumatoid arthritis, post-traumatic arthritis. Moreover, surgery is sometimes needed to repair a patella fracture (broken kneecap), which is the most common form of knee fracture.
What will happen if I don’t have a knee replacement now?
Arthritis is a progressive disease and there is no cure. While conservative treatments can slow the progression of arthritis, symptoms will become worse with each passing day. Surgery is necessary to remove arthritic tissue and effectively stop the spread of the disease.
Moderate arthritis causes joint pain, inflammation, swelling, and muscle weakness that can limit physical activities. During later stages of arthritis, the cartilage that typically prevents bones from rubbing against one another is completely worn away. The affected joint may also fill with inflammatory fluids that cause additional pain, swelling, and stiffness. These factors lead to loss of joint function and disability.
In the case of fractures, pieces of bone may be displaced, or out of place. A surgeon will need to manually position the pieces back into place so the bone can heal correctly. If left untreated, the bone will heal in the wrong of position or develop a deformity. Similar to late-stage arthritis, severe fractures can lead to loss of joint function and disability. The patient will not experience improvements until they receive surgery.
What can I expect during knee replacement surgery?
In general, knee replacement surgery is performed in eight steps.
Step 1: Make an incision in the knee.
Step 2: Rotate the patella (knee cap) to view the knee joint.
Step 3: Remove damaged bone and cartilage from the femur (thigh bone) and shape it for the implant.
Step 4: Implant the metal femoral component.
Step 5: Remove damaged bone and cartilage from the tibia (shinbone) and shape it for the implant.
Step 6: Re-adjust the patella and fit it with an additional plastic piece.
Step 7: Close the incision, apply a bandage, and prepare the patient for recovery.
It is important to note that the exact details of your procedure will depend on whether it is a total knee replacement or a partial knee replacement. For a better idea of what to expect, learn more about choosing between total or partial knee replacement.
Knee replacement surgery may also be performed as an outpatient surgery, which is also called same-day surgery, allowing patients to return home in less than 24 hours after their procedure. Beacon Orthopaedics and Sports Medicine, for example, performs all surgeries in an outpatient setting. While the steps of the procedure remain the same, it places a greater emphasis on pre-surgery preparations. As a result, patients can expect to save on the cost that is typically associated with a hospital stay and spend more of their time recovering in the comfort of their own home.
What can I expect during recovery and rehabilitation from knee replacement surgery?
Recovery is a gradual process and most patients require at least 12 weeks in order to achieve a full recovery. The surgeon will prescribe a comprehensive recovery program that includes precautions and physical therapy. Precautions limit or prohibit activities that can potentially damage the knee implant. Physical therapy has three purposes:
- Reduce post-operative pain
- Strengthen muscles, reduce stiffness, and restore range of motion in the knee
- Educate the patient in regards to proper body mechanics and knee preservation
It must be stressed that a strict adherence to these guidelines will ensure the fastest recovery and best long-term outcomes.
Rehabilitation begins within 24 hours of surgery. A physical therapist will teach patients how to get in and out of bed, how to walk with an assistive device, and exercises that will strengthen their muscles. A nurse will train the patient how to change their bandage as well as how to dress, bathe, and use the toilet with limited knee function. In the case of outpatient surgery, these lessons often begin prior to surgery.
While the recovery process will vary by patient, there are typical milestones.
Week 1-3: Patients will experience some discomfort at the surgical site and will need to RICE the surgical leg when immobile. Patients will be mobile via a rolling walker and will gradually progress to using a single crutch or cane as they near the end of the third week.
Weeks 4-6: Patients will experience a significant decrease in pain and swelling. Patients will be able to perform normal activities (maybe with the assistance of a cane for long periods) around their home more easily and most are able to drive an automobile.
Weeks 7-11: Patients may return to basic activities that require physical exertion, such as gardening, walking, etc., without the use of an assistive device.
Week 12 and Beyond: Patients who have been diligent about physical therapy may be cleared by their physician for swimming, bicycling, golf, and other athletic activities.
Conservative, at-home treatments may be used to aid the recovery process. For a list of treatments, refer to Beacon’s comprehensive recovery protocol for knee injuries.
Will I be able to return to my sport?
This, of course, is the question that every athlete must prior to a knee replacement.
Fortunately, athletes can take assurance in knowing that knee replacement surgery is a routine orthopaedic procedure. Each year, approximately 700,000 knee replacement procedures are performed in the U.S. Many athletes return to a near pre-injury level of performance with proper adherence to their recovery program.
Aside from physical therapy, the skill of the operating surgeon will have the greatest impact on a patient’s outcomes. In other words, a patient’s choice in orthopaedist will determine not only if they can return to sports but also what level of competition. To that end, it is critical that athletes select a knee surgeon who specializes in sports medicine.
- Know When You Need Surgery: Conditions Treated by Knee Replacements
- Knee Surgery: Choosing Between Total or Partial Knee Replacement
- The Benefits of Partial Knee Replacements
- Comprehensive Recovery Protocol: Knee Injuries
Talk to a Knee Replacement Specialist
This article provides you with a list questions that you should your orthopaedist when discussing knee hip replacement surgery. The next step is to schedule an appointment with a knee specialist.
Dr. Haleem Chaudhary at Beacon Orthopaedics and Sports Medicine is a board-certified orthopaedic surgeon with expertise in total knee replacement, partial knee replacement, kneecap replacement, and revision knee replacement. Dr. Chaudhary is also well-experienced in minimally invasive techniques, which are ideal for athletes who must quickly resume competition. Schedule an appointment and rest assured that you will receive expert care.