Patients who suffer from severe knee damage undergo replacement of the natural joint with an artificial one. This replacement is done through a surgical procedure in which one part of the artificial knee is attached to the femur, and the other part is attached to the upper part of the tibia. A polyethylene piece is placed between the femur and tibia to absorb shock, and in 50% of cases, the patella is also replaced.
Causes
The main reason for knee replacement surgery is osteoarthritis, where knee degeneration affects the cartilage, making it unable to absorb shocks. There are many external factors that lead to knee inflammation, such as excess weight, previous knee injuries, partial removal of the meniscus, rheumatoid arthritis, fractures, and some congenital factors. There may also be genetic factors that lead to osteoarthritis.
Clinical Presentations
Pre-operative Complaints
Obesity, age, knee deformity, and previous injuries are factors that lead to degeneration and changes in the knee joint.
Pain
Pain is one of the most common complaints in people suffering from knee degeneration. It is usually felt in the knee itself, but often the patient may feel pain on the inner side, outer side, or behind the patella. Initially, the patient feels pain during rest, known as “start-up pain,” then after a few minutes, the pain gradually subsides. However, as degeneration increases, pain can occur even at rest and may affect sleep at night.
Stiffness / Rigidity
Stiffness initially occurs at night and in the morning, then gradually increases, making it difficult for the patient to change clothes, wear shoes, and perform daily activities.
Walking Difficulty
When knee degeneration becomes advanced, the patient experiences difficulty walking and pain in the entire lower limb. Over time, the patient may need assistive devices such as crutches. In most cases, cycling is easier than walking.
Diagnosis
The doctor performs clinical examinations before surgery to accurately assess the patient’s condition. This includes asking about symptoms and medical history, examining the knee and comparing it with the other knee, and performing imaging such as X-rays and MRI scans.
Medical Treatment
The goal of this surgical procedure is to achieve pain-free movement, restore full joint function, and improve stability with a full range of motion.
The patient undergoes knee replacement surgery when there is a significant limitation in movement. The procedure takes 60–90 minutes and includes replacing three parts of the knee: the femur component, the tibia component, and sometimes the patella, along with the polyethylene insert.
The first day after surgery is for complete rest. From the second day, the medical team begins moving the knee, and by the fourth day, active exercises begin in the hospital. After that, rehabilitation continues with a physiotherapist in the patient’s living environment, focusing on strengthening muscles and stretching exercises to restore full range of motion.
Physical Therapy and Rehabilitation
Pre-operative
The therapist teaches the patient exercises before surgery so they can perform them correctly afterward. This helps speed up recovery. It is also important for the patient to be in the best possible physical condition before surgery to support faster healing.
Post-operative
Many studies have shown that physical therapy after knee replacement is highly beneficial, including hydrotherapy, balance exercises, and cycling.
Rehabilitation involves four stages:
- Joint movement
- Static muscle strengthening
- Dynamic strengthening during movement
- Joint stabilization
On the first day after surgery, stimulating blood circulation is very important. On the second day, the patient can start walking using assistive devices such as a walker.
Important Exercises After Surgery
- Pull your foot toward you, then relax. Repeat 10 times (improves blood circulation).
- Press the knee downward, then lift the patella upward (quadriceps setting).
- Place a pillow under the knee and straighten the leg.
- Extend the leg with assistance from the other leg, repeat 10 times.
Standing Exercises
- Alternate standing on your toes and heels (use a chair for balance if needed).
- Stand on one leg while trying to bear weight on it.
When the knee is affected by previous injuries, rheumatoid arthritis, osteoporosis, or when the cartilage becomes damaged and unable to absorb shocks, all parts of the knee may be affected, making knee replacement necessary.
Post-operative Complaints
Joint stiffness is one of the most common complaints in the early stage after knee replacement surgery, affecting about 6–7% of patients. If the surgery fails, several painful complications may occur.
Possible Complications
Failure or breakage of part of the artificial joint
– Swelling and pain in the joint
– Bone fractures
– Nerve damage
– Joint instability