Total Knee Replacement Surgery | Ideal Candidates and Contraindications | Ms. Thula Chelvan

Key Takeaways

Severe arthritis, debilitating pain, and significant knee function impairment are signs you might be ready for knee replacement.
Medical evaluations including X-rays and MRIs are essential to confirm if you're an ideal candidate for knee replacement surgery.
Active infections, unstable medical conditions, and certain skin issues can disqualify you from being a good candidate for knee replacement.
Post-surgery, patients play a crucial role in their recovery through physical therapy and lifestyle adjustments.
Alternatives to knee replacement should be considered, especially if you have contraindications to surgery.

Are You a Match for Knee Replacement?

If your knee pain has escalated to the point where it's disrupting your daily life and sleep, and if conservative treatments have failed to provide relief, knee replacement surgery might be on your horizon. However, not everyone with knee pain is a candidate for this procedure. Let's explore what makes someone an ideal candidate for knee replacement surgery.

Signs You Might Be an Ideal Candidate for Total Knee Replacement Surgery

When considering knee replacement surgery, it's crucial to recognize the signs that suggest it's time to take this step. Here are the indicators that you might be an ideal candidate:

Severe Arthritis: This includes osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis that has damaged the knee.
Intense Pain: Pain that persists despite rest or medication, affecting your ability to carry out everyday activities.
Stiffness and Immobility: A significant reduction in knee mobility, making it difficult to walk, climb stairs, or get in and out of chairs.
Deformity: A bowing in or out of the knee, indicating advanced arthritis or other knee diseases.

Remember, the goal of knee replacement is to alleviate pain and restore function. If these issues are severely impacting your quality of life, it's time to discuss surgical options with your doctor.

Medical Evaluations: Confirming Your Candidacy

Before you can be cleared for knee replacement surgery, you'll need to undergo a series of medical evaluations. These are designed to assess the extent of damage to your knee and your overall health to ensure you can safely undergo the procedure.

Expect to have:

X-rays: These images show the extent of damage and deformity in your knee joint.
MRI: An MRI may be ordered to get a more detailed look at the knee's soft tissues.
Physical Examination: Your doctor will check your knee's range of motion, strength, and alignment.
Medical History Review: A thorough review of your medical history to identify any conditions that could complicate surgery or anesthesia.

Based on these evaluations, your doctor will be able to determine if knee replacement surgery is the best course of action for you.

When Knee Replacement Isn't Right for You

But in some cases, total knee replacement surgery may not be suitable for you. Here are some absolute and relative contraindications to getting a total knee replacement surgery.

Absolute Contraindications to Total Knee Replacement Surgery

Mild Knee Pain: The surgery is recommended only for moderate to severe knee pain that severely limits daily activities. If the pain is mild and manageable, the risks of surgery may outweigh the benefits, making it an inappropriate treatment option at this stage.
Active Local or Systemic Infections: The presence of an ongoing infection in the knee or elsewhere in the body makes knee replacement surgery highly risky. Infections increase the likelihood of postoperative complications and generally worsen the prognosis of the surgery.
Severe Concomitant Conditions: Conditions such as knee sepsis, severe nerve or peripheral blood vessel diseases, etc. heighten the risk of complications from TKR. These conditions often diminish the chances of a successful outcome, indicating that good overall health is crucial for a positive surgical result.
Non-Joint Related Knee Symptoms: If knee pain and symptoms are not directly linked to joint disease, as determined through a comprehensive evaluation by a healthcare provider, the surgery may not be warranted. This assessment might include physical exams and imaging tests like X-rays, CT scans, ultrasounds, and MRIs to confirm the source of the pain.
Smoking: Smokers are generally considered poor candidates for TKR because smoking significantly hampers the healing process after surgery. It's advised to cease smoking well in advance of the surgery to improve outcomes. If quitting smoking is challenging, seek professional help upon the advice of your healthcare provider.

Relative Contraindications to Total Knee Replacement Surgery

Overweight or obesity, which can increase the risk of complications and prosthesis failure.
Uncontrolled diabetes or heart disease, which can affect healing and surgical outcomes.
Previous infections in the knee joint, raising the risk of postoperative infection.
Muscle weakness or poor bone quality, potentially leading to inadequate support for the new joint.

While absolute contraindications can rule out surgery altogether, relative contraindications require careful consideration and discussion between you and your surgeon. They don't necessarily prevent surgery, but they increase the risks and can affect the outcome. For instance, if you have a heart condition, it doesn't automatically disqualify you, but it's vital to have it well-managed before considering surgery.

Your surgeon may also consult with other specialists to optimize your health preoperatively. This multidisciplinary approach ensures that you are as healthy as possible before going under the knife. It's all about reducing risks and maximizing the benefits of surgery.

Besides that, relative contraindications often have workarounds or treatments that can improve your eligibility for surgery. For example, if you're overweight, your surgeon may recommend a weight loss program to reduce the stress on your new knee and lower the risk of complications.

Maximizing Success: The Patient's Role Post-Surgery

After the surgery, your journey to recovery begins. The success of your knee replacement doesn't just depend on the skill of the surgeon; it also hinges on your commitment to following through with the postoperative plan. This includes adhering to medication schedules, attending all follow-up appointments, and engaging in prescribed physical therapy.

Life After Knee Replacement: What to Expect

Initially, you'll experience pain and swelling, but don't let that discourage you. Pain management is an integral part of the postoperative plan, and your medical team will work to keep you comfortable. Within a few days, you'll start moving with the help of a walker or crutches, and you'll notice gradual improvements in pain and mobility.

It's important to have realistic expectations. You won't be running a marathon right away, but with time and dedication, you can expect to return to many of the activities you enjoyed before your knee pain began. However, high-impact activities might be off the table, as they can put undue stress on your new knee.

Physical Therapy: Your Roadmap to Recovery

Physical therapy is your roadmap to recovery. A physical therapist will guide you through exercises designed to strengthen the muscles around your new knee, improve flexibility, and increase range of motion. It's crucial to stick to the therapy regimen and do the exercises as prescribed. Remember, the effort you put in during recovery directly affects the success of your surgery.

MSK Doctors for Total Knee Replacement Surgery

At MSK Doctors, we're committed to offer comprehensive, high-quality information, trusted resources, and services across the UK for those seeking musculoskeletal care.

Frequently Asked Questions (FAQ)

1. How long does a knee replacement prosthesis last?

On average, a knee replacement prosthesis can last between 15 to 20 years. However, this can vary based on factors such as your activity level, weight, and the type of prosthesis used.

Advancements in surgical techniques and prosthetic materials have increased the longevity of knee replacements. Still, it's crucial to maintain a healthy lifestyle to ensure the durability of your new joint.

Regular follow-up visits with your surgeon are essential to monitor the condition of your knee replacement and address any concerns that may arise over time.

2. What are the risks of knee replacement surgery?

Like any major surgery, knee replacement comes with its set of risks. These include blood clots, infection, implant failure, and nerve damage. It's also possible to experience continued knee pain if the surgery doesn't fully address the underlying issues. However, the majority of knee replacement surgeries are successful, providing significant pain relief and improved mobility to patients.

3. Can I delay knee replacement surgery?

Yes, you can delay knee replacement surgery, especially if your symptoms are manageable with conservative treatments like medications, physical therapy, or joint injections. Delaying surgery is also a consideration if you have health conditions that currently make surgery too risky. The decision should be made in consultation with your healthcare provider, weighing the benefits and potential drawbacks of waiting.

4. Is there an alternative to knee replacement?

Before considering knee replacement surgery, less invasive treatments are typically recommended. These alternatives include:

Anti-inflammatory medications
Physical therapy
Weight loss to reduce joint stress
Injections such as corticosteroids or hyaluronic acid
Bracing or orthotics to stabilize and relieve the knee

It's important to explore these options with your healthcare provider, as they can sometimes provide sufficient relief and postpone the need for surgery.

5. How do I prepare for a knee replacement surgery?

Preparation is key to a successful knee replacement surgery. Start with a preoperative medical evaluation to assess your health and readiness for surgery. It's also a good idea to strengthen your knee through physical therapy exercises, which can aid in your postoperative recovery. Make sure to have a support system in place for help during your recovery period.

Additionally, organizing your home to accommodate mobility limitations post-surgery is essential. This includes setting up a recovery area with easy access to necessities and removing trip hazards to prevent falls.

Ultimately, thorough preparation can lead to a more comfortable and quicker recovery. Make sure to follow all of your surgeon's instructions and attend all pre-surgery appointments.