Tyler Whitmer
COMP 300
Ms. Ryan
Total Knee Replacement Surgery and its Benefits
Abstract:
A full knee replacement procedure is first required when a patient has constant pain and/or stiffness that prevents them from performing in athletic events or even the simplest daily tasks. Once under general anesthesia, an incision is made down the center of the knee using a medical saw to remove the damaged part of the joint from the bone. The surface of the missing joint is then shaped to fit the titanium mold of the new knee. The synthetic knee is hammered into the thigh and shin and held together with special cement adhesive. 5 After the surgery, the patient undergoes a rehabilitation process. Rehabilitation can take several weeks to several months depending on the age of the patient. Physical therapists work with patients either at home or in a rehabilitation clinic to properly assist the patient during the recovery process. 5 Once a patient has recovered from the surgery, the benefits of having a knee replacement have been extremely positive. In numerous studies, patients have improved their overall range of motion, mobility of the knee, and their mean knee score. Patients have also been able to participate in athletic and recreational activities without the loss of speed, strength or agility. Several studies have also found that patients are able to participate in athletics with a decreased risk of future injury. Most importantly, a full knee replacement reduces severe pain and allows the individual to work with normal functioning.
Introduction:
Numerous causes can lead to a full knee replacement surgery; however, most athletic injuries and osteoarthritis are the leading causes. Osteoarthritis is the most common form of arthritis and effects millions of Americans. 4 Osteoarthritis occurs when the cartilage around the joint breaks down and is eventually lost. 4 This becomes extremely painful because once the cartilage is lost because the patella bone, or commonly known as the kneecap, begins to rub against the femur and tibia. This bone on bone movement causes extreme irritation and can force the knee to lock out. Bone on bone movement also causes the bones rubbing against one another to become weak and more likely to break or fracture, which can lead to future medical complications. Along with osteoarthritis, athletic injuries contribute to a vast number of full knee replacement surgeries. Regardless of the sport, injuries are bound to happen. It is an unfortunate part of the game, but it is a reality. Since athletes are becoming bigger, faster, and stronger, when an injury takes place, the body is unable to adapt to the stress and the injury becomes much more severe. If one of these causes becomes severe enough, or prevents an athlete from competing, then the individual might elect to undergo a total knee replacement surgery.
Once an individual elects to have a total knee replacement procedure, they are placed under general anesthesia. Initially an eight to twelve inch incision is made down the center of the knee. 2, 5 The skin surrounding the knee is then pulled back to allow the surgeon to operate. Using special rods and a medical saw, the damaged bone is removed from the knee.5, 6Tools are then used to smooth away at the joint, especially the surrounding tibia, femur, and patella.6 Once the damaged joint and surrounding bone has been properly removed, a metal mold of the knee, usually consisting of titanium, is hammered into the shin and thigh bone for support.5 A special cement adhesive is also added to the joint to keep the knee in place. The surrounding muscles, ligaments and tendons are of the utmost importance to support the stability, strength, and function of the new knee.
After the procedure, the rehabilitation process is essential for recovery and overall mobility of the new knee. The first several days after surgery are dedicated to relieving stiffness and to begin the walking process. 7 This helps the patient to gain full range of motion and relieve possible pain and swelling. Next, the patient is sent home where either they visit a physical therapist clinic or a physical therapist visits them at home for the next several months. 5, 7 The type of exercises performed are strongly determined by the age and athletic ability of the patient. 7 Many therapists use exercises such as leg lifts, leg extensions, foam rolls, heel slides, and ankle pumps to strengthen the knee and improve overall range of motion. 6, 7 Many patients, especially athletes, will continue to do these exercises long after the surgery to ensure the knee has full mobility. Without the recovery process, athletes would be unable to heal effectively and participating in future competition would almost be non-existent.
Knee Score:
The knee score assess knee pain, stability, range of motion, and a patient’s ability to walk and climb stairs. 1, 8 Patients returning to sports showed an overall higher mean knee score than those who did not. The individuals who returned to sports had a mean score of 189 out of 200 when the patients who did not had a 177. 1 In a second study, that had a seven-year follow up, patients that returned to high impact activities, such as basketball, football and hockey, had a knee score of 92.8 out of 100. 8 The patients that did not return to athletics had a mean score of 88.8. 8 This demonstrates that not only were patients able to return to sports, but they also managed pain and improved stability and range of motion better than the patients who did not return to sports. The ability to manage pain and have improved stability is crucial and important for every athlete. The study also showed an improved range of motion in athletes who returned to sports. The athletes who returned to sports had a mean range of motion of 4o to 111o and a mean of 4o to 109o than those who did not.1 A two-degree different does not seem like a large difference, but for an athlete this difference is quite large. A sprinter that has a larger range of motion, regardless of the difference, will cover a larger distance in a shorter time. As stated earlier, the knee score also examines a patient’s ability to successfully walk up and down stairs after the procedure. This measurement is important because walking up and down stairs requires flexion and extension of the knee. This constant motion is essential to proper knee function and if the knee is unable to bend properly, future complications and pain may arise. The score for walking up and down stairs was 47 of 50 in those who returned to sports and 41 of 50 in those who did not. 1 This difference in scores is clearly significant and demonstrates that patients who return to sports have a much better ability to walk up and down stairs.
Pain Management:
After a major surgery, pain will follow; however, one of the main purposes of a total knee replacement is to relieve pain, making it almost non-existent. Initially after the surgery, patients are given pharmaceutical pain relievers as well as a combination of heat and ice to relieve inflammation of the knee. In a study that measured pain using a rating system of 1 to 10, with 10 being excruciating pain, one week after the surgery, the mean pain score was 3.2. 2 On a scale of 1 to 10, this is a very low number, showing that patients did not suffer significant pain only a week after the procedure. As stated earlier, the rehabilitation process allows for a decrease in pain and stiffness, while improving stability and range of motion. Several weeks and months after the surgery, patients, especially athletes, wear a brace for support and to prevent pain from arising. Many patients are able to participate in swimming, golf, driving, light hiking, recreational biking, ballroom dancing, and stair climbing, without difficulty or pain. 7 To fully recover, a patient also needs the ability to rest and sleep properly; however, severe pain can prohibit and disturb a patient from achieving adequate sleep. In one study, sleep disturbance was the highest on the first three nights following the procedure. 2 The study also discovered that patients who combined a pharmaceutical pain reliever as well as heat and ice therapy experienced more recuperative sleep following the three nights after the surgery. 2 This demonstrates that patients who undergo a full knee replacement do not experience a great deal of time trying to manage pain. For athletes, this is important because persistent pain can inhibit performance as well as the length of a career.
Return to Athletics:
For any athlete that has suffered one or numerous knee injuries and is constantly under pain or discomfort, receiving a total knee replacement gives them the best opportunity to return to competition and maintain a successful career. In one study, 79 patients participated in athletics prior to the procedure and 56 (65%) of thoese returned to sports. 1 For those who participated in low-impact activities, 29 out of 32 (91%) returned to sports. 1The study also determined that 43 of 56 patients (77%) who had participated in regular exercise in the year before surgery returned to sports. 1 What was even more stunning, was that 23 of the patients had never participated in athletics prior to the surgery, but 8 of them (35%) began to participate in sports after the procedure. 1 The results found in this study demonstrate that a majority of patients who undergo a full knee replacement are able to continue competing in athletics. This is the main goal of a serious or recreational athlete. The study also demonstrates that the procedure provides enough stability, range of motion, and relief of pain for some patients to participate in sports when they did not prior to the surgery. Unfortunately the study never examines the age of the patients who never returned to athletics. Age is a crucial indicator as to why someone may or may not return to sports. Clearly, the older the patient, the smaller the chance they will participate in athletics following the procedure. This information could further support the belief that patients who undergo a full knee replacement procedure have a greater chance of returning to sports than those who do not receive the procedure.
Conclusion:
A total knee replacement surgery is a serious procedure that requires months of physical therapy in order for a patient to have full movement in the joint. Although the surgery is serious, the benefits that follow the procedure are very encouraging to any patient, especially an athlete. The studies examined have demonstrated that patients who undergo the procedure and return to athletics have a higher mean knee score with an increase in stability, range of motion, and walking ability than those who did not. Also, patients can expect to experience a decrease in overall pain following the procedure, which is one of the main reasons to undergo the procedure. This is crucial for athletes and non-athletes because pain or any discomfort in the knee can hinder overall performance and functioning. Finally, following a total knee replacement surgery, more than half of the athletes are able to return to athletics and compete at a high level. This information demonstrates that a total knee replacement procedure is a beneficial solution to constant knee pain, discomfort, and future surgeries, which allows its recipients to carry on a full and functional life.
References
1. Bradbury N, Borton D, Spoo G, et al. Participation in Sports After Total Knee Replacement. TheAmerican Journal of Sports Medicine. 1998; 26: 530-535. Available at: Accessed March 18, 2010.
2. Buvanendran A, Kroin J, Tuman K, et al.Effects of Perioperative Administration of a Selective Cyclooxygenase 2 Inhibitor on Pain Management and Recovery of Function After Knee Replacement. The Journal of the American Medical Association. 2003;290:2411-2418. Available at: Accessed March 19, 2010.
3. Diduch D, Insall J, Scott W, et al. Total Knee Replacement in Young, Active Patients: Long-Term Follow-up and Functional Outcome. The Journal of Bone & Joint Surgery. 1997;79:572-582. Available at: Accessed March 13, 2010.
4. Felson, D. Osteoarthritis New Insights. Part 1: The Disease and Its Risk Factors. Annals of Internal Medicine. 2000;133:635-646. Available at: Accessed March 14, 2010.
5. Levesque, M. Knee Replacement Surgery Pain, Recovery, Complications and More. WebMD-Better Information Better Health Website. Available at: Accessed March 14, 2010.
6. Leopold S. Total Knee Replacement: A Patients Guide. UW Medicine Orthopaedics and Sports Medicine Web site. 2010. Available at: Accessed March 20, 2010.
7. Luks H. Arthroscopy and Joint Replacement. Howard J. Luks, MD Web site. 2007. Available at: Accessed March 17, 2010.
8.Jasmer R. AAOS: Playing Sports After Knee Arthroplasty Might Be Okay. Medpage Today Web site. 2010. Available at: Accessed March 16, 2010.