Who needs knee replacements?
The first knee replacement surgery was performed in 1968. Since then, cases have increased by a significant amount. From 1991 to 2006 alone, knee replacement surgeries tripled, thanks to factors such as an aging population. By 2030, an estimate of 3.5 million people per year in the United States alone will undergo knee replacement.
The procedure is commonly used to treat patients with advanced stages of osteoarthritis, which at its worst can impede normal activities. Arthritis is usually the affliction of the elderly. Many who need knee replacement surgery are well into their 60’s. In Singapore, the average age of people getting the surgery is 62 years old.
However, knee replacement surgery for younger patients is also on the rise. More people in Singapore between the ages of 18 and 50 years old report suffering from joint problems and arthritis. Ironically, the rise is attributed to an increased interest in sports and being active. People are burning out their knees faster by chasing after health.
What are the kinds of knee replacement surgery?
There are two types of knee replacement surgery: total knee replacement (TKR) and partial knee replacement (PKR). Total knee replacement is more common, and recommended for people who suffer from osteoarthritis, as well as other conditions like rheumatoid arthritis that affect the whole knee. Traditionally, most doctors just choose to replace the whole knee due to the joint’s complexity.
But knee replacement technology has come a long way since 1968. Some surgeons are using custom-made prosthesis and the aid of robots to make partial knee surgery a more viable option. This development is especially significant for younger patients and athletes. “Usually in sporting injuries, one compartment of the knee tends to deteriorate faster than the rest.
Conventional total knee replacements where the entire knee is replaced is not recommended for these younger patients as only one compartment of their knee is damaged,” says Dr. Jeffrey Chew of the Mount Elizabeth Hospital.
What is revision surgery?
Knee replacement surgery, as intimidating as it sounds, actually has high rates of success. Nearly all patients report less pain and increased mobility after the procedure. The artificial prosthetics themselves are pretty hardy, lasting an average of 15 to 20 years.
But, as mentioned, we put our knees through a lot of wear and tear, especially if we are overweight, or lead an active lifestyle. Knee replacements can break down. When this happens, patients need to get a second, corrective procedure called a revision surgery. This surgery is usually more complex than the first, due to scar tissue from the first surgery, and less bone to work with.
Patients who undergo revision surgery may notice less mobility and more stiffness, as knee replacements become less effective each time due to the accumulation of trauma and scar tissue. Complications may also require a patient to get revision surgery long before their replacement gives out. Contracting an infection, although rare, because of first surgery is a typical reason for revision surgery.
How long is the recovery period?
Patients usually stay in the hospital for 3 to 5 days after the surgery, depending on whether they had a total or partial replacement. Patients who have only had partial knee replacement recover faster.
Within 12 to 24 hours after the surgery, patients will be able to stand up, with some help from the medical staff. You will need to use crutches until around 6 weeks after the surgery, but it may take up to 3 months for the pain to completely subside. During this period, doctors usually prescribe painkillers to help you manage the pain.
Full recovery takes at least a year, and it may take longer for your artificial knee to feel completely normal.
Can I ever come back to sports?
The short answer is, yes. With proper rehabilitation, many athletes are able to go back to the playing field. Doctors have even found that patients who exercise, and avoid “non-recommended” sports showed stronger knee functions than those who avoid exercise and being active after surgery. The reason may be that by exercising, you build up muscles and other structures that support your knee. Athletes are also especially better are correcting their form, and protecting their knee.
Yet extra caution is still needed. Some sports, like powerlifting, put too much stress on the knee, and may be permanently on a patient’s blacklist after surgery. Other sports, like swimming and cycling are recommended by surgeons to help build strength and flexibility. A study found that athletes who underwent TKR were able to return to low impact sports 13 weeks after surgery. Still, it is important to consult with your doctor before going back to any kind of physical activity.
Physical therapy is an important part of recovery. Doctors send patients home with a list of exercises. Sticking to the program is even more important for athletes. Doctors usually tailor an intensive rehabilitation program based on the needs of an athlete.
Knee replacement surgery may seem frightening. But many actually have their knees replaced, and go on to live more mobile, active lifestyles. Schedule an appointment with us at the Dr. Andrew Quoc Dutton Orthopaedic and Sports Clinic if you have any questions about your treatment options.
Dr. Andrew Quoc Dutton is a Harvard Fellowship-trained orthopaedic surgeon with clinical interests in arthroscopic/ keyhole surgery for the knee, hip, and shoulder. He also specializes in sports injuries, cartilage regeneration, and arthroscopic ligament reconstruction, among many others.