It is important
that you should be satisfied with the result of your total knee operation. The satisfied patients follow the instructions better,
their recovery is quicker and
their total knee prostheses last longer!
Statistics demonstrate that the majority of the patients perceived
that their knees became much better after the total knee surgery
IMPROVEMENT ACCORDING TO THE PATIENTS| Patient's perception of the knee after surgery | % of all patients | | much better | 83 % | | better | 8 % | | worse | 9 % | Statistics demonstrate that 92 % of all patients believed that they made right decision and would
even recommend the total knee replacement to other patients, 3 % were unsure, and only 5 % believed that to choose total knee
operation was a wrong decision.
Statistics demonstrate that about 90 % of all patients operated on with a total knee arthroplasty
have been satisfied with the results of the operation, and only about 10 % were dissatisfied. (Anderson 1996, Robertsson
2000) Recent reports (2007) on
greater numbers of patients show, however, less optimistic figures. These reports are based on the patient's, not the
doctor's view of the result. Click here for the report.
Your satisfaction will depend on three factors 1) Severity of your preoperative pain and stiffness.
The more pain the patients have had before the operation, the greater the relief by the surgery
2) Outcome of the operation. The less
the operation relieved the pain, the lesser the satisfaction
3)Your expectations before the operation.
Very high expectations usually are not satisfied by the total knee replacement operation
WHAT DO YOU EXPECT FROM YOUR
TOTAL KNEE SURGERY Patients' expectations are individual and vary. Several studies, however, show that patients expect following
improvements from their total knee replacement (items are ranked according to how many patients wished them): Improved walking, independent walking, possibility of hiking
Complete pain relief, relief of pain with stair climbing, Return of mobility into the knee joint
Return to sports (for people who were active before the operation
Improved wellbeing, return of good mood
Improved recreation activities
Improved stair climbing,
Improved activities of daily life
HOW WERE THE EXPECTATIONS FULFILLED The overall satisfaction with total knee replacement has
been about 90%. The patients have
been satisfied with their total knee although they might have still some minor troubles.
Here follow some facts that show how the total knee operation satisfied patient expectations.
(Remember, however, that these are average figures compiled from several reports. Your experience, as the experience of your
fellow patients, is always unique.) (Hawker 1998)
Improved
walking capacity This means different things for different patients in different ages. 55 % of all patients younger
than 70 years could walk ten blocks or more after the total knee replacement.
Relief of pain The total knee operation is a very reliable means to relieve pain. 80 % of all patients reported none pain walking on
flat ground, 84% of the all patients
reported no pain at night in bed, 5
% of all patients operated on with total knee arthroplasty reported " a lot or severe" pain at everyday activities
Return of motion in the new knee This depends on the state of the knee before
the total knee replacement. After completion of rehabilitation treatment, most total knees move from full extension to about 105 degrees
flexion. This range of movement is sufficient for almost all "everyday activities".
People with very stiff knee before the surgery will not get as
much motion as patients with less stiff knees.
In some patients whose knees moved easily, but were painful before the operation the new knee joint
may actually loose some motion after the operation. But the motion will usually be pain-free.
Return to sports Only patients who were active athletes before the total knee surgery have
a reasonable chance to return to spots after the total knee replacement. So for example about 65 % of active golfers and tennis
players returned to the sports. Many of them felt ache and stiffness in the operated knee after more strenuous sports
activity. The satisfaction with return to the sports depends on the realistic preoperative expectations.
Return
of good mood The
chronic pain in the knee causes bad mood and depression. The good mood returns early (during the first week) after the surgery
in the majority of the patients, when the patients realizes that the operation succeeded.
Return of stair climbing facilities The ability to go up and down stairs returned for 50 % of
all patients who were unable to do it before the total knee surgery. But only 18 % of all patients were able to climb stairs
without handrail.
Return to "essential daily activities" Essential daily activities mean different things to different patients. 80 % of patients could do shopping, getting into /out of automobile,
going up and down stairs without or with only little difficulty after their total knee surgery.
For more information please visit the chapter Life with a total knee joint
DISSATISFACTION Statistics demonstrate that about 10% of all patients operated on with total knee replacement were
dissatisfied with the operation. Among
the dissatisfied patients have been
Patients with bad outcome of the operation. The main complaints of dissatisfied patients in this group were
Remaining pain in the knee joint : about 6 % of all patients still have had severe pain in their knees
after the total knee replacement.
Newly occurring pain in the non-operated knee joint (Dickstein 1998)
Difficulty using stairs Reduced range of motion in the new knee joint
Patients
with heart and lung condition About
1 % of the patients with heart and lung condition are dissatisfied with the results of total knee operation, although
the function in their new knee has been restored and is pain-free. They are dissatisfied because their heart and lung condition
remained unchanged after the knee operation and they cannot exploit the good function of their new knee joint.
Patients with exaggerated expectations There is also a small group of patients who nourished exaggerated hopes that the artificial joint
operation will give them unlimited sporting, or sometimes working, capacity. These patients are often dissatisfied with the
operation. Their dissatisfaction is caused mainly by the wrong preoperative information. Artificial joints still do not perform
as normal healthy joints. the
average range of motion in the total knee joint is from full extension to about 105 degrees flexion. Some patients may actually
have less flexion in their total knees after the operation than before the surgery. This is not a bad outcome, because
such pain-free range of motion is sufficient for all activities of daily living, including stair climbing and kneeling after the total knee operation, 50 % of all patients were
able to walk only less than ten blocks, but only 6 % of them have had pain in their total knees during walking. This
is not a bad outcome, because such distance of pain-free walking is sufficient for the majority of the activities of
daily living.
Questions - How
long will I have pain after the TKR?
- Can
I return to playing sports after my total knee replacement?
- When will I experience full benefit of my total knee?
- Can my preoperative X-ray pictures tell how satisfied
I will be?
- Are
obese patients equally satisfied with TKR as other patients?
How long will
I have pain after the TKR? You
will recognize already 1-2 days after the surgery that pain in your knee is different. The gnawing, severe pain you experienced
before the operation will be gone. You will, however, feel "surgical pain", the pain provoked by movement
of severed tissues. This pain lasts longer, perhaps up to 6 months, it depends on several factors such as the type of
the operation (first operation or revision operation), type of prosthesis, etc. Expect this pain to diminish progressively
and be prepared to use pain medication to stifle it.
You may experience occasional pain in your new knee after walking and other activities. This
pain may persist for several months after the operation. The relief of this type of pain is individual, depending among other
thing on the severity of the preoperative deformity in your knee, on the state of your muscles and so on. Remember that the surgeon replaced only the damaged joint surfaces
but could do nothing to the muscles, ligaments, and other soft tissues equally damaged by the "joint" disease.
Can I return to playing sports after my total knee replacement? You may certainly return to playing low-impact sports, that means
sports which don't put high stresses on your new total knee. Examples of low- impact sports are golf, doubles tennis,
bowling, cross country skiing
Activities such as running, jumping, (and stumbling) put high stresses on your total knee. All sport
activities which put high stresses on your new knee are called high-impact sports. Examples of such high-impact sports
are singles tennis, basketball, football.
High-impact sports puts excessive stresses on the total knee joint prosthesis and on its fixation
to the skeleton. There is a risk that this overload may lead to premature failure of the total knee replacement.
It is safer for orthopedic surgeons to recommend low levels of
all activity after joint replacement operations than to advocate high demand athletic activity.
However, young patients seek joint replacement surgery both to reduce their joint stiffness and
pain and to increase their activity, including participation in sports. When the patients understand the risks associated with increased wear of their
new total knee joints caused by high activity when the patients are prepared to accept these risk when the patients are training to diminish these risks then there is no reason to dissuade the young patients from
athletic activity. (Healy, 2001)
When will I experience
full benefit of my total knee? Although
you will experience relief of your preoperative pain and anxiety very soon after the operation, the return of function in
your knee and leg will take much longer time. After three months you will probably have restored the force in the muscles
around your knee, but the range of movement will take much longer to restore. Consider that it will take about one year of
vigorous training before you will achieve full benefit from your total knee.
Can my preoperative
X-ray pictures tell how satisfied I will be? Usually, patients with more severe changes on X-ray pictures (loss of "joint space") experience
quicker relief of preoperative pain after the total knee replacement operation. But one year after the operation, patients
with less severe degrees of X-ray changes have equally good relief of pain as patients with more severe X-ray changes.
Patients with very severe destruction of their skeleton, as demonstrated
on X-rays, have , however, often less good return of function in their total knees.
Are obese patients equally satisfied with
TKR as other patients? Yes,
both obese and non-obese patients are equally satisfied with the result of their total knee operation. The only difference
is that the obese patients have more difficulties with ascending and descending stairs, with participation in physical activities and rehabilitation, and have more pain in the kneecap area but also elsewhere in their total knees. (Stickles 2001)
Note, however, that there is a group of very obese patients (Winarsky
1998) where the total knee operation is followed by a very high rate of serious complications, such as postoperative infection.
These patients have a BMI (Body Mass Index) above 40. A patient weighting 120 kg and only 1,73 m tall, has the BMI of 40.
It is recommended that these patients should have treatment for
their morbid obesity before the total knee surgery.
References: Anderson J et al. J Arthroplasty 1996; 11:831-40 Dickstein R et al. Gerontology, 1998;44:204-10 Healy WL. Am J Sports Medicine, 2001, 29, 377-88 Orbell, et al. J Epidemiol Community Health 1998;52:564-70 Stickles B et al. Obes Res 2001;9:219-23 Robertsson O. The Swedish Arthroplasty Register, Thesis Lund,
2000 Hawker et al. J Bone
Joint Surg-Am 1998;80-A, 163-173) Winarsky
et al. J Bone Joint Surg-Am;1998:1770
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