There are a total of 7 bone cuts in a typical total knee replacement (TKR): distal femur, anterior femur, posterior femur, anterior chamfer, posterior chamfer, tibia, and patella. Each of these cuts has its own special science, and each cut can affect the other cuts and potentially the outcome of the TKR.
The term total knee replacement sounds somewhat drastic. This operation would be better named a surface replacement of the knee. The remaining cartilage and approximately 5-10 mm of bone is removed from the ends of all of the bones: femur , tibia , and patella.
In a total knee replacement surgery, the lower portion of the thigh bone (femoral condyles) is removed to make a space for the upper implant. The damaged top surface of the tibia (tibial plateau) is removed to make a space for the lower implant.
The biggest challenge in the early recovery of a TKR (up to 3 months postoperative) is the regaining of knee motion.
By: Sunil Jani, MD, MS, Orthopedic Surgeon
Healing and recovering from knee replacement surgery is a gradual process. During the first 6 weeks, rapid healing takes place. A full recovery can take 6 months to 1 year or longer.
You shouldn't downhill ski or play contact sports such as football and soccer. In general, avoid sports that require jerking, twisting, pulling, or running. You should be able to do lower-impact activities, such as hiking, gardening, swimming, playing tennis, and golfing.
Most patients can start walking while still in the hospital. Walking helps deliver important nutrients to your knee to help you heal and recover. You can expect to use a walker for the first couple of weeks. Most patients can walk on their own roughly four to eight weeks after knee replacement.
Knee replacement pain: The week following surgery
You should expect to stay in the hospital for several days following knee replacement surgery. This is often considered the most painful stage of the recovery process. Your doctor will prescribe medications to help you manage your pain level.
Start with small, manageable steps over short distances and use an assistive device whenever needed. Gradually work your way up until you can walk longer distances without discomfort. Doing too much exercise can lead to pain and swelling, hindering your recovery.
Recovery is slow
While it's different for everyone and depends on the type of knee surgery you've had, many people are surprised by how long it takes to recover. The time it takes to start doing simple tasks around the home, get back to work and importantly bending your new and improved knee may catch you by surprise.
While surgeons will take care not to cut or damage large nerves whenever possible, sometimes the peroneal nerve or a branch gets cut during the incision process. A study by the Mayo Clinic found that the saphenous nerve is sometimes inadvertently caught and closed in the incision sutures.
Total knee replacement surgery involves capping off the thigh bone (femur) and shin bone (tibia) with metal and inserting a plastic bearing, or artificial joint, in between the bones where cartilage would normally exist. In some patients, a plastic cap is inserted over the kneecap (patella).
For many, this surgery reduces pain and improves the function of the knee. But around one in five people report ongoing pain after surgery. This pain can increase in intensity beyond the initial healing phase of a few months.
Many clinical studies attribute this chronic pain to be the result of swelling (inflammation), damage to one or more peripheral nerves around the knee or other non-specific issues.
Total Knee Replacement
This has the longest recovery time out of all of the options, and therefore is almost always a last-resort choice.
Within 2-3 weeks post surgery, you should be able to walk a short distance – or for around 10 minutes – without depending on a mobility aid.
Crossing your legs
Shortly after your total knee replacement, it is not recommended that you cross your legs. This is most likely due to the lack of range in your knee to be able to cross your legs. If you have ever seen someone sitting cross legged, you know how much their knee needs to bend.
Can you sleep on your side after knee replacement surgery? You can, but it's wise not to do so until at least a few weeks after surgery, when you can start bending your knee. Make sure you lay on your non-operative side. Sleeping this way makes sure no pressure falls on the knee you had surgery on.
You're not alone. Having an orthopedic surgery can leave you feeling tired for weeks or months after the procedure. Here's a list of 7 main causes of fatigue after surgery: surgical stress, blood loss, medications, pain after surgery, energy of healing, dietary changes, and sleep disturbance.
“Kneeling ability varies greatly post-knee replacement, and is multifactorial. Greater pain is a contributing factor to the inability to kneel postoperatively, but this appears to be nociceptive rather than neuropathic in nature.”
Over-the-counter medications — such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — may help ease knee pain. Some people find relief by rubbing the affected knee with creams containing a numbing agent, such as lidocaine, or capsaicin, the substance that makes chili peppers hot.
Spring and fall offer lots of daylight and fresh air. Your physical therapy is another reason to choose spring and fall for your knee surgery. Part of your therapy will be performing exercises indoors and outside, which will be more appealing when the temperature isn't too hot or cold.
There is a range of accepted weight ranges, but the current standard is that anyone obese (greater than 100 pounds over ideal weight or a BMI of roughly 40-45) should not consider joint replacement.