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)
For more information visit please the chapter Life with a total
knee
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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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