What are the indicators that a patient may require artificial knee replacement surgery?

Most patients requiring knee surgery are elderly and suffering with a condition called osteoarthritis, which is often in the latter stages of its development. This group of patients have generally undergone various other forms of treatment already, including courses of medication, physical therapy, and even knee injections, none of which will have been successful. Indeed, their symptoms may have been exacerbated by treatment, meaning the condition has reached a point whereby patients have consulted their doctor regarding surgery. Most patients opt for artificial knee replacement surgery themselves as they hope it will enable them to lead a normal life without the pain and torment caused by knee osteoarthritis.

 

What are the characteristics of an artificial knee, and can they be an effective replacement for a natural knee?

Artificial knees are very similar to the real thing, being made up of 3–4 parts, except that these are mostly made from cobalt-chrome and titanium instead of bone, while the middle section is made from plastic or polyethylene, which is the standard across all brands of replacement knees.

 

In cases of osteoarthritis affecting both knees, will surgery be conducted one knee at a time or both knees simultaneously?

Generally, surgeons will first operate on the knee that is causing the most pain. Some such cases may end up not requiring surgery on the other affected knee because once one knee has been operated on, it will become the main knee through which the most weight is placed, removing the need for surgery on the other side. Additionally, the other knee will tend to become less painful than before as the side which is operated on will be the one taking the most weight. However, in cases where it is necessary to operate on both knees, doctors will recommend waiting for any inflammation to go down following surgery on one side before operating on the other side, which usually takes around 3–4 months.

For patients undergoing dual knee surgery, the benefits are that any pain and costs are reduced to a single event. However, patients must accept that the risks are doubled in accordance with the time spent in the operating theater, meaning a heightened risk of infections and illness following surgery. Usually, patients who undergo dual knee surgery are foreign nationals who fly to Thailand specifically for the procedure and who have decided that it is best to get the surgery out of the way in a single session, rather than returning to Thailand for a repeat procedure.

 

Lifespan of artificial knee joints

Medical staff normally inform patients that the lifespan of their replacement knee will be between 15–20 years, although this is dependent on the usage and care taken by the recipient.

 

Post-surgery care

Artificial knee replacement surgery is a major procedure that requires making a large incision, through which the new knee can be positioned. As such, it is normal for patients to experience swelling after surgery. The most important aspect of the post-surgery recovery is wound care, with doctors recommending that patients keep their wound dry at all times for a period of between 10- 14 days. Patients will also be prescribed medication to alleviate pain and inflammation until both those symptoms go away.

 

Physiotherapy following artificial knee replacement surgery

Physiotherapy is an essential part of the recovery process, and it must be undertaken daily while the patient is still recovering in hospital, as well as following their return home. Physiotherapists will help train patients to walk properly and will demonstrate a range of exercises and stretches aimed at strengthening and improving flexibility in the muscles surrounding the knee. Post-surgery physiotherapy sessions usually go on for around 3–4 weeks following the procedure.

 

Are there any side effects associated with artificial knee replacement surgery?

Any inflammation tends to be centered around the incision site and this is a normal part of the recovery process. However, some patients may experience a slight fever, which medical staff will assess to determine whether the situation is caused by more serious complications, although any such symptoms tend to go away with time.

Nevertheless, there are rare occasions when more serious side effects present, such as an infection, which can be distinguished by redness and swelling at the incision site, or a fluid discharge coming from the wound. In such cases, patients should seek immediate medical attention. Another serious symptom that is common among western patients but less so in their Asian counterparts is leg swelling caused by deep vein thrombosis. As mentioned, this is more common among westerners than Thais, though all patients should be especially vigilant for any such symptoms following their surgery.

 

Is the quality of an artificial knee joint comparable to that of a natural knee joint?

When speaking about the quality of life for patients, especially elderly groups, osteoarthritis can have a significant impact, posing an obstacle to various activities, such as traveling with their families. However, artificial knee replacement surgery can enable elderly patients to walk without the aid of a frame, thus instantly improving their quality of life and easing the minds of family members, who may have otherwise been concerned that their grandparent would no longer be able to lead a normal life.

 

How long after surgery can patients expect to rely on their knee again?

It generally takes around 4 weeks for the replacement knee to be ready for regular use.

 

Can the new knee be relied upon to enable daily activities, such as ascending steps, sitting cross-legged, or wearing high-heeled shoes?

Previous lifestyle habits will dictate whether patients can climb steps, sit cross-legged, or assume difficult sitting positions. For instance, if the muscles surrounding the knee are strong enough, elderly patients may be able to sit with their knees flexed to angles of 100-120 degrees, although angles greater than this may not be possible in this group. With regard to wearing high-heeled shoes, the height of any heels worn after the procedure may require a reduction because wearing such footwear places greater pressure and strain on the knees when compared to flat shoes.

 

Will an artificial knee lead to issues when passing through security at airports?

Bumrungrad International Hospital supplies artificial knee replacement recipients with a special card that confirms the presence of metal in their knees and can be used when going through airport security checks. This card includes the patient’s name and personal details as provided to the hospital.

 

Is it still possible to exercise, drive, or ride a motorbike following surgery?

Doctors will advise patients to only partake in light exercises and low impact sports in the immediate aftermath of surgery, such as swimming, cycling, water aerobics, or other non-impact activities. Any form of exercise involving knee impact should be avoided, including running and tennis. Patients must accept that the lifespan of their replacement knee is dependent on them using it correctly and not placing it under any undue strain.

Any exercises that do not involve the use of the knees, such as those involving the upper body, can be continued normally. Additionally, doctors will recommend that patients try to strengthen the muscles surrounding the knees, including the quadriceps, as doing so will improve knee function and flexibility, making it easier to ascend and descend steps when necessary.

Regarding driving vehicles, patient should wait approximately 2 weeks after surgery before seeing how their knee reacts to pushing the pedals with the engine switched off. Riding motorbikes, on the other hand, requires sufficient leg strength to kickstart the engine, so doctors recommend waiting around 1–2 months depending on how rehabilitation is going.

 

Is there any specific care advice regarding artificial knees following surgery?

Once the scarring has fully healed and the inflammation has gone down, which usually takes around 2–3 months, patients who see a reduction in knee swelling and the dissipation of any joint warmth, and who have kept the wound clean, should be able to resume their daily lives. Nonetheless, they should still avoid impact sports to ensure the new knee is not placed under undue strain.

 

Are dietary supplements designed to aid knee strength necessary following surgery?

There will be a complete lack of cartilage in the knee joint following surgery, thus eliminating the need for patients to take any dietary supplements.

 
The Sports Medicine and Joint Center at Bumrungrad International Hospital offers a full range of treatment services for patients suffering with osteoarthritis of the hips and osteoarthritis of the knees. Our team of knee and hip surgery specialists are renowned in their field, both throughout Thailand and the region as a whole. With the latest tools and equipment at their disposal, our highly experienced doctors and surgeons specializing in arthroplasty have decades of experience between them and have performed a significant number of successful procedures. Working alongside the doctors and surgeons, our support team of medical personnel provide the highest standards of pre- and post-surgery care, including physical therapy as part of the rehabilitation process.

The team is working in a comprehensive multidisciplinary team available to provide specialist care and advice. These team members cooperate effectively and efficiently to ensure our patients receive the best care possible, from the moment they enter the hospital for their procedure through to post-surgery care and rehabilitation. We work as one to achieve the ultimate objective of restoring a high quality of life for our patients so that they can make a full return to their former lifestyles.
 
Article by Pitt Thanachanan, M.D., expert orthopedic surgeon at the Sports Medicine and Joint Center, Bumrungrad International Hospital.