What’s Involved in Total Knee Replacement Surgery?

What happens when your knees start to fail you? Knee pain, stiffness, and swelling can be highly debilitating, keeping people from performing daily activities. The good news is, there is an effective strategy for reducing and even eliminating pain: knee replacement surgery.

Dr. Paul Schuppner, orthopaedic surgeon at Fort HealthCare, offers helpful information surrounding this procedure—including the diagnostic process, who is a good candidate, and the key to successful outcomes.

From Symptoms to Diagnosis

The primary cause of knee pain is osteoarthritis, a degenerative process often referred to as “wear and tear.” Typically, osteoarthritis affects people in the age range of about 50 to 80 years old—but individuals in their late 30s and 40s can also suffer.

Dr. Schuppner explains there are two ways to diagnose knee osteoarthritis. One is a physical examination, where he assesses the knee for symptoms such as swelling, redness, warmth, tenderness, and any grinding sensation. He also analyzes range of motion, both active and passive, as well as stability.

“Active motion means we ask you to move your knee to see how it moves. Passive range of motion means you’re relaxed and your surgeon or your doctor does the moving for you, just to get an assessment of how your knee moves,” he states. “We also look at stability of the knee joint to make sure the ligaments and tendons are working appropriately.”

The second diagnostic method is imaging in the form of an x-ray. “I tell people all the time that a picture is worth a thousand words, and for what I do that really is the rule and holds true,” adds Dr. Schuppner. “A set of simple knee x-rays gives me, as your surgeon, a wealth of information about what most likely you’re going to describe to me as your pain or your problem.”

Next steps depend on what was uncovered post-assessment. Not everyone who has arthritis needs to undergo knee replacement surgery, but it is an option. Some individuals may find relief via more conservative treatments, such as anti-inflammatory medications, physical therapy, or injections.

Preparation Prior to Surgery Is Key

One crucial component in knee surgery success, per Dr. Schuppner, is preparation. This encompasses different aspects of both physical and psychological preparation.

“The more prepared you are, the more you know about your knee replacement procedure, the better off you’re going to be. I feel strongly about that. There are patients that frankly probably shouldn’t have a knee replacement if they’re not prepared,” he notes. “When we discuss a total knee replacement in the office, it can be a lengthy conversation.”

That conversation includes:

• Stressing the importance of strengthening the muscles surrounding the knee with exercise or physical therapy
• Reinforcing why physical therapy after the surgery is critical for success
• Setting expectations for the recovery timeline and what one’s pain level might be
• Understanding the patient’s level of support during their recovery (family members, friends, neighbors who can help out)

Role of Physical Therapy in Successful Outcomes

A successful surgery doesn’t solely rely on the surgeon’s expertise. The patient has a lot of work to do postoperatively. Specifically, adhering to one’s physical therapy program makes a world of difference—a protocol that commences before knee replacement patients even leave the hospital.

“A physical therapist can be your best friend. They can also be more than your physical therapist but also your mental health specialist. They’ve been there and done that. The reassurance and tips and tricks they’ll teach you is really invaluable,” assures Dr. Schuppner.

While “full” recovery can take up to a year, Dr. Schuppner says many individuals are able to return to normal activities in about six weeks. “Their incision is well healed. They’re nearing completion of their physical therapy process and treatment, and they’ve gotten back to normal life. It’s not uncommon that most patients six weeks after surgery are back to work and doing low-impact activities.”