Concerns of Patients with Total Knee Arthroplasty

The concerns of patients who are about to undergo, or have already undergone, total knee arthroplasty, are completely normal, as every surgery is a stressful experience. The stress and questions that arise before surgery are to be expected and should not be underestimated. Many patients are reluctant to formulate their questions, yet the need for full information is completely understandable. The surgeon’s main responsibility is to provide detailed information about the procedure of the operation, the expected results and the postoperative course. Proper preoperative guidance and a clear understanding of what to expect after surgery contribute substantially to reassuring the concerns of patients with total knee arthroplasty.

When is the patient led to total knee arthroplasty?

Total knee arthroplasty is recommended when chronic pain from osteoarthritis or another degenerative knee condition no longer responds to conservative treatment. When medication, intra-articular injections and physiotherapy do not offer substantial or long-term relief, then surgical treatment is the most effective solution.

The symptoms that lead to knee arthroplasty most often are:

• Constant or severe pain
• Nocturnal pain
• Difficulty walking
• Reduced walking endurance
• Difficulty climbing or descending stairs
• Pain or weakness in prolonged standing
• Difficulty even at short distances inside the house
• Severe stiffness, especially in the morning or after immobility
• Deformity of the joint
• Reducing the range of motion

The decision for total arthroplasty is based on the overall clinical picture, the radiological findings confirming extensive wear and tear of the articular cartilage and the functional condition of the patient.

The aim of the operation is to definitively relieve pain, restore the alignment of the lower limb and substantially improve the quality of life.

Concerns of Patients with Total Knee Arthroplasty: Implant Selection and Design

The selection of the appropriate implant in total knee arthroplasty is the responsibility of the attending surgeon, who decides based on his experience and the special characteristics of each patient.

There are many different implants and designs available for total knee arthroplasties, which differ in shape, construction materials, and how they stabilize in the bone. The important thing is for the design to have proven survival, documented through international registrations and multi-year clinical studies. The long-term reliability of an implant is a key selection criterion, as the goal is the stability and functionality of the joint for many years.

In the past, some designs were presented as innovative, but were withdrawn due to increased rates of complications or premature relaxation. For this reason, the selection is based on scientific data and clinical experience.

The surgeon’s experience in this arthroplasty system plays a decisive role. Finally, personalizing the selection, based on the patient’s age, physical activity, and bone quality, ensures optimal function and maximum implant lifespan.

Concerns of Patients with Total Knee Arthroplasty: Normal Postoperative Symptoms

The healing that takes place after surgery is related to inflammatory processes. Therefore, it is completely normal for a wound to be warm for a period after surgery, especially after a total knee arthroplasty. The heat of the wound is normal for at least 6 months after surgery and does not mean anything bad.

Most patients after total knee arthroplasty feel numb their skin on the outer surface of the knee. This is also to be expected and is not a problem.

As for edema, it is normal for a leg to be swollen, especially on the operated side, until the gait has been fully restored. However, leg swelling can sometimes be a sign of deep vein thrombosis and requires evaluation.

Concerns of Patients with Total Knee Arthroplasty: Pain, Stiffness and Sounds After Total Arthroplasty

It is very common for a total knee replacement to be accompanied by mild pain in the first few weeks after surgery. This pain differs substantially from the preoperative pain of arthritis, which was intense and continuous. More specifically, after surgery, the discomfort is mainly related to the healing process of the tissues and the gradual adaptation of the joint to the new implant. Gradually, this discomfort decreases with rehabilitation and physiotherapy, but in cases where the pain persists, worsens or is accompanied by swelling or redness, immediate evaluation is required.

Stiffness is also common, particularly in the morning hours or after prolonged immobility. Most of the time, normal range of motion is not fully restored. The main reason is that the artificial joint cannot perfectly reproduce the function of a knee without wear. However, the functional range achieved is sufficient for daily activities.

In terms of sounds, it is extremely common for the joint to produce mild noises during movement, especially in the first few weeks. These sounds are due to the mechanical contact of the implants and usually decrease over time, without indicating a problem.

How long does total knee replacement repair take?

One of the concerns of patients with total knee replacement is the duration of rehabilitation. Rehabilitation after total knee replacement is a gradual procedure that usually takes 1 to 3, while full functional improvement can continue up to a year after surgery.

The first 4-6 weeks are considered decisive, since during this time the basic recovery of joint mobility and the stabilization of the lower limb are achieved.

However, the mobilization begins from the first postoperative days, with a gradual increase in loading and intensification of physiotherapy. Most patients can return to basic daily activities within 2-4 weeks, such as:

• walking short distances
• light domestic activity

However, activities that require greater endurance or stability take longer.

Consistency in the rehabilitation program, correct execution of exercises and adherence to medical instructions significantly affect the final result, both in terms of mobility and long-term functionality of the joint.

Concerns of Patients with Total Knee Arthroplasty: The Role of Physical Therapy and Adaptation at Home

Physiotherapy is a key success factor after total knee replacement and begins immediately after surgery.

The exercises aim to:

• restoring joint mobility
• in strengthening the muscles of the lower limb
• to improve balance

Thus, the patient safely returns to daily activities. At the same time, significant modifications are usually not required at home, however some practical adjustments facilitate the postoperative period. Having a handrail on the stairs and handles in the bathroom offers extra security, especially in the first few weeks. In addition, it is recommended to use a high chair with a straight back and handles, about 50 cm high in the seat, to facilitate the process of sitting and standing up without excessive bending of the knee. Proper organization of the space in combination with systematic physiotherapy reduces the risk of stiffness and contributes to faster and safer recovery.

Concerns of Patients with Total Knee Arthroplasty: Potential Complications and How They Are Treated

As in any surgery, there is a small but real risk of complications in total knee arthroplasty.

The most important, but not frequent, include:

• thrombosis of the leg
• joint infection
• persistent stiffness
• Loosening the implant

Although the rates are low, proper prevention and early diagnosis are crucial.

Prevention is based on immediate and proper mobilization, the administration of anticoagulant treatment to avoid thrombosis and the meticulous care of the surgical wound. Following postoperative instructions significantly reduces the risk of complications.

The patient should contact the doctor immediately if they experience severe or worsening pain, redness, increased heat in the knee area, fever or persistent swelling in the lower limb. Finally, regular monitoring and scheduled reviews by the surgeon help to identify any problem early and effectively address.

If you are experiencing chronic knee pain or have questions about total knee arthroplasty, it is important to consult a doctor with expertise and experience in reconstructive surgery of the large joints.

Orthopedic Surgeon Anastasios Lilikakis is the Director of the Third Orthopaedic Clinic of the Athens Euroclinic and the President of the Department of Hip & Knee Reconstructive Surgery of EEHOT, specializing in total knee arthroplasty and the modern treatment of arthritis.

Contactus to schedule your assessment and receive comprehensive, responsible, and personalized medical guidance.