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Total Knee Replacement

By Alan Williams, PT, OTR/L, ATC, CSCS

These days, millions of baby boomers (myself included) are nearing retirement. In between discussions of 401k’s and daydreams of golf and fishing, you may also want to ask yourself, “Will I be mobile enough to actively enjoy my golden years?”

A total knee replacement (TKR), also called a knee arthroplasty, may be an option if you’re one of the 46 million Americans with arthritis, or if you suffer from another degenerative disease or have had past significant knee trauma. According to the American Academy of Rheumatology, approximately 418,000 total knee replacements were performed in the US in 2003, and that number will continue to grow as more and more Americans reach senior citizen status. However, having a TKR is not as simple as changing the tires on your car. The benefits must be carefully weighed and each risk totally understood.

Do you need a total knee replacement? The American Geriatrics Society’s Foundation for Health in Aging suggests asking yourself these questions:

1) Is sleeping difficult due to your joint pain?
2) Do standing, climbing stairs, and other everyday actions cause you pain?
3) Does joint pain inhibit you from enjoying your activities or keep you from participating in them altogether?

If you answered “yes” to these questions, you may begin to consider a TKR.

Although total knee replacements are a very common surgery, not everyone is a good candidate for a TKR. As with other medical procedures, blood tests, X-rays, EKGs, and other exams will be used to evaluate your general health and fitness for surgery. In general, the ideal candidate for a TKR is a non-smoker, has a healthy body weight, is free from cardiac, pulmonary, or vascular disease, has relatively good leg muscle strength (to aid post-operative recovery), and is over 60 years of age. Because the implants will not last forever, younger (and presumably more active) candidates should look to alternatives (such as an arthroscopy or an osteotomy - a type of knee surgery that shifts stress points on the knee rather than replacing the joint) to avoid having complications and possible repeat TKRs in the future.

Even if you are not the ideal candidate, a total knee replacement may still be a good option for you. Your doctor will be able to outline any concerns about the procedure and may recommend a course of action to help improve your chances for surgery success.

What exactly is entailed in a total knee replacement? A TKR is a procedure in which the damaged areas of the joint are removed and replaced with metal and plastic components. There are several variations on the surgery – ligaments are sometimes removed, as may be the patella (kneecap). Most types of knee implants also call for the quadriceps muscled to be cut into, which usually prolongs recovery when compared with less invasive TKR procedures. Your doctor should be able to answer any questions you may have regarding total knee replacements and should discuss all surgery options with you.

Perhaps the greatest concern for anyone considering a total knee replacement is whether or not you can commit to several weeks or even a few months of intense, often times painful, post-operative physical therapy. This physical therapy is necessary to receive the greatest benefit from your new knee – the strength, stability, and range of motion that will allow you to get out and enjoy life. Patients who skip their physical therapy or quit it early experience the chronic pain that comes with a partially functioning limb – the poorer quality of life that results from compromised ability to perform daily tasks. In many ways, these patients are worse off after surgery than they were before.

Total knee replacement surgery is not for everyone, but it is a valuable consideration if you deal with the daily debilitating pain and frustration of a degenerating joint. Handled correctly, a TKR can add years of activity to your life.

Don’t let knee pain hold you back. Call 463-0022 today for your FREE Knee Pain Assessment!