Presented by Midwest Orthopaedics at Rush
Total knee arthroplasty, or knee replacement, is a surgical procedure to treat advanced arthritis of the knee. Knee replacements are performed by orthopaedic surgeons and specialists in joint replacement. The major weight bearing arthritic surfaces of the knee are replaced with metal and plastic implants.
In the properly selected individual, knee replacement can provide significant pain relief allowing them to return to many of their desired activities. Patients who have exhausted conservative treatments such as oral anti-inflammatories, steroid injections and other types of injections including “lubricants” such as hyaluronic acid and have long standing arthritic knee pain are often considered to be the most appropriate candidates. While age is often considered an important decision variable when considering knee replacement, the degree of symptoms and the failure to respond to non surgical treatment remain the most important factors.
A total knee replacement is performed in just a few hours and requires an overnight stay. Patients are ambulatory within the first week following surgery. In the early postoperative phase, the goals include maximizing muscle control and mobility, and minimizing swelling. Thereafter, many patients will engage in physical therapy. A gradual return to normal activities and exercise occurs over the next several months. Returning to these activities and including general exercise is an important step to maintain good health.
There have been many recent advances in knee replacement surgery including less invasive tissue sparing techniques and improvements in implant design. A successful result is possible for 15-20 years before another surgery might be required. Deciding on which activities are possible following knee replacement surgery is based upon preserving the implant for the longest duration possible. Similar to driving a sporty car, the life of a knee replacement is based on the knowledge that components are like tires on a wheel…the more aggressive your driving, the less time the tires will last.
Low impact, non-ballistic exercises are suggested. In a study from the American Journal of Sports Medicine, nearly 91% of patients were able to return to walking and over 77% of the patients returned to their regular exercise routine. Walking, swimming, golf, yoga, cycling, moderate weight lifting, rowing, and even doubles tennis are generally considered to be safe activities after undergoing a knee replacement.
In this same study, only 20% of patients were able to return back to higher impact activities such as tennis. Understanding the risk of earlier wear and potential implant complications is always a factor when physicians counsel their patients on activities they may participate in following knee replacement surgery. Certainly, the ability to regain and sustain a pain-free active lifestyle is obtainable and remains the primary goal of the surgery.
Return to sport is a highly debated topic due to the potential complications of early polyethylene wear or implant loosening. In the aforementioned study, more than half of the patients who required revision of their knee replacement never had returned to sport following their knee replacement surgery.
Ultimately, sports and exercise participation is a decision between the patient and his or her physician. Avoidance of high impact activities like running and contact sports (football, baseball, rugby etc.) is generally recommended, but remaining active with a healthy lifestyle remains important and obtainable.
Bradbury, N. Borton, D., Spoo, G., and Cross, M. (1998). Participation in Sports After Total Knee Replacement, American Journal of Sports Medicine. 26(4)