But when is knee replacement necessary?

In addition to persistent pain at rest, even younger people may need arthroplasty (total or in limited cases partial) after:

• Serious car accident
• Falls
• Repetitive injuries
• Knee surgeries, having developed post-traumatic arthropathy
• Difficulty and lameness when walking
• Stiffness
• Instability
• Distortion in the area
• Persistent pain and swelling in the area, even during simple daily activities

Total knee replacement

“Total knee arthroplasty with the evolution of technology, incorporates the contribution of biomechanical precision and technological know-how. Nowadays it is a reliable surgical procedure applied to patients who present degenerative changes in the knee joint, i.e. end-stage osteoarthropathy” says Mr. Andreas A. Karagiannis Orthopedic Surgeon, Director of the First Sports Injury Clinic Metropolitan General and continues:

“During the operation, implants are placed in the joint, replacing the worn articular surfaces, with the aim of relieving pain and restoring the function of the knee.

We remove the worn surfaces (cartilaginous surfaces, menisci, ligaments), and replace them with high-quality artificial prostheses, metal implants that we place on the lower end of the femur and the upper end of the tibia, interspersed with polyethylene, which allows the artificial joint smooth and efficient movement.

These prosthetic parts are designed and manufactured to mimic the natural movement and stability of the knee, allowing the patient to return to their daily activities pain-free after a reasonable period of recovery.

Indications and goal of total knee arthroplasty:

Indications for the operation are:

• The pain in the knee and especially the constant pain at rest, but also during the night
• Unsteadiness while walking
• The obvious limitation in movement and great stiffness in the knee, which do not subside with conservative means of treatment (strengthening, physical therapy)
• The permanent joint
• Imaging changes in the joint, with narrowing of the mesenteries
• The obvious rawness or lameness of the leg
• The ongoing pain

Contraindications for the operation:

• The presence of inflammation in the knee
• Secondary osteonecrosis of the joints, due to the possibility of loosening of the implants in the course of the disease
• The existing heavy weight of the patient

Goals of total arthroplasty:

• Pain relief
• Restoring the function of the knee
• A stable – painless gait
• Discontinuation of any kind of analgesic and anti-inflammatory treatment
• The patient’s return to “good everyday life”, with a clear improvement in his quality of life

“Total arthroplasty”, adds the expert, “allows everyday activities to be carried out painlessly and independently, with stability and without the use of aids, such as medication, splints, knee braces, bacteria, etc.

Of course, what every patient should know is that by placing a “mechanism”, such as total arthroplasty, their knee will never be the same as it was initially, in young teenage or even adult life, that is, in the period before the problem arose of osteoarthritis”.

Preoperative assessment

“All patients about a month before their surgical treatment should undergo:

• Taking their detailed history (any coexisting conditions, diabetes mellitus, previous hospitalizations and infections), measuring their body mass index (BMI)
• Clinical orthopedic examination
• Appropriate diagnostic tests (x-rays of the lower limbs under load, CT scans, of the knee and associated hip and ankle joint, magnetic resonance imaging in some cases), hematocrit check for possible anemia and check for any blood coagulation disorders
• Electrocardiogram or ultrasound of the heart, measurement of blood pressure and heart rate
• Checking the blood group, in order to ensure the safety of our patient, to manage the appropriate medication and with the aim of the optimal result.

In our clinic, in recent years, we have been using advanced and innovative surgical techniques that help us to improve the existing techniques, according to the current literature. With our necessary and small surgical interventions, the reduction of surgical trauma, but also our tissue intervention, with the use of special analgesia protocols (fast track), as well as with the use of special physical therapy measures, we reduce the postoperative pain of our patient and the recovery is now clearly faster, our patient returning to his previous daily routine in 15-20 days” explains Mr. Karagiannis and adds:

“Robotically assisted knee arthroplasty belongs to the new innovative surgical methods of recent years. With electronic guided navigation systems, with the use of robotic assisted technology, with the use of guides and cutting tools, as well as materials adapted to the anatomy of each patient (Patient Specific Instruments and Customized individually made total knee arthroplasty), the surgeon is equipped so that it has the maximum effect and a patient extremely satisfied”.

Pain and recovery after knee replacement

“Effective pain management after surgery is our obligation and duty, for the optimal rehabilitation and satisfaction of each patient. Applying modern and multimodal analgesia protocols, using drugs and anesthetic techniques targeting different pain pathways, adapted based on the profile, history and characteristics of each patient (age, height, weight), we are able to completely manage the postoperative pain and the first “difficult” days after such an operation.

The patient will remain hospitalized for 24 hours in the Hospital, he will start a physical therapy program, so that he can return home the next day, while he has understood the exercise program he needs, can walk comfortably with the bacteria, while he will also have to be trained in a specific program rehabilitation, so that we can all achieve the desired functional result together.

Immediate postoperative reduction of edema is extremely important, and cryotherapy, which should be applied to every patient, has amazing benefits. With less swelling in the operated leg, with the use of the anti-thrombotic stocking, with the limb in a retracted position, with frequent cryotherapy, the pain is alleviated, the possibility of thrombosis is reduced, the movement of the knee is initially good and painless, so the physical therapy approach is very satisfactory” emphasizes.

When will I be able to walk after total knee replacement?

“Walking starts on the first postoperative day, but once the initial pain is reduced, most patients can walk progressively longer distances, with bacteria left in about six weeks.

In the next 15-20 days, the patient performs exercises aimed at regaining the range of motion in the operated knee, strengthening exercises, balance exercises, with the result that in the next 5-6 weeks post-surgery he returns to his daily activities.

Each patient, in order to “come back” and be happy with his new joint, should follow the directions and instructions of the therapist and for a period that depends on the patient, even for a period of up to 6-8 months , knowing that consistency in the execution of the exercises, as well as the hygiene of each patient, is vital. In addition, throughout this time, patients have a continuous support and training from the therapist and his surgical team, so that with advice and modification of his activities, we can achieve the desired result.

Now walking without pain, having full extension and flexion of at least 110 – 120 degrees, stability and alignment in the joint, the patient is led to his former activity and a normal lifestyle.

With all of the above, the therapist aims for the longevity and good functioning of the implants, aiming for 15-20 years, at least,” he clarifies.

Can both my knees be operated on at the same time?

“Technically it is possible to perform total arthroplasty on both knees on the same day. But there are clearly more risks in this case, such as the higher risk of possible thrombosis (DVT), increased risk of transfusion, increased length of stay in the hospital, which can reach up to 5-6 days, as the risk of inflammation also increases. Of course, if we are talking about a young, perfectly “healthy” patient, with a low body weight and for whom we have all the assurances from our partners, pathologists, cardiologists and anesthesiologists, the patient can undergo total arthroplasties on both knees at the same time”, concludes Mr. Karagiannis.

*At Metropolitan General and specifically at the 1st Sports Injury Clinic, personalized care is provided to your problem and help to regain your previous mobility, eliminating pain, offering fuller movement and stability to the joint, restoring the function of the joint as much as possible to normal and improving your daily quality of life.