Total Knee Replacement is a very successful operation if performed properly. However, you should remember that the recovery period is long and the progress is gradual. Here are a few things you should know about your recovery.

Pain and stiffness

Your knee will feel slightly warm and stiff, especially in the mornings up to 6 months. Cold packs are helpful for the pain in the first 3 weeks. Your surgeon will prescribe a set of different painkillers (called multi-modal analgesia) to control your pain. A moderate amount of  pain, especially at night is expected in the first month, but will get better gradually. Depending on your pain threshold, you might need regular pain medications up to 2 months after surgery. A small amount of swelling in the operated leg is expected in the first few days, this should resolve with placing a pillow under your leg and using anti-embolic stockings.

Walking and stair climbing

Walking on an even surface is possible after your discharge from hospital, however you should not overdo it. Remember you just had an operation and your knee needs to recover. Limit your walking distance to 20  minutes in the first 1-2 months then increase this as you progress without pain and swelling. Stair climbing will get better every month; however you should use rails to prevent falls. Start stair climbing one step at a time and move on to normal stair climbing once your operated leg feels stable. You might need a walking aid such as a cane or walker in the first few weeks, especially if you have a bilateral (both knees replaced during the same operation) knee replacement.

Knee motion

Your knee range of motion will improve in time. The most important gains in knee motion are in the first 3 weeks, however your motion will improve up to one year while the soft tissues adapt to your new knee. It is essential that you perform your prescribed exercises, even when you have slight pain in the early weeks after surgery. This is important, since it is difficult correct limited motion of the knee after six weeks. If your surgeon is not satisfied with your knee motion at 6 weeks, he might advise a procedure called “manipulation under anesthesia” in which your doctor overcomes the adhesions and restores your knee motion under general anesthesia. Although your knee can bend to almost normal, squatting is not advised after knee replacement, since this might cause undue stress on the implant and shorten its life.

You should not worry if you cannot actively lift your leg in the first few weeks after surgery, your muscle strength will recover gradually. Physiotherapy with electrical stimulation and assisted exercises will be helpful to regain your muscle strength and balance.

Showering and wound care

Your surgeon will not discharge you until your surgical wound is dry and there is no bleeding or discharge. Small spots of blood in the wound dressing  are normal in the first few days and usually no dressing changes are needed. Your surgeon might advise you to protect your dressing with a clingfilm during showering in the first few days. Usually,  you can remove the dressing after 3 days and leave the wound open. Showering without protection  is possible once the surgical wound is dry and clean. A slight redness and warmth  around your scar and front of the knee is expected in the first few weeks, this should fade when you lift your leg above heart level. Bruising in the back of your leg than extends down to the ankle is normal and will resolve in a few weeks.

Sports activities

Swimming is possible after the first 3 weeks. Cycling  and hiking are encouraged after total knee replacement once the knee has recovered in a few months. Running, impact sports such as soccer, volleyball, singles tennis and basketball may negatively impact the lifetime of your knee by increasing wear and are not advised. You should consult with your surgeon if you want to ski  and play doubles tennis, this might be possible under certain conditions.

Contact your surgeon  as soon as possible if..

There are several situations when you should contact your surgeon  as soon as possible  before your scheduled appointment:

1. If you have a fever over 37.5 degrees Celsius (100 degrees Fahrenheit)
2. If you have drainage of blood or pus from your wound
3. If you have continuous pain even when taking full dose pain medication
4. If you have shortness of breath and abnormal heart rhythm
5. If you have blood in your urine or stool
6. If you have severe swelling in your whole leg that does not resolve with elevating the leg.

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Vertebral Body Tethering is a new, revolutionary treatment method for scoliosis. By using this method, we can avoid the traditional fusion surgery, which is stopping the remaining growth of patient, so that the entire motion capacity of the spine is lost and a motionless, length-fixed spine is created. As a result of vertebral body tethering however, the spinal column continues to grow, and this growth potential combined with the implants is yielding a gradual, very successful correction of the scoliosis. This is why vertebral body tethering is classified as a growth modulating treatment option.

a:Pre-op, b:Post-op 1st Year c:Post-op 3rd year

In addition to growth preservation, this method also preserves the motion of the entire spinal column, including the instrumented segments. Therefore, patients can move freely after surgery, which is impossible if traditional fusion surgery is undertaken. This method is also applied to professional athletes and dancers, because this is the only method which preserves growth and motion of the spinal column.

a:Pre-op, b:Post-op 1st Year c:Post-op 3rd year

Professional dancers and athletes are able to return to the same activity-performance level as before the surgery without any restrictions. Vertebral body tethering is the future of the scoliosis surgery and we are able to perform this revolutionary technique with great success on patients with scoliosis.

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Partial (unicondylar) knee replacement is a surgical treatment for patients who have end stage cartilage damage confined to a single compartment of the knee. Your surgeon resurfaces only the damaged parts of the knee joint while preserving your ligaments, cartilage and menisci in the uninvolved part.

Is partial knee replacement suitable for me ?

This surgery is for patients over 50 years of age, when other joint preservation techniques such as osteotomies and cartilage regeneration are not feasible. Mostly performed for osteoarthritis (cartilage wear), partial knee replacements are also an excellent choice for osteonecrosis of the knee (bone infarct and collapse of a part of knee). (Figure 1) Your surgeon evaluates your X-rays and MRI’s to see if this surgery is suitable for you. If you elect to undergo robotic surgery, computed tomography (CT) scan of the whole limb is also necessary for the planning of surgery.

Figure 1 : Osteonecrosis on the inner part of the knee, arrows depict collapse of the bone. Treatment with partial knee replacement.

How is partial knee replacement performed ?

The operation takes about 1.5 hours, general or epidural/spinal anesthesia is used. Your surgeon replaces the worn out parts of the knee with small implants, through a 7-10 cm incision, taking care to preserve your soft tissue balance (Figure 2). The implants can be fixed with bone cement (a special putty that fixes the implant to bone) or cementless implants can be used in younger patients. You can get out of bed and walk on the operated leg the afternoon of surgery. Immediate knee exercises are started. A drain is not usually necessary.

Figure 2: Length of the incision in partial knee replacement

What is the role of robotic surgery in partial knee replacement ?

Robotic surgery is more accurate and precise than classical surgery. Robotic surgery can achieve an accuracy of 1 mm within the pre surgical plan. This results in better alignment and soft tissue balance of your knee, resulting in more normal feeling knees. However, no difference in survivorship has been proven compared to classical methods. Robotic surgery is more expensive than classical surgery and takes longer to perform.

What happens during my stay in the hospital after partial knee replacement ?

Physiotherapy can be started immediately and you are encouraged to perform exercises. Pain is controlled with medications and you can move around with a walker. You can be discharged from the hospital when you have active control of your muscles with good knee motion and pain manageable by tablets. This occurs usually during the 2. Day after surgery.

What should I expect from a partial knee replacement ?

Pain after surgery is mostly gone after 4 weeks and you can walk independently. Some stiffness in the knee and numbness around your scar is expected for a few months. You should  be able walk and climb stairs without difficulty in a few months after surgery. Your knee range of motion will be the same or slightly improved after surgery. Swimming and cycling are possible, impact sports such as soccer and volleyball are not allowed.

Can partial knee replacements fail ?

Like all implants placed in the body, partial knee replacements wear and loosen after a certain time and need to be replaced. This is called a revision surgery. The expected lifetime of partial knees are 11-15 years but may last longer.  Revision surgery is needed if the implants wear out or loosen, or there is disease progression in the uninvolved parts of the knee that become painful.  Revision surgery for unicondylar replacement is conversion to a total knee replacement.

What is the difference between a total and partial knee replacement ?

In total knee replacement, all compartments of the knee are resurfaced, taking out your menisci and cruciate ligaments (Figure 3). This is an extremely successful operation for advanced cartilage destruction in your knee. However, comparative studies have shown that, partial knee replacements have better pain relief, better knee motion, easier rehabilitation and more “normal like feeling” knees compared to total knee replacements. Complications such as infection are less frequent after partial knee replacements. However, the survivorship of total knees is longer, with an expected lifetime of 20-25 years.

Figure 3 : The difference between a partial and total knee replacement. In partial knee replacement, the uninvolved parts of the knee are preserved.

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