Total Knee Replacement (TKR) is an orthopedic surgical procedure where the articular surface of the knee, the femoral condyles, and the tibial plateau are replaced. In 50% of cases, the patella is also replaced. The goal of patellar reconstruction is to restore the extensor mechanism. It depends on the level of bone loss, what type of patella prosthesis is placed. The main clinical reason for the operation is osteoarthritis with the goal of reducing an individual’s pain and increasing function. Another reason may be trauma or other rare destructive diseases of the joint. Regardless of the cause of the damage to the joint, the resulting increasing pain and stiffness and decreased daily function lead the patient to consider total knee replacement. The decision about whether or when to have knee replacement surgery is usually not an easy one for the patient.
The implants are made of metal alloys, ceramic material, or strong plastic parts that can replace up to three bone surfaces in a total knee replacement.
 The lower end of the femur.
 The upper surface of the tibia.
 The surface of the patella.
Current implant designs recognize the complexity of the joint and more closely mimic normal knee motion. Some implant designs preserve the patient’s own ligaments while others replace them. Several manufacturers make knee implants and there are currently more than 150 designs on the market.
One of the main reasons for postponing knee replacement can be summed up in the word “fear.” Fear of the unknown. fear of bread Fear of recovery. Fear of being vulnerable. For some, this fear can be paralyzing, causing additional stress and anxiety in the months, weeks, and days leading up to the procedure. What joint replacement candidates often don’t realize is that this rampant fear or anxiety can negatively affect the outcome of the surgery. Studies have shown that patients who go to surgery.
We have to make the patient believe that they will outgrow their joint replacement and live a richer life because of it. Training the mind to stay in the moment and not wander into anxiety and fear-driven thoughts will keep anxiety and stress at bay. Practicing mindfulness has the ability to improve the way one interprets and overcomes negative experiences.
Quacks in the field of medical lines are very common. Therefore, one must be aware of physical therapists who are only diploma holders or some technicians. They do not know ethics, principles and do not have the proper knowledge.
And in case of TKR they make the case worse. Inadequate exercises, delay in treatment, late mobilization, all these activities put the patient in trouble.
Therefore, a qualified physical therapist should always be consulted before and after the operation for the best results after surgery.
Myth: One should wait as long as possible to have knee replacement surgery.
Fact: It is wrong. It is not necessary to wait for surgery until the pain becomes intolerable. However, the longer life of joint replacement allows people to consider surgery even at a younger age. Unnecessarily waiting and delaying surgery is more technically challenging for the surgeon and causes the patient’s health to deteriorate over time and increases complications.
Myth: Alternative therapies such as acupressure, ozone treatment, massage beds, oils, laser therapy, and braces will cure advanced arthritis and knee pain.
Fact: To date, there is no scientifically proven permanent non-surgical cure for advanced knee arthritis. These provide temporary relief in easy to moderate arthritis for some time and are not curative modalities.
Myth: Knee replacement is a very painful surgery. There is a lot of pain in the postoperative period.
Reality: Modern pain management, as in the multimodal approach, ensures that the patient does not feel any pain during surgery or postoperatively.
Myth: After knee replacement, one has to stop some activities and sports.
Fact: The patient has a high chance of returning to activities such as brisk walking or bicycling in 6 to 12 weeks; however, contact games are best avoided. Squatting and sitting cross-legged are possible, but should be kept to a minimum to prolong the life of the implant.
Myth: After a knee replacement, it takes months to recover.
Fact: 24 to 48 hours after surgery, the patient becomes independent for toileting activities, weight bearing is tolerated, and bending at the knees is allowed. At around 3 weeks, the patient can participate in social activities outdoors. Most patients can return to work within 6 weeks.
Myth: A new knee only lasts 15 to 20 years.
Fact: With today’s precision, including computer-assisted knee replacement and advancement in biomaterials, it lasts 20-25 years or more 8 in many people for life.
Myth: Diabetics, hypertensive or heart disease patients cannot undergo TKR.
Fact: To access a patient’s cardiac function, several tests are performed prior to surgery. These diseases do not affect the outcome of surgery although caution is required. In fact, one can get better health and better control of diabetes, hypertension or heart disease after knee replacement as one can walk without pain, can take long walks if needed.
Myth: Expensive implants are always better and the patient can get good results if an expensive knee implant is implanted.
Fact: Not always true. The result of the surgery depends on the implant, not on the cost and its technique. The other important role of the physiotherapist, who keeps the patient moving.
When rehabbing from a total knee replacement, a physical therapist will be your ‘best friend’. He or she will play the role of personal trainer, cheerleader, counselor, offering you tough love along the way. They know when to push it, when to relax and when it’s time for you to ‘fly the nest’ and stop physical therapy. They have a role both preoperatively and in the past.
Pre-Operation – The physical therapist chooses to teach the patient the exercises prior to surgery so that the patient can understand the procedure and after surgery is ready to practice a correct version of the appropriate exercises so recovery begins quickly. The physical therapist trains the patient in postural control, the need to walk to perform functional exercises and develop lower extremity strength, as well as bowel and bladder control.
Postoperative: Studies have shown the importance of physical therapy in the postoperative period, as it keeps patients moving. Physiotherapist as it keeps the patient moving. The goal of the physical therapist is to strengthen the quads and hamstrings to improve the results of TKR. The physical therapist’s protocol includes intensive functional and strengthening exercises administered on land based aquatic programs that progress as the patient reaches clinical and strength milestones. Due to the highly individualized characteristics of these exercises, therapy should be performed under the supervision of a trained physical therapist. Usually the steps followed are mobilization, then static strength followed by dynamic strength and stabilization. The important role of physiotherapy in the management of the TKR patient is to facilitate mobilization within 48 hours after surgery, as part of an accelerated pathway. Hospital physical therapy in the rehabilitation setting for patients after TKR should focus on activity-based interventions.