Knee prosthesis - Recovery after surgery, Risks and Benefits

Knee prosthesis - Recovery after surgery, Risks and Benefits

Post-operative period

After the knee replacement surgery, the post-operative period is made up of several obligatory stages, which serve for a speedy recovery and the resumption of normal daily activities.
In the following, the classic recovery path will be described, after the implantation of a total prosthesis. However, it should not be forgotten that partial dentures require shorter healing times and that each patient is a case in itself.




THE FIRST DAYS

In the past, the solution considered best for the newly operated patient was bed rest, despite the risk of thrombosis.

Today, however, thanks to modern prostheses and advanced surgical technology, the situation has completely changed. In fact, the medical staff advocates the immediate resumption of movement (even on the day of the operation), to be carried out, obviously, with the help of crutches or the walker.
The hospitalization is, therefore, short (about a week) and serves as a precautionary measure. The greatest attention is paid to the sutured wound, to avoid infection.



THE RECOVERY TIMES

The patient must use crutches, or the walker, for a long period of about 3-6 weeks. This is the time it takes for the wound and the musculo-ligament system to heal and return to normal.
As long as walking is reduced, injections of anticoagulant (for example theheparin), to prevent blood clots from forming in the legs.
If the patient diligently follows the rehabilitation program and does not rush the times, the resumption of normal activities normally takes place after 3 months. Among the normal activities, sports practice is also included (maximum caution), with the exception of all those sports in which there is the danger of performing extreme movements or suffering falls. Therefore, it is not recommended, especially for younger patients, to practice football, skiing, horse riding, rugby, etc.
Full recovery takes one to two years: this is the time it takes for the scar and muscles to heal properly.
The following table summarizes the average times for returning to some of the most common daily activities.


Activities How soon can you resume? Short description
To drive 4-6 weeks after the operation It is good to refrain from driving if you are not yet able to bend the knee freely. Considerable attention must also be paid to how to get into the car: it is better to sit down and turn around on the seat with your legs parallel.
Work 6-12 weeks after the operation Times depend on the type of work. If sedentary, recovery obviously takes less time.
Housework 6-12 weeks after the operation For the first 2-3 months, it is good to avoid heavier housework, in which the joint is stressed the most. Lighter jobs, such as dusting or washing dishes, can take place after a short time.
Sex life 6-8 weeks after the operation It is better to wait for the consultation of the attending physician.

PAIN AND TIREDNESS

Il pain Post-operative is one ailment that patients fear the most, but it is an obligatory step during the recovery process, and it is normal to feel it. If you strictly adhere to the advice of your doctor and physiotherapists, the painful sensation usually disappears in a short time.
A very similar argument also applies to the continuous sensation of fatigue. It too should not worry, as it is the natural consequence of a surgery, such as that of knee replacement. The fatigue will begin to fade as the wound and ligament tissue heal.



PERIODIC CHECKS

The patient is called for the first post-surgery check-up, at the doctor's, after about 6-12 weeks. If healing is progressing smoothly, the second checkup is set exactly one year after the first.
If, then, the second check also gives a positive result, all subsequent checks will be set at a distance of 5 years from each other. On these occasions, in addition to evaluating joint mobility, an X-ray examination will also be performed to establish the state of wear of the prosthesis.

THE MOVEMENTS TO AVOID

The post-operative period is delicate and every movement performed must be taken care of in the smallest details, if you want to recover in the best possible way. A wrong gesture, in fact, can have deleterious effects on the newly implanted prosthesis. Here are the most dangerous movements, which should be avoided, and some tips.


THE REHABILITATION

La rehabilitation it plays a fundamental role in recovering good joint mobility at the right time.
The rehabilitation process, which begins 24-48 hours after the operation, consists of an exercise program to be performed in the gym. Here, a physiotherapist takes care of the patient, showing which exercises to perform, correcting any errors in their execution.
After discharge, it is suggested to combine the gym with exercises to be practiced at home (also illustrated by the physiotherapist). The benefits that can be drawn are considerable.
Rehabilitation is an important moment, not only for physical recovery, but also for psychological one. The sensation of pain, suffered at the beginning of the recovery process, can discourage the patient, but the support offered by the people around him can help him to overcome such difficulties.



The benefits and risks of the surgery

Most knee prostheses are successfully implanted and the resulting benefits are obvious. It is a fairly common and routine operation: just think that, between England and Wales, the number of knee prostheses applied every year is about 70.000.
However, like any surgical operation, this too can present complications; these are rare episodes, affecting one patient out of 20.

THE COMPLICATIONS

The possible complications are:

  • Infections.
    Characteristics: they occur due to the proliferation of bacteria in correspondence with where the incision was made. If left untreated, surgery to replace the newly implanted prosthesis may be required.
    Solutions: antibiotics.
  • Sudden blood loss within the joint.
  • Damage to the joint's ligaments, blood vessels, or nerves.
  • Deep vein thrombosis.
    Characteristics: due to the immobility, which the patient is forced to in the first post-operative period, blood clots (thrombi) can form inside the veins. These clots obstruct normal blood flow, with deleterious effects (pulmonary edema).
    Solutions: exercise from the first days, take anticoagulants and wear special elastic stockings.
  • Bone fractures.
    Characteristics: during some operations, it may happen that the bones on which the prosthesis is implanted are fractured.
  • Joint stiffness.
    Characteristics: it may be due to an abnormal bone regrowth around the prosthesis or to an excessive formation of scar tissue where the incision was made.
    Solutions: Surgical removal of bone or scar tissue restores joint mobility.
  • Dislocation of the patella.
    Solutions: corrective surgery.
  • Feeling of numbness in the operated area.
  • Allergic reactions to one of the materials used (metal or concrete).

Of this list, the most dangerous situations for the patient's life are infections and, above all, venous thrombosis.

HOW TO RECOGNIZE A THROMBOSIS?

The formation of a thrombus it is characterized by the appearance of heat, redness, joint stiffness or pain in one of the two legs (not necessarily the operated one).
If, on the other hand, lung pain and shortness of breath are felt, it means that the thrombosis is taking on the characteristics of a pulmonary edema.
In both cases, you should contact your doctor immediately.

THE RISKS OF A SECOND PROSTHESIS

A second knee replacement surgery, in addition to being difficult to perform for the reasons already mentioned, is also less effective. Therefore, in these situations, the risk / benefit ratio is in favor of the former.

The alternatives to the prosthesis

As has already been said several times, the knee prosthesis represents one of the possible remedies for joint damage.
Other solutions consist of the following operations:

  • Joint washing of the knee
  • Osteotomy
  • Transplant of autologous chondrocytes
  • Mosaic plastic

Future developments

Medical technology is looking to further refine knee replacements.
The research is based on:

  • Improvement of materials: stronger, more resistant, non-toxic and able to guarantee maximum joint mobility.
  • More accurate scanners, to study the anatomy of the knee. This would allow surgeons to create even more effective bespoke prostheses.
  • Improvement of computerized surgery, to apply the knee prosthesis with extreme precision.

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