Knee Replacement Surgery and Recovery

Knee replacement (total knee arthroplasty) removes a thin layer of worn joint surfaces and replaces it with metal and specialised plastic (polyethylene) components. Despite the name, the entire joint is not removed; only damaged surfaces are resurfaced while preserving ligaments and muscles where possible.

The aim is not to provide a new knee, but to control pain and make everyday movement possible again. After surgery, walking distance is expected to increase and activities such as using stairs or the toilet to become easier. Outcomes vary between patients; muscle strength, weight, coexisting conditions and adherence to rehabilitation directly affect the result.

Replacement is not decided from one image. Broadly, surgery is discussed when advanced knee osteoarthritis (gonarthrosis) or rheumatic joint damage causes persistent pain despite non-surgical treatment and substantially limits daily life.

• Pain that interrupts sleep at night and does not improve with rest
• A marked reduction in walking distance and an increased need for a walking stick
• Insufficient relief from exercise, weight management, medicines and injections
• Advanced joint-space narrowing and bone-on-bone contact on X-rays
• Restricted knee extension or flexion, or increasing leg angulation

The knee has three compartments: inner, outer and kneecap. Implant type depends on the extent of wear.

• Total knee replacement: used when wear affects the whole knee; the most common type.
• Partial (unicompartmental) knee replacement: may be suitable when only one compartment is worn and ligaments are intact; it is a smaller operation but is not suitable for everyone.
• Patellofemoral replacement: considered in selected patients when disease is confined to the kneecap compartment.
• Revision replacement: a more extensive operation for loosening, wear or infection of an existing implant.

Preoperative planning uses standing knee X-rays, full-length leg alignment films and additional imaging when necessary; implant size and bone cuts are planned from these measurements. Blood tests, heart and lung assessment and anaesthetic review are completed. Your doctor will explain which blood thinners, diabetes medicines and rheumatology medicines need to be stopped; do not stop medicines on your own.

Dental, urinary tract and skin infections should be treated before surgery because an infection elsewhere in the body can spread to the implant. Stopping smoking helps wound healing. Quadriceps strengthening started before surgery ("prehabilitation") makes mobilisation afterwards easier. Bed height, toilet seats, grab rails and trip hazards such as rugs and cables should be addressed at home before surgery.

Surgery is usually performed under spinal or general anaesthesia, selected by the anaesthetist. The joint is accessed through an incision at the front of the knee, worn surfaces are prepared in thin layers, trial components are used to check movement and balance, and the definitive components are then fitted. Ligament balance and leg alignment are among the most important stages.

Surgery on one knee generally takes one–two hours, although this varies with the patient and technique; preparation, anaesthesia and recovery-room time make the total time longer. Nerve blocks and a combination of medicines may be used for pain control during and after surgery; anticoagulants and early movement are planned to reduce clot risk.

The current aim is early mobilisation. Most patients stand on the day of surgery or the next day, supported by a walker or crutches and accompanied by a physiotherapist and nurse. Hospital stay is usually a few days and varies with the patient's general condition. Discharge criteria include pain controlled with oral medication, safe walking with aids and the ability to use the toilet.

During the first weeks, priorities are wound care, swelling control (ice and leg elevation), exercises to achieve full knee extension, and gradually increasing flexion. Stitches are removed within the first two weeks. Progression from assisted to unassisted walking varies between individuals but usually occurs within a few weeks. Your doctor must clear you for driving, returning to work and travel.

Full recovery takes months: substantial relief is expected in the first three months, followed by slower gains. Warmth, mild swelling and sensitivity to weather changes may persist for a long time and do not alone indicate a problem. Regular adherence to the exercise programme is one of the most important factors affecting the outcome.

Knee replacement is a commonly performed and generally well-tolerated operation, but, like every surgical procedure, it carries risks. These include infection, clots in the leg veins (deep vein thrombosis), wound-healing problems, joint stiffness, fractures around the implant and loosening over time. Preoperative preparation, appropriate antibiotics and clot-prevention treatment, early mobilisation and regular follow-up aim to reduce these risks.

Fever, wound discharge, increasing redness or warmth around the knee, one-sided calf swelling or pain, or sudden breathlessness after surgery require immediate assessment. The practice is not a 7/24 emergency department; call 112 or attend the nearest hospital emergency department if these occur.

Low-impact activities such as walking, swimming, cycling, light fitness and golf are generally recommended after knee replacement. Running, jumping and contact sports are discouraged because they can accelerate wear of the implant surfaces. Prolonged squatting, sitting cross-legged and kneeling are difficult for many patients; home and work arrangements should be adapted accordingly.

Implant components can wear over time. Most patients use their joint replacement without problems for many years; no exact lifespan can be given because weight, activity level, bone quality and alignment affect longevity. Annual review and X-rays when necessary help identify problems such as loosening early. Tell your doctor about your joint replacement before dental extractions or major surgery; additional precautions may be needed to reduce infection risk.

Follow-up appointments for patients from Ordu and nearby are arranged around travel plans; obtain your review dates in writing on discharge.