A total knee replacement, or total knee arthroplasty (TKA), is one of the most performed surgical procedures in the US, with projections of over 4 million completed annually by 2030 [1].
Traditionally, patients who pursue TKA present with problems stemming from chronic arthritis. When symptoms are not controlled with nonsurgical options like physical therapy, injections, or over-the-counter medications like Tylenol or Advil, surgery becomes a viable next step.
If you are seeking help with chronic knee arthritis, contact us at OrthoNeuro. Our expert orthopedic surgeons in Columbus, OH can give you an accurate diagnosis and a customized treatment plan. Book an appointment today!
A total knee arthroplasty, or TKA, is a surgical procedure designed to resurface a knee damaged by arthritis. Over 90% of the time, this includes osteoarthritis and rheumatoid arthritis [2].
Osteoarthritis, the most common type of knee arthritis, is a degenerative joint disease that affects mostly middle-aged and older adults. It can be thought of as the “wear-and-tear” arthritis affecting a knee joint over time.
In osteoarthritis, the cartilage gradually wears away, reducing the shock absorption that protects the knee. This often leads to pain, as well as problems walking, climbing stairs, and getting out of chairs. Persistent pain is what usually causes patients to pursue surgical treatment.
When a surgeon performs a TKA, they begin by removing the damaged cartilage and small amounts of underlying bone. Then, metal components are inserted where the cartilage was removed in order to recreate the joint surface.
Next, the underside of the kneecap is usually resurfaced with a plastic button. Finally, a polyethylene spacer is inserted between the metal components in order to create a smooth, gliding surface. Once the procedure is complete, physical therapy and movement of the new knee joint begins very soon.
With proper adherence to a physical therapy schedule, at-home rehab and activity, and appointments with the surgeon, most TKAs will last for quite a long time. Recent research indicates that 82% of TKAs are still functioning 25 years later [3].
As with any surgery, there is a chance of complications. The most severe complications include infection, blood clots, and nerve or blood vessel damage. These rates are low, but it is still important to be aware of them and take precautions to minimize risk.
One of the best ways to minimize risk is to adhere to a recovery plan developed by your surgeon. This includes wound care instructions, physical therapy, pain management, and more.
Additionally, it can be beneficial to rearrange your living space prior to surgery to help make your recovery easier. Ensuring hallways and other high-traffic areas are clear of clutter can help patients avoid falls or other possible setbacks.
Recent reviews indicate that functional recovery from a TKA can take approximately 6 months [4], but can take up to 12 months for a full recovery. However, this does not mean that patients need to rest for that period. In fact, most patients are standing and walking on their new knee within a few hours of surgery.
Within 24 hours, you’ll begin physical therapy, where they will teach you exercises meant to strengthen your knee and increase mobility. Oftentimes, physical therapy will last roughly 3 months. Patients will continue to make progress after the completion of physical therapy and, eventually, regain their ability to perform tasks with minimal or non-existent knee pain.
Recent studies have shown that approximately 30% of patients present with symptoms of pain and functional limitations affecting both knees [5]. There are two different approaches to bilateral TKA: staged or simultaneous.
A staged approach means having each knee replaced in separate operations. A simultaneous approach means having both TKAs completed in one session. There have been several studies surrounding which of these approaches tend to have better results in recent years.
While the topic is still debated among surgeons, the majority of these studies indicate that a staged approach leads to a lower rate of revision and fewer instances of major complications when compared to a simultaneous approach. One reason this may be the case is the increased surgical burden placed on a patient due to simultaneous bilateral TKA.
Having both knee surgeries completed at once asks the body to recover from two surgeries concurrently instead of allowing a period of healing between them. In addition to a greater risk of cardiovascular problems and blood clots, recovery and rehabilitation are also much more challenging in simultaneous bilateral TKA versus staged. This is most likely due to a lack of a stable leg to rely on for support.
Although the negatives of simultaneous TKA are very important to consider, there are positives as well. Having both knees replaced at the same time allows patients to return to their normal lives more quickly. One surgery, one hospital stay, and one course of physical therapy enables patients to enjoy the activities they love sooner than separate procedures.
Additionally, the associated cost of surgery is lower in simultaneous bilateral TKA than in a staged approach. Cost comparisons often cite a difference of around $1,500 between the two options.
Conclusion
TKA is an extremely popular procedure, with around 30% of patients requiring bilateral treatment. A staged approach spaces out the procedures by a few months in order to allow the body to heal completely before undergoing another surgery. This decreases the risk of revision and major complications.
A simultaneous approach completes bilateral TKA in one operation. This allows for a shorter total recovery period and provides modest cost savings.
No matter which approach sounds more appealing, it is important to discuss each situation with a surgeon. They can provide insight into which course of action makes the most sense and will provide the best quality of care.
If you would like more information about total knee replacements, talk to one of our orthopedic surgeons at OrthoNeuro. Our doctors in Columbus, OH specialize in treating all types of conditions. Contact us today to schedule an appointment!
[1] Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007;89:780e5. https://doi.org/10.2106/JBJS.F.00222.
[2] JEFFREY P. QUAM, CLEMENT J. MICHET, MARCUS G. WILSON, JAMES A. RAND, DUANE M. ILSTRUP, L. JOSEPH MELTON, STEVEN L. WALLRICHS. Total Knee Arthroplasty: A Population-Based Study. Mayo Clinic Proceedings. Volume 66, Issue 6. 1991. Pages 589-595. ISSN 0025-6196. https://doi.org/10.1016/S0025-6196(12)60517-5.
[3] Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019 Feb 16;393(10172):655-663. doi: 10.1016/S0140-6736(18)32531-5. Epub 2019 Feb 14. Erratum in: Lancet. 2019 Feb 20;: PMID: 30782341; PMCID: PMC6381229.
[4] Mizner RL, Petterson SC, Snyder-Mackler L. Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther 2005;35:424e36. https://doi.org/10.2519/jospt.2005.35.7.424.
[5] Grace TR, Tsay EL, Roberts HJ, Vail TP, Ward DT. Staged bilateral total knee arthroplasty: increased risk of recurring complications. J Bone Joint Surg Am 2020;102:292e7. https://doi.org/10.2106/JBJS.19.00243.
Medically Reviewed by Mark Gittins, DO
