The Patient’s Role in Total Knee Replacement

The multiple objectives of Total Knee Replacement (TKR) include:

1. Relieving pain

2. Restoring correct gait

3. Re-establishing normal knee alignment

4. Improving range of motion (ROM).

The surgeon’s responsibility is to reconstruct the knee in order to alleviate pain and provide the opportunity for increased mobility. The patient’s responsibility is to manage the preparation and recovery processes in order to restore a correct gait and realize the potential benefits of the surgery.

Here is a visual summary of the TKR experience. The first frame shows the prosthetic knee, the second frame shows the wound after the prosthetic knee has been surgically implanted, the third shows an x-ray of the new knee, and the fourth shows the scar after about four months of healing.

Prosthetic knee model   Wound 2 weeks post-surgery

X-ray of implant post-surgery. Wound 3 months post-surgery

Pictures can be misleading. The sequence above may give the impression that all it takes to regain mobility is to get a new knee and let the wound heal–then you’ll be good to go. This is not the case. New knees are not plug-and-play. While the artificial joint is designed for durability and flexibility, the prosthetic by itself cannot create a full range of motion. Research has shown that a strong predictor of success after surgery is the condition of the leg before surgery.

The strength of the muscles responsible for knee function and restrictions in tissue movement due to prior adhesions will affect the length of the recovery period and the procedure’s ultimate success. Since the entire body moves while walking, weakness in any part of the body will affect subsequent gait patterns. Prehab or exercising before surgery will increase the strength and flexibility of the leg. In addition, physical therapy can reduce the number of adhesions in the leg muscle tissues and tendons. These adhesions limit movement before surgery and complicate healing after. This is why it is essential to invest in a prehab routine in order to facilitate your recovery.

It is important to remember that once the surgery is over, the damaged knee will no longer be limiting what you can do. Instead, you will be healing (a natural process involving the physical healing at the cellular level) and in recovery (the process of gaining control of the new knee).

The more prepared the body is before surgery, the easier it will be to heal affected tissue and restore proper functioning after surgery.