Postoperative period
After the knee prosthesis is applied, the post-operative period consists of several obligatory stages, which are used for a speedy recovery and for the resumption of normal daily activities.
Below, the classic recovery path will be described, after the implantation of a total prosthesis. However, it should not be forgotten that partial prosthesis requires shorter healing times and that each patient is a case in itself.
Factors that influence recovery times
- Age of the patient
- General state of health of the patient
- Type of prosthesis used
- Previous knee operations
THE FIRST DAYS
In the past, the solution considered best for the newly operated patient was lodging, 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 the movement (even on the day of the operation), to be carried out, obviously, with the help of crutches or a 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.
RECOVERY TIMES
The patient must use crutches or a walker for a period of about 3-6 weeks. This is the time it takes for the wound and the ligament-ligament apparatus to heal and return to normal.
As long as walking is reduced, anticoagulant injections are given (for example heparin ), to prevent thrombus formation in the legs.
If the patient diligently follows the rehabilitation program and does not hurry, the normal activities take place normally after 3 months. Among the normal activities, the sport practice (maximum caution) is also included, 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 the muscles to harden properly.
In the following table, the average times for the return to some common daily activities are summarized.
| Activities | How long can you resume? | Short description |
| To drive | 4-6 weeks after the operation | It is good to refrain from driving if you are still unable to bend your knee freely. Considerable attention must be paid to how you get in the car: better to sit and turn on the seat with the legs parallel. |
| Work | 6-12 weeks after the operation | The times depend on the type of work. If sedentary, recovery obviously requires less time. |
| Housework | 6-12 weeks after the operation | For the first 2-3 months, heavier housework should be avoided, where more stress is placed on the joint. 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 best to wait for the doctor's consultation. |
PAIN AND TIRES
Post-operative pain is a disorder that patients fear most. However, it is a necessary step during the healing process, and it is normal to feel it. If you follow the advice of your doctor and physiotherapist with care, the painful sensation is normally exhausted in a short time.
A very similar speech also applies to the continuing feeling of fatigue . It too must not worry, as it is the natural consequence of surgery, such as knee prosthesis. Fatigue will begin to fade as the wound and muscle-ligament tissues heal.
PERIODICAL CHECKS
The patient is called to the first post-intervention check-up, to his own doctor, after about 6-12 weeks. If healing is progressing smoothly, the second check is set at exactly one year from the first.
If, then, even the second check gives a positive result, all subsequent checks will be set at 5 years apart. On these occasions, in addition to assessing joint mobility, an X-ray examination will also be performed to establish the state of wear of the prosthesis.
MOVEMENTS TO AVOID
The post-operative period is delicate and every movement must be treated in the smallest details, if you want to recover at its best. 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 advice.
What are the movements to avoid?
- Avoid rotating the knee
- Don't cross your legs
- Avoid compressing the wound
- Do not put a pillow under the knee when sleeping. There is a risk of permanent knee flexion
- Do not kneel (it is the doctor who will tell you when it is possible)
- Do not sit on too low chairs
Some advices
- With crutches, go up the stairs advancing the healthy limb first
- With the crutches, go down the stairs advancing the operated limb first
- Get off the bed from the side of the operated limb and at the same time
- Get in and out of the car on foot
REHABILITATION
Rehabilitation plays a fundamental role in recovering good joint mobility at the appropriate times.
The rehabilitation program, which begins 24-48 hours after the operation, consists of a program of exercises to be performed in the gym. Here, to take care of the patient, is a physiotherapist, who shows what exercises to perform, correcting any errors in execution.
After discharge, it is suggested to combine the gym with exercises to be practiced at home (also illustrated by the physiotherapist). The benefits, which can be drawn from it, are considerable.
Rehabilitation is an important moment, not only for physical recovery, but also for psychological recovery. The feeling of pain, suffered at the beginning of the recovery path, can discourage the patient, but the support offered by the people around him can help him overcome these difficulties.
The benefits and risks of the intervention
Most knee implants are successfully implanted and the benefits that follow are obvious. It is a fairly common and routine procedure: think that, between England and Wales, the number of knee prostheses, applied every year, is around 70, 000.
However, like any surgical operation, this can also present complications; these are rare episodes that affect a patient operated on 20.
THE COMPLICATIONS
Possible complications are:
- Infections .
Characteristics: they occur due to the proliferation of bacteria where the incision was made. If left untreated, a replacement of the newly implanted prosthesis may be required.
Solutions: antibiotics.
- Sudden blood loss inside the joint .
- Damage to ligaments, blood vessels or nerves of the joint .
- Deep vein thrombosis .
Characteristics: due to immobility, to which the patient is forced in the first post-operative period, blood clots (thrombi) may form inside the veins. These clots hinder normal blood flow, with deleterious effects (pulmonary edema).
Solutions: make movement 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 can 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: correction surgery.
- Sense of numbness in the operated area .
- Allergic reactions to one of the materials used (metal or cement).
Of this list, the most dangerous situations for the patient's life are infections and, above all, venous thromboses.
HOW TO RECOGNIZE A THROMBOSIS?
The formation of a thrombus is characterized by the appearance of heat, redness, joint stiffness or pain in one of the two legs (not necessarily the one operated on).
If you feel, on the other hand, lung pain and respiratory distress, it means that the thrombosis is taking on the characteristics of a pulmonary edema .
In both cases, contact your doctor immediately.
THE RISKS OF A SECOND PROSTHESIS INTERVENTION
A second knee prosthesis 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 already mentioned several times, knee prosthesis is one of the possible remedies for joint damage.
Other solutions consist of the following operations:
- Knee joint washing
- Osteotomy
- Autologous chondrocyte transplantation
- mosaicplasty
Future developments
Medical technology is trying to further refine knee implants.
The search is based on:
- Improvement of materials: stronger, more resistant, non-toxic and able to guarantee maximum joint mobility.
- More precise scanners, to study the anatomy of the knee. This would allow surgeons to create even more effective custom-made prostheses.
- Improvement of computerized surgery, to apply the knee prosthesis with extreme precision.
