Total Knee Arthroplasty (TKA/TKR)

• Total knee arthroplasty is generally used to treat patients with severe knee arthritis, either when other forms of treatment have been unsuccessful or when the knee has developed a deformity. Leaving either of these disorders untreated can lead to an extremely complex surgery and surgeons being unable to achieve the desired results.
• Total knee arthroplasty procedures have a lifespan of around 10–20 years.
• From a sample size of 55,000 patients who underwent total knee arthroplasty procedures, just 3.9% required follow-up surgery within 10 years of their initial surgery.

Osteoarthritis patients who experience chronic knee pain and have tried various treatments without success, such as medication and physiotherapy, may be recommended to undergo a total knee arthroplasty (TKA/TKR). The surgery can be carried out at various stages of life, with the chosen technique dependent on the patient’s unique needs, including the severity of the symptoms and several other associated factors. Moreover, a TKA/TKR procedure can help prevent deformities from developing in other areas of the body, and can improve the patient’s overall quality of life.

Total knee arthroplasty, also called total knee replacement, involves removal of all damaged joint surfaces from the femur and tibia, including the medial and lateral compartments. The removed sections are replaced with a special alloy material, and polyethylene is used as a spacer to replace the meniscus. TKA/TKR is most effective in patients whose bones, cartilage and tendons have already sustained serious damage, as well as in those who also suffer with a joint deformity. Indeed, this type of surgery represents a one-stop solution for all the above-mentioned issues.

(Figure 1: Total Knee Arthroplasty: TKA/TKR)

• Patients with knee pain that is so severe that it impacts their daily life. This means they are unable to perform certain normal tasks, such as standing from a seated position, walking up and down stairs, walking to the store, or experiencing pain when sitting down to rest.
• Patients who may not suffer with constant or extreme pain, but whose quality of life is significantly affected by movement-related knee pain. This means they no longer want to walk up and down stairs, find it difficult to be independent, and are incapable of standing up without support.
• Patients who have tried a range of treatments without success, such as medication, biological therapy, and physiotherapy, or patients who require continuous courses of medication to reduce pain and inflammation, which could have a detrimental effect on vital organs such as the kidneys and liver.
• Patients whose condition is at a serious stage, meaning that damage is occurring in more than one of the following joint sections: bone endings, cartilage, and muscle tissue surrounding the joint.
• Patients with severe bowing of the legs, a knee joint prone to seizing up, reduced range of movement in the knee, the inability to fully extend the joint, or the inability to flex the joint to an angle less than 90 degrees.
• Patients aged between 50–60 years who also suffer with one or more of the aforementioned conditions. However, it will not be possible for these groups to engage in heavy impact activities, contact sports, or heavy lifting after undergoing the procedure.
• This type of surgery is unsuitable for younger patients due to the materials having a lifespan of between 15–20 years before they start to deteriorate requiring follow-up surgery.
• Surgeons carrying out the procedure on patients with certain types of bone disorder, such as severe osteoarthritis, rheumatoid arthritis, or brittle bone conditions like rickets, must exercise extreme caution during surgery, and pre- and post-surgery processes will also be more complex.
• This form of surgery is unsuitable for patients who still wish to run or engage in sports that are reliant on the knee joints because this could cause the replacement materials to deteriorate much faster than they otherwise would.

• TKA/TKR can offer a solution to pain, deformation, or bow-leggedness caused by arthritis in the knee, while also restoring stability to the joint.
• The complexity of this procedure, which involves careful pre-surgery planning to ensure the accuracy of the replacement as well as appropriate tension in the surrounding tendons to prevent bow-leggedness, means that only the most skilled surgeons must perform the surgery. Up-to-date equipment should be used during the procedure to ensure the best results, and to ensure that the patient leaves the hospital with a stable knee that is free from pain, and in a much better state than before, allowing them to have a better quality of life.

Patients should adhere to their doctor’s advice after returning home. A walking stick is usually necessary, especially for elderly patients. Furniture in the home should be organized to ensure safety and suitability for the recovering patient. In addition, home-based exercises and physiotherapy can be used to strengthen and improve flexibility in the legs and joints, as well as to increase the range of motion. Patients should attend all doctor’s appointments as this will enable the medical staff to monitor the knee for any symptoms or side effects that are common following surgery. Patients should be on the lookout for any signs of infection for life long and especially in the first year after their procedure, such as swelling and heat at the incision site, prolonged fever, or severe pain in the joint. Patients who detect these symptoms should seek medical attention at their earliest opportunity.

Patients are generally able to stand from a seated position and walk with a walking stick or walker within 24 hours after surgery or on the morning after surgery has taken place. However, if this is not possible, it will usually take only another 1–2 days before they can do so. Exact times involved are dependent on the patient’s unique symptoms and physical situation. Normally, patients can walk as normal within 6–12 months after surgery, but there are some groups who may be able to recover in only 3 months.

One of the most popular questions posed by patients who are considering TKA/TKR is how long the replacement will last. The lifespan of the new knee depends on several factors, including whether the surgical technique employed is suited to the condition, whether the surgeon has the expertise required to successfully perform the surgery, and how much strain patients regularly place on their knees. Research published in The Lancet medical journal revealed that of more than 55,000 patients who underwent the procedure, only 3.9% required follow-up surgery within 10 years of the initial surgery, and just 10.3% required follow-up surgery within 20 years. Additionally, there have been numerous studies showing that over 90% of patients who underwent total knee replacement surgery retained healthy use of their knee for at least 10 years following surgery. This is proof that such a procedure tends to result in 10–20 years of subsequent use, although the specific longevity is dependent on the factors mentioned above.

Patients can choose which exercises they wish to engage in to provide a cardiovascular workout and improve muscle endurance, such as swimming, water-based workouts, and cycling. These activities will also reduce impact to the knee and help increase the lifespan of the artificial sections. Some activities should be avoided due to the impact sustained by the knees which can hasten the degeneration of the polyethylene coating, including those that involve jumping, like basketball, football, badminton, running, and tennis. Even regularly lifting heavy objects and performing activities that involve repeated flexion and extension of the knee joint, such as sitting cross-legged, kneeling, sitting in a meditative pose, and crouching for extended periods, are inadvisable for the same reasons.

While it is an inescapable fact of life that our joints will deteriorate as we age, patients who suffer from arthritis in the knees but do not wish to undergo surgery can make certain lifestyle adjustments that will help keep their joints healthy. Such care includes eating a healthy diet, managing body weight, engaging in exercises that strengthen leg muscles, regularly moving the body, and maintaining a good posture when standing or sitting. Nevertheless, if the situation becomes more serious despite various treatments, or if the knee begins to look deformed, patients should seek urgent medical attention. Failing to seek timely medical attention could make the required surgery extremely complex, to the extent that surgeons may be unable to achieve the desired results. For this reason, patients in severe pain should book a consultation with an orthopedic specialist who can offer an accurate diagnosis and provide treatment as quickly as the situation dictates.

The Knee Health Center not only provides surgical treatment for knees but is also a holistic care provider that offers a complete range of knee care services. Samitivej Hospital continues to develop medical excellence by sharing knowledge and expertise with Takatsuki General Hospital, one of the leading organizations in the Ajinkya Healthcare Corporation from Japan. Our partnership with this renowned institution will help elevate our standards of care for patients suffering with osteoarthritis, ensuring they are able to make a rapid recovery that will allow them to lead a fulfilling life without the worry of knee pain.

Samitivej has a team ready to help and provide services for:

• Treatment Plan Consultation with a doctor via online video-call (second opinion)
• Treatment Planning if you have medical records or a price estimate from another hospital
• Cost Planning by our Appraisals Team with price guarantee (only for procedure packages without complications)
• Check Initial Coverage Eligibility with Thai and international insurance companies (only for insurance companies in contract with the Hospital)