Total Knee Arthroplasty (TKA) or Total Knee Replacement (TKR) is a common orthopedic surgery that replaces parts of injured or worn-out knee joints. The surgery can help ease pain and make the knee work better. During the surgery, damaged bone and cartilage are replaced with parts made of metal and plastic.

To decide whether a knee replacement is right for you, a surgeon checks your knee’s range of motion, stability, and strength. X-rays help show the extent of damage.

The right artificial joints and surgical techniques for you depend on your age, weight, activity level, knee size and shape, and overall health.

Clinically Relevant Anatomy

Why it’s done?

The most common reason for knee replacement surgery is to ease pain caused by arthritis. People who need knee replacement surgery usually have problems walking, climbing stairs and getting up out of chairs.

If only one part of the knee is damaged, surgeons often can replace just that part. If the entire joint needs to be replaced, the ends of the thighbone and shinbone are reshaped and the entire joint resurfaced. These bones are hard tubes that contain a soft center. The ends of the artificial parts are inserted into the softer central part of the bones.

Ligaments are bands of tissue that help hold joints together. If the knee’s ligaments aren’t strong enough to hold the joint together by themselves, the surgeon may choose implants that can be connected so they can’t come apart.

Total knee arthroplasty is more commonly performed on women and individuals of older ages. In Dramatic increases in TKA surgeries are projected to occur with an increasing rate of younger TKA recipients under the age of 60.

Diagnostic Procedures

Before a TKA surgery, a full medical evaluation is performed to determine risks and suitability. As part of this evaluation, imaging is used to assess the severity of joint degeneration and screen for other joint abnormalities. A knee radiograph is performed to check for prosthetic alignment before the closure of the surgical incision.

Pre-surgical Physiotherapy

Post-surgical rehabilitation exercises may be taught before surgery, so that patients may perform the appropriate exercises more effectively immediately after TKA surgery.  A pre-surgical training program may also be used to optimize the functional status of patients to improve post-surgical recovery. Pre-surgical training programs should focus on postural control, functional lower limb exercises and strengthening exercises for bilateral lower extremities

Evidence supporting the efficacy of pre-surgical physiotherapy on patient outcome scores, lower limb strength, pain, range of movement or hospital length of stay following total knee arthroplasty is lacking.

Post-TKA Surgery

A TKA surgery typically lasts 1 to 2 hours. The majority of individuals begin physiotherapy during their inpatient stay, within 24 hours of surgery. Range of motion and strengthening exercises, physiotherapy and gait training are typically initiated, and a home exercise program is prescribed before discharge from hospital. There is low-level evidence that accelerated physiotherapy regimens reduce the length of stay in an acute hospital.

Patients are usually discharged after a few days’ stay in hospital and receive follow-up physiotherapy, in the outpatient or home care setting, within 1 week of discharge.

Post-surgical Physiotherapy

Physiotherapy interventions are effective tools for improving patient’s physical function, range of motion and pain in a short-term follow-up following total knee replacement.