Total Knee Replacement (TKR)

Total Knee Replacement (TKR) involves the resurfacing of the worn portions of the arthritic knee with specialised implants to help alleviate pain. Pain from arthritis, is due to the loss of protective cartilage on the surfaces of the bone in the joint. Dr Agolley is a knee surgeon on the Gold Coast who performs Total Knee Replacement using computer navigation, and the latest technology to customise each Total Knee Replacement with the utmost precision, for each individual patient.

Without a knee replacement, the knee becomes progressively more painful and can become quite deformed (bow legged or knock knee). The benefit of a TKR, is to decrease pain and to improve the ability to be active and enjoy a good quality lifestyle.

What are the symptoms?

Depending on the area of the knee joint that is worn and the reason for the arthritis, the pain experienced may be localised to the front of the knee, behind the knee cap, the inside, outside, behind, or all over the knee. The knee may be stiff, grind and swell daily. More advanced cases of knee arthritis may cause pain in the night that stops you from sleeping and impedes your ability to walk, work and take part in enjoyable activities in life.

Dr Agolley will take a thorough history and examination to help with the diagnosis.

What investigations will be required?

Plain x-rays of the knee are essential, taken while your are weight bearing. Dr Agolley will request any further investigations as necessary.

When Should I have Surgery?

Dr Agolley will discuss and guide you through non-surgical treatments of knee arthritis prior to recommending surgery. Low impact activity, keeping weight down, changing activity or occupation, bracing or a walking stick, physiotherapy and taking regular pain medication may all be helpful non-surgical options.

After a thorough history and examination, Dr Agolley will guide you through the decision making process if total knee replacement is an appropriate option. Surgery is usually recommended when the knee is:

Painful most of the day
Keeps you awake at night
Stops you from walking for pleasure
Stops you from working comfortably
Stops you from part taking in activities that you would otherwise enjoy

Post-operative recovery and specific precautions

The specific type of knee replacement required will be discussed with you prior to surgery, as there are many factors for consideration and Dr Agolley will customise the procedure to your requirements. In general for most patients:

Your anaesthetist will perform general anaesthetic and/or regional (spinal) anaesthetic as discussed with you prior
An incision is made over your knee to avoid important blood vessels and nerves in the area
The knee joint is exposed and the worn portions are resurfaced using precision measuring instruments including computer navigation
Dr Agolley precisely measures knee replacement implants that will be specifically size matched to your anatomy
A trial of the implants is performed to ensure stable functional range of motion, and that your anatomy has been correctly restored.
The definitive implants are seated and re-trialled
The wound is thoroughly cleaned and closed

The post-operative recovery consists of:

An in patient hospital stay for approximately 3-5 days
Weight bearing through your operated knee immediately with the support of a mobility aid for 4-6 weeks
To prevent deep vein thrombosis, you will have a combination of treatments including medication in either an injected or a tablet form.
Walk without mobility aid at 4-6 weeks
Back to sedentary work 4 weeks
Back to driving 4-6 weeks
Back to running sports hen you achieve good knee control at 4-6 month

Specific precautions

There may be numbness on outside of the knee scar. This usually resolves quickly, but may persist for a few weeks and there may be a permanent small patch of numb skin. Major nerve or blood vessel injury in uncommon. Blood clots in the legs and lungs are also very uncommon with blood thinning treatment. Infection is uncommon as several steps are taken to minimise risk. The Australian Joint Registry reports that 90-95% of knee replacements have not required revision by 10 years, and independent data reports high survivorship rates up to 20 years.