Knee pain can be life-altering, making simple tasks like walking or climbing stairs ahuge challenge. For many, Total Knee Replacement (TKR) is a solution that restores mobility and reduces pain. But what exactly is TKR, and what does recovery look like? Let’s dive in.
What is TKR?
Total Knee Replacement (TKR), also known as Total Knee Arthroplasty (TKA), is a surgical procedure where the damaged knee joint is replaced with an artificial joint. It is commonly performed in people with severe arthritis or knee injuries who experience chronic pain and mobility issues.
Benefits of TKR
- Significant pain relief
- Improved mobility and quality of life
- Enhanced ability to perform daily activities
- Increased independence and participation in work or leisure activities
Recent Advances in TKR Surgery
- Minimally Invasive Techniques: Smaller incisions leading to faster recovery
- 3D-Printed Implants: Customized implants for a better fit
- Robotic-Assisted Surgery: Increased precision, reducing complications and improving long-term outcomes
Who Needs TKR?
TKR is recommended for those who have advanced degenerative changes in the knee joint and the cartilage.
Causes of Knee Damage
- Osteoarthritis (OA): A common condition where the knee joint wears down over time due to aging, high-impact sports, or prolonged strain
- Rheumatoid Arthritis (RA): An autoimmune disease that causes joint inflammation and damage
- Injury or Trauma: Accidents or repetitive stress on the knee leading to severe wear and tear
- Lifestyle Factors: Obesity and a sedentary lifestyle, which put extra stress on the knee
- Post-Traumatic Arthritis: Develops after a knee injury, such as a fracture or ligament damage, leading to long-term joint wear
- Genetic Factors: Some people may have a family history of joint problems, making them more prone to arthritis
- Infections: Joint infections (septic arthritis) can cause long-term damage, leading to the need for TKR
- Avascular Necrosis: A condition where bone tissue dies due to a lack of blood supply, leading to joint collapse
- Gout & Other Metabolic Disorders: Conditions like gout or hemochromatosis can cause joint degeneration over time.
In a nutshell, you will need a TKR if you:
- have severe knee pain due to a worn-out knee joint and cartilage, that makes your daily activities difficult.
- experience stiffness or swelling that does not improve with non-surgical treatments
- have knee deformities, such as bowing in or out
- have not found relief from medications, injections, or physical therapy
(Verra et al., 2016)
To have a TKR, your GP would assess you to see if your knee pain is having a big effect on your life and alternatives to a knee replacement have not worked.
Most people who have a knee replacement have pain and movement problems caused by osteoarthritis( www.nhs.uk).
Importance of Prehabilitation: A Key to Optimal Recovery
The Role of Prehabilitation (Prehab):
Prehabilitation, or pre-surgery physiotherapy, helps prepare your body for surgery and improves recovery outcomes. Since TKR is usually a planned procedure, you have time to prepare yourself.
At The Sherwood Clinic, we very much welcome people who are considering TKR or have a planned date for the operation. We prepare you effectively by maximizing the strength in your knee, by optimizing the flexibility of the muscles and soft tissues that support your knee and provide detailed clear understanding of what to expect following the procedure. At the same time, if you have had any associated muscle or joint issues which can impact your post operative recovery will also be addressed. We work with you to have a successful procedure and maximize your potential for overall recovery.
Pre Operative Physiotherapy Management will include:
- Strengthening exercises for the large muscles that support the knee and the entire lower limb
- Flexibility training for improved joint movement
- Pain management strategies like manual therapy and hydrotherapy
- Patient education on post-surgical expectations
Impact of Prehab on Recovery
Many case studies have shown that patients who undergo prehab recover faster and achieve better mobility compared to those who don’t (Adebero et al., 2024). It has also been noted that the pain rating is reduced post-operatively in patients who undergo prehab (Sutton et al., 2023).
Over the years, many case studies carried out by The Sherwood Clinic point to a significant improvement in outcome for those who have had physiotherapy prior to the surgery (prehab).
The TKR Procedure: What to Expect
- Surgery Duration: Approximately 1-2 hours
- Hospital Stay (IPD Time): 2-4 days
- Discharge Time: Once mobility with a walking aid is achieved
- Post-Surgery Care: Pain management, wound care, and physiotherapy sessions begin immediately
Post-Operative Management
Recovery from TKR can be divided into three phases:
Phase 1: Early Post-Operative (0-4 Weeks)
- Pain and swelling management (icing, elevation)
- Gentle knee movements for flexibility
- Learning to walk with assistive devices
- Soft tissue therapy to prevent stiffness
Phase 2: Intermediate Recovery (5-8 Weeks)
- Strength training for knee and hip muscles
- Walking practice to improve gait
- Addressing issues like stiffness and muscle weakness
Phase 3: Advanced Rehabilitation (8+ Weeks)
- Restoring full mobility and confidence
- Balance training and endurance exercises
- Returning to daily activities without assistive devices
Physiotherapy at The Sherwood Clinic
Physiotherapy plays a crucial role in recovery. At The Sherwood Clinic, we design personalized rehabilitation plans, this will include:
- Effective pain relief using soft tissue techniques, addressing your analgesia effectively to suit you.
- Manual Therapy: To reduce stiffness and improve movement
- Exercise Therapy: Strength and flexibility exercises tailored to each patient
- Gait Training: To improve walking patterns and prevent complications
- Support in Functional Activities: To provide you with guidance regarding activity modification at each phase and enabling you to regain more strength, flexibility to attain improved levels of physical activity and independence.
We have a physiotherapy clinic in Harrow.
Challenges in Rehabilitation & Solutions
- Weak Muscles: Strengthening exercises like leg lifts and resistance training
- Walking Difficulties: Gait retraining and balance exercises
- Night Pain & Stiffness: Soft tissue release, heat therapy, and stretching
Common Complications After TKR and Their Management
While TKR is highly successful, some patients may experience complications. Understanding these potential issues and their management strategies is crucial for optimal recovery.
Common Complications After TKR & Their Management (Healy et al, 2013)
- Blood Clots (DVT) – Prevented with early movement and leg exercises
- Infection – Managed with antibiotics and proper wound care
- Nerve Damage – Addressed with physiotherapy and medical assessments
- Stiffness – Improved with manual therapy and stretching
- Implant Loosening/Wear – Regular follow-ups and strengthening exercises
- Persistent Pain – Managed with medication, therapy, and psychological support
- Fixed Flexion Deformity (FFD) – Treated with stretching, strengthening, and splinting
- Extension Lag – Overcome with quadriceps strengthening and neuromuscular training
What to Expect at the End of Rehabilitation
With an early structured rehab and commitment, you can expect:
- Pain-free movement
- Improved knee strength and stability
- Independence in daily activities
- Return to an active lifestyle
Conclusion
TKR is a highly successful procedure aiming to enhance your quality of life, but successful recovery depends on structured and disciplined rehabilitation. at The Sherwood Clinic, we are committed to guide our patients through every step of their journey to mobility.
If you or your loved one are considering knee replacement, start prehab early and follow a structured rehab plan post-surgery. Your journey to pain-free movement begins today!
References
https://www.nhs.uk/conditions/knee-replacement/why-its-done/
Adebero, T., Omana, H., Somerville, L., Lanting, B., & Hunter, S. W. (2024). Effectiveness of prehabilitation on outcomes following total knee and hip arthroplasty for osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Disability and rehabilitation, 46(24), 5771–5790. https://doi.org/10.1080/09638288.2024.2313128
Healy, W. L., Della Valle, C. J., Iorio, R., Berend, K. R., Cushner, F. D., Dalury, D. F., & Lonner, J. H. (2013). Complications of total knee arthroplasty: standardized list and definitions of the Knee Society. Clinical orthopaedics and related research, 471(1), 215–220. https://doi.org/10.1007/s11999-012-2489-y
Sutton, E. L., Rahman, U., Karasouli, E., MacKinnon, H. J., Radhakrishnan, A., Renna, M. S., & Metcalfe, A. (2023). Do pre-operative therapeutic interventions affect outcome in people undergoing hip and knee joint replacement? A systematic analysis of systematic reviews. Physical Therapy Reviews, 28(3), 175–187. https://doi.org/10.1080/10833196.2023.2243581
Verra, W. C., Witteveen, K. Q., Maier, A. B., Gademan, M. G., van der Linden, H. M., & Nelissen, R. G. (2016). The reason why orthopaedic surgeons perform total knee replacement: results of a randomised study using case vignettes. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 24(8), 2697–2703. https://doi.org/10.1007/s00167-015-3961-5
