Complications
Of course, there are also conditions in which the use of a knee prosthesis does not appear to be appropriate. Just as there are many indications for the possible necessity of using an artificial joint, there are also many contraindications. Listed below are some important contraindications that may delay the use of a knee prosthesis In particular, the use of an artificial knee joint should not take place in such cases,
- If not all conservative treatment options have been exhausted.
- If the stretching device is defective.
- If there is a risk of prosthesis infection.
This is usually the case when physical infections still exist. Under certain circumstances, this may also include minor skin impurities such as hair root inflammation or pimples.
- When, as a result of a disease, such as diabetes mellitus, the arterial blood flow is disturbed.
- If paralysis occurs near the joints or
- Extensive soft tissue damage exists in the surgical area.
Pain can occur both before and after the operation of a knee prosthesis. Pain before the operation is typically an expression of the broken joint and the most common reason for an operation with installation of a knee prosthesis.
In most cases (about 90% depending on the study situation) the pain can be eliminated by surgery. Pain that occurs immediately after the operation is normal and is due to the operation itself. The pain should be improved by taking painkillers in the first days after the operation.
If the pain persists for a longer period of time after the wound has healed, this may be an expression of an infection of the operated joint. A loosened prosthesis can also cause pain in the knee. If the pain occurs very long (15-20 years) after the operation, it is possible that the lifetime of the prosthesis has been reached and another operation is necessary to replace the prosthesis.
Pain, which is only noticeable under certain loads, can always occur in everyday life with a knee prosthesis and is a sign of excessive stress on the artificial joint. They are therefore no cause for concern. Avoiding these load peaks can reduce the pain.
You can read more information on this topic here:
- Pain with a knee prosthesis
- Pain after knee surgery
In the meantime, patients are quickly mobilized again after a knee joint prosthesis. Thus, the post-operative treatment begins almost immediately after the operation (between the 1st and 3rd day).Usually you start by moving the knee joint with the help of a motorized splint. This bends and stretches the leg at different levels of difficulty.
These first movement exercises are followed by physiotherapeutic exercises. It is at least as important as the movement exercises described above that the patient learns to “stand on his own feet” again. During the first few days, the patient should only leave the bed with the help of the nursing staff.
With the help of a walking frame and/or learning how to use the crutches, the patient learns to become more independent. This walking must be learned. In addition to the movement exercises and thus the physiotherapeutic aftercare, the removal of the drains on the 3rd day after the operation is also important.
At the latest now the physiotherapy is intensified. The aim is to increase the mobility and functionality of the knee joint so that an improved preoperative condition is achieved. Mobilization in particular requires the patient to show an increased degree of strength, willpower and self-confidence: An improved preoperative condition after the operation is only possible with the patient’s cooperation.
From now on, physiotherapeutic post-operative treatment can be integrated in order to achieve the goal of regaining the often significantly restricted mobility and function of the operated knee joint. This requires some effort from both the patient and the therapist. In the further course of the operation, regular wound and laboratory checks are carried out in order to detect any disturbance of wound healing as early as possible and to be able to initiate appropriate measures.
As long as the mobilisation of the patient could not be fully restored and full weight bearing is therefore possible, thrombosis prophylaxis in the form of antithrombosis stockings and heparin injections is of great importance. Since a thrombosis can have far-reaching consequences, one should observe one’s own body closely. If (nevertheless) calf pain or foot or lower leg swelling occurs, a doctor should be informed immediately.
You should plan an in-patient stay of about two to three weeks after the operation, as well as rehabilitation of about another three weeks, which can either take place as an in-patient (in the form of a cure) or as an out-patient. Regardless of which measure you decide on: As soon as the rehabilitation measures have been completed, an x-ray checkup will take place. This X-ray control is usually carried out where the operation took place.
It is then decided whether the rehabilitation measures have achieved the desired success and whether the knee joint can now be bent beyond the right angle. In rare cases, in which sufficient mobility of the knee joint has not been achieved, a further operation can be performed, in which any adhesions can be loosened by moving the knee joint through. As a rule, full mobility is only achieved after a few months.
Only then will the swelling subside after the operation and the soft tissues heal to a large extent. Therefore, regular check-ups are very important for the further healing process and improvement of mobility. For this reason, patients with endoprosthetic operations receive a so-called endoprosthesis pass.
Here the “control data” of each examination are entered until the mobility has been restored satisfactorily. Life with an artificial knee joint: The goal to be achieved with a knee prosthesis is of course the pain-free movement of the knee joint. This freedom from pain should generally be achieved after the rehabilitation measures.
In order to achieve this, you will need your help, but also your patience. Not all movements can be carried out again quickly. Especially climbing stairs is quite difficult in the first phase after the operation of the knee prosthesis.
Since climbing stairs in particular cannot be avoided in everyday life, you will get to know different possibilities during the rehabilitation. Walking with walking aids is also not easy for every patient: This is where the so-called “walking school” comes in, which is designed to prepare you for everyday life. Avoid falls if possible!
The artificial knee joint is built into your bone and a fall can cause bone fractures, making further operations necessary. Never lift and carry more than 20% of your own body weight! Generally, various sports can be combined with a knee prosthesis.At this point, we will briefly discuss cycling, which is basically a cheap sport.
Cycling requires the ability to bend the knee at least 90°, but it should not be done in the first months after the operation. After a knee prosthesis has been inserted, many affected persons are faced with the question of whether, when and what kind of sports activity is suitable again. Early movement of the operated joint is essential for an optimal result after the operation.
The optimal range of motion and sequence can be achieved through special rehabilitation programs and physiotherapy. In general, the presence of a knee prosthesis is no reason to abstain from sports. It should be noted, however, that sports that put a lot of stress on the joint can wear out the artificial joint more quickly, making further surgery necessary.
Sports that involve blows and fast rotations in the joint should be avoided if possible in order to avoid the risk of the prosthesis loosening. Therefore, sports such as skiing, tennis or soccer are not recommended. The following list contains some recommendations for various sports, which have been ranked according to their degree of suitability for knee joint prosthesis wearers. Sports that can be considered suitable Sports that can be considered suitable to a limited extent: Sports that must be considered unsuitable after the installation of a knee joint prosthesis:
- Swimming, best suited: Crawl and backstroke swimming.
- Gymnastics, provided that no extreme movements of the operated joint take place.
- Rowing, however: Avoid too extreme knee flexion.
- Sailing
- Paddle
- Hiking
- Nordic Walking
- Cross-country skiing (diagonal technique, wide hiking skis are especially recommended)
- Endurance run (only with good running technique, soft ground and sprung running shoes)
- Golf (only with good technique and little torsion = turn)
- Sports, whose emphasis lies in the speed – endurance – range
- Martial arts
- Any jumping discipline
- Setback games (tennis, squash)
- Most ball games
- Alpine skiing
