TKRs are appropriate for individuals suffering from more severe pain and stiffness, which limits their day to day activities and affects their wellbeing. In addition, X-rays or other forms of imaging should show that there is significant damage to the joint. A TKR should be considered when other conservative treatment modalities have not been so effective. A TKR consists of replacing the worn joint surface at the bottom of the femur (thigh bone) with metal surfaces and the tibial surface (top of the shin bone) with a plastic and metal surface. The patella (knee cap) can also be replaced. Cement, a type of very strong glue is normally used to bond the prosthesis (replacement), although cementless replacements can be used. With the latter there are holes or rough edges of the part inserted into the bone, encouraging bone growth to hold the prosthesis in place.
A lengthy, intensive period of rehabilitation is necessary post TKR to promote healing and maintain functional range of movement of the lower limb and prosthesis.
A unicompartmental knee replacement can be carried out to address degeneration affecting only the medial (inside part) side of the knee joint. This surgery normally allows for quicker healing and improved function. It is usually more appropriate for the younger patient as they will likely have stronger, more stable ligaments. A TKR or revision surgery may be required later on if degeneration occurs within the unoperated parts of the knee.
The rehabilitation period following both TKR and unicompartmental knee replacement surgery can vary from patient to patient and depends on a number of factors. These include pre and post-operative muscle function, bone healing, and the type of surgery itself. Without rehabilitation the outcome of the surgery has little success. This is because the proprioceptive activity around the joint is altered by surgery. Tissues & ligaments send information and feedback to the brain about the positioning and movement of the limb in space (proprioception), which is needed for a co-ordinated motor response to stabilise the joint. If these structures are altered, which they inevitably are when a patient undergoes surgery, the information that is sent to and processed by the nervous system becomes impaired. The result is impaired neuromuscular control and reduced joint stability.
How can AposTherapy® be used alongside surgery?
AposTherapy® is effective in relieving pain, increasing joint stability, proprioception and improving function both pre and post surgery. By adjusting the pertupods of the AposTherapy® device, the joints are supported in a more optimal biomechanical position, reducing the forces acting on the affected joint. Pertubation (the convexity of the pertupods) is used to improve muscular control and function, which reduces muscular over activity, in time improving neuromuscular control. This results in pain relief, due to increased joint stability and a greater ability to function.