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Total knee Replacement

When should it be considered?

If you have deterioration in the knee and your pain is severe enough to restrict not only work and recreation but also the ordinary activities of daily living, you are probably a candidate for knee replacement surgery. In the past, knee replacement surgery was an option primarily for people over 60 years of age, because older people tend to be less active and put less strain on the artificial joint. In recent years, however, doctors have found that knee replacement surgery can be very successful in younger people as well.


How to prepare for surgery.

As you prepare for the surgery you should educate yourself about the procedure. Knowing what to expect can ease many fears and make recovery much smoother. If possible, find someone who has had the surgery to talk to.

If you are physically able, exercises to strengthen your upper body might be a good idea. Crutches will be used after the surgery and can be tough on weak arms.

Blood transfusions are often needed after TKR's. Ask if you are a candidate for autologous blood donation, this means storing your own blood for transfusion. It is generally suggested you store 1-2 units of blood.

Arrangements need to be made for your recovery. You will need assistance at home for several days to a couple of weeks after your discharge. If there is no one available to help you at home, a short stay in an extended care facility should be considered. You may want to install handrails around the toilet, bath areas and stairwells. Any scatter rugs should be removed and torn areas in carpet or tile tacked down to prevent falling.

What happens during the surgery?

You will be given a general or spinal anesthetic. The doctor will put a tourniquet above your knee and make a cut from above the kneecap to below it. He will then expose the knee joint, loosen the muscles connected to it, and turn the kneecap out of its place. The capsule is opened, exposing the inside of the joint. The ends of the thigh bone and the shin bone are removed using a saw. The artificial parts are cemented into place. The new knee will consist of a metal shell on the end of the femur, a metal and plastic trough on the tibia, and if needed, a plastic button in the kneecap. The entire procedure takes about 2 hours.


What happens after surgery?

When you wake up there will be a large bulky dressing on your knee. You will have an IV tube for fluids, pain medication and antibiotics. There may also be a small drain tube collecting blood from your surgical site. Your knee may be in a continuous passive motion machine (CPM) to keep your knee moving and prevent stiffness. Physical therapy will begin later that day, or the following day. You will stay in the hospital 3-7 days depending on how fast you heal.

Before discharge you will be given very specific instructions. The best surgeon in the world does not mean a successful recovery, YOU are responsible for your recovery. Follow all instructions and do your exercises faithfully.

Some of the normal home-going instructions include:

Continue to walk with crutches/walker

Continue to wear your knee immobilizer as instructed. It may be worn at night to keep your knee straight.

You should not drive a car until after the two-month follow-up appointment.

Wear elastic stockings (TEDS) until your follow-up appointment.

Do not shower until the staples are removed. Do not sit in a bathtub until your doctor says it is okay.

Keep the incision clean and dry. If any swelling, increased pain, drainage from the incision site, redness around the incision, or fever is noticed, report this immediately to the doctor.

What is the expected outcome of a knee replacement?

If replacement provides you with pain relief and if you do not have other health problems, you should be able to carry out many normal activities of daily living. About 90 percent of patients with stiff knees before surgery will have better motion after a total knee replacement.

What complications may occur?

The most common complications are not directly related to the knee and do not usually affect the result of the operation. These include blood clots in the leg, difficulty urinating and blood clots in the lung
Complications that affect the knee are less common, but in these cases, the operation may not be as successful. These complications include loosening of the prosthesis and infection in the joint.

For more information:

Total Knee Replacement, A Guide for Patients
MedicineNet - Knee Replacement
SCOI - Total Knee Replacement



References:
Iowa Health Book: Orthopaedics, Total knee Replacement: A Guide for Patients
Adult Health Advisor-Total Knee Replacement, Copyright © Clinical Reference Systems 1999