• Knee Replacement

    (Knee Arthroplasty; Total Knee Replacement)

    Definition

    This surgery involves removing a diseased or injured knee joint and replacing it with an artificial one.
    Total Knee Replacement
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    Reasons for Procedure

    This is done if you have pain and stiffness in the knee joint that limits activities. Before surgery, other measures are tried, such as:
    • Rest
    • Medicines
    • Physical activity
    Knee replacement surgery is most often done to:
    • Ease knee pain and disability due to arthritis or previous severe knee injury
    • Correct a knee deformity (eg, knee bows in or out)

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have a knee replacement, your doctor will review a list of possible complications, which may include:
    • Infection
    • Blood clots
    • Excessive swelling or bleeding
    • Injury to nearby nerves or blood vessels
    • Anesthesia-related problems
    Some factors that may increase the risk of complications include:
    Be sure to discuss these risks with your doctor before the surgery.

    What to Expect

    Prior to Procedure

    Your doctor will likely do the following:
    • Physical exam
    • Blood tests
    • X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones
    • MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
    Leading up to your procedure:
    • If you are overweight, lose weight. This will help to decrease the amount of stress on your new joint.
    • Make home modifications to help make recovery easier: Install equipment to help keep you safe, such as:
      • Safety bars
      • Raised toilet seat with arms
      • Shower bench and shower hose
      • Handrails on stairways and steps
    • Remove items that could cause falls. These might include throw rugs and extension cords.
    • Make sure you have a firm-backed arm chair and a footstool.
    • Stay on the first floor. Climbing stairs will be difficult at first.
    • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Anti-inflammatory drugs (eg, aspirin )
      • Blood thinners, like clopidogrel (Plavix) or warfarin (Coumadin)
    • If advised by your doctor, take antibiotics.
    • Arrange for a ride to and from the hospital. Also, arrange for help at home.
    • Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.

    Anesthesia

    Different types of anesthesia can be used, including:

    Description of the Procedure

    The doctor will make a cut in the skin. The damaged cartilage and bone will be removed. The remaining bone will be prepared to receive the new plastic and metal joint. The doctor will then place the artificial joint in the proper position. It will be cemented within the bone. The doctor will close the incision with staples. A drain will be left in to allow extra fluid to flow out.

    Immediately After Procedure

    • You will be taken to the recovery room and monitored closely
    • A splint or brace will be placed to hold the knee in the right position

    How Long Will It Take?

    About 2 hours

    How Much Will It Hurt?

    You will have pain during recovery. Your doctor will give you pain medicine.

    Average Hospital Stay

    This procedure is done in a hospital setting. The usual length of stay is 3-4 days. Your doctor may choose to keep you longer if complications arise.

    Post-procedure Care

    At the Hospital
    While you are recovering at the hospital, you may need to:
      Use a continuous passive motion machine, which is designed to:
      • Slowly move your knee
      • Restore function
      • Decrease swelling
      • Improve circulation
    • Move your foot and ankle to increase blood flow back to your heart.
    • Wear support stockings. These may help prevent blood clots from forming in your legs.
    • Work with a physical therapist. You may start the day after surgery. You will learn safe ways to move your knee and support your weight.
    • Wear a brace or splint. You will learn how to use a walker , crutches , or other support devices.
    • Take blood-thinning medicines.
    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • Be sure to follow your doctor's instructions .
    • Keep the incision area clean and dry. Place a clean dressing over it.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Slowly progress to walking and then to climbing stairs. Avoid jogging and other high-impact sports.
    • Get the staples removed in a few weeks.
    • Maintain a healthy weight after surgery.
    • Talk to your doctor before taking over-the-counter medicines.
    • Take antibiotics before surgery or dental procedures. Antibiotics will decrease the risk of bacteria entering the bloodstream and traveling to the artificial knee.
    Within six weeks, you should be able to go back to light activities and driving. You may feel a soft clicking in the joint when walking or bending. Continue to work with the physical therapist. Water-based exercises may help to improve joint pain, swelling around the knee, and range of motion.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
    • Pain that you cannot control with the medicines you have been given
    • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
    • Cough, shortness of breath, or chest pain
    • Your leg, foot, or toes appear chalky white, blue, or black
    • Numbness or tingling in your leg, foot, or toes
    • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
    • Swelling, redness, or pain in your legs, calves, or feet
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org/

    American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org/

    Canadian Orthopaedic Foundation http://www.canorth.org/

    References

    Total knee replacement. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00389 . Updated August 2007. Accessed December 22, 2008.

    4/16/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Harmer AR, Naylor JM, Crosbie J, Russell T. Land-based versus water-based rehabilitation following total knee replacement: a randomized, single-blind trial. Arthritis Rheum. 2009;61:184-191.

    6/2/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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