The decisions you make and the actions you take
before knee replacement surgery can be every bit
as important as the procedure itself in ensuring
a healthy recovery.
You
should discuss with your physician and his support
staff what devices will be needed when you are
discharged from the hospital following surgery.
If your hospital has a pre-operative total knee
class, where you can speak with nurses and therapists,
it is recommended that you attend. These classes
provide valuable information.
Understand
the potential risks and benefits of the surgery,
and ask your surgeon any questions that will help
you better understand the procedure. It can also
help to talk to someone else who has undergone
the same surgery.
Any
physical problems, such as a fever or infection,
should be reported to your surgeon, and you should
notify your surgeon of any medication you are
taking.
In
the weeks prior to surgery, your physician may
recommend that you donate some of your own blood
to be used for transfusion after surgery. Your
physician will instruct you about where and when
you can donate blood.
Discontinue
the use of any anti-inflammatory medicine at least
one week prior to surgery, to prevent excessive
bleeding during the surgical procedure. All decisions
regarding your medications should be discussed
with your physician.
To
reduce the risk of infection or wound healing
problems, smoking should be stopped at least one
week prior to surgery and not resumed following
surgery.
Getting
a second opinion from a surgeon who is as qualified
as the surgeon who gave the initial diagnosis
is usually recommended.
Make
sure the orthopedist performing the surgery is
board-certified, which can be determined by calling
the American Board of Orthopaedic Surgery at 919-929-7103.
Seven to ten days before surgery, you may be
instructed to go to the hospital for pre-admission
testing. A nurse will review your medical history
and provide you with all the preoperative instructions
you need. You will be given a complete physical
exam, have blood and urine tests done, and undergo
X-rays and a cardiogram (EKG). If you are taking
any medication, you will receive instructions
about safe doses to take in the days leading up
to surgery.
At most medical centers, you will go to "patient
admissions" to check in for your inpatient
total knee replacement procedure. After you have
checked in to the hospital or clinic, you will go
to a holding area where the final preparations are
made. The paperwork is completed and your knee area
may be shaved (this is not always necessary). You
will wear a hospital gown and remove all of your
jewelry. You will meet your surgeon, his operating
room nurse and staff, along with the anesthesiologist
or anesthetist (a nurse who has done graduate training
to provide anesthesia under the supervision of an
anesthesiologist). Then, you will walk or ride on
a stretcher to the operating room. Most patients
are not sedated until they go into the operating
room. Here are some important steps to remember
for the day of your surgery:
You
will be told not to eat or drink anything after
midnight on the night before your surgery. This
will reduce the risk of vomiting while you are
under anesthesia.
Arrange
for someone to drive you home when you are released,
usually within three to six days after surgery.
Wear
loose fitting clothing for your arrival to the
hospital.
Bring
only what you will need for the first 24 hours,
like a toothbrush, glasses, or dentures.
Pack
a bag for someone to bring you the day after surgery
that contains a full length robe, toiletries,
underwear, personal phone numbers you may need,
and any other items you would like to have around
during your hospital stay.
Take
it easy. Keeping a good frame of mind can help
ease any nerves or anxiety about undergoing surgery.
Distractions such as reading, watching television,
chatting with visitors, or talking on the telephone
can also help.
During a total knee replacement, surgeons reshape
your knee joint. The metal and plastic implant is
attached to the thighbone (femur), shinbone (tibia),
and kneecap (patella). The procedure usually takes
about two hours to perform. SURGERY
The
choices of anesthesia include epidural, spinal,
or general, and will be decided upon by your surgeon
and anesthesiologist, who will review with you
the advantages and disadvantages. Once entering
the operating room, you will be placed on the
operating table and anesthesia will be administered.
The surgical team washes and prepares the leg
with an antibacterial solution. IV (intravenous)
antibiotics will also be administered.
The
surgery is performed through an approximately
eight to ten inch incision in the front of the
knee. The front (anterior) muscles are incised
and the joint is exposed. The thighbone, shinbone,
and kneecap are seen.
After
opening the joint, the surgeon uses precision
instruments to cut and reshape the knee joint
in order to accomodate the prosthetic components.
The
final components may be either cemented in place
or press fit in a cementless manner.
During
the operation, surgeons check the alignment of
the knee as well as test function and stability
of the knee joint.
The
knee is stitched closed, a sterile dressing is
applied, and you are taken to the recovery room.
Following a total knee replacement, you usually
stay in the recovery room where there may be several
other patients for at least two hours while the
anesthetic wears off. If you were given spinal anesthesia,
you may not have any sensation in your legs when
you wake up after surgery. You will be given adequate
pain medicine, either orally or through an IV (intravenous)
line. IVs will deliver fluids, blood, and medication
as needed. Oxygen may need to be delivered through
a nasal tube or facemask. A Foley catheter may be
inserted into your bladder in the operating room
to drain urine. The catheter is usually removed
the second day following surgery. Your knee will
be bandaged and may have ice on it. You may have
significant pain early on and you should take the
pain medicine as directed. Remember that it is easier
to keep pain suppressed than it is to treat pain
once it becomes present, so ask the nurse for medication
when you feel pain coming on. Blood tests and an
X-ray of your knee may be performed while you are
in the recovery room. You should try to move your
feet and ankles while you are in the recovery room
to improve circulation. Your temperature, blood
pressure, and heartbeat will be monitored by a nurse,
who, along with the doctor, will determine when
you are ready to be transfered to your hospital
room. Most patients remain in the hospital for three
to five nights following surgery. If you have a
previous heart condition or a significant past medical
condition, you may be taken to the intensive care
unit (ICU) for routine cardiac monitoring for a
day or two. Following the monitoring, you will be
transferred to your hospital room and begin your
formal physiotherapy program.
After total knee replacement, you are usually taken
to a hospital room where doctors, nurses, and therapists
will regularly monitor your recovery. Most patients
feel sleepy and fatigued the day after surgery.
Following surgery you may be placed in a CPM (continuous
passive motion) machine, which will mocve your knee
while you are in bed. This flexion and extension
of your knee will help reduce knee stiffness. You
will also start daily physical therapy, which includes
active and passive range of motion exercises, walking,
getting yourself out of bed, and getting up from
a chair. You can expect to be given pain medication
as needed. Ice also helps control pain and swelling.
You may become nauseated after surgery and you should
inform a nurse immediately so your medication can
be changed to relieve nausea. To help keep your
lungs clear, you will receive instructions about
deep breathing and using a device called an incentive
spirometer. For two or three days after surgery,
you may experience an elevated temperature. This
is common and should not alarm you. Your doctor
may suggest acetaminophen, deep breathing exercises,
and spending more time out of bed. The medical staff
will evaluate prolonged fevers. It is important
to move your bowels before the third day after surgery,
even if you have not been eating. Ask for a laxative
if you need assistance. While in the hospital, you
will wear tight-fitting, anti-embolism stockings
that help control swelling in your legs. They are
removed daily for bathing and then reapplied. Physicians
usually prescribe wearing the stockings day and
night for up to six weeks after surgery. By the
third or fourth day after surgery, you can usually
walk freely around the hospital. The incision usually
starts to close within six days and the bandage
can be removed. You will be ready to leave the hospital
when you can get in and out of bed and a chair,
go up and down a few stairs, bend your knee between
70 and 90 degrees, and manage your pain with oral
medication. You should be able to fully bear weight
on your leg when released from the hospital, but
most patients may need to use crutches, a cane,
or a walker for a few weeks until they are comfortable
walking on their new knee. You will be given a prescription
for pain medication and schedule a series of follow-up
visits starting sometime around three and six weeks
after surgery.
You may feel pain or discomfort for the first few
weeks at home after a total knee replacement, and
you should take your prescribed pain medication
as needed. A prescription-strength painkiller is
usually prescribed and should be taken as directed
on the bottle. Taking one every four to six hours
as directed is a good idea during the first few
days to suppress pain. Swelling in your knee usually
slowly decreases over the weeks following surgery.
The surgical incision should be dry, but there may
be occasional slight spotty bleeding along the wound.
A light dressing may cover the incision and the
compression stockings should be worn, as prescribed
by your doctor. If you notice increased swelling,
redness, or wound bleeding, you should call your
physician. Arrangements for a visiting nurse and
home physical therapist will be made at the time
of discharge from the hospital. Their role is to
help you with your transition into the home environment
and monitor your progress. Physicians generally
recommend that you focus on your therapy program
and avoid strenuous activities that may irritate
your knee for about six weeks following surgery.
The goal is to restore your motion and improve your
strength. Progressively walking longer distances
each day is helpful. Riding a stationary bicycle
can also help restore motion and strength to your
knee. Here is what you can expect and how you can
cope after a total knee replacement:
Try
to arrange for someone to visit you at home to help
you for up to six weeks. You may need help putting
on the elastic stockings, cooking, doing laundry,
cleaning, and getting around town. You may be qualified
to receive personal care services from a home health
aid if you do not have family members who can provide
all the help you need.
Icing
your knee for 20 to 30 minutes a few times a day
during the first few weeks after surgery will help
reduce pain and swelling.
Whenever
possible during the first few weeks after surgery,
you should periodically elevate your leg to help
reduce the swelling.
Most
patients may shower when they get home. Whether
or not the incision can get wet needs to be discussed
with your surgeon.
Most patients can begin physical therapy immediately
after surgery. This will be initially performed
at your home with a home physical therapist. Once
you are strong enough, arrangements will be made
for your physical therapy at an outside physical
therapy center that is convenient for you. Crutches
or a cane may be needed for up to six weeks, depending
on the pain. Older patients may have to continue
using a walking aide for a longer period of time.
In the first few weeks of rehabilitation, your
physical therapist will help you stretch and strengthen
the muscles about your knee. The goal is to restore
your knee motion and resume comfortable walking.
As your strength and motion improves, you may
be instructed on endurance exercises such as long
distance walking, cycling, and swimming. These
exercises should restore your feeling of wellness.
You may take up to six weeks off from work, depending
on the type of job you perform and how you get
to work. It is useful to discuss this with the
doctor before surgery so that you can make appropriate
arrangements. Following total knee replacement,
patients are encouraged to resume an active lifestyle.
However, they are strongly advised doing activities
that produce high impact loads such as running
and jumping. Sports such as golf, cycling, swimming,
and walking are permissible. You should discuss
with your physician the exact level of sport participation
recommended for you.
Total knee replacement is a predictable and durable
procedure. How you treat your new knee will influence
its longevity. Therefore, it is important to know
which activities are permissible and which are not
following total knee replacement. The pain relief
achieved by total knee replacement, combined with
the correct regimen of exercise and sports, should
improve the patient’s overall health and quality
of life. The benefits of an active lifestyle have
been well documented. Following total knee replacement,
you should be instructed about limitations and have
good self-control and self-awareness when returning
to recreational sports. After surgery, most activities
require some reflection and often some modification.
Your level of expertise in your particular activity
needs to be considered. Sports and fitness regimens
must be individualized. Participation in sports
and recreational activities should be discussed
with your surgeon.
RECOMMENDED
ACTIVITIES
Cycling is an excellent aerobic workout. Calisthenics,
swimming, low-resistance rowing, stationary skiing
machines, walking, hiking, and low-resistance weight
lifting all are excellent ways to maintain fitness
without overstressing the implant. Suitable activities
include bowling, croquet, golf, doubles tennis,
table tennis, ballroom dancing and square dancing.
Other activities that are suitable but slightly
more risky include downhill skiing, scuba diving,
in-line skating, ice skating, softball, volleyball,
speed walking, horseback riding, hunting and low-impact
aerobics.
DISCOURAGED
ACTIVITIES
In general, patients who have undergone total knee
replacement should avoid high-impact activities
that cause high stress loads on the implant and
therefore may increase the risk of early failure.
Activities to avoid include baseball, basketball,
football, hockey, soccer, high-impact aerobics,
gymnastics, jogging, power lifting , rock climbing,
hang gliding, and parachuting.
A total knee replacement resurfaces your knee joint
by removing the diseased bone and cartilage. This
includes the lower end of the thighbone (femur),
the upper end of the shinbone (tibia), and the backside
of the kneecap (patella). These surfaces are replaced
with a metal and plastic implant, which mimics natural
knee motion and function. Total knee replacement
can help put an end to arthritic pain in your knee
and enable you to resume a functional and active
lifestyle.
You
should discuss with your physician and his support
staff what devices will be needed when you are
discharged from the hospital following surgery.
If your hospital has a pre-operative total knee
class, where you can speak with nurses and therapists,
it is recommended that you attend. These classes
provide valuable information.
