Patients with severe destruction of the knee joint associated with progressive pain and impaired function may be candidates for total knee replacement.

Osteoarthritis is the most common reason for knee replacement operation in the U.S.

Risks of total knee replacement surgery have been identified.

Physical therapy is an essential part of rehabilitation after total knee replacement.

Patients with artificial joints are recommended to take antibiotics before, during, and after any elective invasive procedures (including dental work).

Shortness of breath

Chest pain

Shock

Urinary tract infection

Nausea and vomiting (usually related to pain medication)

Chronic knee pain and stiffness

Bleeding into the knee joint

Nerve damage

Blood vessel injury

Infection of the knee which can require reoperation

Potential heart damage

Potential lung damage

Potential kidney damage

Potential liver damage

All medications that the patient is taking are reviewed. Blood-thinning medications such as warfarin (Coumadin) and anti-inflammatory medications such as aspirin may have to be adjusted or discontinued prior to knee replacement surgery.

Routine blood tests of liver and kidney function and urine tests are evaluated for signs of anemia, infection, or abnormal metabolism.

Chest X-ray and EKG are performed to exclude significant heart and lung disease that may preclude surgery or anesthesia.

A knee replacement surgery is less likely to have a good long-term outcome if the patient’s weight is greater than 200 pounds. Excess body weight simply puts the replaced knee at an increased risk of loosening and/or dislocation and makes recovery more difficult.

Passage of urine can be difficult in the immediate postoperative period, and this condition can be aggravated by pain medications. A catheter inserted into the urethra (a Foley catheter) allows free passage of urine until the patient becomes more mobile.

Physical therapy is an extremely important part of rehabilitation and requires full participation by the patient for optimal outcomes. Patients can begin physical therapy 48 hours after surgery.

Some degree of pain, discomfort, and stiffness can be expected during the early days of physical therapy.

Knee immobilizers are used to stabilize the knee while undergoing physical therapy, walking, and sleeping. They may be removed under the guidance of the physical therapist for various portions of physical therapy.

A unique device that can help speed recovery is the continuous passive motion (CPM) machine. The CPM machine is first attached to the operated leg. The machine then constantly moves the knee through various degrees of range of motion for hours while the patient relaxes. This can help to improve circulation and minimize the risk of scarring and contracture of the tissues around the knee.

Patients will start walking using a walker and crutches. Eventually, patients will learn to walk up and downstairs and grades.

Several home exercises are given to strengthen the thigh and calf muscles.