Get The Facts On Total Knee Replacement

Here are a few quick facts on knee replacement surgery:

  • 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).

What is a total knee replacement?

A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with artificial material. The knee is a hinge joint that provides motion at the point where the thigh meets the lower leg. The thighbone (or femur) abuts the large bone of the lower leg (tibia) at the knee joint.

During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The end of the lower leg bone (tibia) is also removed and replaced with a channeled plastic piece with a metal stem. Depending on the condition of the kneecap portion of the knee joint, a plastic “button” may also be added under the kneecap surface. The artificial components of a total knee replacement are referred to as the prosthesis.

The posterior cruciate ligament is a tissue that normally stabilizes each side of the knee joint so that the lower leg cannot slide backward in relation to the thighbone. In total knee replacement surgery, this ligament is either retained, sacrificed, or substituted by a polyethylene post. Each of these various designs of total knee replacement has its own particular benefits and risks.

Know the risks of undergoing a total knee replacement

Risks of total knee replacement include things such as blood clots in the legs that can travel to the lungs (known as Pulmonary Embolism).

Pulmonary Embolism can cause:

  • Shortness of breath

  • Chest pain

  • Shock

Other risks include:

  • 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

Risks of anesthesia include:

  • Potential heart damage

  • Potential lung damage

  • Potential kidney damage

  • Potential liver damage

Pre-operative evaluation for total knee replacement

Before surgery, the joints adjacent to the diseased knee (hip and ankle) are carefully evaluated. This is important to ensure optimal outcome and recovery from the surgery. Replacing a knee joint that is adjacent to a severely damaged joint may not yield a significant improvement in function as the nearby joint may become more painful if it is abnormal.

  • 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.

What happens in the post-operative and recovery period from surgery?

A total knee replacement generally requires between one and a half to three hours of operative time. Post-surgery, patients are taken to a recovery room, where vital organs are frequently monitored. When stabilized, patients are returned to their hospital room.

  • 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.

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