The knee joint, which is made up of the femur (thigh) bone, tibia (shin) bone, and patella (knee cap), allows the lower body to move in various ways. Walking, running, jumping, and sitting all utilize the knees. When this joint experiences damage or disease, the discomfort and loss of function can have a serious impact on a patient’s day-to-day life. Extensively trained in a comprehensive range of knee conditions, our board certified orthopaedic surgeons offer the latest surgical and non-surgical treatment options, including partial and total knee replacement. In the event this operation is recommended, our state-of-the-art practice can help you manage each step of the process through full recovery.
If you would like to learn more about total knee replacement, or if you would like to schedule a consultation, please contact our office today.
Total Knee Replacement
Total knee replacement, also called knee arthroplasty, can reduce pain and improve the function of an arthritic knee joint by resurfacing the worn down or damaged areas with artificial (prosthetic) parts. The end of the femur and the top of the tibia will be resurfaced in metal and a medical-grade plastic called polyethylene will be attached to the metal tibia to allow smooth motion between the other artificial parts. Either cement or a porous coating will be used to secure the prosthetic part to the bone. The knee cap, or patella, will also have a new surface on its underside made of polyethylene.
During surgery, the replacement parts will be inserted through a vertical incision over the front of the knee that varies in length based on a patient’s size, weight, and knee stiffness. The prostheses will be stabilized the same way your natural knee would be, using your own ligaments and muscles.
Your Knee Evaluation
One of the most important steps before considering knee replacement surgery is to fill out a detailed questionnaire that reveals your full medical history. This information, along with a physical examination and diagnostics, helps our experienced orthopaedic surgeons determine if an operation is appropriate for your needs. These pieces of data are also essential in developing the optimal treatment plan. Questions may include the level of pain you experience, as well as how your activity is limited and whether the condition has worsened over time.
We will also conduct a physical evaluation. Your surgeon may ask you to perform certain movements to determine your range of motion. Measurements may also be taken and your muscle strength will be analyzed.
Any X-rays you’ve had taken of the joint should be brought to your initial consultation. Your surgeon may also ask that you have additional X-rays or other diagnostics completed to determine the extent of your condition and to create a customized surgical plan. Your candidacy for partial or total knee replacement is determined at this time.
Preparing for Surgery
There are many steps that must be taken before the knee replacement surgery can be completed. Your orthopaedic surgeon will likely suggest you meet with your primary care physician or an internist for a comprehensive medical examination. Patients who are overweight may be asked to diet, and individuals who smoke will need to cease smoking in order to reduce the risk of complications. Certain medications will also have to stopped about two weeks before the procedure, including aspirin. Tell your doctor about any medications you take (prescription and over-the-counter), so that they can determine which ones are safe to continue taking and which should be stopped beforehand.
Knee Replacement Surgery
It is critical that you not eat or drink anything after midnight. You will meet with the anesthesiologist, who will go over the type of anesthesia that will be used for your surgery. An intravenous (IV) line will be started, and medication and fluids will be provided to you through this during the operation.
The Day of Surgery
After surgery is complete, you will wake up in the Post-Anesthesia Recovery Room. It’s not unusual to feel like you have been asleep for only a few minutes. Some discomfort is normal, and pain medication will be provided to help you feel more comfortable. You will be monitored by experienced nurses and then moved to a more permanent room to recover on the orthopaedic specialty unit.
What to Expect After Surgery
A dressing will be placed over your incision, and you may have a drainage tube. This device will be attached to a suction apparatus and is used to gently remove blood that can accumulate in your surgical site. The drain and bandage will be managed by the surgical team, your doctor, and the physician assistant.
The IV line will typically remain in your arm for the duration of your hospital stay, to provide you with antibiotics, fluids, and other medication, and blood will be drawn daily. Additionally, you should use the incentive spirometer as directed if recommended as part of your treatment. This device encourages you to cough and breathe normally to protect your lungs from infection and other problems.
Physical therapists will help you mobilize as quickly as possible, oftentimes on the day of surgery. Exercises will be taught and guidelines reinforced for an optimal outcome
Some discomfort is normal, and the nurses will provide medication to enhance your recovery. If your pain increases, tell your team promptly.
An important part of the healing process will be knee rehabilitation. Within 24-hours after surgery, a physical therapist will direct you to perform certain actions as recommended by your surgeon. These exercises may include flexing your leg muscles without moving your knee (isometric exercises) while you remain in bed. You will be advised how many times to perform these movements per day. Additionally, you will be instructed to move your ankles and other joints to maintain muscle tone and enhance the healing process.
Physical therapy exercises are designed to help your leg and knee restore strength and function. Part of your program will also be learning the safest ways to get into and out of bed, as well as how to sit and rise from a chair, toilet, or other seated position. Your therapist should also cover what you can and cannot do during knee replacement recovery to optimize your outcome.
Soon after surgery you will begin walking and performing knee exercises, typically with the help of the physical therapist and a walking aid. You should gradually gain strength, flexibility, and endurance. Range of motion exercises will be a part of the program, and these movements should help you bend your knee joint up to 90 degrees by the end of your hospital stay. Your physical therapist, in addition to guiding you through recovery, will also keep your surgeon informed of your daily progress.
Physical therapy can feel uncomfortable, and pain medication will be provided if you require it. Additionally, we offer a range of other options to help relieve discomfort before and after therapy, including ice and heat packs.
Over time, the physical therapist will also teach you how to get out of bed, dress, use crutches or a walker, and complete other simple tasks on your own. You will also continue your strengthening exercises in preparation for going home. You will need an elevated chair and toilet seat for home use, and your medical team can help you source these items. Chairs you sit in should be firm and have arms, so that you can use them to support yourself.
How you sit is important. Proper posture and positioning are essential to maintain throughout the healing process. You may still experience some discomfort, which is normal, and you can request medication or use over-the-counter painkillers recommended by the surgeon if needed. Your stitches and/or clips will be removed approximately 15-20 days after the operation, and arrangements will be made for a medical professional to perform this task. While everyone is unique, the full recovery process typically takes between three and six months to complete, and symptoms can continue to improve as far as a year after surgery.
When you reach the end of your hospital stay, you will be given a list of instructions to help you continue recovery from home. Once you reach your residence, it’s important to call our office and make an appointment for a follow-up with your surgeon. Until that visit, you should be extra cautious about how you move and take care to complete exercises as directed. Additionally, you should contact us promptly if you notice any of the following:
- Foul odor or drainage coming from your incision
- Fever of 101 degrees (38 degrees C) that lasts two days or longer
- Increased redness, swelling, tenderness, or pain
The most important thing for you to do is to relax and follow your surgeon’s recommendations for recovery. It may take some time to acclimate to your home environment, and sleeping is often difficult, but we encourage you to be patient and take it easy.
As each patient gains strength and mobility at a different pace, you will be ready to return to normal activities in your own time. Your orthopaedist will discuss your progress with you regularly, and he or she will advise you when you can begin working again. Discuss driving with your doctor and physical therapist. It’s important that you practice driving in a safe place first.
Once home, you can engage in sexual activity whenever you feel comfortable. You should keep any precautions your surgeon recommended in mind.
Healthy patients tend to recover more quickly than unhealthy ones, and we recommend that you try to maintain a reasonable weight and remain active during the healing period and beyond. Generally speaking, you should be able to perform low-impact exercises and activities. Discuss higher impact activities with your surgeon. While highly durable, your knee replacement will still experience normal wear and tear. If you have any questions about which exercises you can safely engage in, contact your orthopaedist.
Medication and Pain Management
To help make your recovery as swift, effective, and comfortable as possible, your orthopaedic surgeon will prescribe you medication to relieve discomfort. If you need a refill, we recommend alerting your surgeon or the nurse about five days before you run out. This will give them time to order more without experiencing an interruption. If your pain increases, however, you should inform your physician immediately. Knee replacement surgery is uncomfortable, but it is unusual to require narcotic pain medication after 8-10 weeks.
Your orthopaedic surgeon will give you a general timeframe for when each follow-up visit will occur, and they usually include two weeks, six weeks, three to six months, and 12 months after your operation. Furthermore, your surgeon may ask you to return every two years after your surgery for a check-up even if you’re not experiencing any concerns.
Risk of infection is approximately one percent and can seriously affect your recovery. If your medical team discovers an infection, more surgery may be required. You must be vigilant against the development of an infection in your artificial joint from now on. Always tell any of your physicians and dentists that you have a knee replacement. If you undergo a medical or dental procedure, alert your orthopaedic surgeon so that he or she can give you an antibiotic to take before and after treatment.
If you have additional questions about knee replacement, please contact our office today. Our friendly and knowledgeable medical team can provide more information and help you schedule a consultation.