Knee Replacement Surgery

(Knee Arthroplasty; Total knee Replacement)

Definition:

This surgery involves removing a diseased or injured knee joint and replacing it with an artificial one.

A knee joint consists of the following:

Cartilage. A type of tissue that covers the surface of a bone at a joint. Cartilage helps reduce the friction of movement within a joint.

Synovial membrane. A tissue that lines the joint and seals it into a joint capsule. The synovial membrane secretes synovial fluid (a clear, sticky-fluid) around the joint to lubricate it.

Ligament. A type of tough, elastic connective tissue that surrounds the joint to give support and limits the joint’s movement.

Tendon. A type of tough connective tissue that connects muscles to bones and helps to control movement of the joint.

Knee replacement, also called total knee arthroplasty, is a surgical procedure to replace a worn out or damaged knee with prosthesis (an artificial joint). This surgery may be considered for someone who has severe pain due to arthritis.

Various types of arthritis may affect the knee joint. Osteoarthritis, a degenerative joint disease that affects mostly middle-aged and older adults, may cause the breakdown of joint cartilage and adjacent bone in the knees. Rheumatoid arthritis, which causes inflammation of the synovial lining of the joint and results in excessive synovial fluid, may lead to severe pain and stiffness. Traumatic arthritis, arthritis due to injury, may also cause damage to the articular cartilage of the knee and avascular necrosis of the knee.

The goal of knee replacement surgery is to replace the parts of the knee joint that have been damaged and to relieve knee pain that cannot be controlled by other treatments.

A mini-incision total knee replacement is also a surgery to replace a diseased or injured knee joint. A traditional knee replacement involves an incision several inches long over the knee joint. A newer approach that uses one smaller incision to perform the procedure the procedure is called minimally invasive knee replacement. However, the minimally invasive procedure is not suited for all candidates for knee replacement. The physician will determine the best procedure for a person. Based on that individual’s situation.

Reasons for Procedure:

This is done if you have advanced degenerative joint disease that presents as pain and stiffness in the knee joint that severely limits activities.

Knee replacement surgery is a treatment for pain and disability in the hip. The most common condition that results in the need for knee replacement surgery is osteoarthritis.

Osteoarthritis is characterized by the loss of joint cartilage in the knee. Damage to the cartilage and bones limits movement and may cause pain. People with severe pain due to degenerative joint disease may be unable to do normal activities that involve bending at the knee, such as walking or sitting, because they are painful.

Other forms of arthritis, such as rheumatoid arthritis and arthritis that results from a knee injury, can also lead to degeneration of the knee joint.

If medical treatments are not satisfactory at controlling pain due to arthritis, knee replacement surgery may be an effective treatment. Some medical treatments for degenerative joint disease may include, but are not limited, to the following:

Non-steroidal anti-inflammatory medications (NSAIDS; Advil, Naproxen, etc.)

Glucosamine and chondroitin sulfate

Pain medications

Limiting painful activities

Assistive devices for walking (such as a cane)

Physical Therapy and low impact exercises

Within six weeks, you should be able to resume normal light activities.

Before surgery, other measures are tried, such as:

• Rest and ambulatory assist devices
• 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 (e.g. 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:

• Smoking
• Obesity
• Pre-existing medical conditions
• Current infection
• Diabetes
• Taking steroid medicine
• 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

Your doctor will explain the procedure to you and offer you the opportunity to ask my questions that you might have about the procedure.

You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

• Physical exam
• Blood tests
• X-ray a test that uses radiation to take a picture of structures inside the body, especially bones
• CT scan – a special type of x-ray that uses a computer to make pictures of structures inside the body
• MRI scan – a test that uses magnetic waves to make pictures of structures inside the body.

In the time leading up to the procedure

• Try to lose weight if you are overweight. This will decrease the amount of stress on your new joint. Pool exercise may be a good option.
• To enhance safety and recovery, make home modifications:

• Install safety bars, a raised toilet seat, a shower bench, and hose. Install handrails on stairways and steps
• Remove throw rugs. Check to make sure extension cords are in a safe place.
• Purchase a stable, firm-backed arm chair. When seated, your knees should remain lower than your hips.
• Buy items to make daily activities easier (e.g. reachers, dressing aids).
• Place items so that they are ease to reach. This way you will be able to avoid bending.

• 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)
  • Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
  • Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape and anesthetic agents (local and general).
  • If you become sick or have a fever just before the surgery, tell your doctor right away.
  • Arrange for a ride to and from the hospital. Also, arrange for help at home.
  • If you smoke, try to smoke less or stop smoking.
  • Eat a light meal the night before the surgery. Do not eat or drink anything after midnight. If you have diabetes, ask your doctor if you will need to adjust your medicine.

• 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 (e.g. 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:

• General anesthesia – blocks pain and keeps you asleep through the surgery; given through an IV in your hand or arm
• Spinal or epidural anesthesia –numbs the area from the chest down to the legs ; given as an injection in the back

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 into place. The doctor will close the incision with an absorbable suture.

After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Hip replacement surgery usually requires an in-hospital stay of two days.

It is important to begin moving the new joint after surgery. A physical therapist will meet with your soon after your surgery and pain an exercise program for you. Your pain will be controlled with medication so that you can participate in the exercise. You will be given exercise plan to follow both in the hospital and after discharge.

You will be discharged home or to a rehabilitation center. In either case, your doctor will arrange for continuation of physical therapy until you regain muscle strength and good range of motion

Immediately After Procedure

• You will be taken to the recovery room and monitored closely
• You will get out of bed and walk around with the help of the physical therapist on the day of surgery

How long will it take?

About 2 hours

How much will it hurt?

Your pain will be controlled after surgery by our dedicated joint replacement pain service

Average Hospital Stay

This procedure is done in a hospital setting. The usual length of stay is 2 days.

Post-procedure Care:

At the Hospital

While you are recovering at the hospital, you may need to:

• 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 will start the day of surgery. You will learn safe ways to move your knee and support your weight.
• You will learn how to use a walker, crutches, or support devices.

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.
• Maintain a healthy weight after surgery
• Talk to your doctor 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 the 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.