This surgery involves removing a diseased or injured knee joint and replacing it with an artificial one.
Total Knee Replacement
Reasons for Procedure
This is done if you have pain and stiffness in the knee joint that limits activities. Before surgery, other measures are tried, such as:
- 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 (eg, knee bows in or out)
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:
- Blood clots
- Excessive swelling or bleeding
- Injury to nearby nerves or blood vessels
- Anesthesia-related problems
Some factors that may increase the risk of complications include:
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:
- Physical exam
- Blood tests
- X-ray]]> —a test that uses radiation to take a picture of structures inside the body, especially bones
- ]]>MRI scan]]> —a test that uses magnetic waves to make pictures of structures inside the body
Leading up to your procedure:
- If you are overweight, lose weight. This will help to decrease the amount of stress on your new joint.
Make home modifications to help make recovery easier:
Install equipment to help keep you safe, such as:
- Safety bars
- Raised toilet seat with arms
- Shower bench and shower hose
- Handrails on stairways and steps
- Remove items that could cause falls. These might include throw rugs and extension cords.
- Make sure you have a firm-backed arm chair and a footstool.
- Stay on the first floor. Climbing stairs will be difficult at first.
- Install equipment to help keep you safe, such as:
- Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- 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.
Different types of anesthesia can be used, including:
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 within the bone. The doctor will close the incision with staples. A drain will be left in to allow extra fluid to flow out.
Immediately After Procedure
- You will be taken to the recovery room and monitored closely
- A splint or brace will be placed to hold the knee in the right position
How Long Will It Take?
About 2 hours
How Much Will It Hurt?
You will have pain during recovery. Your doctor will give you pain medicine.
Average Hospital Stay
This procedure is done in a hospital setting. The usual length of stay is 3-4 days. Your doctor may choose to keep you longer if complications arise.
At the Hospital
While you are recovering at the hospital, you may need to:
Use a continuous passive motion machine, which is designed to:
- Slowly move your knee
- Restore function
- Decrease swelling
- Improve circulation
- 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 may start the day after surgery. You will learn safe ways to move your knee and support your weight.
- Wear a brace or splint. You will learn how to use a walker , crutches , or other support devices.
- Take blood-thinning medicines.
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.
- Slowly progress to walking and then to climbing stairs. Avoid jogging and other high-impact sports.
- Get the staples removed in a few weeks.
- Maintain a healthy weight after surgery.
- Talk to your doctor before taking over-the-counter medicines.
- Take antibiotics 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 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 911 .
American Academy of Orthopaedic Surgeons
American Orthopaedic Society for Sports Medicine
Canadian Orthopaedic Association
Canadian Orthopaedic Foundation
Total knee replacement. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00389 . Updated August 2007. Accessed December 22, 2008.
4/16/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Harmer AR, Naylor JM, Crosbie J, Russell T. Land-based versus water-based rehabilitation following total knee replacement: a randomized, single-blind trial. Arthritis Rheum . 2009;61:184-191.
Last reviewed November 2009 by ]]>Robert E. Leach, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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