 Replacing
Your Problem Knee
A painful, stiff knee can keep you from
doing the simple things in life, even walking without pain. Your
physician may be able to replace your problem knee thanks to
improved surgical techniques and materials. After a total
knee replacement, you will have some restrictions when using
your new knee, but you can look forward to returning to many
activities of daily living.
History
Chronic knee pain is commonly caused by
arthritis. There are three common forms of arthritis: osteoarthritis, rheumatoid
arthritis, and traumatic arthritis.
Osteoarthritis usually occurs in
patients over 50 years old, and very often they will have a
family history of arthritis. The cartilage in the knee
that acts as a cushion for the bones thins out and wears away. This,
in turn, allows for the bones to rub together causing pain
and stiffness.
Rheumatoid arthritis is a disease
which there is thickening and inflammation of the synovial
membrane. Over time this chronic infammation can cause
cartilage damage, leading to pain and stiffness.
Traumatic arthritis can follow a
serious knee injury. Fracture or ligamentous injuries
may damage the articular cartilage over time, causing knee
pain.
As your knee pain and stiffness increases,
simply walking or climbing stairs can hurt. Conservative
treatment is always attempted first. Antiinflammatories,
physiotherapy, activity modification, ambulatory assistive
devices, braces, corticosteroid injections, and viscosupplementation
are common conservative treatment options attempted before
total knee replacement is considered
 Knee
Anatomy/Knee Prosthesis
You can only walk without pain, when the
bones in your knee joint are smooth and cushioned by healthy
cartilage. You also need strong muscles and ligaments
for stability, because your knee is more than a simple hinge
joint. Each time you bend your leg to walk or climb stairs,
the bones rotate, roll, and glide on each other.
Like a normal knee, your prosthesis has
smooth weight-bearing surfaces. The femoral component
covers your thigh bone, the tibial component covers the top
of your shin bone, and the patellar component covers the underside
of your kneecap. Your physician will choose the
best prosthesis design, either cement or cementless, for your
knee.
Your Orthopedic Evaluation
Your orthopedic evaluation helps your physician
to determine if you are a candidate for a total knee replacement,
and if you are, to choose the best prosthesis for your particular
knee problem.
Your medical history includes questions
about knee pain, medication you may be taking, prior injury,
infections, bleeding disorders, and other bone or joint problems
you may have.
Your physical exam includes assessing your
range of motion (stiffness or instability), any deformity in
your legs (bowlegged or knock-kneed), stability, and watching
how you walk and sit. X-rays will be taken to determine
the extent of damage and deformity in your knee.
Occasionally blood tests, an MRI, or bone
scan may be performed to assess the condition of the bone and
soft tissues around the knee.
 Deciding
On Surgery
After your evaluation, our team will discuss
whether total knee replacement is the best treatment for you
at this time. Your clinician may recommend some or all
of the conservative treatment options mentioned above, or maybe
even a different surgical procedure, such as a tibial osteotomy
or an arthroscopy.
Understanding the risks and complications
is part of your decision. Your physician will
talk with you about infection, blood clots, stroke, heart attack,
anesthetic problems, pneumonia, stiffness, pain, prosthesis
loosening, blood vessel or nerve loss, or other post-operative
risks before you decide on total knee surgery. (Make
sure you understand these risks)
Prior To Surgery
You will be asked to AVOID ASPIRIN, BLOOD
THINNERS, or ANTI-INFLAMMATORY MEDICATION FOR TWO (2) WEEKS
PRIOR TO SURGERY TO MINIMIZE BLEEDING. You will also
be asked to STOP SMOKING to decrease the chance of post-operative
lung complications.
Continue leading a normal, healthy lifestyle,
and be sure to let the doctor know about any infection or leg
sores. You should call his office if any medical problems
arise that may require rescheduling of your surgery. Be
particularly aware of any urinary problems such as burning,
difficulty voiding, frequent urination, or symptoms of infection
and report these immediately before your surgery.
It is VERY IMPORTANT to report any infection
in your body before and after surgery. Any skin lesions
in the area of your knee may cause a delay in surgery.
The morning of surgery, you will have an
IV (intravenous) line started for medications before you are
given general anesthesia. You and your family can
expect your surgery to take from two to three hours, depending
on how much knee damage you have and whether you need all three
of your knee bones resurfaced.
The Hospital Recovery Period
After surgery, you may wake up feeling
a bit groggy. Specially trained nurses will be with you
to keep you comfortable and provide pain medications. Your
nurses also coach you with coughing and deep breathing exercises
to help clear your lungs and prevent post-operative complications. You
will have a large dressing on your knee with a drain for normal
post-operative bleeding. Once you are awake and alert,
you will be transferred to your hospital room.
Once you are back in your room, the goal
for the rest of your hospital stay is to begin walking again
before you go home. You will be started on a physical
therapy program to exercise you knee muscles and regain strength
and range of motion in your new knee. These exercises
will also improve circulation to your leg, improving the healing
time.
Physical Therapy
Physical therapy, a vital part of the recovery,
helps you regain your full knee potential. Gentle knee
exercises strengthen the muscles around your new knee and help
restore its range of motion. Your physical therapist
will design a program especially for you and teach you how
to do the exercises. Your therapist also starts you walking,
a few steps at a time, to promote healing. Progressing
from a walker, to crutches, and then a cane, helps you to regain
confidence and your normal walking motion. This is
hard work, and you must show perseverance and determination
in doing your exercises if you want to get the best results
possible.
Going Home
Once you have recovered and can bend your
knee enough to go home, your surgeon will discharge you. Prior
to your surgery you may organize a short stay (1-2 weeks) at
a skilled nursing facility. This will give you more time
to work on physical therapy to increase strength and range
of motion in your knee. Your sutures and bandages are
usually removed before you leave the hospital/skilled nursing
facility, and you are given instructions for safe home recovery,
which often includes follow-up physiotherapy. Feel free
to ask any questions you may have.
Your Home Recovery
At home, your new goal is to return safely
and comfortably to your activities of daily living. Your
follow-up physiotherapy relieves any stiffness and awkwardness
you may feel, and helps you regain independence as you learn
to care for your new knee. Most patients return to normal
activities three to six weeks following surgery. Night
pain is common for several weeks after surgery. Driving
can begin when your knee bends sufficiently to enter
and sit comfortably in a car seat, and when your muscle control
provides adequate reaction time from accelerator to brake,
typically 4-6 weeks.
At
any time during your recovery you notice fever,
redness, increasing stiffness, calf pain, or shortness
of breath, report to the emergency department IMMEDIATELY! |
Follow-up Physical Therapy
Your physical therapist will instruct you
to continue with the exercises you learned in the hospital,
and may teach you others as well. Strength exercises
tone your thigh muscles, which have the greatest control over
your new knee. Range of motion exercises help you bend
and straighten your knee more fully.
Caring for Your New Knee
Your knee prosthesis is the result of years
of research. Like any other device, your new knee's life
span depends on how you care for it. In your follow-up
visits after surgery, your physician will follow your progress
and answer any questions your may have about caring for your
new knee.
Helpful Hints
-
Follow your physician's advice on
using crutches or a cane to keep weight off your healing
knee.
-
Keep in mind that your prosthesis
is designed for activities of daily living, not sports.
-
Before dental work or surgery, let
your doctor know you have a new knee; antibiotics may
be needed to help prevent infection.
-
If your prosthesis wears out or loosens,
it can be replaced with another. Revision surgery
is difficult, however, so preserve your new knee.
Enjoying Your New Knee
After a total knee replacement, you can
look forward to less knee pain, stiffness, and deformity in
your leg. While your new knee is not a normal knee, you
can expect to enjoy your activities of daily living with greater
ease and comfort. You can once again enjoy life more
fully with a more independent, mobile lifestyle.
There are limitations, however, and you
will not be able to do all of the activities you did when your
knee was healthy and normal. This is a major operation,
and should only be done when all other treatment fails and
you have significant and disabling pain that stops you from
your activities of daily living.
BEFORE
your surgery, make sure you understand all
of this page, particularly the risks and complications,
as well as possible alternative treatments. |
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