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Patient Education: Knee Replacement
Disclaimer
The following text is a list of facts and commonly asked
questions regarding joint replacement. The information provided below
is offered for general education purposes only and should not be used
for diagnosing orthopaedic problems, nor should it be considered a
replacement for consultation with a physician.
Only your healthcare provider can diagnose you and treat you in
the way best suitable for you. While BioPro has endeavored to make sure
the information contained in this site is accurate, BioPro can not
guarantee the accuracy of such information, and it is provided without
warrant or guarantee of any kind. If you have any questions or concerns
about your health, please contact your healthcare provider.
Knee Replacement
Understanding Knee Replacement
The knee is a complex, hinged joint. With support from cartilage,
ligaments, and muscles, the two bones at the joint move over each
other so you can straighten and bend your leg. A knee that becomes
stiff and painful may be replaced with a knee prosthesis, which
will allow you to walk without pain.
In a healthy knee (shown below), the surfaces of the thigh and shin
bones are smooth so they can glide easily over each other. Cartilage
covers the bones evenly, allowing smooth movement. Protected by
the kneecap and held in place by muscles and ligaments, the joint
bends freely.
A
HEALTHY KNEE
In
a problem knee (shown below), the surfaces of the bones may become
rough, causing pain when they rub together. The cartilage may wear
away, becoming rough and no longer allowing easy movement of the
joint bones. Because of arthritis, the joint may be swollen and
inflamed, resulting in stiffness and pain.
A
PROBLEM KNEE
Your
damaged knee joint can be replaced with new, smoothly surfaced components
(shown below). The lower knee component will replace the rough surface
of the shin bone, while the upper knee component will replace the
surface of the thigh bone. The kneecap component will cover the
underside of your kneecap.
A
KNEE PROSTHESIS
When is Knee Replacement Needed? top of page
A painful knee can keep you from doing the things you enjoy in life,
and your decision to replace your knee is your first step toward
regaining control of your life. Technical advances have given us
new materials to replace your problem knee. Therefore, when lesser
methods are no longer able to control the pain and disability to
your satisfaction, knee replacement becomes a reasonable option.
Knee replacement is usually performed to treat severe arthritic
conditions. Most patients who have artificial knees are over the
age of 55, but the operation is occasionally performed on younger
patents as well. Circumstances vary, but generally patients are
considered for knee replacements if:
1) Pain is severe enough to restrict work, recreation, and the ordinary
daily
activities.
2)
Pain is not relieved by anti-inflammatory medicine, the use of a
cane, and other
restricting devices.
3)
There is a significant stiffness of the knee.
4)
X-rays show advanced arthritis or other knee problems.
Knee replacement is an elective operation and there are always nonoperative
alternatives. The decision to have the operation is not made by
your doctor, but by yourself. The doctor may recommend the operation;
however, your decision must be based upon weighing the benefits
of the operation against the risks. You may wish to discuss the
surgery with your own doctor or even get another opinion so all
your questions are answered before you decide to have the operation.
Commonly Asked Questions Regarding Knee Replacement top of page
Having concerns about knee replacement surgery is normal, and it
may be helpful and assuring if one knows what to expect after surgery.
Some of the commonly asked questions are discussed below.
1) Will the pain in my knee stop?
As you recover your pain should lesson. Your prosthesis should relieve
the pain and stiffness you had prior to surgery. It is important
to note that medication and gentle exercise can help reduce the
pain from your operation.
2) When will I be able to go home again?
Your health care team will assess your condition and will determine
when the best time for you to return home is. When you are ready
to leave, the health care team will help you make the transition
from the hospital to your home.
3) Will I be able to do the things I enjoy again?
As your knee heals and grows stronger, you will become more active.
Eventually, you’ll be able to enjoy your favorite activities.
4) When will I walk again?
You can expect to walk within a couple of days after surgery with
the help of your physical therapist and an assistive device such
as a walker or cane. By the time you leave the hospital, you will
be walking on your own using a walker, crutches, or cane.
5) Will I regain my independence?
You should be able to manage most or all of your activity by yourself.
depending on how well you heal and how regularly you exercise.
Preparing for Knee Replacement Surgery top of page
Before surgery, you may need a general physical exam by your regular
doctor. In addition to following your doctor’s instructions, there
are several things you can do to prepare yourself for surgery. You
may be asked to lose extra weight, since extra weight will put more
stress on your new knee. You may be asked to avoid aspirin for two
weeks before surgery to minimize bleeding. You may also be asked
to stop smoking to help decrease the chance of post-operative lung
complications.
You should also finish any dental work that may be needed to prevent
germs in your mouth from entering the bloodstream and infecting
the joint. It is also important for you to know that if you are
having dental work (after you have received your prosthesis) that
you inform your dentist about your joint replacement. He or she
may want to put you on an antibiotic to prevent the possibility
of an infection to your new joint. Also, if you develop an infection
such as respiratory or bladder infection, you should notify your
physician for the same reason.
A blood transfusion is often necessary after a knee surgery. You
may wish to donate several pints of blood prior to surgery. Then
if you require a transfusion you will receive your own blood. It
is important to note that when donating blood you must be healthy,
with no cold or flu, as you would get this same illness when your
blood is transferred at the time of surgery.
When making preparation for surgery, you should begin thinking about
your recovery following surgery. A patient with a new knee replacement
may need help at home for the first few weeks to assist with dressing,
getting meals, and other essential tasks. Therefore, you should
look into possibly finding somebody to help assist you or making
arrangements to stay a few weeks in an extended care facility.
To prevent blood clotting you may be fitted with elastic supported
stockings. You should wear them on both legs to the hospital the
morning of your surgery. These stockings will aid in the circulation
of your legs and feet to reduce the risk of blood clots. You will
also be asked to shower the day before and the day of the surgery.
You will be instructed to perform a 5 minutes scrub to the surgical
area using a provided antiseptic brush. The brushes contain a special
soap that will reduce the risk of infection so if you are allergic
to Iodine or soap please notify the nurse or your doctor as soon
as possible.
Finally, you may be instructed in deep breathing exercise to minimize
the risk of lung complications after surgery. These exercises are
necessary to remove any secretions that may settle in your lungs
while you are asleep during surgery. These exercises should be done
every one or two hours after surgery.
The Surgical Procedure top of page
Knee replacement is one of the most common forms of total joint
replacements. To begin the surgical procedure, the patient will
be given an anesthetic (usually a spinal unless contraindicated).
The surgeon will then make an incision and prepare the knee for
implantation of the prostheses by reshaping and resurfacing the
bones of the arthritic knee joint. The surgeon will then place and
secure the implants in the appropriate areas to replace the joints.
Ultimately, the damaged and rough surfaces of the knee joint will
be replaced with new, smooth-surfaced components. The lower knee
component will replace the roughened surface of the shin bone. The
upper knee component replaces the roughened surface of the thigh
bone. The kneecap component covers the underside of your kneecap.
When the surgery is finished, the incision will be closed and a
small tube (called a hemovac) will be placed in the incision to
help drain fluid from the operative area for the first day or so.
Complications of Knee Replacement Surgery top of page
Most complications that occur after knee replacement are successfully treatable. Possible complications after knee replacement include:
Infections:
Any infection in your body can spread to your joint replacement. Infections may occur while you are in the hospital or after you go home. Minor infections can be treated with antibiotics, while major infections may require surgery and removal of the prosthesis.
Blood Clots:
If there is a severe pain and / or swelling that develops in your calf or thigh, you may have developed a blood clot. Blood clots result from several factors, including decreased mobility that causes a slow movement of the blood through your leg’s veins. Your doctor may take preventative action to reduce the possibility of blood clots, such as blood thinning medications, elastic stockings, exercises that increase the blood flow in the leg muscles, or plastic boots that inflate with air to compress the muscles in your legs.
Loosening:
Loosening of the prosthesis within the bone may occur after knee replacement. If the loosening is significant and there is a large amount of pain, a revision surgery to correct the loosening may be necessary.
Wear:
Wear can be found in several joint replacements. Excessive wear can lead to loosening and pain and may require revision surgery.
Prosthetic Breakage:
Breakage of a knee replacement is extremely rare, but it can occur. If this case does occur, a revision surgery will be needed.
Nerve Injury:
Nerves in the vicinity of the total joint replacement can be damaged during the total replacement surgery. This type of injury is not common and may often improve and/or completely recover after some time.
Stiffness:
In some cases, the ability to bend the knee does not return to normal after an artificial knee replacement. Increased scarring after surgery can lead to an increasingly stiff knee. If this occurs, your surgeon may manipulate the knee to regain motion without injuring the joint.
It is also important to notify your surgeon or nurse if you experience any of the following symptoms:
1) Pain, soreness, swelling, or redness in the calf muscles of either leg.
2) Unexplained, increased pain in the operative area.
3) Redness, swelling, or puslike drainage from the area around the incision
4) Cough, high fever, or chills.
5) Chest pain, shortness of breath, or difficulty breathing. What to Expect After Knee Replacement Surgery top of page
After surgery, you will be taken to the Recovery Room for a period
of close observation. Your blood pressure, pulse, and temperature
will be monitored and close attention will be paid to the circulation
and sensation in your legs and feet. Post operatively, you may have
temporary nausea and vomiting due to anesthesia or medications.
(Anti-nausea medication may be given to you when you are in your
room to minimize nausea and vomiting.) It is also important to tell
your nurse if you experience any numbness, tingling, or extreme
pain in your legs or feet. When your condition is stabilized, you
will be transferred to your hospital room.
When you wake up from surgery, you will rest in bed with your bandaged
leg slightly raised by a pillow. A tube (called a hemovac) that
may have been placed in you during surgery will drain excess fluid
to keep swelling down, while an intravenous (IV) line may be used
to provide fluids for nourishment, medication to prevent blood clots,
and antibiotics to prevent possible infection. You may also have
a catheter placed to aid in urination. To relieve pain, you can
be attached to a special device that will allow you to get pain
medication when you feel it is necessary.
At first, you will be restricted to ice chips and clear liquids,
but your diet will be allowed to progress as your condition permits.
Meanwhile, the surgeon and physical therapist will work together
to set movement guidelines for you. The physical therapist may also
recommend some gentle exercises that will help strengthen your new
knee.
After total knee replacement surgery, it takes only a few months
to regain strength and confidence in your new knee. With the help
of your orthopedist and physical therapist, activities that you
were not able to do before surgery can be enjoyable again.
Hospital Recover and Rehabilitating After Knee Replacement Surgery top of page
Before knee replacement surgery, the patient’s problem knee probably
kept them from doing many activities. The decision to replace a
painful knee is the first step toward regaining control of your
life. The next step is to strengthen the replacement knee so one
can return to an independent and active lifestyle. Every patient
will have a different program and your doctor can give you a list
of home exercises that will best suit you and your new knee.
Once you are out of the hospital and in your own familiar setting,
it is easy to return to old habits. It is important that you continue
to follow your doctor’s instructions and that you continue to exercise.
To avoid injuries always think before you move and become more aware
of the possible hazards in your home. You may want to have your
living space rearranged and / or cleared to avoid falls and to make
it easier to get around. It is also important that you use handrails
on stairs and wear low -heeled shoes. Even though your home setting
is different from the hospital, use the same technique and precautions
that you learned at the hospital and be sure to keep your knee in
a safe position whether you are resting, exercising, walking, sitting,
or standing.
The key to a full recovery and becoming independent is to stick
with your recovery program and work at is consistently. Whatever
your goals are, you can reach them by mastering one step at a time.
Make a commitment to going a little further with each new step you
take!
Your Home Recovery After Knee Replacement top of page
Before knee replacement surgery, the patient’s problem knee probably
kept them from doing many activities. The decision to replace a
painful knee is the first step toward regaining control of your
life. The next step is to strengthen the replacement knee so one
can return to an independent and active lifestyle. Every patient
will have a different program and your doctor can give you a list
of home exercises that will best suit you and your new knee.
Once you are out of the hospital and in your own familiar setting,
it is easy to return to old habits. It is important that you continue
to follow your doctor’s instructions and that you continue to exercise.
To avoid injuries always think before you move and become more aware
of the possible hazards in your home. You may want to have your
living space rearranged and / or cleared to avoid falls and to make
it easier to get around. It is also important that you use handrails
on stairs and wear low -heeled shoes. Even though your home setting
is different from the hospital, use the same technique and precautions
that you learned at the hospital and be sure to keep your knee in
a safe position whether you are resting, exercising, walking, sitting,
or standing.
The key to a full recovery and becoming independent is to stick
with your recovery program and work at is consistently. Whatever
your goals are, you can reach them by mastering one step at a time.
Make a commitment to going a little further with each new step you
take!
Caring for and Keeping Your Knee Healthy top of page
Your knee prosthesis is the result of years of research. But like
any other device, your new knee’s lifespan depends on how you care
for it. In your follow-up visits after surgery, your doctor will
follow your progress and answer any questions that you may have
about caring for your new knee. It is important that you follow
these directions that your doctor advises you to follow. It is also
a good idea to keep the telephone numbers of your surgeon and therapist
handy so you will have them if you need them.
You can also keep your knee healthy by knowing the right moves and
avoiding the wrong ones. Some activities could harm your artificial
knee and may be permanently restricted. Below is a list of do’s
and don’ts:
DO
1) Do position your knee comfortably as you go about daily activities.
2) Do continue to exercise and walk everyday.
3) Do use an ice pack if your knee begins to swell or feel tender.
4) Do take small steps to turn your body.
DON’T
1) Do not twist your knee. Turn your entire body instead.
2) Do not jump because it could loosen your new knee joint.
3) Do not bend your knee too far.
Knee Replacement
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