Total Knee Replacement

Total knee replacement is one of the most successful surgical procedures. The first knee replacement was performed more than 35 years ago. Today, more than 400,000 procedures are being performed every year in the United States alone. It is a fairly routine procedure. Total knee replacement, also called Total Knee Arthroplasty, involves removing the diseased bone and cartilage and resurfacing it with orthopaedic implants.

The word “replacement” gives the impression that your surgeon is removing the entire knee. However, your surgeon will only resurface the damaged bone and cartilage of your joint. During surgery, the joint is exposed by an incision, made down the center or off to the side of the knee. The damaged bone ends are then resurfaced with components designed to re-create the natural contours of the bones in a healthy knee. The metal and polyethylene (plastic) implants allow the bones to smoothly glide against each other, like your natural cartilage.

Total knee replacement is performed while you are under anesthesia. There are various types of anesthesia available and your surgeon will explain the options before your surgery.

The length of surgery may vary from approximately one to two hours. Care before surgery and time spent in the recovery room can add an additional one or two hours to the procedure.

Complications/Risks

Joint replacement surgery is a major operation. As with any major operation, there are possible complications. Some of these are related to the anesthesia, while others are associated with the joint surgery itself. Every possible effort is made by the medical team to prevent complications, but this cannot be accomplished without your participation.

Therefore, it is important that patients know about the following, which include, but are not limited to, infection, blood clots, implant breakage, malalignment and premature wear. Any of these can require additional surgery. Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as a patient’s post-surgery activities and weight can affect longevity. Your surgeon will discuss these and other risks with you.

There are many things that your surgeon will do to minimize the potential for complications. Your surgeon may have you see your family physician before surgery to obtain tests. You also may need to have any upcoming dental work completed or prepare your home to avoid any post-surgery falls.

After Surgery

After surgery you will receive pain medication and begin physical therapy. It is important to start moving your new knee as soon as possible after surgery to promote blood flow, to regain knee motion and to facilitate the recovery process. You may be out of bed and walking with crutches or a walker within 24 hours of your surgery.

You will be shown how to safely climb and descend stairs, how to get into and out of a seated position and how to care for your knee once you return home. It is a good idea to enlist the support of family or friends to help you when you return home.

You will be shown a variety of exercises designed to help you regain mobility and strength in your knee.

Most patients are ready to go home between three to five days after surgery; however, some people may go to a separate rehabilitation facility, which your surgeon should discuss with you before surgery. Many patients will go directly home and begin supervised therapy either at home or as an outpatient.

Recovery

Exercise is necessary for proper healing. Therapy will begin in the hospital and usually continues after discharge for approximately six weeks.

Physical therapy, a healthy diet and willingness to follow all of your surgeon’s recommendations will contribute to a more successful recovery after surgery. Most patients are able to walk without support and drive three to six weeks after surgery. Activities such as golf, doubles tennis and swimming can usually be resumed, but only after a thorough evaluation by your surgeon. Recovery time will vary for each patient.

High-impact activities or contact sports are typically not recommended. These types of activities place an extreme amount of pressure on the joints, which could lead to complications. Your surgeon will discuss this with you.

Your surgeon will schedule a follow-up appointment for six months and every year following your surgery to evaluate your progress. It is important to see your surgeon if you notice any unusual changes regarding your new joint.