Knee replacement surgery is designed to reconstruct a damaged or nonfunctional knee joint with an artificial implant. Typically only the joint surface is replaced leaving the muscles and ligaments in place and attached. The actual device used is chosen by your surgeon for your specific size and condition and is called a knee prosthesis or implant.
You will receive an anesthetic chosen for your individual medical condition before this surgery. This means you will be comfortable and unaware during the operation and unable to feel pain.
After you are comfortable under the anesthesia, your surgeon will make an incision (cut) on the front of your knee to expose the damaged joint. Then your surgeon will:
- Shape the ends of your thigh bone and shin bone by removing the damaged surfaces to fit the prosthesis exactly. Your surgeon will also trim the underside of your kneecap to prepare it for an artificial surface that will be attached there.
- Secure the new prosthesis to your bones. All the worn and damaged surfaces of your old knee will be renewed with metal and plastic parts rigidly fixed to your bone. Your surgeon will use a special bone cement to attach these parts.
- When the parts have been installed your muscles will power the implant and your ligaments will stabilize it just as they did in your natural knee.
- After wound closure and dressings are applied, you will return to the recovery room and then to your hospital room to begin your rehabilitation.
- Special methods of pain management will be used by your surgeon to allow early walking and movement of the knee in the first day to ensure a rapid recovery.
Knee replacement may be recommended for
- Severe arthritis (osteoarthritis or rheumatoid arthritis) of the knee that has not gotten better with medicine, injections, or physical therapy. Surgery is used when nonoperative methods have failed to allow pain relief and function.
- Inability to sleep through the night because of knee pain
- Knee pain from structural damage to the joint that has not improved with other treatments.
- Knee pain that limits or keeps you from being able to do your normal and necessary activities, especially your daily activities such as bathing, preparing meals, household chores, and other things.
- Structural damage to the joint from injury or trauma.
Before the procedure
- Be sure tell your doctor or nurse what drugs you are taking, whether it is prescription medication or drugs, supplements, or herbs you bought without a prescription
- Two weeks before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs or dietary supplements.
- Ask your doctor which drugs you should still take on the day of your surgery.
- If you have diabetes, heart disease, or other medical conditions, your surgeon will likely ask you to see your personal medical doctor who treats you for these conditions.
- You will find that attending our pre-op Joint Replacement Class is very informative and calming as you look forward to this big step in improving your health and well being.
- You will have a large dressing (bandage) over your knee. A small drainage tube will be placed during surgery to help drain fluids that build up in your knee joint after surgery. It will be removed in the first day when you no longer need it.
- You will have an IV (a tube that is inserted into a vein, usually in your arm). You will receive fluids and medications through the IV until you are able to drink on your own.
- You may have a urinary catheter inserted into your bladder to drain urine. Usually it is removed the day after surgery.
- You may wear special compression stockings hooked to a pump at your bedside on your legs. These stockings improve blood flow and reduce your risk of getting blood clots.
- Most people will also receive blood-thinning medicine to further reduce the risk of blood clots. This may begin before you enter the hospital to increase its effectiveness.
- Your doctor will prescribe pain medicines to control your pain. This is very important to your recovery and we will closely monitor your pain control needs during your stay. Your doctor will also prescribe antibiotics to prevent infection.
- You will be assisted to sit at the edge of a bed by the nursing staff the evening of your surgery.
- A physical therapist will work with you the day after surgery to help you get out of bed and to a chair. You will even be able to walk a short distance.
- By the second day, you will be encouraged to do as much as you can for yourself, with staff assistance for safety. This includes going to the bathroom and taking walks in the hallways. You will need to be as independent as possible when you go home so the team will encourage your progress.
Most patients stay in the hospital three nights. Some people may require a short stay in a rehabilitation center or a skilled nursing unit after they leave the hospital and before they go home. This will be assessed and arranged in the first few days after surgery.
The results of a total knee replacement are routinely excellent. The operation effectively relieves pain and most people are walking on their own without assistance soon after the procedure. Most artificial knee joints can last more than 20 years. Some may last longer depending on the activity of the patient and how they take care of their new joint. Loosening and wear are the common ways that these implants can fail with time.
People who have prosthesis, such as an artificial joint, need to carefully protect themselves against infection. You should carry a medical identification card in your wallet that says you have a prosthesis. You should take antibiotics before any dental work or invasive medical procedures likely to cause bacterial contamination.