Total Knee Replacement

What is a total knee replacement?

A total knee replacement is a procedure in which the surgeon removes an arthritic knee joint and replaces it with an artificial knee joint.

When is it used?

This procedure may be done when your knee joint is painful or is not working well and other treatments have not helped.

This surgery is usually not recommended if:

• You have active heart disease.
• You have severe lung disease.
• You are in frail health.

Alternatives to this procedure include:

• taking acetaminophen, aspirin, or other medicines for pain and inflammation
• limiting your activity (for example, avoiding squatting, going up or down stairs, and heavy lifting) and using a walking aid, such as a cane or walker
• using ice or heat to reduce pain and swelling.

Ask your healthcare provider about these choices for treatment.

How do I prepare for a total knee replacement?

Because you may need blood transfusions during the operation or during recovery, you may want to donate some of your own blood before the procedure. Blood should be donated within 4 weeks of the procedure.

Plan for your care and recovery after the operation, especially if you are going to have general anesthesia. Allow for time to rest and find people to help you with your day-to-day duties and care for at least the first week at home.

You may meet with a physical therapist before surgery to learn exercises that will help you after surgery.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any instructions your healthcare provider may give you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight on the day of the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You will be given a general or spinal anesthetic. A general anesthetic will relax your muscles and make you feel as if you are in a deep sleep. It will prevent you from feeling pain during the operation. A spinal anesthetic blocks pain in the lower part of your body. It should keep you from feeling pain during the operation.

The surgeon will put a tourniquet above your knee and make a cut from above the kneecap to below it. This will give the surgeon access to the knee joint. The surgeon will loosen the muscles connected to the joint and move the kneecap out of its place. The surgeon will remove the ends of the thigh and shin bones. He or she will then cement the artificial replacement parts to these bones. The surgeon may cement an artificial surface to the back of the kneecap. He or she will try to remove any excess cement and place a tube in the knee to drain any extra fluid from the cut. The surgeon will close the cut with stitches or staples and put a bandage and a splint around your knee.

You may need a blood transfusion. The hospital will either use blood you have donated or blood from a donor that matches your blood.

What happens after the procedure?

You may be in the hospital for 3 to 6 days, depending on how fast you heal. You will be encouraged to get out of bed (with help) as soon as the day after surgery. Depending on your overall medical condition and your living arrangements, you may be sent to a rehabilitation center for 1 week or more before returning to your home. You may have a catheter (tube) in your bladder if you are unable to urinate. You will start walking with a walker, crutches, or cane as soon as possible. You may use a continuous passive motion machine (CPM) to keep your knee moving and prevent stiffness.

The replacement knee is designed only for usual day-to-day activity. At first you will be restricted in your movements and will need some physical therapy for weeks to months after your surgery. You will not be able to participate in some sports or activities that involve squatting or jumping. Ask your healthcare provider to suggest physical activity that is safe for you.

If medicine to help prevent blood clots has been prescribed for you, be sure to follow your healthcare provider's instructions for taking this medicine.

Let your dentist and healthcare providers know that you have an artificial joint. If you have a dental infection or skin infection, you may need to start antibiotics right away. If you have a condition such as diabetes that puts you at higher risk for infection, you may need to take antibiotics before dental procedures or some kinds of surgery. For simple dental and surgical procedures, most people with replacement joints do not need to take antibiotics in advance, but you should check with your provider about this.

Constipation is common after joint replacement surgery. It is caused by narcotic pain killers as well as inactivity. You may be given a stool softener and a laxative after surgery to avoid this. When you are home again, be sure to eat a high-fiber diet and plenty of liquids according to your provider's recommendations.

Ask your provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

You may go back to a more normal life. The knee replacement should relieve the problems of a painful knee. It will be easier for you to walk and do other activities that use your knee.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. In older adults, mild to severe confusion can occur. Discuss these risks with your healthcare provider.
• If you have a spinal anesthetic, the anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used for this type of anesthesia.
• A blood clot may form in the veins, escape into the bloodstream, and block an artery in the lungs. Medicine to help prevent clots is usually given for several weeks after knee replacement to prevent this from happening.
• You may lose a lot of blood and need a blood transfusion. If you did not donate your own blood, the hospital will try to match your blood with donated blood. It is not always possible to avoid reactions with donated blood. You could also get a disease from donated blood, but the risk for this is low.
• Nerves may be injured from swelling or pressure and cause some numbness, but this is rare.
• You may have infection or bleeding.
• Your legs may not be the same length after the operation.
• The new joint may loosen over a period of time (over 10 to 15 years), but this happens only a small percentage of the time.

Ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have a fever.
• You are in uncontrollable pain.
• You become short of breath or cough up blood.
• You have excessive drainage from the wound.
• Your knee has unusual swelling, warmth, or redness.
• You have chest pain.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.

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