Knee Replacement Surgery

What is knee replacement surgery?

Knee replacement surgery is a procedure done to remove an arthritic knee joint and replace it with an artificial knee joint.

When is it used?

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

This procedure is usually not recommended if:

  • You are very young.
  • You have a knee infection or other infection that could spread to the knee.
  • You are paralyzed or have nerve disease affecting the knee.
  • You have a serious disease, such as cancer, that has spread to other parts of your body.
  • You have severe heart failure or advanced lung disease.
  • You are in frail health.
  • You are very overweight (over 300 pounds).

Alternatives to this procedure include:

  • Taking acetaminophen, aspirin, or other medicines for pain and inflammation
  • Limiting your activity and using a walking aid such as a cane or walker
  • Avoiding activities that make the pain worse, such as squatting, going up or down stairs, and heavy lifting
  • Using ice or heat to lessen pain and swelling.

Ask your healthcare provider about these choices.

How do I prepare for knee replacement surgery?

Talk to your knee surgeon about what he or she expects before and after surgery. Read the general information given to you by the surgeon’s office. Ask your surgeon for more precise information if you are unsure of what might be happening. Also talk to several people who have had a knee replacement to get an idea of what the procedure and recovery time are like.

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. You should donate blood no more than 4 weeks before the procedure.

Plan for your care and recovery after the operation. Allow for time to rest and find people to help you with your care and day-to-day duties 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. If you can, increase your leg motions and general exercise before surgery. The fitter you are, the easier time you will have recovering from the surgery. Everyone can improve a little bit. Getting yourself into an exercise habit helps you continue good exercise habits 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 these reasons, 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. Plan to stay smoke free for several months after surgery. Quitting forever would be good to do if you can.

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 regional or general anesthetic. A regional anesthetic numbs the lower part of your body while you stay awake. A general anesthetic relaxes your muscles and puts you to sleep. Both types of anesthesia 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 (patella) out of its place. This gets the knee joint open and ready for the artificial parts. New techniques reduce how much muscle is cut and how far the kneecap is moved. With less stretch and moving around, your recovery soon after surgery goes faster. Most surgeons have moved to this new technique, called less invasive total knee surgery. Ask for this technique if you can get it.

The surgeon will remove the ends of the thighbone (femur) and shin bone (tibia). 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. The kneecap then is moved back into place.

Your surgeon 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 use either blood you have donated or blood from a donor that matches your blood.

What happens after the procedure?

You will be encouraged to get out of bed (with help) as soon as the day after surgery. 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.

Many people are able to go home after a few days in the hospital. If you and your surgeon think you might need extra help with recovery, you may first go to a rehabilitation center for 1 week or more before returning to your home. Deciding between going home or to a rehab center depends on your fitness, your ability to cope, other medical problems you have, and whether or not you have help at home.

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.

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.

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. Ask for a list of good, OK, and bad exercises.

Most people who have had a knee replacement can go back to their usual activities 3 to 6 weeks after surgery. You should keep exercising your knee with range-of-motion and strengthening exercises. Most people find that they can get stronger than before the surgery, but building up that strength takes lots of time. You will probably have to wait at least 3 months before you can do strenuous activities like climbing and running. If you were athletic or a vigorous exerciser before your knee problems developed, you will need to work up to higher levels of exercise gradually. The more you can strengthen you legs, the more you will enjoy the new knee.

Use a calendar or journal to keep track of what you think is happening each day from just before your surgery to several months after the surgery.

Ask your provider what other steps you should take and when you should come back for a checkup. When you have knee surgery, a few regular follow-up visits are part of the service of having the surgery. These are for wound checks and to give you recovery advice close to the time you need it. Be sure to keep these appointments.

Will I need to take antibiotics to prevent infection in the artificial knee?

Some healthcare providers may recommend taking an antibiotic before and right after you have a dental or medical procedure or surgery. This may be done to help prevent an infection around the knee replacement. However, such infections are rare, and it’s not clear from studies that taking antibiotics before a procedure helps prevent an infection.

If you do get some other infection (such as a bad gum infection or sinus, bladder, or skin infection), the infection should be treated right away. Let all of your healthcare providers, including your dentist, know that you have an artificial joint. If you are having infections treated with a procedure (like deep cleaning of bad tooth and gum problems, or sinus surgery for infections), talk to your provider about having preventive antibiotics to protect your knee.

What are the benefits of this procedure?

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. Most people get back to a more normal life.

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 regional 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, move 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 around your knee may be injured from swelling or pressure. Rarely, this can cause some numbness.
  • 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 have uncontrollable pain.
  • You become short of breath or cough up blood.
  • You have foul-smelling drainage coming from the surgical 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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