Information For Patients Considering Total Knee Replacement

You have seen your MJRI doctor and are considering total knee replacement surgery. Total knee replacement surgery is performed to relieve pain and increase mobility of the knee joint. Hopefully, this will answer some of your questions and increase your understanding of the procedure. It is not meant to replace talking to your MJRI doctor or asking any questions.

Before Surgery

Total knee surgery is major surgery and requires careful preparation to get the best result. There is a lot to be done before surgery, and because of that you will find that the date of your surgery will be at least six weeks after your visit with your MJRI doctor. In this period of time you will be asked to do several things.

• You will be asked to visit your dentist (if you have teeth) as cavities or gum disease can be a source of infection that can travel to the knee during or after surgery, creating major problems. A visit to your dentist could prevent this.

• You may be asked to donate some of your own blood for your surgery in case you need a transfusion after surgery. (This is called autologous donation)

• You will be asked to get some preoperative lab work done at Brighton Medical Center or Mercy Hospital and meet with the anesthesiologist.

• You may be asked to see your primary care doctor or perhaps a specialist for evaluation to ensure you can tolerate the surgery well.

• You will be asked to come into the office approximately two weeks before the surgery for a history and physical examination and possibly x-rays. This will also allow you to have any additional questions answered. Any medications that you take will be reviewed at this time. You will also be informed if any of the medications need to be stopped or changed prior to the surgery.

Procedure

Total knee arthroplasty, sometimes known as total knee replacement, involves the cutting and resurfacing of bone from the end of the femur (thigh bone) and replacement with a metal implant. The top of the tibia (shin bone) is also cut and resurfaced and then replaced with a metal and plastic component. The kneecap (patella) is also resurfaced. This procedure generally takes about two hours in the operating room but takes 4-5 hours when you consider the preparation and recovery time in the recovery room. It may be done under either general or spinal anesthesia. Spinal anesthesia is often suggested as it is usually more comfortable for the patient. During the procedure a tourniquet is usually used to minimize blood loss. Despite this, there may be blood loss in the postoperative period that may require a transfusion.

As with any surgery, there are risks inherent with this procedure. The major risks for this procedure are the risks associated with anesthesia, risk of infection, risk of fracture, risk of phlebitis or blood clots in the legs.

After Surgery

After surgery you can expect to have some pain, but you will be given pain medication to control this. You will also be given antibiotics during surgery to prevent infections. Patients are also placed on a blood thinning agent to prevent blood clots. If necessary, you may be given a blood transfusion of your blood that you donated prior to surgery or blood bank blood if necessary.

Most patients having a total knee replacement are in the hospital for three to four days. If you live alone and have no one to help you at home, you may go to a rehabilitation or skilled nursing facility until you become more independent. Generally, your MJRI doctor likes to have his patients able to safely get in and out of bed, climb stairs, walk with crutches or a walker, and be progressing with knee motion before discharged from the hospital. While in the hospital you can expect to have physical therapy daily by a trained therapist, and your knee will be placed in a CPM (Constant Passive Motion) machine. This machine will constantly passively move your leg into flexion and extension, resulting in easier motion of your knee. You can expect to get out of bed to a chair the day of or the day after surgery. You will need to continue using a walker or crutches for about 5 weeks following your surgery. Immediately after surgery you will still have the intravenous lines in your arm that were started before surgery. These will be discontinued as soon as you are taking food and fluids well and are no longer requiring any intravenous medications. You will wear graduated compression stockings (TED hose) while in the hospital and will continue wearing these for two to six weeks (longer if you continue to have swelling in the operative leg). You need only wear these during the day and may remove them at night.

After Discharge

After leaving the hospital you will be walking on crutches or a walker. Physical therapy is necessary at your home for at least two weeks, and then at a facility near your home for two to three weeks until you reach 110-115° of flexion. Follow up appointments will be arranged with your MJRI doctor's office, and are arranged before surgery. Be sure to check the appointment times and dates. If necessary, you will be given pain medicine to take home with you . Also any other medications will be provided to you.

It is usually recommended that patients undergoing knee replacement surgery do not drive for six weeks after surgery because muscle weakness will slow reaction time. It is also wise to avoid situations where you might fall, be jostled, or otherwise injure your knee.

As mentioned above, dental infections or bad teeth can be a source of infection for a total knee even after the surgery is completed. For this reason it is wise to advise your dentist that you have had a total knee replacement surgery. For any dental procedures, including cleaning of your teeth, you should have antibiotic prophylaxis. This is generally a dose one hour before dental procedures. Other infections in the body, such as boils or bacterial infection, could also represent a source of problems for a person with total knee surgery. For this reason, if you have any infection you should consult your family doctor promptly so that proper treatment can be carried out.

Expectations

Total knee replacement surgery is major surgery and should not be undertaken lightly. It is wise to keep in mind when considering this surgery that even the best total knee replacement is not as good as your knee was when it was healthy. The goal of the surgery is to relieve your pain, if not totally, then at least somewhat. It is also the goal with this surgery that you will maintain reasonable stability and flexibility as well.

Even when you feel much better you must keep in mind that this metal and plastic knee is a mechanical device. Just like any mechanical device, including your automobile, there can be problems or failures. In general, total knee replacements last about ten years or more. It is hoped that in the future this period of time can be extended to 20 years. As with any medical procedure, there is no guarantee.

Even if you feel much better following your surgery it is wise that you avoid activities which cause marked flexion of the knee, high impact to the knee, or any twisting motions. It is advised that you walk with a cane until you can walk without a limp.

If you have any further questions, please feel free to call your MJRI doctor or his clinical assistant at (207) 828-2100.