TOTAL KNEE REPLACEMENT

Replacing Worn Knee Joint

You use your knee every time you take a step.  Because of this, living with a worn or injured knee joint can be painful and frustrating.   Even simple things, such as squatting to pick up the morning paper, may cause pain.   But you don't have to live this way.  In many cases,  an orthopaedic surgeon (a doctor who treats bone and joint problems) can replace the damaged knee joint.   The surgery is safe and effective.  For many people, having a total knee replacement means a return to pain-free-movement. 

A Problem Knee
No matter what your age, a problem with the knee joint may keep you from activities you enjoy.  Pain and stiffness may even limit the daily tasks you can do.  Problems with the knee joint tend to build up over time.  Your knee pain may be caused by any of the following:

• A bad injury that did not heal properly
• A chronic illness
• Wear and tear from years of constant use

• Stops or greatly reduces joint pain.  Even the pain from surgery should go away within weeks.
• Increases leg strength.  Without knee pain, you'll be able to use your legs more.  This will build up your muscles.
• Improves your quality of life by allowing you to do daily tasks and low-impact activities in greater comfort.
• Provides years of easier movement.  Most total knee replacements last for many years

How the Knee Works A healthy knee bends easily.  The joint absorbs stress and glides smoothly.   This allows you to walk, squat, and turn without pain.   But when the knee is damaged, the joint may lose its ability to cushion stress.   You may feel pain during movement.  Sometimes a damaged knee joint will swell and hurt even when you are at rest. A Healthy Knee The knee is a hinge joint, formed where the thighbone and shinbone meet.    When the knee is healthy, the joint moves freely.  This is because the joint is covered with slippery tissue and powered by large muscles.

• Cartilage is a layer of smooth, soft tissue.  It covers the ends of the thighbone and shinbone, and it lines the underside of the kneecap.  Healthy cartilage absorbs stress and allows the knee to glide easily.
• Ligaments are another type of soft tissue.  They hold the bones of the joint together.
• Muscles power the knee and leg for movement.
• Tendons attach the muscles to the bones.

A Damaged Knee
When one or more parts of the knee are damaged, joint movement suffers.    Over time, cartilage starts to crack or wear away.  Because cartilage cannot fully repair itself, the damage may keep increasing.  At first, your knee may just be a little stiff.  But as the bones of the joint begin rubbing together, you're likely to feel pain.

Osteoarthritis
Years of normal use can cause cartilage to crack and wear away (osteoarthritis)>  As exposed bones rub together, they become rough and pitted.    The joint grinds.  Being overweight or having an alignment problem, such as knocked or bowed knees, puts extra force on the joint.  This may speed up the damage.

Inflammatory Arthritis
A chronic disease, such as rheumatoid arthritis or gout, can cause swelling and heat (inflammation) in the joint lining.  As the disease progresses, cartilage may be worn away and the joint may stiffen.

Injury
A bad fall or blow to the knee can injure the joint.  If the injury does not heal properly, extra force may be placed on the joint.  Over time, this can cause the cartilage to wear away (traumatic arthritis).

Is Surgery Right for You?

Your doctor may have tried to reduce your knee pain with medications.  You may even have had minor surgery (arthroscopy) to help treat the problem.  But if this didn't help enough, total joint replacement might be right for you.  To find out, your surgeon will evaluate your knee joint.  You'll have a full exam and x-rays.   When forming a treatment plan, your surgeon thinks about how surgery can best benefit you over your lifetime.

Your Medical History
Your surgeon will ask you about any past medical problems.  He is likely to ask where your knee hurts and what makes the pain worse.  Tell him about any other joint problems or any injuries to your knee or leg.  If surgery see,s likely, be sure to mention any past problems with anesthesia or bleeding.

Your Physical Exam
Your surgeon will fully examine your knee.  He will feel for swelling around the joint.  Nearby muscles and tendons may also be checked.  The joint itself will be tested for strength and stability, and range of motion.  You surgeon may also look for other problems, such as a pinched nerve, that may be causing pain in or near the knee.

Your Treatment Plan
Your surgeon uses the results of your exam and tests to form a treatment plan that is right for you.  Depending on your age and the amount of damage to your knee, surgery may offer the best answer to your problem.  A total knee replacement lasts many years, and it can often be repeated if the first prosthesis wears out.  But if you are still fairly young, your surgeon may suggest delaying surgery.  In this case, medications or arthroscopy may help control your symptoms until the time is right for joint replacement.

Getting Ready for Surgery

You may want to make a few simple changes around the house before surgery.  This will help make life easier during recovery.  Before to see your primary care doctor or dentist.  Treating health and dental problems ahead of time helps improve healing after a joint replacement.  If you're a smoker, do your best to stop or cut down.   Your surgery risks and recovery rate will improve.

Prepare at Home
Make life easier and sager after surgery.  Reduce household hazards now.    Also, limit the amount of reaching and stair climbing you'll have to do.  

Arrange for Help
After your knee replacement, you won't be able to drive for the first few weeks.    Perhaps a family member or friend can deliver groceries and help you run errands.   If you live alone, ask someone to stay with you for a few days after surgery.   By planning ahead now, you'll have less to worry about during recovery.

See Your Doctor
Your primary care doctor makes sure that you're in shape for surgery.  You may have an ECG (electrocardiogram) to find out what type of anesthesia is best for you.    You also may have a chest x-ray, and lab or blood tests.  Your doctor will talk with you about any health problems such as diabetes and high blood pressure, that need to be treated before surgery.

Finish Dental Work
Have tooth or gum problems treated before surgery.  Also, finish any dental work that is under way.  If you don't, germs in your mouth could enter the bloodstream and infect the new joint.  This could delay your recovery.  In an extreme case, an infection in the new joint might mean that the prosthesis would have to be removed.

Donating Blood
Blood lost during surgery may need to be replace.  Donating your own blood ahead of time is often best, since there is  less risk of reaction this way.  If necessary, blood can be provided by a blood bank.  This blood is always screened to rule out disease.

Your Knee Replacement Surgery

You will most likely arrive at the hospital on the morning of surgery.  In many cases, pre-op tests are done days or even weeks ahead of time.   Follow all of your surgeon's instructions on preparing for surgery.  When you arrive, you'll be given forms to fill out.  You may also talk with the anesthesiologist if you haven't done so already.  It's normal to feel a little nervous.  But rest assured: This is a common surgery that tends to have very good results.

Preparing for Surgery
You will be told when to stop eating and drinking before surgery.  If you take a daily medication, ask if you should still take it the morning of surgery.  At the hospital, your temperature, pulse, breathing, and blood pressure will be checked.  An IV line may be started to provide fluids and medications needed during surgery.

Risks and Complications
As with any surgery, total knee replacement has possible risks and complications.    These include the following:

• Reaction to the anesthesia
• Blood clots
• Infection
• Damage to nearby blood vessels, bones, or nerves
• Dislocation of the kneecap

The Surgical Procedure
When the surgical team is ready, you'll be taken to the operating room.    There you'll be given anesthesia will help you sleep through surgery, or it will make you numb from the waist down.  Then an incision is made on the front or side of your knee.  Any damaged bone is cleaned away, and the new joint is put into place.   The incision is closed with staples or stitches.

Preparing the Bone
All of the bone surfaces of the joint are shaped to hold the prosthesis.    Then the parts of the prosthesis are put in place.  At this point, your surgeon tests the fit and alignment of the prosthesis.

Joining the New Parts
If the prosthesis fit correctly, its parts are secured to the thighbone, kneecap, and shinbone.  Then these parts are joined.  Together they form the new joint.

Your Hospital Stay

You'll be moved to your room when you are awake.  By then your family or a friend will be able to join you.  You can expect to feel some pain.  To gain the best pain relief, answer honestly when you are asked how badly you hurt.  Soon after surgery, special trained therapists will start working with you.   For the quickest, safest recovery, practice what they teach you.

Special Therapies
During your hospital stay, you'll learn skills that will help you return to normal life.  You will be shown how to strengthen your leg, walk, and clear your lungs.  To make moving easier, use the PCA pump or ask for pain medication before your physical therapy sessions. (PT sessions).

Gaining strength

Your PT program is likely to start with gentle exercises.   You may be shown ways to increase blood flow and control swelling.  Working the quadriceps muscles (in the from of your thigh) builds leg strength.  This helps protect your new joint by keeping the knee more stable.  Exercises also help you bear weight without pain - a goal you can work toward.

Walking Again
You may begin to stand and walk within hours after surgery.  An IV and catheter are likely to still be in place, so using the walker may be a little tricky.    But don't worry.  A physical therapist will help you.  You will be taught how much weight, if any, to bear on your new joint.  With practice, you'll soon be able to walk with just the aid of a walker.

Clearing Your Lungs
Fluid can collect in the lungs after any surgery>  To avoid pneumonia, breathe deeply and cough.  You should do this often - a few times and hour, at least.  A respiratory therapist or nurse may show you how to use an incentive spirometer.  This machine can help you breathe more deeply.

During Your Recovery

Whether you're recovering at home or in a rehabilitation facility, you need to protect your new knee.  Practice your exercises. Those shown here help build strength and increase range of motion.  For the best recovery, avoid risky moves and see your surgeon for scheduled follow-up visits.  Return to activity slowly, and don't be surprised if your new joint feels a little stiff at first.

See Your Surgeon
Post-op visits allow us to make sure your knee is healing well.  Sutures or staples are often taken out about two weeks after surgery.

When to Call Your Surgeon
Call us if you have any of the symptoms below:

• An increase in knee pain
• Pain or swelling in a calf or leg
• Unusual redness, heat, or drainage at the incision site
• Trouble breathing or chest pain
• Fever over 101º F

Avoiding Risky Moves
Some movements put too much strain on the new joint.  This could cause the prosthesis to wear out more quickly.  Protect your new joint:

• Do not twist your knee, as can happen when you turn your body without moving your feet.
• Do not perform high-impact activities, such as running, jumping, race walking, or playing basketball.

Returning to Activity
To build strength, practice walking everyday.  Try to do more each week.    But be aware that some days you will feel better than others.  You may be ready to drive or return to a desk job about a month after surgery.  If you do more active work, you may need to wait 3 or 4 months before going back.  Total knee replacement is a major surgery, so don't be surprised if it takes a few months before you feel really good.

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