Total knee replacement

Total knee replacement is a common operation I do for arthritis of the knee. The success rate is about 95% with today’s technology, so you won’t have much to worry about. Here are answers to some of the most commonly asked questions.

WHY DO I NEED X-RAYS?
X-rays provide us with a road map of your knee. They tell us how severe the arthritis is and give us an idea of the proper size of the knee replacement which will be necessary, and tell us if we need to take into consideration the overall alignment of your leg. If any special techniques will be required to repair the problem (such as bone grafting, or a special type of knee prosthesis), these too can be determined by evaluation of your x-rays.

WHEN WILL I BE ADMITTED TO THE HOSPITAL?
We are all concerned with the rising cost of health care. We are lucky to be living in the United States where we can have access to the best health care system in the world. We have to protect that privilege. For that reason, we will not admit you into the hospital until just before your total knee replacement. In some cases, that will be the morning of the operation (this is due to Medicare regulations), or if your operation is the first case in the morning you will be admitted shortly after midnight on the day of your operation. You can expect that your preoperative blood tests, electrocardiogram, chest x-ray, and other studies will be completed approximately one week before your surgery as an outpatient.

WHAT HAPPENS BEFORE SURGERY?
Before your admission to the hospital, you will be seen in our office for preoperative planning of your surgery. An autologous blood donation schedule will be determined for you. With autologous blood donation, you will donate two or three units of your own blood at the hospital blood bank. This is done within the month preceding your surgery. Your own donated blood will be then given back to you during or after your surgery. Autologous blood donation admonishes the risks of blood transfusions, particularly exposure to the HIV virus (AIDS virus), and the hepatitis virus. Supplemental iron therapy will also be prescribed at the onset of your autologous blood donation program. Approximately one to two weeks before your surgery, you will be seen in our office for a preoperative examination during which your health history will be reviewed and a physical examination will be performed.

After your admission to the hospital, you will meet the nurses who will be taking care of you. They will show you around the orthopedic floor, and will answer questions about how to get any assistance you need. Before surgery, the nurse will assist you in cleansing your operative knee area to prevent infection. You may have an intravenous line inserted. You will not get an enema!

Post-op pain management is determined individually for each patient. The options include IM injections, Patient Controlled Analgesia (PCA), or Epidural. PCA dispenses medication at the push of a button into an I.V. line. The epidural is similar to a spinal. The post-op pain system is determined by each patient’s need and hospital protocol.
You will also be instructed in the use of the continuous passive motion machine (CPM machine). This is a machine that is applied to your knee postoperatively to assist in straightening and bending your knee.

HOW LONG DOES THE SURGERY TAKE?
As the wise old orthopedic surgeon once said, "The time it takes to do the operation is the time it takes to do it right!" Usually about an hour and a half gives us the time to position you for the surgery, wash your knee and prepare the skin for surgery, do the operation, wake you up, and move you to the recovery room. You can anticipate being in the recovery room for an hour before going back to your room. Ask your family to wait in the surgical waiting room, and I will be looking forward to telling them about your total knee replacement.

HOW LONG WILL I BE IN THE HOSPITAL?
This depends on how quickly you heal and how quickly you regain your strength, usually five days. Immediately following the surgery, the CPM machine will be applied to the knee to begin gentle flexibility exercises. We will start slowly by helping you get out of bed on the first day after your surgery, You will be a little sore but it will get easier each time, besides you will have plenty of help! Not only are the nurses specially trained, but we have a physical therapist who will assist you. You will learn how to get into and out of bed the proper way and how to get to the bathroom and care for yourself. (Don’t be concerned, our staff has lots of patience and plenty of experience!) In addition to the CPM machine, a physical therapist will also assist you with straightening and bending your knee as well as learning how to walk properly using a walker while in the hospital. When you are able to get into and out of bed yourself, get into and out of the bathroom, and can walk without assistance, you will be ready to go home, If you need additional assistance at home in the way of home health care, we will help you arrange that too.

"HOW ‘BOUT THAT THERAPY DOC?"
I always tell my patients that there are two parts to the operation. The first is the part that I do, and that usually finishes when they leave the hospital. The second is the part that they do, and that begins the moment they wake up.
We will start you with gentle range of motion exercises and the continuous passive motion (CPM) machine. The CPM will help you get going but it is not the answer to getting a perfect result from a knee replacement. The only good answer is hard work. You will need work at least five times a day and preferably every hour to get flexibility of the knee. Work on straightening it and work on bending it-particularly at the extremes of motion (that’s where we need to make progress). After flexibility comes strength. By about three month you won’t need very much more in the way of exercise except just to keep the knee strong. It is very important to start the therapy early and to diligently complete it. Otherwise the result will not be as good as either you or I would like to see.

WHEN WILL YOU SEE ME AGAIN?
Home Health Care Nurses will take our your staples (we don’t use stitches on the skin anymore!) about ten days after your surgery. You will work on exercises to gain strength and flexibility in your knee at home. Out patient therapy will begin two weeks after surgery. About a two weeks after your surgery, we will see you in the office, sooner if there are problems.

HOW LONG WILL I USE THE WALKER?
You will use the walker for six weeks and then a cane for six weeks longer or until you have recovered your strength and can walk without a limp. If you had surgery on your left leg, you can drive in two to three weeks. If it is your right leg, you can drive when you have regained good control of your leg muscles. This can take from three to six weeks. You can gradually resume usual activities, as you become stronger. We will give you specific guidelines.

WHAT ACTIVIITES CAN I PARTICIPATE IN AFTER MY SURGERY?
Pretty much whatever you like. Walking, dancing, bowling, doubles tennis, swimming, bicycling, boating, fishing – you name it and we will tell you! We do not recommend contact sports like football, or jarring sports like running.

See our animated knee anatomy.