Total Knee Replacement
If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down. If nonsurgical treatments like medications, injections, and walking supports are no longer helpful, you may want to consider total knee replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.
When Surgery is Recommended
There are several reasons why Dr. Antebi or Dr. Sherfey may recommend knee replacement surgery. People who benefit from total knee replacement often have:
- Severe knee pain or stiffness that limits your everyday activities
- Moderate or severe knee pain while resting, either day or night
- Chronic knee inflammation and swelling that does not improve with rest or medications
- Knee deformity — a bowing in or out of your knee
- Inadequate pain relief from anti-inflammatory medications, injections, or physical therapy
Candidates for Surgery
There are no absolute age or weight restrictions for total knee replacement surgery.
Recommendations for surgery are based on a patient’s pain and disability, not age. Most patients who undergo total knee replacement are age 50 to 80, but Orthopedic surgeons evaluate patients individually. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.
How Your New Knee is Different
Improvement of knee motion is a goal of total knee replacement, but the restoration of full motion is uncommon. The motion of your knee replacement after surgery can be predicted by the range of motion you have in your knee before surgery. Most patients can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently to climb stairs and get in and out of a car. Kneeling is sometimes uncomfortable, but it is not harmful.
Most people feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities. Most people also feel or hear some clicking of the metal and plastic with knee bending or walking. This is normal. These differences often diminish with time and most patients find them to be tolerable when compared with the pain and limited function they experienced prior to surgery.
Extending the Life of Your New Knee Implant:
Currently, more than 90% of modern total knee replacements are still functioning well over 15 years after the surgery. Follow your surgeon’s instructions after surgery to take care and protect your new knee replacement. After surgery, make sure you participate in regular light exercise programs to maintain proper strength and mobility of your new knee. Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery. See Dr. Antebi or Dr. Sherfey periodically for a routine follow-up examination and x-rays, usually once a year.
How is it Performed?
A KNEE REPLACEMENT (also called Knee Arthroplasty) or more accurately termed a knee “resurfacing” because only the surface of the bones are actually replaced. There are four basic steps to a knee replacement procedure.
- Prepare the Bone: The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
- Position the metal Implants: The removed cartilage and bone is replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or “press-fit” into the bone.
- Resurface the Patella: The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case
- Insert a Spacer: A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.
Dr. Sherfey or Dr. Antebi will remove the damaged cartilage and bone, and then position the new metal and plastic implants to restore the alignment and function of your knee. The surgical procedure takes 45 minutes to 1 hour.
After surgery, you will be moved to a recovery room monitored by nurses where you will remain for several hours while you recover from the anesthesia. You will most likely go home within a few hours after surgery if needed you will be kept overnight for further monitoring.
Preparing for Surgery
FOLLOW ALL PRE-OPERATIVE INSTRUCTIONS given to you by Dr. Sherfey or Dr. Antebi. Stop all Aspirin, blood thinners, and anti-inflammatory medications (Motrin, Aleve) 10 days prior to surgery as then can cause bleeding during surgery. DO NOT STOP your blood thinners without consulting your primary care physician first.
Stop any naturopathic or herbal medication 10 days prior to surgery as these can also cause bleeding. Continue with all other medications unless otherwise specified. Bring a list of ALL medication with you on the day of surgery to give to the anesthesiologist. You are advised to STOP SMOKING for as long as possible prior to surgery.
An important factor in deciding whether to have surgery is understanding what the procedure can and cannot do. More than 95% of people who have surgery experience a dramatic reduction of pain and a significant improvement in the ability to perform common activities of daily living. But surgery will not allow you to do more than you could before you developed arthritis. With normal use and activity, every replacement or implant begins to wear. Excessive activity or weight may speed up this normal wear and may cause the replacement or implant to loosen and become painful.
Your surgeon may ask you to schedule a complete physical examination with your primary care physician four weeks before the operation especially if you preexisting medical conditions. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist such as a cardiologist, before the surgery.
Several tests, such as blood and urine samples, and an electrocardiogram, may be needed to help Dr. Antebi & Dr. Sherfey plan your surgery.
Tell your surgeon about the medications you are taking. He will tell you which medications you should stop taking and which you should continue to take before surgery.
Losing weight prior to surgery can help minimize stress on new knee and decrease surgical risks.
Dental Evaluation Although the incidence of infection after surgery is very low, an infection can occur if bacteria enter your bloodstream. To reduce the risk of infection, major dental procedures (such as tooth extractions and periodontal work) should be completed before your surgery.
Urinary Evaluation People with a history of recent or frequent urinary infections should have a urological evaluation before surgery. Older men with prostate disease should consider completing required treatment before undertaking surgery.
Social Planning Although you will be able to walk on crutches or a walker soon after surgery, you will need help
for several weeks with such tasks as cooking, shopping, bathing, and doing laundry. If you live alone AVORS, a case
manager, or a discharge planner at the hospital can help you make advance arrangements to have someone assist
you at home.
Most patients go home the same day of surgery, but some may go home the following day.
Your Recovery at Home The success of your surgery will depend largely on how well you follow your surgeon’s specific instructions at home during the first few weeks after surgery. Elevate your leg on pillows several times a day to help reduce swelling. Do not place a heat pad on your knee. It is important to have a balanced diet (often with an iron supplement) to promote proper tissue healing and restore muscle strength. Drink plenty of Water!
You will be given wound care instructions when discharged home. It is normal to have some blood oozing under the dressing, however if the dressing becomes saturated, you can change the dressing with gauze and an ace bandage. Remove the dressing 1 week after surgery. You will have stitches, staples, or a glued sterile mesh (most commonly used) on the skin. The stitches, staples, or mesh will be removed at your follow-up appointment usually 2 weeks after surgery. You can shower after you remove the dressing 1 week after surgery. Wash the would gently with soap and water while showering. Avoid soaking the wound in water such as a bath or jacuzzi. You may continue to bandage the wound to prevent irritation from clothing or support stockings.
Surgery pain is a common concern for most patients. Dr. Antebi & Dr. Sherfey utilize advanced techniques intreating post operative pain. This includes medications given prior, during and after your surgery. After your surgery, you may experience a minimal amount of pain. Your surgeon will provide medication to make you feel as comfortable as possible. Ice packs should be used regularly to reduce swelling and pain.
Activity and Exercise
This is a critical component of healing, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within 3 to 6 weeks following surgery. Some pain with activity and at night is common for several weeks after surgery.
Your activity program should include:
- A graduated walking program to slowly increase your mobility, initially in your home and later outside
- Resuming other normal household activities, such as sitting, standing, and climbing stairs
- Specific exercises several times a day to restore movement and strengthen your knee
You will most likely be able to resume driving when your knee bends enough that you can enter and sit comfortably in your car, and when your muscle control provides adequate reaction time for braking and acceleration. Most people resume driving approximately 4 to 6 weeks after surgery.
Time Off Work
This depends on your work requirements. Oﬃce workers usually require 2-3 weeks oﬀ and manual laborers 2-3 months oﬀ.
It is common for patients to have shallow breathing in the early postoperative period. This is usually due to the eﬀects of anesthesia, pain medications, and increased time spent in bed. This shallow breathing can lead to a partial collapse of the lungs (termed “atelectasis”) which can make patients susceptible to pneumonia. To help prevent this, it is important to take frequent deep breaths. Your nurse may provide a simple breathing apparatus called a spirometer to encourage you to take deep breaths.
A fall during the first few weeks after surgery can damage your new knee and may result in a need for further surgery. Stairs are a particular hazard until your knee is strong and mobile. You should use a cane, crutches, a walker, hand rails, or have someone to help you until you until you have improved your balance, flexibility, and strength.
Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:
- Safety bars or a secure handrail in your shower or bath & a stable shower bench or chair for bathing
- Secure handrails along your stairways & removing all loose carpets and cords
- A stable chair for your early recovery with a firm seat cushion, a firm back, two arms, and a footstool for intermittent leg elevation
- A toilet seat riser with arms if you have a low toilet
- A temporary living space on the same floor because stairs will be more diﬃcult during your early recovery
Possible Complications From Surgery
Your knee needs time to heal, so be patient. Do not rush the recovery process.
It is important to follow Dr. Sherfey & Dr. Antebi’s instructions carefully and make sure your are not pushing yourself too fast or too soon. Although the risk of infection is low, it may occur. Minor superficial wound infections are generally treated with wound cleansing and antibiotics. Major or deep infections may require more surgery and possible removal of the prosthesis.
Keeping your wound clean with antibacterial soap and water is crucial in preventing infection. A common cause of infection following surgery is from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your replacement and cause a joint infection. Your surgeon will discuss with you whether taking preventive antibiotics before dental procedures is needed in your situation.
Warning Signs of Infection
Notify AVORS immediately if you develop any of the following:
- Persistent fever (higher than 100°F orally)
- Shaking chills
- Increasing redness, tenderness, or swelling of the wound
- Drainage from the wound
- Increasing pain with both activity and rest
Blood clots in veins are one of the most common complications of surgery. These clots can be life-threatening if they break free and travel to your lungs.
Preventing Blood Clots:
Follow your surgeons instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. He may recommend that you continue taking the blood thinning medication you started in the hospital. Once dressing is removed, compression stockings need to be worn for two weeks.
They can be removed for bathing or showering. Notify your surgeon if you develop any of the following:
- Warning signs of blood clots in leg
- Increasing pain in your calf
- Tenderness or redness above or below your knee
- New or increasing swelling in your calf, ankle, and foot
- Warning Signs of Pulmonary Embolism
If these occur go to the ER or call 911.
- Sudden Shortness of Breath
- Sudden onset of Chest Pain
- Localized Chest Pain with Coughing
Implant Problem: Although implant designs and materials, as well as surgical techniques, continue to advance, implant surfaces may wear down and the components may loosen. Motion may be more limited, particularly in patients with limited motion before surgery.
Pain: A small number of patients continue to have pain after surgery. However, this complication is rare and the vast majority of patients experience excellent pain relief following surgery.
Pain Management: After surgery, you will feel some mild pain. This is a natural part of the healing process. Your surgeon and nurses will work to reduce your pain. Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain including opioids, non-steroidal anti- inflammatory drugs (NSAIDs), and local anesthetics. Your surgeon may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.
Neurovascular Surgery: Although rare, injury to the nerves or blood vessels can occur during surgery.