Total Knee Replacement
What is a total knee replacement?
In total knee replacement surgery, also known as knee arthroplasty, the damaged bone and cartilage from the patient’s shinbone, thighbone, and kneecap are cut away. An artificial joint made from metal alloys, high-grade plastics, and polymers replaces the removed areas. Now the knee can move and function again without pain.
Total knee replacements are one of the most successful procedures in medicine, with over 600,000 performed each year in the U.S.
Benefits of Knee Replacement Surgery
This surgery almost always reduces joint pain and improves your quality of life. With your newly restored knee, you can return to normal activities, that limited you before. Your orthopedic surgeon will secure the parts of the prosthesis to the bones of your knee, and together they will form your new joint.
Who would be a good candidate for total knee replacement?
The above list isn’t all-encompassing but covers the conditions where a person would be a good candidate for total knee replacement. The question is usually one of quality of life. If the pain from your degraded knee is seriously impacting your life, it’s probably time to have this surgery.
You would not be a good candidate for replacement surgery if your knee symptoms are not related to joint disease. Also, if a person is too heavy for an artificial joint to support the weight, he or she cannot have this surgery. If you have a severe illness or infection, or if you have poor or fragile skin covering your knee, that would need to improve before you could have this surgery.
Before your Knee Replacement surgery
You will most likely arrive at the hospital on the morning of your knee surgery. Be sure to follow all of your surgeon’s instructions on preparing for surgery:
- You should stop eating or drinking 10 hours 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 (intravenous) line may be started to provide fluids and medications needed during surgery.
Why should I consider having a total knee replacement?
Patients considering having a knee replaced by the Summit Healthcare team are usually at the end of their rope with their damaged knee. Conservative measures have not provided the relief they hoped for, and the pain has really begun to limit their everyday activities. Insignificant activities such as walking the dog become out of the question.
Serious, chronic pain would be first and foremost among conditions that would merit replacement. These are conditions where we would likely recommend total knee replacement:
- Severe knee pain or stiffness that limits your everyday activities, including walking, climbing stairs, and getting in and out of a chair.
- Moderate or severe knee pain even when at rest.
- Chronic knee inflammation and swelling that does not resolve with rest and medications.
- Knee deformity, such as bowing inward or outward.
- Failure to substantially improve with conservative treatments, such as cortisone injections, lubricating injections, physical therapy, and the like.
Total Knee Replacement Procedure
When your surgeon and the surgical team are ready, you’ll be taken to the operating room. There you’ll be given anesthesia to help you sleep through your knee replacement surgery, or to 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 by your knee doctor, and the new joint is put into place. The incision is closed with special surgical glue.
Knee Replacement Patient Testimonial
” I have had two total knee replacements and I am currently lying in the hospital bed for my second one. The staff the hospital and the care has been outstanding. We are very fortunate to have this hospital and their capabilities for such rural setting…” – Judy C.
After Knee Surgery
After your knee surgery, you will be sent to the PACU (Post Anesthesia Care Unit). When you are fully awake, you will be moved to your room. The nurses will give you medications to ease your pain. An SCD (Sequential Compression Device) may be used to prevent blood clots by gently squeezing then releasing your leg.
Soon, our skilled orthopedic team will help you get up and moving. They know precisely what they’re doing and how to help you recover, heal, and get back to life in the fastest, safest way possible. You may also have physical therapy or occupational therapy after your knee surgery.
After surgery, you will probably be hospitalized for one-to-three days. Recovery time varies following knee replacement surgery, but most people are able to drive after two weeks, garden after three-to-four weeks, and golf after six-to-eight weeks. Your doctor will tell you which activities you can return to, and when, and which activities you’ll need to avoid.
What happens if you wait too long to have a knee replacement?
If you put off knee replacement the joint will continue to degrade, and your pain will worsen. This will mean your quality of life will worsen along with your knee. One way people look at the value in this is by reducing it to a mathematical formula. This is a method orthopedic surgeons use to detail the potential improvement total knee replacement can provide for a patient. Here’s how it works.
- A normal adult scores 50 on a “function scale.”
- A person with a problem knee, on average, scores 32.
- Typically, a total knee replacement patient gains a fixed amount of improvement — about 12 points on this function scale.
- If done at the appropriate time, total knee replacement can bring a person’s “function” score up to 44. That’s not the 50 of normal, but pretty close. Life returns with that kind of mobility.
- If a patient waits until they are in so much pain they can’t sleep or their mobility is limited, their score drops, and their post-surgery score may only rise to 32. That’s far below what they could achieve with earlier intervention.
Waiting is only pushing your quality of life down for a longer period of your life. Isn’t life too short to roll the dice that way? There’s a reason over 600,000 people in the U.S. opt to have total knee replacement every year, rather than “toughing” it out and missing out on life.
How long before I can return to work after total knee replacement?
How much work you’ll need to miss with total knee replacement is variable, depending upon the patient and the type of work. If you work in an office environment, you can return to work when you can safely travel to and from the site. This can be anywhere from 2-6 weeks after surgery. If at a desk job, you should try to elevate the leg as much as possible and take walks at appropriate intervals.
If your job involves more standing and walking, you can return to it when you can walk without a limp, generally between 6 to 12 weeks.
If your job involves more physical stress, it will be 10-12 weeks before you can return. This will depend on when you can safely perform your job duties.
Recovery From Knee Replacement Surgery
Once at home, call your doctor 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
- Fever of 101 degrees Fahrenheit (38.3 degrees Celsius) or higher
- Trouble breathing or chest pain (call 911)
What positions are good and bad for my knee during recovery?
Motion is important for your recovery. You want as much flexion (bending) and extension (straightening) as possible. It can take weeks to establish the range you need. It’s important to obtain full extension because this allows the knee to “lockout.” This reduces fatigue of the quadriceps muscles were standing for a long period of time. It also will allow the knee to function more normally when walking.
The goal with bending is to surpass 90 degrees. This can be difficult due to stiffness. Riding a stationary bike is excellent for increasing flexion. At some point, patients may need manipulation under anesthesia. Your orthopedic surgeon will do this at Summit Healthcare. This is necessary in about 2 percent of patients to release the adhesions that have formed and are preventing motion.
Sleep positions are important for at least 6 weeks. The best position is on your back with your surgical leg propped up with 2-3 pillows. Don’t put them behind your knee. You want to keep the leg above your heart. You can sleep on the opposite side of your replacement, but you cannot sleep on the repaired knee side. With your new knee up toward the ceiling, you need to keep two pillows between your legs. Keep your legs even, and don’t cross your legs ever. It is not safe to sleep on your stomach for at least 6 weeks.
How long does it take to recover from a total knee replacement?
There are really two parts to your recovery after total knee replacement surgery: planning for recovery and actual physical recovery.
Planning out your recovery is one of the keys to success. It needs to be done before you’ve even scheduled your surgery. You’ll want to go through your house and check some things, such as the stability of your handrails. And you’ll need to enlist help. You will be able to walk on crutches or with a walker soon after surgery, but you’ll need help around the house for several weeks with tasks such as cooking, shopping, bathing, doing laundry, and the like.
You’ll need to get your house or apartment ready for when you come home after surgery. Consider these items:
- Making sure stair handrails are secure
- Adding safety bars in the shower
- Having a stable chair at a height of 18-20 inches with a firm back, two arms, and a footstool for intermittent leg elevation
- A stable shower bench or chair for bathing
- Removing all throw rugs and loose carpeting
- A temporary recovery room on the ground floor, as walking up and downstairs will be very difficult in the early part of your recovery
In the hospital
You’ll likely stay in Summit Healthcare Regional Medical Center for a couple of days before heading home. We’ll get you moving your foot and ankle immediately following your surgery to increase blood flow in your leg muscles to help reduce swelling and decrease the chances of developing a blood clot. We’ll have you on a medication to prevent blood clot formation and decrease leg swelling. We may also use compression hose or even an inflatable leg covering.
You will begin physical therapy the day after your surgery. Your physical therapist will teach you the specific exercises you’ll need to strengthen your leg and restore knee movement. A continuous passive motion exercise machine could be used to help with this.
We will provide you with instructions for recovery when you return home a couple of days after your surgery. You must follow these diligently, as this will largely dictate the successful return of full function in your new knee. These instructions will include wound care and bathing information.
Exercise is probably the most important part of your home care. Your activity regimen will include:
- A graduated walking program to slowly increase your mobility
- Resuming other normal household activities, such as climbing stairs
- Specific daily exercise plans that both restore movement and strengthen your knee. At first, you’ll have a physical therapist come to your home to help you with these.
- You should be able to resume most normal activities of daily living within 3-6 weeks of your surgery.
Is knee replacement surgery painful?
You will experience pain after this surgery and during recovery, but it helps to think back to the daily, ongoing pain your degraded knee was causing you before your surgery. After your anesthesia wears off, you’ll still have a nerve block that has lasting anesthetic qualities. That will cover the first day. From there, you’ll be on narcotic pain medication taken orally or in IV form. This will likely be morphine, fentanyl, or oxycodone. They are addictive, but you’ll only be on them for a short while. Your pain should diminish relatively quickly, within 4 or 5 days at the most.
Future lingering pain is somewhat dependent upon you. If you follow your physical therapy diligently and make some lifestyle modifications to eliminate areas of impact, your future pain should be minimal, especially compared to your pre-surgery levels of pain.
Risks Of Total Knee Replacement Surgery
As with any surgery, knee replacement surgery carries possible risks and complications. These include:
- Reaction to the anesthesia
- Blood clots
- Dislocation of the joint
- Loosening of the prosthesis
- Wearing out the prosthetic
- Damage to nearby blood vessels, bones, or nerves
What kinds of activities can I do after I have a knee replacement?
Our knee replacement patients from Show Low and the surrounding areas are excited by the feeling of freedom after having this surgery. That’s because their knee pain was causing them to have to miss out on more and more activities such as hiking or even walking around the block.
You’ll be walking at just 1 to 3 weeks, but you’ll use a walker. From there you’ll move to crutches, and then a cane. In 4-8 weeks, you should be walking without support.
Many people equate “activities” with sports. Here are some dos and don’ts moving forward.
- Swimming, cycling, and golf can resume after the surgical wound is healed.
- Jogging, basketball, and volleyball are likely out, as they put pressure on your new knee and will cause it to wear out more quickly.
- Tennis should probably change to doubles only, and at a relaxed pace. Or consider switching to pickleball.
- Downhill skiing, skating, and sports where there is a risk of falling can be resumed, but the patient should have been proficient prior to their surgery, and you need to understand the risks.
Schedule A Consultation
To learn more about total knee replacement surgery and how it can change your life, contact us today to schedule a consultation.