Total Knee Replacement

The doctor has recommended that you undergo a total knee replacement.  Total knee replacement surgery has been done in the United States for over 30 years.  The results continue to improve every year.  Presently we are telling patients that if you have a knee replacement at this time, there is a 9 out of 10 chance that the knee will be in good working order in 10 years. Our goal with the knee replacement surgery is to restore motion to the knee, allow the patient to walk without a limp, and to remove 90% of the pain in the knee.

A total knee replacement is an inpatient surgical procedure where the doctor will resurface your knee joint.  At present, because of the arthritis in your knee, there is no longer a shock absorber between the bones.  When you walk, the bones are rubbing and grinding on each other.  Normally there should be an 1/8 inch to 1/4 inch of shock absorber on the end of the bones which prevent friction and allow a smooth gliding motion as you bend and straighten your knee.  This no longer exists.  By cutting the bone at surgery and replacing the end of the thigh bone with a smooth metal surface and the end of the tibia bone with a smooth plastic surface, a smooth gliding motion will be restored to the knee.  In some cases, the knee cap will also have to be resurfaced and a smooth plastic surface will be placed.  All three surfaces are cemented into place.  Good to excellent results are expected in 90 to 95% of patients.

The doctor may ask you to see your primary care doctor 3-4 weeks prior to your surgery, for a complete history and physical evaluation.  If you internist feels a need for special testing prior to your surgery, this will allow ample time to get this done.  Prior to surgery, you will receive an EKG, urinalysis, blood count and testing of your blood for clotting function.  If you are taking high blood pressure pills, or are a diabetic, additional blood work will be checked.  If you are a smoker or have a history of asthma, you will receive a chest x-ray.  We will schedule an appointment with the hospital’s Surgical Day Care Program prior to surgery to have these tests done and so that you will have the opportunity to discuss anesthesia options with the hospital anesthesiologist.

Because of the arthritis in your knee, you are most likely taking aspirin, ibuprofen, Motrin, Naprosyn, or another kind of anti-inflammatory medication to help control pain.  This will need to be stopped 10 days prior to your surgery.  The reason for this is anti-inflammatory drugs affect the clotting in your blood.

It is our goal for you to have normal clotting during the surgical procedure and the first 24 hours after the surgery.  After that, we want to make the blood thinner to help prevent any clotting in the veins. 

One month prior to surgery, the doctor will ask you to start taking iron pills (Ferrous Gluconate) two times a day.  This is done in order to build up your blood count.  Because you are taking iron pills, there is a possibility that you may become constipated.  Bran and fruit juices, especially apple or prune, may help keep you regular.  For some patients, Milk of Magnesia or other gentle laxatives may be required.

On the day of surgery, you will be admitted to the hospital.  You will be notified as to when to arrive by the Pretesting Department of the hospital.  In most cases you will start your day in the Surgical Day Care Department.  You will be admitted to this department and then brought to the Operating Room.  You will meet your anesthesiologist in the pre-anesthesia area about a half hour before surgery.  For most patients there are two options for anesthesia for your surgery.  Both are safe and effective.  Many patients choose to undergo general anesthesia.  For those patients, they receive a PCA pump for the initial recovery period.  This is a patient controlled pump where you hit a button and receive immediate pain narcotic medication into your IV.  This is a safe and effective way to control pain and allow you a smooth recovery from surgery.  Some patients undergoing a total knee replacement will receive a spinal anesthetic with an epidural to follow.  The advantage of the epidural anesthetic is that it may be continued for the first two days after surgery for pain control.  The epidural is a small plastic tube placed very close to the nerves in your spine which numbs them such that you should feel very little pain after surgery.  In some patients who have had back surgery or have bleeding disorders, an epidural may not be done.  After your PCA or epidural is stopped, you will receive appropriate pain medication pills.  After your surgery, which will take approximately 2-3 hours, the doctor will call your family at home,
or speak to them in the waiting room.

After your surgery is completed, you will go immediately to the Recovery Room (also called Post-Anesthesia Unit in some hospitals) where the nurses will watch you very closely as you recovery from anesthesia.  From the Recovery Room, you will then be transported to the Surgical Nursing floor.  Once settled in your room, you will start with physical therapy.  Your leg will be placed in a continuous passive range of motion machine.  This is very similar to having a small exercise bike in your bed.  By starting motion early, this will help speed up your recovery and your return to normal activities.

On post-operative day 1, you will be visited by the physical therapist who will start muscle exercises and stretching exercises to your legs.  On post-operative day 2, your epidural or PCA will be removed, you will be out of bed, and progress with walking.  Initially you will
walk with a walker or crutches and as your balance improves, and your discomfort decreases, advance to a cane. You may put as much weight on the operative leg as you feel comfortable. 

Your dressing will be changed daily.  You will receive an anticoagulant to help prevent blood clots. We will use Lovenox a twice a day injection.  You will remain on Lovenox for four weeks after surgery and will need to have your blood checked at lease once a week after discharge.

It will be our goal to discharge you home within 2-4 days after your knee replacement.  For some patients, because of disease in their other leg, and/or other medical conditions, admission to a rehabilitation facility after the hospital may be necessary. (This will be an individual decision made by the doctor.) Your wound staples will be removed 10 days after surgery.  You can then shower regularly.    You will then be seen in our office at 6 weeks and 12 weeks after surgery.  You will have an x-ray taken on your first post-operative visit.  After arriving home from the hospital or rehabilitation facility, you will have physical therapy through the Visiting Nurses Association.  A therapist will work on range of motion of your knee, strengthening of your operative leg and restoring your balance when walking.  When you have restored normal motion and strength as well as balance, physical therapy will be discontinued.  The cane will be used until your limp goes away.  This decision will be made by your doctor.

We hope this has been helpful.  If any questions should arise, please feel free to contact our office at 508-478-7135.