Information
The following questions and answers are from Thomas P. Vail, M.D.
This is
for informational purposes only. The appropriate prescription for
each individual is provided by that person's doctor.
TOTAL KNEE REPLACEMENT SURGERY
What is a total knee replacement?
The knee is a hinge joint, where the end of the femur (thigh bone) hinges with the upper end of the tibia (shin bone) and the
patella (kneecap) acts as a fulcrum in the front. A total knee is a surgical procedure where one's arthritic femoral joint surface is
removed and replaced with a chrome steel cap. The tibial surface is removed and a metal or plastic tray is placed, usually set on
a stem. The stem is inserted into the
tibial (shin bone) canal and often fixed
with
cement and/or screws. A high density
polyethylene spacer is then placed on the tibial tray.
Your
patella (kneecap) is then resurfaced with a high density polyethylene
(plastic) button.
What are the indications for a total knee replacement?
Total knee replacements are performed for individuals with arthritis who have severe pain, significant loss of motion and the
inability to perform reasonable routine and recreational activities. This is an elective surgery, it is not a matter of life or death.
The decision to proceed with total knee replacement surgery is ultimately yours, it is you who must accept the risks and
potential complications. Please feel free to ask your physician questions to assist you in your decision making.
How successful is total knee replacement surgery?
Results are generally very good, most people are relieved of nearly all of their knee pain.
Approximately 90%of total joints will
last 10 years and 80% will last a
person
20
years - depending on patient use and activity levels. This may
vary from
person to
person.
Are there risks to the surgery?
Yes, total joint replacement surgery is a major operation. The risks include, but are not limited to: 1) infection, which can
ultimately result in the removal of your prosthesis, 2) bleeding, 3) nerve damage, 4) a blood clot in the leg. If this blood clot
were to go to your lung you could die. Actions are taken, and medication given to prevent and reduce your risks of these
complications.
How long does the surgery take?
It depends upon how complicated your particular knee problem is, but usually a total knee replacement takes about 1 and 1/2
hours.
Will I need blood?
Many patients do require a blood transfusion of between 1-2 units (pints) of blood after a total knee. Most doctors
recommend
you donate your own blood in advance to use after your surgery. This is called autologous blood
donation. Some
patients are
unable to give their
own blood.
If so, a family member or friend wit the same blood type can donate for you. This is called
directed donation. Of course, there is always blood available in the blood bank. There are also some new medications which
will allow you to boost your blood count without donating blood.
Do I need to have any special tests before surgery?
An appointment will be made for you at the Preoperative Screening Unit (PSU) on the 2nd floor of Duke South Hospital in the
Orange zone. You will be given a complete physical exam, and any necessary laboratory tests will be performed (such as blood
work, x-rays and EKG). These tests are completed to assure your body is ready for surgery. Depending on your individual
condition, other physicians may be asked to examine you such as a cardiologist. This visit
usually lasts several hours, so make
your plans accordingly. Bring a list of your medications and their
dosages.
When will I be
admitted to the
hospital?
You will be admitted to the hospital by way of the operating room the day of surgery. You will be given a phone number to call
the day prior to surgery to get your arrival time for surgery. Your family (limited to 2 members) may accompany you to the
pre-op holding area and will then be instructed to wait in the family waiting area. Your doctor will speak to your family after the
procedure.
What should I bring with me to the hospital?
Bring your personal items and toiletries that you are accustomed to using at home. You may want your own pajamas a day or
two after your surgery, but generally a hospital gown is preferred immediately after surgery. A pair of comfortable flat tie shoes
is also recommended. Bring your medications, but do not take these without permission of
your doctor. Large amounts of
money and jewelry should be left at home. No jewelry is permitted in the operating room. If you
already have crutches or a
walker,
bring these also.
How long will I be hospitalized after surgery?
The hospital stay usually ranges from 3 to 5 days. On occasion, some patients need a rehabilitation facility after surgery or a
skilled nursing facility, but most patients go directly home. It depends on your individual responsibilities and your available
resources.
What should I expect after surgery?
When you awaken, there will be a large bulky dressing on your knee. There will also be an IV tube for fluids, pain medication
and antibiotics. There will be a small drain tube called a hemovac collecting blood from your surgical site. A foley catheter may
be in place draining your bladder until you are able to urinate on your own. Your nurse will remind you to take frequent deep
breaths and to cough.
Physical therapy will start the day following your surgery.
Will I need anything special at home?
Not particularly. Optional
things
include handrails around the
toilet,
bath areas and stairwells. Any scatter rugs should be
removed and torn areas in carpet or tile tacked down to prevent falling. It will be helpful to have someone stay with you for a
week or two after you get home. The discharge planner will assist you with any special needs.
Will I need more therapy once I am home?
Many patients are do require additional therapy. Depending on your individual setting, this may be as home visits or in an
outpatient physical therapy clinic near your home.
How long will I be on a walker?
You will be on crutches or a walker for 4-6 weeks. At that time you will be permitted to advance to a cane. Once you are
comfortable with the cane, have regained your confidence and balance you may discontinue
it's use.
What about driving?
This varies, but generally you will be permitted to resume driving at 6 weeks.
Is there life
after a total knee
replacement?
Of course, but it will
take
approximately 3 months before you will feel like your old self. When you resume your activities it is
recommended that you avoid jarring or stop/start sports such as jogging, singles tennis, soccer and basketball. Activities that are
generally well tolerated include bicycling, walking, swimming and golf. For further information ask for a copy of the article,
"Athletics after total joint replacement surgery".
Are there certain precautions I should be aware of following my total knee replacement?
Yes, during the first several weeks after surgery you are permitted to ride in a car, bus or plane as long as you make frequent
stops. It is recommended you stop once hourly to get out and walk around. Also, when
visiting physicians and dentists it is
important that you inform them that you have a total joint replacement. You will need antibiotics for certain dental and
medical
procedures, ask your doctor for a letter
outlining this, if you don't already have one.
This
precaution will be in force forever.
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