Knee Replacement Surgery
Preparing for Surgery
Medical Evaluation – If you decide to have total knee replacement surgery, you will be asked to have a pre-operative assessment by specialist nurses in the hospital where your surgery will be performed a few weeks before surgery to assess your health and to rule out any conditions that could interfere with your surgery.
Tests – Several tests-such as blood samples, a electrocardiogram (heart tracing), a urine sample and some skin swabs will be needed to help to prepare for your surgery.
Medications – Tell Prof Jari and your anaesthetist about the medications you are taking. He or she will tell you which medications you should stop taking and which you should continue to take before surgery.
Dental Evaluation – Although the incidence of infection after knee replacement is very low, an infection can occur if bacteria enter your bloodstream. Treatment of significant dental diseases (including tooth extractions and periodontal work) should be considered before your total knee replacement surgery.
Urinary Evaluations – A preoperative urological evaluation should be considered for individuals with a history of recent or frequent urinary infections. For older men with prostate disease, required treatment should be considered prior to knee replacement surgery.
Social Planning – Though you will be able to walk on crutches or with a zimmer frame from the day of your operation, you will need help for several weeks with such tasks as cooking, shopping, bathing and doing laundry. If you live alone, your GP and a social worker or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at home. They also can help you arrange for a short stay in an extended care facility during your recovery, if this option works best for you.
Home Planning – Several suggestions can make your home easier to navigate during your recovery. The hospital Occupational Therapists can help with this via the Social Services. Consider:
- Safety bars or a secure handrail in your shower or bath
- Secure handrails along your stairways
- A stable chair for your early recovery with a firm seat cushion (height of 18-20 inches), a firm back, two arms, and a footstool for intermittent leg elevation
- A toilet seat raise with arms, if you have a low toilet
- A stable shower bench or chair for bathing
- Removing all loose carpets and cords
- A temporary living space on the same floor, because walking up or down stairs will be more difficult during your early recovery
Your Stay in the Hospital
Prof Jari’s patients following a less invasive knee replacement stay in hospital an average of 3 days following their operation.
After surgery, you will feel some pain, but medication will be given to you to make you feel as comfortable as possible, including pain-killers in your spinal anaesthetic, if appropriate. Pain management is an important part of your recovery. Prof Jari will prescribe you regular pain medication to take including Paracetamol, an Anti-inflammatory drug and a codeine-based drug. These must be taken regularly for 3 weeks to prevent you having pain and so allowing you to undertake your rehabilitation exercises. If you develop any side effects to the pain tablets, then you must stop them (you will be told about what to watch out for) and contact your GP for alternate pain medication.
Walking and knee movement are important to your recovery and will begin immediately after your surgery. You may initially be on a CPM machine (see above) to restore movement in your knee and leg. The CPM machine decreases leg swelling by elevating your leg and improves your venous circulation by moving the muscles of your leg. You will also do regular 2 hourly active exercises as will be explained to you by the physiotherapists. The physiotherapists will also get you up and walking on the day of your operation if all is well.
To avoid lung congestion after surgery, you should breathe deeply and cough frequently to clear your lungs. It is advisable to take 10 deep breathes and cough 10 times every hour, for the first week after your operation.
Prof Jari will prescribe one or more measures to prevent blood clots and decrease leg swelling, such as special support stocking (TED), inflatable leg coverings (compression boots) and blood thinners (Aspirin or Heparin).
Foot and ankle movement also is encouraged immediately following surgery to increase blood flow in your leg muscles to help prevent leg swelling and blood clots. Most patients begin exercising their knee the day of their surgery. A physiotherapist will teach you specific exercises to strengthen your leg and restore knee movement to allow walking and other normal daily activities soon after your surgery.
Possible Complications After Knee Replacement Surgery
The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, occur in less than 2 percent of patients. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit your full recovery.
Blood clots in the leg veins are the most common complication of knee replacement surgery. Your prevention program will include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings and medication to thin your blood.
Although implant designs and materials as well as surgical techniques have been optimized, wear of the bearing surfaces or loosening of the components will occur over the years. If this becomes a problem, you may need a revision of your knee replacement.
Additionally, although an average of 115 degrees of motion is generally anticipated after surgery, scarring of the knee can occasionally occur and motion may be more limited. This is particularly true in patients with limited motion before surgery. In general terms you should expect to get back a similar, but greater, range of movement than you had before your operation.
Finally, while rare, injury to the nerves or blood vessels around the knee can occur during surgery as can fracture to the bones around the knee, especially if your bone density is reduced (Osteoporosis).
Discuss your concerns thoroughly with Prof Jari prior to surgery.
Your Recovery at Home
The success of your surgery also will depend on how well you follow your Mr Jari’s instructions at home during the first few weeks after surgery.
You will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed 10-12 days after surgery. A suture beneath your skin will not require removal. Avoid soaking the wound in water until the wound has thoroughly sealed and dried (about 3 weeks). The wound may be bandaged to prevent irritation from clothing or support stockings.
Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength.
Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within three to six 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 and standing and walking up and down stairs.
- Specific exercises several times a day to restore movement and strengthen your knee. You probably will be able to perform the exercises without help, but you will have a physiotherapist help you at home or in the hospital the first few weeks after surgery.
Driving usually begins when your knee bends sufficiently so you can enter and sit comfortably in your car and when your muscle control provides adequate reaction time for braking and acceleration. Most individuals resume driving about four to six weeks after surgery.
Avoiding Problems After Surgery
Blood Clot Prevention
Follow Prof Jari’s instructions carefully to minimize the potential of blood clots that can occur during the first several weeks of your recovery.
Warning signs of possible blood clots in your leg include:
- Increasing pain in your calf
- Tenderness or redness above or below your knee
- Increasing swelling in your calf, ankle and foot
Warning signs that a blood clot has traveled to your lung include:
- Sudden increased shortness of breath
- Sudden onset of chest pain
- Localized chest pain with coughing
Notify your GP or go to the A&E department immediately if you develop any of these signs.
The most common causes of infection following total knee replacement surgery are from bacteria that enter the bloodstream during dental procedures, urinary tract (bladder) infections, or skin infections. These bacteria can lodge around your knee replacement and cause an infection.
For the first two years after your knee replacement, you must take preventive antibiotics before dental or surgical procedures that could allow bacteria to enter your bloodstream. After two years, talk to Mr Jari and your dentist or urologist to see if you still need preventive antibiotics before any scheduled procedures.
Warning signs of a possible knee replacement infection are:
- Persistent fever (higher than 100 degrees orally)
- Shaking chills
- Increasing redness, tenderness or swelling of the knee wound
- Drainage from the knee wound
- Increasing knee pain with both activity and rest
Notify your doctor immediately if you develop any of these signs.
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 stick, crutches, a zimmer frame, hand rails or someone to help you until you have improved your balance, flexibility and strength.
Prof Jari and your physiotherapist will help you decide what assistive aides will be required following surgery and when those aides can safely be discontinued.
How Your New Knee Is Different
You will feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities. Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery is predicted by the motion of your knee prior to surgery. Most patients can expect to nearly fully straighten the replaced knee and to bend the knee sufficiently to go up and down stairs and get in and out of a car. Kneeling is usually uncomfortable, but it is not harmful. Occasionally, you may feel some soft clicking of the metal and plastic with knee bending or walking. These differences often diminish with time and most patients find these are minor, compared to the pain and limited function they experienced prior to surgery.
Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated.
After surgery, make sure you also do the following:
- Participate in regular light exercise programs to maintain proper strength and mobility of your new knee.
- Take special precautions to avoid falls and injuries. Individuals who have undergone total knee replacement surgery and suffer a fracture may require more surgery.
- Notify your dentist that you had a knee replacement. You should be given antibiotics before all dental surgery for the rest of your life.
- See Prof Jari periodically for a routine follow-up examination and X-rays.