Total Knee Replacement
- Day of your surgery
- Surgical procedure
- Post-operation course
- Risks and complications
Find out more about Total Knee Replacement with the following link
A Total Knee Replacement (TKR) or Total Knee Arthroplasty is a surgery that replaces an arthritic knee joint with artificial metal or plastic replacement parts called the ‘prostheses’.
The procedure is usually recommended for older patients who suffer from pain and loss of function from arthritis and have failed results from other conservative methods of therapy.
The typical knee replacement replaces the ends of the femur (thigh bone) and tibia (shin bone) with plastic inserted between them and usually the patella (knee cap).
Other causes include
- Trauma (fracture)
- Increased stress e.g., overuse, overweight, etc.
- Connective tissue disorders
- Inactive lifestyle e.g., obesity, as additional weight puts extra force through your joints which can lead to arthritis over a period of time
- Inflammation e.g., rheumatoid arthritis
In an arthritic Knee
- The cartilage lining is thinner than normal or completely absent. The degree of cartilage damage and inflammation varies with the type and stage of arthritis.
- The capsule of the arthritic knee is swollen
- The joint space is narrowed and irregular in outline; this can be seen in an X-ray image.
- Bone spurs or excessive bone can also build up around the edges of the joint
- The combinations of these factors make the arthritic knee stiff and limit activities due to pain or fatigue.
The combinations of these factors make the arthritic knee stiff and limit activities due to pain or fatigue.
The diagnosis of osteoarthritis is made on history, physical examination & X-rays.
There is no blood test to diagnose osteoarthritis (wear & tear arthritis).
The decision to proceed with TKR surgery is a cooperative one between you, your surgeon, family, and your local doctor.
The benefits following surgery are relief of symptoms of arthritis. These include
- Severe pain that limits your everyday activities including walking, shopping, visiting friends, getting in and out of chair, gardening, etc.
- Pain waking you at night
- Deformity – either bowleg or knock knees
Prior to surgery you will usually have tried some conservative treatments such as analgesics, weight loss, anti-inflammatory medications, modification of your activities, canes, or physical therapy.
Once these have failed it is time to consider surgery. Most patients who have TKR are between 60 to 80 years, but each patient is assessed individually and patients as young as 20 or old as 90 are occasionally operated on with good results.
- Your surgeon will send you for routine blood tests and any other tests required prior to your surgery
- You will be asked to have a general medical check-up with a physician
- You should have any other medical, surgical or dental problems attended to prior to your surgery
- Make arrangements for help around the house prior to surgery
- Stop aspirin or anti-inflammatory medications 10 days prior to surgery as they can cause bleeding
- Stop any naturopathic or herbal medications 10 days before surgery
- Stop smoking as long as possible prior to surgery
- You will be admitted to the hospital, usually on the day of your surgery
- Further tests may be required on admission
- You will meet the nurses and answer some questions for the hospital record
- You will meet your anesthesiologist, who will ask you a few questions
- You will be given hospital clothes to change into and have a shower prior to surgery
- The operation site will be shaved and cleaned
- Approximately 30 minutes prior to surgery you will be transferred to the operating room
Each knee is individual and knee replacements take this into account by having different prosthetic sizes available for your knee. If there is more than the usual amount of bone loss, sometimes extra pieces of metal or bone are added.
Surgery is performed under sterile conditions in the operating room under spinal or general anesthesia. You will be on your back and a tourniquet applied to your upper thigh to reduce blood loss. Surgery takes approximately forty-five minutes.
The surgeon cuts down to the bone to expose the bones of the knee joint.
The damaged portions of the femur and tibia are then cut at the appropriate angles using specialized jigs. Trial components are then inserted to check the accuracy of these cuts and determine the thickness of plastic required to place in between these two components. The patella (kneecap) may be replaced depending on a number of factors and depending on the surgeon’s choice.
The real components are then inserted with or without cement and the knee is again checked to make sure things are working properly. The knee is carefully closed with drains usually inserted, and then the knee is dressed and bandaged.
In anticipation of your surgery please review the links below for some helpful exercises to improve your surgical outcome.
When you wake up, you will be in the recovery room with IV’s in your arm, a tube (catheter) in your bladder, and a number of other monitors to check your vitals.
Once stable, you will be taken to a room. The post-op protocol is surgeon dependent, but in general your drain will come out at 24 hours and you will sit out of bed and start moving you knee and walking on it within a day or two of surgery. The dressing will be reduced usually on the second postop day to make movement easier. Your rehabilitation and mobilization will be supervised by a physical therapist.
To avoid lung congestion, it is important to breathe deeply and cough up any phlegm you may have.
Your orthopaedic surgeon will use one or more measures to minimize blood clots in your legs, such as inflatable leg coverings, stockings, oral pills, and injections into your abdomen to thin the blood and prevent clots or DVT’s, which will be discussed in detail in the complications section.
A lot of the long-term results of knee replacements depend on how much work you put into it following your operation.
Usually, you will remain in the hospital for 2 days. Then, depending on your needs, either return home or proceed to a rehabilitation facility. You will need physical therapy on your knee following surgery.
You will be discharged on a walker or crutches and usually progress to a cane at six weeks.
Bending your knee is variable, but by 6 weeks should bend to 90 degrees. The goal is to obtain 110-115 degrees of movement.
Once the wound is healed, you may shower. You can drive at about 6 weeks, once you have
regained control of your leg. You should be walking reasonably comfortably by 6
More physical activities, such as sports previously discussed, may take 3 months to do comfortably.
When you go home you need to take special precautions around the house to make sure it is safe. You may need grab bars in your bathroom or to modify your sleeping arrangements, especially if they are upstairs.
You will usually have a 6-week checkup with your surgeon who will assess your progress. You should continue to see your surgeon as recommended to check your knee and take X-rays. This is important as sometimes your knee can feel excellent but there can be a problem only recognized on X-ray.
You are always at risk of infections especially with any dental work or other surgical procedures where germs (bacteria) can get into the blood stream and find their way to your knee.
If you ever have any unexplained pain, swelling or redness or if you feel generally poor, you should see your doctor as soon as possible.