TOTAL KNEE REPLACEMENT
What Is a Knee Replacement?
Knee replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the knee joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of knee replacement surgery include increasing mobility, improving the function of the knee joint, and relieving pain.
Who Should Have Knee Replacement Surgery?
People with knee joint damage that causes pain and interferes with daily activities despite treatment may be candidates for knee replacement surgery. Osteoarthritis is the most common cause of this type of damage. However, other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), osteonecrosis (or avascular necrosis, which is the death of bone caused by insufficient blood supply), injury such as old ACL and meniscal tears and fracture may lead to a breakdown of the knee joint and the need for knee replacement surgery.
In the past knee replacement surgery was reserved for the elderly, but current trends show knee replacement surgery being done in much younger patients. Despite the success of knee replacements, surgery should be delayed as long as possible, particularly if you are under 55 years of age.
Today, a person’s overall health and activity level are more important than age in predicting a knee replacement’s success. Knee replacement may be problematic for people with some health problems, regardless of their age. For example, people who have chronic disorders such as Parkinson’s disease, or conditions that result in severe muscle weakness, are more likely than people without chronic diseases to struggle to mobilise and regain strength after surgery. People who are at high risk for infections or in poor health are less likely to recover successfully. Therefore they may not be good candidates for this surgery.
Why Do People Have Knee Replacement Surgery?
For the majority of people who have knee replacement surgery, the procedure results in:
- a decrease in pain
- increased mobility
- improvements in activities of daily living
- improved quality of life.
What Are Alternatives to Knee Replacement?
Before considering a total knee replacement Mr Richardson may try other methods of treatment, such as exercise, walking aids, and medication. An exercise program can strengthen the muscles around the knee joint, and can be the most effective way to improve pain and function. Walking aids such as canes and walkers may alleviate some of the stress from painful, damaged knees and help you to avoid or delay surgery.
Alternative surgical procedures such as arthroscopy, high tibial osteotomy (HTO) and unicompartmental knee replacements will be considered.
What Are Possible Complications of Knee Replacement Surgery?
New technology and advances in surgical techniques have greatly reduced the risks involved with knee replacements. Better pain relief and rapid early mobilisation can overcome many medical problems previously encountered.
Serious but less common complications of knee replacement surgery include infection, blood clots, nerve and vascular injury. To minimize the risk of complications, it is important to know how to prevent problems and to recognise signs of potential problems early and contact your doctor. For example, tenderness; redness and swelling of your calf; or swelling of your thigh, ankle, or foot could be warning signs of a possible blood clot. Warning signs of infection include fever, chills, tenderness and swelling, or drainage from the wound. You should call your doctor if you experience any of these symptoms. At no point in time should antibiotics be started unless Mr Richardson has been contacted.
When Is Revision Surgery Necessary?
Knee replacement is one of the most successful orthopaedic surgeries performed. However, because more people are having knee replacements at a younger age, and wearing away of the joint surface becomes a problem after 15 to 20 years, replacement of an artificial joint, which is also known as revision surgery, is becoming more common. Early revision can sometimes be required for instability, pain and stiffness. It is more difficult than first-time knee replacement surgery, and the outcome is generally not as good, so it is important to explore all available options before having additional surgery.
Doctors consider revision surgery for two reasons: if medication and lifestyle changes do not relieve pain and disability, or if x rays of the knee show damage to the bone around the artificial knee that must be corrected before it is too late for a successful revision. This surgery is usually considered only when bone loss, wearing of the joint surfaces, or joint loosening shows up on an x ray. Other possible reasons for revision surgery include fracture and infection.
What Types of Exercise Are Most Suitable for Someone With a Total Knee Replacement?
Proper exercise can reduce stiffness and increase flexibility and muscle strength. People who have an artificial knee should talk to their doctor or physical therapist about developing an appropriate exercise program. Most of these programs begin with safe range-of-motion activities and muscle-strengthening exercises. The doctor or therapist will decide when you can move on to more demanding activities. Many doctors recommend avoiding high-impact activities, such as football and jogging.
These activities can damage the new knee or cause loosening of its parts. However, a well functioning knee replacement will cope with the demands of bush walking, cycling, tennis (doubles on a soft court), swimming and golf.
TOTAL KNEE REPLACEMENT
CARE OF YOUR KNEE AFTER SURGERY
Mr Richardson will expect you to remain in hospital until you are comfortable, medically stable, mobilising safely and independent in self care. Typically you will be ready for discharge 4-5 days after your surgery. If you are at all worried about going home around this time, then please discuss it with Mr Richardson or the nursing staff looking after you. Inpatient rehabilitation is available for you if you live alone, or require additional time to regain your independence.
To improve your recovery and to minimise the risks of complications you will be encouraged to mobilise as soon as possible. You will be able to fully weight bear through your new knee, but will need crutches or gait aids for 3-4 weeks before your muscles have recovered their strength to be able to walk unaided. Please continue to use a single crutch or walking stick until you no longer limp when walking.
A Total Knee Replacement is a big operation and you will require regular narcotic based analgesia for 2-3 weeks. It is very important to make sure that you are as comfortable as possible immediately after you surgery so you can mobilise safely.
You will be given a pre-medication before your surgery which will continue for the first 4 weeks post-operatively. Your wound and all soft tissues will be infiltrated with local anaesthetic, making your procedure as pain free as possible. This will enable you to stand and walk immediately after your surgery, with the aim of weight bearing on the same day as your surgery.
You will be prescribed a combination of analgesics that can be given to you as required. You should never be left in pain, without something stronger being offered to you by your nurse.
For the first 2 weeks you will be given a regular slow release narcotic based pain killer (commonly called Oxycontin, Targin, Tramadol SR), along with paracetamol.
You will have available top-up medication which is to be used for break-through pain.
When your serious pain starts to decline, Mr Richardson would expect you to cease the regular slow release narcotic , and to continue with panadol, non-steroidal anti-inflammatories and “top-up” narcotics only. It is best to avoid stronger analgesics during the day unless absolutely necessary. If the stronger pain killers are continued, the side effects such as nausea, lethargy, confusion and constipation will worsen.
Constipation is very common and you will be offered a laxative to help, which you are encouraged to keep taking until you are off all narcotic medications.
If you experience worsening pain after discharge then please consult your GP or contact Mr Richardson rooms for further advice.
Mr Richardson sutures all his wounds with a dissolving suture. As a result, nothing needs to be removed.
Your wound will have the post-operative dressing left intact for your hospital stay. Prior to discharge your dressing will be taken off. Small pieces of tape (steristrips) will be removed. There will be 2-3 cm of suture at the ends of the wounds which will be lifted up and trimmed flush with the skin. The wound will then be sprayed with a clear dressing. Nothing further needs to be done to the wound. You can then shower safely over the wound, with no other dressing required.
Please do not soak the wound in a bath, or swim in pool for a minimum of 2 weeks. You may do so after 2 weeks if the wound is perfectly clean and dry.
It is normal for a wound to be warm and swollen after surgery. Some redness around the wound can also be normal healing. At no stage should antibiotics be given for any of these symptoms.
IF AT ANY STAGE AFTER DISCHARGE YOU EXPERIENCE A DISCHARGE FROM THE WOUND PLEASE CONTACT MR RICHARDSON IMMEDIATELY.
Your physical therapy will commence as soon as you are able. Typically you will be stood and taken for a short walk the first morning after surgery.
You will be encouraged to use a Continuous Passive Motion (CPM) machine after surgery. It is critical after a knee replacement to push your knee until you can easily achieve a perfectly straight leg (Full Extension). You will leave hospital with a minimum of 90 degrees of bend. Mr Richardson has the expectation that upon review at your 6 week appointment you will have achieved 120 degrees of flexion.
Your physiotherapist will give you an exercise programme, which will change as you progress. It is important to continue with this until your post-op review with Mr Richardson at the 6-week mark.
Occasionally it is necessary to be taken back to theatre to perform a manipulation under anaesthesia (MUA) if the range of motion is considered inadequate at the first post-operative visit.
You are not allowed to drive for a minimum or 6 weeks. Mr Richardson will assess your progress at the 6 week post-operative appointment as to when you may resume driving.