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Contents

  • Introduction
  • Total knee replacement
  • Preparation for surgery
  • Pre- op Visit
  • After surgery
  • Physical therapy and Exercise program
  • Guidelines for care.

Introduction

The knee joint is among the strongest, largest and most complex joints of the body. When you walk, sit, squat, climb stairs up and down, play, jump and drive or do many other simple movements, you are depending on the knee for support and mobility.

When your knee is healthy, you may take it for granted, not giving a thought about the job it does for you. However, once it starts to become painful, stiff and you are forced to restrict certain activities, you may come to realise how much freedom of movement means for you.

Fortunately, today’s remarkable advances in medical technology and research makes it possible to replace the knee joint with long-lasting durable and fine-tuned artificial one that eliminates pain, corrects the deformity, strengthens your legs and improves your quality of life. This page provides information for you and your family regarding Total Knee Replacement surgery. The surgical procedure, pre-operative and post-operative Care, the risks and benefits of surgery, as well as rehabilitation, are explained.

Please read and discuss with your family before your total knee replacement surgery. The orthopedic surgeon’s goals are to restore your knee to a painless, functional status and to make your hospital stay as beneficial, informative and comfortable as possible. Please feel free to ask questions or share concerns with your consultant surgeon and physiotherapist.

Total Knee Replacement

Total knee replacement is a surgical procedure in which damaged components of the knee joint are replaced with artificial parts. The procedure is performed through a skin incision on the front of the knee; the muscular, ligamentous and bony components of the joint are exposed.

The worn out bony surfaces are shaved off with special instruments (resurfacing) and replaced with implants. Most common implant consists of three components: the femoral, the tibial and the patellar component.

Popular femoral component designs use highly specialized heavy metal alloys (Stainless steel, vanadium, titanium etc.) and are contoured more or less like the original bone.

The tibial component is a metal platform which holds a plastic tray (High density polyethylene) and this surface moves against the femur during joint motion. The patellar component is an all plastic button like implant which moves in the femoral notch simulating normal joint motion.

Who is a candidate for surgery ?

  • People suffering from severe arthritis of knee joints.
  • Daily knee pains from a very long time with swelling.
  • Debilitating pain restricting activities of daily living.
  • Severe deformity of the legs following knee pains (bent or bowlegs).
  • People suffering with rheumatoid arthritis.( young and old )
  • Arthritis or deformity following bony or ligamentous injuries around the knee joint

What can I expect from an artificial knee? Benefits of a Total Knee Replacement

An artificial knee is not a natural knee, so it is unfair to expect it to function as a normal free joint. But a near normal function of the new joint is an achievable target.

With the availability of technically advanced implants and well established surgical expertise in premier institutions such as Apollo group of hospitals the success rate of this surgery has been reported world wide approximately 97% at a 12 year follow up.

The average life of the implant for all age groups and indications has been found to be 15 years.

Relief from joint pain and stiffness.

Improve joint movement.

Ability for independent movement.

Improvement in the alignment of the deformed joints.

Independence to carry out functional activities of daily living like; walking, climbing stairs up and down, swimming, driving and social activities.

What are the risks of Total Knee Replacement ?

Total Knee Replacement is a major operation. In spite of all precautions some complications are encountered in clinical practice. The most common complications are

  • Blood clots in legs.
  • Blood clots in lungs.
  • Post operative blood loss may require transfusion.
  • Complications affecting the knee are less common, they are:-
  • Loosening of the prosthesis.
  • Knee Stiffness.
  • Infection in the knee

Preparation For Surgery

Maintaining good physical health before your operation is important. Activities that will increase your upper body strength will improve your ability to use walker or crutches after surgery. A blood transfusion may be needed after the operation. The Physician may order blood tests and urine analysis to rule out the presence of any infections. A review of your medical condition is necessary. Chest x-rays and an ECG may also be taken.

Pre-op visit

This visit would include an interview by your consultant or registrar about the past medical history and current medications and a chest x-ray will be taken. You may be instructed to stop taking Aspirin, Ecosprin and Warfarin group of medication four to seven days before surgery. Inform your doctor about drug and substance allergies.

  • You have to sign a written consent for surgery and rehabilitation.
  • Diet: you can take regular diet before surgery. DO NOT EAT OR DRINK AFTER MIDNIGHT before the day of surgery.
  • AFTER MIDNIGHT before the day of surgery.
  • Bathing: A shower, bath or sponge bath should be taken the evening before and morning of surgery. If you are allergic to iodine or soap, please inform the nurse.

Care after surgery

After surgery, the patients are monitored in the intensive care unit until post-op stabilization and are transferred to the ward. It is important that any numbness, tingling or sudden severe pain in your feet and legs should be reported to the nurse immediately during this period. These are some of the things you would find after your surgery:

Dressing is applied to the surgical area. (Changed 2-3 days after the surgery)

  • A suction drain that has tubes leading directly into the surgical area.
  • An IV line that will continue till you can take adequate amounts of fluid by mouth.
  • Post-operative nausea or vomiting that can be reduced by anti-nausea medication.

Elastic stockings:

You may be fitted with suitable elastic surgical stockings that help prevent blood clots and improve circulation. You may wear these stockings every day for six to eight weeks following surgery.

Physical Therapy and Exercise program

When muscles are not used, they become weak and do not perform well in supporting and moving the body. Your leg muscles are probably weak because you have not used them much due to your knee problems. The surgery can correct the knee problem, but the muscles will remain weak and will be strengthened through regular exercise. You will be assisted and advised how to do this under therapist supervision.

Instituted in the immediate post operative period

  • Elevation and positioning of the leg.
  • Thigh muscles tightening- loosening for both legs
  • Movements of the Ankle and Toes to prevent blood clots.
  • Straight lifting of the legs.
  • Coughing and deep breathing exercises to help prevent complications.
  • Mobility in bed – Turning to normal side and lifting the buttocks helps to prevent bedsores.
  • Once the dressing is reduced your doctor may advice you to under go venous doppler study. (checking of blood clots in legs)
  • After that your doctor will decide when to make you walk and start knee bending exercises. Ambulatory activity like walking with the help of a walking aid, bearing as much weight as indicated by your doctor or physiotherapist, and often a support is applied to operated leg to pro-vide stability if your muscles are weak.

In case of both knees replacement, ambulation is done with supports for few days.

Getting discharged

Your consultant doctor will decide when to discharge once he ensures wound healing is good and your walking with the walker is satisfactory. He will review prescription for medication, home exercise and follow up date for staple removal. Your physical therapy will continue till you become more independent in your exercises, transfer from bed to chair, staircase climbing and other activities your therapist has designed for you.

Guidelines for care

Your knee replacement should give you years of service. You can protect it by taking a few simple tips for safety and greater efficiency

Do’s

  • Exercise to maintain knee movement.
  • Cold application.
  • Weight reduction program if obese.
  • Bathroom modifications.
  • Prevent infection, urinary ,dental etc, because your new knee is sensitive to infection.
  • Swimming, driving, normal family life and social activities.
  • In case of injury to your new knee apply ice and consult your doctor immediately.

Don’ ts

  • Hot fomentation.
  • Forceful bending of artificial knee.
  • Bending beyond 120 degrees.
  • Massage over the artificial knee.
  • Squatting and low sitting.
  • Sudden jerky and rotating movements.
  • Crossed leg sitting.
  • Cycling.
  • Activities that over load the artificial knee must be avoided.

Follow-up care:

When you leave the hospital, you will be given a schedule of follow-up visits. These visits will ensure the long-term success of your operatio.