A Total Knee Replacement is a surgery to replace a diseased or injured knee joint. It is a type of surface replacement in which damaged surfaces of bones forming knee joint are replaced with artificial components.
Reasons for the Procedure :
This surgery is done when pain and stiffness usually due to knee arthritis is not relieved by conservative measures of treatment .These conservative treatments include rest, medicines and exercise. Other reasons for the Knee arthritis include Rheumatoid arthritis, Seronegative spondarthritis like ankylosing spondylosis, psoriatic arthritis ,gouty arthritis etc, Malunited fractures, Tumours around Knee Joint .
What to Expect:
Prior to procedure your doctor may do the following:
- Physical Examination.
- X-Rays of your knees and hips .
- Blood Tests.
- Echocardiography
- Magnetic Resonance Imaging (MRI) if required.
- Computed Tomography (CT) if required.
In time leading up to the procedure :
- Try to lose weight if you are overweight. This will decrease the amount of stress on your new joints.
- To enhance safety and recovery,Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like anti inflammatory drugs,blood thinners.
- Your doctor may suggest donating blood for the surgery. You will most likely lose some blood and fluid during this surgery. If you need a blood transfusion, the doctor can u:se the donated blood.
- If you become sick or have a fever just before the surgery, tell your doctor right away.
- Arrange for a ride to and from the hospital. Also, arrange for help at home.
- If you smoke, try to smoke less or stop smoking.
- Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.
- If you have diabetes, ask your doctor whether you will need to adjust your medicine.
Anaesthesia:
Generally spinal and epidural anaesthesia is used. It will block pain and keep you asleep through the surgery. It is given through an injection in your back.An epidural catheter is kept in your back through which medicines will be given after surgery in the ward this will significantly reduce post surgery pain and help in your rehabilitation.
Description of the procedure :
Total Knee Replacement
An incision will be made along front of your knee joint. The muscles will be moved aside. The damaged bone and cartilage from lower end of femur bone and upper end of tibial bone will be removed with precision saw using specific jigs. The remaining bone will be prepared for seating prosthesis. Soft tissues releases done as required for balancing the ligaments around knee joint. Prosthesis seated using bone cement. Lastly incision will be closed in layers using stitches and staples.
How long it will take for surgery?
Total Knee replacement will take about one and half hour to finish.
How much it will hurt?
You will have moderate pain, after the surgery pain medicine will be given to help with discomfort . There will be a epidural catheter left in your back through which medicines are given to reduce your post surgery pain .
Average Hospital Stay
This procedure is done in a hospital setting. The usual length of stay is 4-6 days for a total Knee Replacement. Your doctor may choose to keep you longer if recovery is delayed . The focus will be on regaining function.
Post surgery Care:
At The Hospital
While you are in the hospital joint range started on the day of the surgery itself. If patient is comfortable he/she will be made to stand with a walker on 1st day after surgery. Physiotherapist will assist and teach exercise to regain the function.
At Home
When you return home do the following to ensure a smooth recovery.
- Keep incision area clean and dry.
- Ask your doctor about when it is safe to take shower, bathe or sock in water.
- Seat on a high chair or bed.
- Avoid sitting on floor.
- Use walker for mobilization till you get sufficient muscle power around knee joints.
- Physiotherapist will assist you to regain full function of the joints.
- Avoid jogging, jumping and high impact activities.
- Antibiotic may be needed before certain dental procedures and surgery. consult your doctor before you under go any procedure and inform the treating doctor that you have an artificial joint.
- Within six weeks, you should be able to resume normal, light activities. A total knee replacement typically lasts 10-15 years.
After you leave the hospital, contact your doctor if any of the following occur:
- Signs of infection like fever and chills,Redness, Swelling, Increasing pain, Excessive bleeding or discharge around incision site.
- Pain and/or swelling in the feet, calves, or legs.
- Cough, shortness of breath, chest pain
- Severe nausea or vomiting.
- Knee pain that you cannot control with the medicines you have been given or that becomes worse.
- Numbness, tingling, or loss of feeling in your leg, knee, or foot.
- If you are planning to have a knee replacement, your doctor will review a list of possible complications, which may include:
- Infection .
- Blood clots in the legs.
- Swelling or bleeding injury to nearby nerves or blood vessels .
- Anaesthesia-related problems .
Factors that may increase the risk of complications include:
Pre-existing medical conditions such as heart or lung problems, Obesity, Infections such as urinary tract infection or gum disease increases the risk of bacteria entering the bloodstream and infecting the joint. Previous problems with blood clots,Smoking, uncontrolled diabetes mellitus.
Be sure to discuss these risks with your doctor before the surgery.
