Injuries and Conditions : Knee : Total Knee Replacement : Treatment : Surgical :
Total Knee Arthroplasty
Evaluation of Patient for Surgery
Patients are given a complete physical examination to assess the patient's overall health.
An examination of the range of movement in both the knee with degenerative arthritis as well as the other knee of the patient.
X-rays of the knee while the patient is standing are obtained to provide proper alignment of the replaced knee
Expectations for Recovery
A replaced knee will usually allow patients to regain stability, motion, and control of the knee.
The durability of the replaced knee is dependent upon the type of use and the stresses to which the replaced knee is subjected. High impact, shock-producing activities like running, jumping, or frequent kneeling should be avoided to insure a longer lasting knee.
Pain should be minimal throughout the life of the replaced knee, increasing only if the implants begin to separate or loosen from the bone. A second surgical procedure, or revision, may be necessary to replace the components if the pain or loosening becomes significant.
Under normal use a replaced knee can last more than 20 years.
Post Operative Recovery
Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, although the after-effects of anesthesia can vary greatly from patient to patient.
The knee will remain tender and slightly painful after surgery. However, the pain will tend to decrease as painkillers are administered and the knee recovers from the operation.
Post Operative instructions Activity:
Follow general post-operative guidelines.
Be wary of any signs of infection.
Elevate the operative leg for 48 hours after surgery.
Use crutches to assist walking, place weight on the operative leg as much as can be tolerated by pain.
Return to sedentary work (school or desk work) as tolerable.
Avoid long periods of sitting and long distance traveling without frequent (hourly) breaks and only after receiving clearance to do so from your surgeon.
Do not drive until the knee feels natural enough to allow comfortable motion.
Home Exercise:
Straight leg raises.
Quad sets.
Heel slides.
Ankle pumps.
Ice Therapy:
Begin ice therapy immediately after surgery.
Use a cryocuff continuously or as tolerated for the first week after your operation or until your follow-up appointment with your doctor. If you have not been instructed to use a cryocuff, icing should be performed every two hours for twenty minutes swelling is controlled.
Rehabilitation Program
The joint can be used immediately after surgery, but only to moderate capacity.
A period of time is required to acclimate the body to the replaced knee. Physical therapy will be required for three months to restore the muscle strength, flexibility and balance lost after surgery.
To help maintain a healthy knee, continued gentle use of the knee will be required.
Medication and Medical Products
NSAIDs NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
Pain resulting from inflammation or swelling.
Pain after injury.
Joint pain and arthritis.
Knee: Cold Therapy Cold therapy is used to reduce pain and swelling and is a convenient method to apply cold to an injured or rehabilitating extremity, such as a knee or shoulder. A cuff fits like a sleeve around the extremity and utilizes cold water supplied by a connected thermos or canister to chill the extremity. Water flow into the cuff can be controlled by different mechanisms. The simplest way is gravity; elevating the canister fills the cuff and controls the amount of pressure against the extremity. Water flow may also be controlled by a pump which will automatically circulate the cold water to and from the cuff. After surgery or immediately following an injury, the canister should be refilled with cold water every one to two hours to maintain a proper temperature. The cold therapy may also be used during rehabilitation, especially after physical activity, reducing the inflammatory heat from exercise.
Cold therapy can be used to treat:
Knee, Shoulder, Elbow, Wrist and Hand, Back, Hip, and Foot & Ankle Injuries.
Knee Examples include:
Pre-operative ACL/PCL injuries.
Non-surgical ACL/PCL injuries.
General knee pain or swelling.
Soft tissue injuries.
Possible Complications and Risks
Risks during and after surgery include problems that may develop in relation to bleeding, the possibility of infection and reactions to anesthesia.
DVT (Deep Vein Thrombasis) clots forming within the blood vessels of the legs are a potential complication during this type of major surgery.
The most common reason artificial joints fail is due to the loosening of the cement where the implants meet the bone. As the artificial joint wears, increasing pain may mean that a revision, or second surgery, is required to replace the loosened components.
Stiffness in the knee may result after surgery as scar tissue forms inside the joint and affects motion. If this is a severe problem, a second surgery may be required to remove the scar tissue.
The surgeon may also manually move the knee through a full range of motion while the patient is asleep (under anesthesia) to break-up scar tissue.
