Knee Replacement

(Knee Arthroplasty; Total Knee Replacement)

Definition    TOP

Knee replacement, also called arthroplasty, is a surgical procedure to replace a knee damaged by disease or injury.

Recovery may take several weeks to months depending on your overall health.

Total Knee Replacement

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Reasons for Procedure    TOP

This is done if you have chronic pain and stiffness in the knee joint that limits activities.

Knee replacement surgery is most often done to:

  • Ease knee pain and disability due to arthritis or previous severe knee injury
  • Correct a knee deformity

Possible Complications    TOP

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Infection
  • Excess bleeding
  • Swelling
  • Blood clots
  • Chronic weakness in knee joint
  • Worsening or unchanged pain

Factors that may increase the risk of complications include:

  • Smoking
  • Poor nutrition
  • History of blood clots
  • Long-term illness
  • Use of certain medications

What to Expect    TOP

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam
  • Blood tests
  • X-ray
  • MRI scan to get images of the internal structure of the knee

Before surgery, you will need to:

  • Arrange for a ride home.
  • Arrange for help at home while you recover.
  • Talk to your doctor about any allergies you have.
  • Ask your doctor about assist devices you will need.
  • If you are overweight, lose weight. This will help to decrease the amount of stress on your new joint.
  • Install safety equipment in the bathroom, shower, and on the stairs.
  • Prepare a bedroom on the first floor if possible. Climbing stairs will be difficult at first.

Talk to your doctor about any medications, herbs, or supplements you are taking. You may be asked to stop taking some medications up to one week before the procedure, like:

  • Anti-inflammatory medications such as ibuprofen and naproxen
  • Blood thinners
  • Anti-platelet medications

Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.

Anesthesia

Anesthesia will keep you pain-free and comfortable during the procedure. You will havegeneral anesthesia and an area in your lower body will be numbed with an injection.

Description of the Procedure    TOP

A cut will be made in your skin. The damaged cartilage and bone will be removed. The remaining bone will be prepared to receive the new joint made from material such as plastic and metal. The artificial joint will be placed in the proper position. It may be cemented within the bone. The incision will be closed with staples. A drain will be left in to allow extra fluid to flow out.

How Long Will It Take?    TOP

About 2 hours.

How Much Will It Hurt?    TOP

Anesthesia will block pain during the procedure. You will have pain after the procedure. Ask your doctor about medication to help manage pain.

Average Hospital Stay    TOP

This procedure is done in a hospital setting. The usual length of stay is 3-4 days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care    TOP

At the Hospital

Right after the procedure, you will be taken to recovery and monitored closely. The staff may give you:

  • Pain medication
  • Antibiotics to prevent infection
  • Medication that prevents blood clots

While you are recovering at the hospital, you may need to use a continuous passive motion machine, which is designed to:

  • Slowly move your knee
  • Restore function
  • Decrease swelling
  • Improve circulation

During your recovery, you will need to:

  • Move your foot and ankle to increase blood flow back to your heart.
  • Wear support stockings. These may help prevent blood clots from forming in your legs.
  • Work with a physical therapist. You may start the day after surgery. You will learn safe ways to move your knee and support your weight.
  • You will learn how to use a walker, crutches, or other support devices.
At Home

To help ensure a smooth recovery at home, take these steps:

  • Start working with a physical therapist once you are instructed to. The therapist will focus on balance, range-of-motion, and strength training.
  • Maintain a healthy weight after surgery.

Within six weeks, you should be able to go back to light activities and driving. You may feel a soft clicking in the joint when walking or bending. Continue to work with the physical therapist. Water-based exercises may help to improve joint pain, swelling around the knee, and range of motion.

Antibiotics may be needed before certain dental procedures or surgeries now that you have an artificial joint. This will prevent possible infections from entering the bloodstream. Make sure to let the dentist or doctor know that you have an artificial joint.

Call Your Doctor    TOP

Call your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Swelling, redness, or pain in your legs, calves, or feet
  • Pain that you cannot control with the medications you have been given
  • Nausea and vomiting
  • Cough, shortness of breath, or chest pain
  • A chalky white, blue, or black appearance in your leg, foot, or toes
  • Numbness or tingling in your leg, foot, or toes
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine

If you think you have an emergency, call for medical help right away.

RESOURCES:

American Academy of Orthopaedic Surgeons
http://orthoinfo.org
American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org

CANADIAN RESOURCES:

Canadian Orthopaedic Association
http://www.coa-aco.org
Canadian Orthopaedic Foundation
http://www.canorth.org

References:

Knee replacement surgery procedure. Johns Hopkins Medicine. Available at:
...(Click grey area to select URL)
Accessed February 28, 2014.
Total knee arthroplasty. EBSCO DynaMed website. Available at:
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Updated February 6, 2014. Accessed February 28, 2014.
Total knee replacement. American Academy of Orthopaedic Surgeons website. Available at:
...(Click grey area to select URL)
Updated December 2011. Accessed February 28, 2014.
4/16/2009 DynaMed's Systematic Literature Surveillance
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Harmer AR, Naylor JM, Crosbie J, Russell T. Land-based versus water-based rehabilitation following total knee replacement: a randomized, single-blind trial. Arthritis Rheum. 2009;61:184-191.
6/2/2011 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
9/16/2014 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Abdallah FW, Chan VW, et al. The analgesic effects of proximal, distal, or no sciatic nerve block on posterior knee pain after total knee arthroplasty: a double-blind placebo-controlled randomized trial. Anesthesiology. 2014 Aug 5. [Epub ahead of print].
Last reviewed February 2014 by Teresa Briedwell, PT, DPT
Last Updated: 9/16/2014