Our goal is to restore your knee to a painless and functional status, and to make your hospital stay as beneficial, informative, and pleasant as possible.
Please review this information before your surgery and write down any questions you have so you can ask a member of your health care team.
Contents
Total Knee Replacement
Total knee replacement is a surgical procedure in which injured or damaged parts of the knee joint are replaced with artificial parts.
The procedure is performed by opening up the knee capsule and removing the ends of the thigh bone (femur), the shin bone (tibia), and the underside of the kneecap (patella). Artificial parts are cemented into place and make up the new knee joint.
The new knee consists of metal implants on the ends of the shin bone and thigh bone, and a plastic trough in between them.
Cemented into place are metal implants at the top of the shin bone (tibia) and the bottom of the thigh bone (femur). A tray is placed on top of the tibial implant and a button is placed on the underside of the kneecap (patella). Sometimes the patella does not need to be replaced.
When do we consider total knee replacements?
Total knee replacement surgery is usually done on people with severe arthritic conditions. It varies from person to person, but you would most likely be considered for a total knee replacement if:
- Pain is severe enough to restrict work, recreation, and/or activities like walking, dressing, and preparing meals
- You have severe stiffness of your knee
- x-rays show advanced arthritis or significant deformity of your knee
- You have daily pain
- You have significant instability (constant giving way) of your knee
What can I expect from an artificial knee?
An artificial knee will never work as well as your original knee did before you had arthritis. With pain relief, and good health, you should be able to resume most of your normal activities.
The artificial knee may allow you to return to active sports or heavy labor under your physician’s instructions. Activities that overload the artifical knee must be avoided. About 90 percent of patients with arthritic knees before surgery will have better motion after a total knee replacement.
What are the risks of total knee replacement?
Total knee replacement is a major operation. Complications are rare, but may happen. The most common complications are not related to the knee and do not usually affect the result of the operation. If they occur you may need to stay in the hospital longer than planned. These include:
- Blood clots in the leg
- Blood clots in the lung
- Urinary infections or difficulty urinating
Complications that affect the knee are less common, but in these cases, the operation may not be as successful. These complications include:
- Some knee pain
- Loosening of the prosthesis
- Stiffness
- Infection of the knee
How do artificial knees stand up over time?
Research shows that artificial knees last a long time.
Loosening is the major long-term problem. This occurs because the cement crumbles or the bone melts away over time from the wear and tear caused by normal activity.
A loose, painful artificial knee can usually, but not always, be replaced. The results of a second operation are not as good as the first, and the risks of complications are higher. There is an increased risk of wearing your new knee out if you are overweight.
Preparing for Surgery
Preparing for a total knee replacement begins several weeks ahead of the actual surgery date. Good physical health before your operation is important. Keeping or getting your upper body strong will improve your ability to use a walker or crutches after the operation. Performing leg strengthening exercises will help with your recovery also.
Medical Management
You and your doctor will make a plan about what to do about the blood you lose during surgery. Some surgeons have you donate blood, others use a blood transfusion device after your surgery.
Please schedule an appointment with your dentist if you have not had a dental check during the last six months. An infected tooth or gum could cause your new knee to get infected.
Your orthopaedic doctor will ask you to see a medical doctor, or other specialist, at University of Iowa Hospitals and Clinics, especially if medical problems have been present in the past.
The doctor may order blood tests and a urine sample before surgery to make sure you do not have a urinary tract infection. Urinary tract infections are common and many people don't know they have an infection.
Preparing for Surgery and Recovery
When getting ready for surgery, you should begin thinking about the recovery period after surgery.
- You will be able to go home from the hospital two to four days after surgery
- You will need someone to stay with you at home for at least the first several days
- You will need help dressing, getting meals, etc.
- Your energy level will not be normal at this time
If you do not have anyone to help you when you go home, you may need to go to a nursing facility until you regain strength and can care for yourself. Your social worker can help with these arrangements.
Pre-operative Visit
All patients come to the clinic before their surgery to meet with the health care team. This visit will take several hours, so you should plan to spend at least half the day or more to complete it.
The visit begins in the Orthopaedic clinic, where a nurse will ask you about your medical history and the medicines you take, including prescription medicines and over-the-counter medicines. Bring a list of your past surgeries and a list of the medicines with the dose (amount) that you take at home.
The nurse practitioner will meet with you to reviewed your medical history and the medicines that you take. She/he will check you for infection. Any blisters, cuts, or boils should be reported. If you have an infection, surgery is generally delayed until the infection is gone. Additional x-rays are taken if needed.
Before you leave the hospital make sure your questions are answered. If at any time before your scheduled surgery, you become ill, such as with a cold or flu, you need to call your orthopaedic doctor at University Hospitals right away. Remember we want you to be in your best possible health when you come for surgery.
Diet
You can brush your teeth the day of your surgery but do not swallow anything. You can drink a total of eight ounces (one cup) of clear liquid from midnight until two hours before your surgery. You may not eat solid food on the day of surgery. Your choice of a clear liquid will include black coffee, clear tea, water, apple juice or soda.
Bathing
You will shower or bathe the night before your surgery and the morning of surgery if you can. Please use the special soap you get at your pre-operative visit. We will instruct you on how to do your scrub. If possible, shampoo your hair. Nail polish and make up should be removed. Do not shave your legs within five days of surgery.
Blood Clot Prevention
You may be fitted for foot pumps and/or elastic support stockings (TEDS) before surgery. These help to keep your blood moving through your legs after surgery. You will be taught ankle exercises to help increase blood circulation in your legs while lying down. Medicine will be given to you to thin your blood after surgery. Your doctor will decide what is best for you.
Anesthesia
You will see an anesthesiologist either in the late afternoon on the day of your pre-operative visit or on the day of your surgery. A nurse practitioner will talk about your choices of anesthesia and review your medical history. He/she will talk to you about what medicines to take on the day of your surgery.
If you are scheduled to see anesthesia on the day of your surgery, one of their staff will call you at home before your surgery and tell you which of your medicines you should/can take on the day of the surgery.
Pain Management
Good pain management is one of the best ways to ensure you get up and get moving after surgery. You will be asked to rate your pain on a scale of 0 to 10 with 0 being no pain and 10 being the worst possible pain.
You will be given pain medicine after your surgery. If your pain medicine is not working, we want to know so we can control your pain. You will be given pain medicine to take home.
Deep Breathing Exercises
The nurses will teach you how to do deep breathing exercises and how to use a device called an “incentive spirometer”. These exercises are needed to help remove secretions that may settle in your lungs while you are asleep during surgery and helps prevent pneumonia.
Activity
Some patients have discomfort in their back after surgery. This is caused by the general soreness of the knee area and partly by the lack of movement required before, during and after surgery.
Changing your position helps to relieve discomfort and will also help to prevent skin breakdown.
Therapy and Rehabilitation Program
After surgery you will work with a physical therapist to become independent in walking, going up and down stairs, getting in and out of bed and doing exercises to improve the range of motion and strength of your knee.
Your physical therapist will give you an exercise program for home. In addition to exercises for you to do in your home, you may have to go in to a clinic for more therapy after your discharge. Your doctors and therapists will let you know if this is needed.
Surgical Checklist
Night Before Surgery
- Shower (with five minute wash to surgical area with soap provided)
- Nothing to eat after midnight, only clear liquids after midnight
- Pack t-shirt and shorts, tennis shoes, toiletries
- Do not bring valuables to the hospital
You will be called and given the time of your surgery and what time to arrive at the hospital. It is important that you arrive at the time given to you over the phone or your surgery may be delayed or cancelled.
Morning of Surgery
- Take your medicines as instructed with sips of water
- Take a second shower and wash the surgery site
Day of Surgery
Please arrive at the Day of Surgery Admissions at the instructed time, with your knee already washed. The nurse will spend a few minutes making sure you are still in good health and ready for surgery.
It is hard to predict how long each surgery will take, so expect some waiting time. Bring something to help pass the time.
You will be given a hospital gown and an intravenous (IV) line will be started for fluids and medicines during and after surgery. You will also have blood drawn to find your blood type and prepare blood for you in case you need a blood transfusion.
Your family can stay with you until you go to the operating room. You will be taken to the operating room after talking to your anesthesiologist. Your family will be sent to the Day of Surgery waiting room, Level 6.
The actual surgical procedure may take two to four hours, depending on how bad the knee was. Preparationfor surgery as well as wake-up time may make your operating
room and recovery room stay longer.
After Surgery
The surgeon let your family know how the surgery went. After surgery you will be taken to the recovery room for one to three hours. Your blood pressure, pulse, respiration and temperature will be checked often.
Close attention will be paid to the circulation and sensation in your legs and feet. When you wake up and your nurse and doctor feels you are ready, you will be taken to your room.
You will likely have some or all of the following after surgery:
- A large dressing on your knee to keep the wound clean and absorb any fluid. This dressing is usually changed one day after surgery by the doctor.
- A Hemovac suction or blood recycling container with tubes leading into your knee allows the nursing staff to measure and record the amount of drainage being lost from the wound after surgery. The hemovac is usually removed by your doctor the morning after surgery.
- The IV started before surgery will continue until you are taking enough fluid by mouth. When you are taking fluids well, the IV may be capped off so you do not need to be hooked up all the time. Antibiotics will be given for 24 hours after surgery to prevent infection.
- One side effect of anesthesia is trouble urinating after surgery. For this reason, a sterile tube called a catheter will be inserted into your bladder to keep your bladder empty. This will stay in place until the first day after surgery.
- Your doctor will decide what type of stockings or inflatable boots you will wear during and after surgery to help prevent blood clots from forming in your legs. You will be given medicines and exercise instructions (moving your ankles up and down) to help to prevent clots.
- After surgery you may have nausea and vomiting due to anesthesia or other medicines. Medicine will be given to help relieve nausea and vomiting.
- You will be allowed to eat and drink your usual diet, starting with ice chips, then clear liquids, and then to solid food.
- To help prevent lung congestion or pneumonia, deep breathing and coughing exercises are important. Inhale deeply through your nose; then slowly exhale through your mouth. Repeat this three times and then cough two times. You will be encouraged to use your incentive spirometer.
- After surgery you will work with a physical therapist to become independent in walking, going up and down stairs, getting in and out of bed, and doing exercises to improve the range of motion and strength of your knee. Your physical therapist will also provide you with an exercise program for at home.
Guidelines for Going Home
When you go home from the hospital you will be independent in walking with crutches or a walker, climbing a few stairs, and getting into and out of bed and chairs.
You will need someone to help you at home for at least a few days, and then someone to help as needed, until your energy level gets better.
Medicine
- You will continue to take medicines as prescribed by your doctor.
- You will be sent home on medicine to prevent blood clots. Your doctor will decide whether you will take a pill (Warfarin or enteric coated aspirin) or give yourself a shot (Enoxaparin). If an injection is needed, the nursing staff will discuss it with you, and teach you or a family member how to give this medicine. A visiting nurse can also provide this service. If you go home on Warfarin you will need to have your blood drawn two times per week. You will be given special instructions for the medicine the doctor wants you to take at home after surgery.
- You will be sent home on medicine to control pain. Plan to take your pain medicine 30 minutes before exercises. Preventing pain is easier than trying to catch up with your pain. If pain control continues to be a problem, call your doctor.
Activity
- Continue to walk with crutches or a walker as directed by the doctor or physical therapist
- Your doctor will determine how much weight you can place on your operated leg
- Walking is good for muscle strengthening
- Walking does not replace the exercise program that you are taught in the hospital. The success of the operation depends to a great extent on how well you do the exercises and strengthen your weakened muscles.
- If you have a lot of muscle aching, or sudden onset of pain, you should cut back on your exercises
Sitting and Resting
For the first week or two, avoid sitting more than 60 minutes at a time. Always sit in a chair with arms. The arms of the chair give you a place to push yourself up to the standing position.
A high kitchen or bar-type stool works well for kitchen activities. Avoid low chairs and overstuffed furniture because they may take too much work for you to get up.
Rest with your leg above the level of the heart and you may apply ice to your knee, two times a day for the first week or two.
If you sit up for more than an hour or two and develop a painful or swollen leg, use ice and keep your leg up for an hour to decrease pain and swelling. Be sure to follow the knee precautions your therapist taught you in the hospital.
Other Considerations
- Do not drive for six weeks after surgery or until your doctor tells you can. When getting into a car, back up to the seat of the car, sit and slide across the seat toward the middle of the car with your knees about 12 inches apart. A plastic bag on the seat will help you safely slide in/out of the car.
- For the next four to six weeks, do not engage in sexual intercourse. Sexual activity can often be resumed after your six-week follow-up appointment.
- You can return to work within two to three months, or as instructed by your doctor.
- Continue to wear elastic stockings (if ordered) until your return appointment.
- Do not shower until your sutures (stitches) are removed, unless you are instructed differently. Showers may be taken two days after your sutures are removed.
Do not soak in a bathtub until your doctor has said you may
Your Incision
Keep the incision clean and dry. Watch for signs of infection. If you notice:
- Any swelling
- Increased pain
- Drainage from the incision site
- Redness around the incision,
- Fever
Report this to the doctor right away.
The staples in your incision are either removed before you leave the hospital or two weeks after you go home. Staple removal can be arranged in your hometown. The wound sutures are removed in two to three weeks either by your local doctor or at your follow-up appointment in the Orthopaedic clinic.
Prevention of Infection
If at any time (even years after the surgery) an infection develops such as strep throat or pneumonia, call your doctor. Antibiotics should be given as quickly as possible to prevent the complication of the infection settling in the area of your joint replacement.
Tell any or all of your doctors and dentists that you have had a joint replacement. You will be given a medical alert card. Carry this in your billfold or wallet. It will give information on antibiotics that are needed before any dental work or oral surgery, or if a bacterial infection develops.
When do I return to the clinic?
Your first return appointment is three to six weeks after surgery. At your return appointment you will be examined and have x-rays. Appointments are then at three to six months, one year, and two years after surgery. Each surgeon has their own routine for follow-up visits.
Should I have a total knee replacement?
The total knee replacement is an elective operation; it is not a matter of life or death. There are always non-operative choices.
The decision to have the operation is not made by the doctor. It is made by you, for it is you who must accept the risks and complications. The doctor may suggest the operation, but, your decision must be based on weighing the benefits of the operation against the risks.
You may wish to discuss the surgery with your personal doctor or get another opinion. All of your questions should be answered before you decide to have the operation. Please feel free to ask any questions you have in order to make your decision easier.
Remember, your doctor, physical therapist, and nurses are working to help you get the most functional knee replacement possible for you. After the surgery, the success of your knee replacement, depends on you and how well you follow your exercise plan and follow the instructions you have been given. |
