TOTAL KNEE
REPLACEMENT
TOTAL JOINT REPLACEMENT is one of the most
consistently successful therapeutic measures in all of medicine and
surgery today. Overall patient satisfaction with the relief of pain
and enhanced mobility is, in general, extremely high.
However, as in all major surgical procedures, there are significant
risks that patients will want to discuss carefully and thoughtfully
with their surgeons. Patients should ask their surgeons to explain any
risks or benefits, which will help them make an informed decision.
The following text explains the key points about total knee replacement
surgery and hospital stay. If you would like additional materials to
study, videotapes and other brochures are available. Just ask.
Once again, please keep in mind that procedures and protocols vary,
sometimes widely, from surgeon to surgeon and hospital to
hospital. We will be more than happy to answer your specific questions and
explain how these procedures will be tailored to fit your personal
condition and needs.
The Knee and the Arthritic
Process
Total knee replacement is a procedure that is done for the severe
arthritic joint, and only after other forms of treatment no longer
have any benefit. It is not done for minor arthritic joint pain.
The knee is what is commonly referred to as a "hinge" joint, although
it is not as simple a hinge as those found on doors. The knee
not only bends back and forth, but it also has some ability to move in
a rotational manner. The knee, a major weight-bearing joint, is
surrounded and held together by muscles, ligaments and other soft
tissues. Cartilage is the material that "cushions" the knee and allows
the joint to move in a smooth and free manner.
As the arthritic process develops, the cartilage wears out, and the
nerve endings that lie beneath the surface become irritated and
produce the symptoms of pain. As the joint becomes more and more
destroyed, the soft tissues offer less and less support. At that point, it
is time to consider surgical replacement.
The Surgical
Procedure
The surgical procedure involves removing the diseased portions of the
joint and replacing them with new parts. Very accurate cuts are made
on the undersurface of the femur (thigh bone) to match the
undersurface of the femoral prosthesis so that they will fit together well
and be both solid and stable. Similarly, accurate cuts are made
to the top surface of the tibia (shin bone), and the tibial component is
anchored in place.
These components are then fitted together to allow the knee to bend
back and forth and also have some of the rotational movement of the
normal knee. Since the painful diseased cartilage (cushioning) has
been removed, there is generally a very quick relief of pain, an
outstanding feature of this procedure.
The surgical procedure for total knee replacement usually takes about
two to three hours, and the new joint is often immediately solid.
However, strengthening the weakened muscles and soft tissue surrounding
and supporting the joint requires a longer-term program of exercise and
physical therapy. Although many patients see and feel immediate benefits,
they must continue to rehabilitate themselves for several months to
get the total benefit.
Anesthesia
Anesthesiology has come a long way in the last twenty-five years. There
are newer, more stable drugs, and there is more accurate and more
complete monitoring.
There are, however, some risks involved which are largely related to
the severity and amount of underlying diseases, such as heart,
atherosclerosis (hardening of the arteries) or lung problems. With an
increase in the amount of severity of these conditions, there is,
naturally, an increase in the risk. Nevertheless, the safety record of
anesthesia today is very high.
It is essential that patients tell their surgeon and anesthesiologist about
all of the medical conditions they have as well as all the medicines
that they are taking.
After Surgery--The first few
days
During the first few days after surgery, there is naturally some pain;
this should be expected. But it can be adequately controlled by
medication.
In spite of any mild discomfort, it is important that patients make the
effort to do the deep breathing and physical therapy exercises as
instructed. Patients who breathe well and work at tightening their
muscles, better their lung capacities and circulation, and they improve
and get well faster.
There are also certain restrictions that may be placed on patients
early in the postoperative period in order to avoid unusual strains on
the joint that could result in dislocation of the joint or disruption
of the sutures. The nurses and therapists are very familiar with the
procedures and will give instructions that can be easily handled.
Exercise and Physical
Therapy
One of the most frequently asked question is, "When can I start walking
again?"
While patients are often encouraged to stand and sit (with assistance)
within twenty-four hours after surgery, walking is approached gradually
and in a guided manner so as to avoid injury and complications. It is
very important to rebuild and strengthen the muscles through isometric
exercises.
Social Services
Many patients, especially those that live alone, are concerned about
whether or not they will be able to manage for themselves in the first
few weeks after they leave the hospital. And if they should need
assistance, they are concerned about who will pay for it.
Insurance coverage for home care is generally limited, but there are
agencies available that can provide some help. Someone can visit the
home and show patients how to lay things out so they won't have to
worry about falling. There are a variety of Home Health Care agencies that
can arrange to help with needs like bathing and the preparation of
meals. The hospital Social Services Department can direct patients to
these agencies.
Patient Involvement and
Commitment
With Total Knee Replacement, the surgeon replaces the diseased knee
joint and, along with the physical therapist and nursing staff, guides the patient through the recovery process. But
rehabilitation is up to the patient. The patient must participate fully in
the rebuilding and strengthening of weakened muscles. To get the total
benefit of knee replacement, the patient must make a serious
commitment to doing the prescribed exercises and developing and
maintaining an active life-style. | 
