TOTAL KNEE REPLACEMENT
Total knee replacement is a common surgical procedure to relieve the pain associated with knee arthritis. It is a major surgical procedure that requires general or spinal anesthesia and an overnight stay of 1 to 2 days with a possible short stay at a rehabilitation center if there's not an adequate support structure at home. Your surgery may be performed at the hospital or our new MUVE non-hospital joint replacement center depending on your individual situation.
The success rate is extremely high. It is one of the most successful surgery performed in relieving arthritic pain.
Almost one million knee replacements are performed each year in the United States. The most significant benefit of total knee replacement is significant pain relief.
Many patients also feel that their knee is more stable after surgery. The average recovery time is 60% at 6 weeks and 85-90% at 12 weeks. Following surgery, most patients are able to return to a normal lifestyle, including walking, hiking, biking, golf, tennis, and even skiing.
What does total knee replacement involve?
Arthritis is when the cartilage cushion on the ends of the bones has worn out and there is no longer any smooth space between the bone ends. This results in rough surfaces scraping and rubbing against each other causing pain. Total knee surgery relieves the pain by resurfacing the ends of the bones with smooth surfaces. In addition removing the rough surfaces results in more comfortable range of motion.
Knee replacement is a terrible term in that it implies complete removal of the knee joint when in reality only the very tips of the bone or removed. Only approximately 1/3 of an inch of the end of the bone is removed. The surgery is done through an incision on the very front of your knee. The length of the incision varies with the size of the knee but is generally 5 to 6 inches in length.
During the surgery the worn ends of the bones are removed and replaced with the parts of the knee prosthesis. The end of the thigh bone (femur) is replaced with a metal cap.
The top of the shin bone (tibia) is replaced with a thin metal plate and a smooth piece of plastic that is snapped into that metal plate. This piece of plastic functions as your new cartilage. The under surface of your knee cap (patella) is replaced with a smooth piece of plastic as well. The part of your knee cap that you can touch in the front of your knee remains intact.
All of these parts come in various sizes so that they can be customized to fit each patient's needs. When completed everything inside your knee rubs smooth metal on smooth plastic instead of rough bone against rough bone.
Before surgery, preoperative evaluation is necessary. The extent of the testing depends on each patient's age, gender and medical condition. All patients need at least a history and physical examination by a medical doctor, usually your primary care physician. And EKG and
blood work or also necessary and sometimes a valuations by medical specialist such as a cardiologist may be needed.
Our surgical scheduler will determine the specific tests and evaluations that you need.
You will arrive the morning of your surgery. There is no need to come in before that as all of your pre-admission testing will have been completed prior to that time. Remember not to eat or drink anything that morning. You should not have anything by mouth from the midnight before your surgery until the time of your surgery, and that includes chewing gum, cough drops, etc. You may brush her teeth, and take your morning medicines as instructed by anesthesia with a very small sip of water.
Dr. Vernace will see you in the pre-operative area before your surgery to review your chart and to mark your knee with his initials in order to identify the proper side for surgery.
From the time you leave the preoperative area to go into the operating room to the time that you arrive in the post anesthesia care unit (PACU) will be approximately 90 minutes. The surgery itself takes approximately one hour.
At the completion of your surgery Dr. Vernace will contact your family to let them know that all is well and that you are on your way to the PACU. Following your stay in the PACU, you will be taken to your room to start your rehabilitation.
As with any major surgery, knee replacement surgery carries certain risks and potential complications. The most significant of these are infection, blood clot, anesthesia risks and the possibility that the knee implant may not last forever. You will be given antibiotics in the pre-operative area to help prevent infection. The risk never goes to zero but our infection rate is below the national average and is approximately one half of one percent.
In order to to try to prevent blood clots, you will be placed on 81mg aspirin twice a day for 4 to 6 weeks. If you are at higher risk for blood clots because of your medical history you will be placed on a different blood thinner.
Anesthesia risks are minimal for healthy individuals. You will fill out an anesthesia information questionnaire that will help the anesthesiologist discuss risks directly with you, as well as to discuss your options for the type of anesthesia to be used.
The implant used today are very long lasting and we would expect 90 to 95 percent of knee replacements to last 20 years or more.
You will be up and out of bed very rapidly after your knee replacement surgery.
You will start walking with a walker and progressed to a cane as you tolerate your rehabilitation in the days or weeks following your surgery. You will be provided pain
medication during your stay and when you are discharged. Although we understand the need for pain medication we recommend weaning this down as rapidly as possible to avoid any potential complications. For most patients the first or second day after surgery will be your discharge day. In those instances where further inpatient rehabilitation is needed this can be arranged as well.
Once home your physical therapy program should start almost immediately. You will receive physical therapy tailored to your needs. For some of you this will involve following an on-line rehabilitation program and for others it will involve in person outpatient physical therapy.
Your first postoperative visit to the office will be approximately two weeks after surgery to have your incision checked and to obtain an x-ray. There will be no need for suture removal since all of the sutures are placed under your skin at the time of surgery.
If you have any questions following surgery you may call the office at any time at 610-527-9500.