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Total Knee Replacement Surgery

Replacing the worn out surfaces of the end of the thigh bone (femur) and top of the shin bone (tibia) and undersurface of the kneecap (patella) with metal and polyethylene (hard plastic) bearing surfaces. We use both fixed-bearing and mobile-bearing prostheses to maximize motion and longevity. This is done to relieve the pain associated with arthritis of the knee. This requires an inpatient hospital stay of 2 to 4 days. The procedure takes approximately 60 to 90 minutes to perform. A system of specific instruments, along with the use of computer-assisted techniques, are used to insure correct placement and alignment of your prosthesis. The implants are fixed to your bones with bone cement. Ninety to 95 percent of patients are happy with their procedure.

What is the Process?

  • Make the decision to have surgery.
  • Pick a date for your procedure.
  • Pre-op medical evaluation with a primary care physician and consults as needed.
  • Pre-op labs and tests within 3 weeks of surgery.
  • Attend informational seminar at the Center for Joint Replacement.
  • Donate blood, if indicated, 3-4 weeks prior to surgery.
  • Arrange for family and/or friends to assist you after you go home from the hospital.

The Day of Surgery

What to Bring

  • Walking shoes with rubber soles or tennis shoes. No house slippers.
  • Pen and pad of paper to write down questions you may have.
  • Personal care items.
  • Women: Gowns and robes; knee length only. Bring panties. May wear shorts, sweatpants, and T-shirts, or a hospital gown with a robe, if you prefer.
  • Men: Short pajamas or exercise shorts and T-shirts. May prefer hospital gown with a robe. Bring underwear.
  • Do not bring over $5.00 or jewelry, credit cards, or other valuables.

Report to

The outpatient surgery area of the hospital at the time designated on your surgery checklist. A nurse will review your medical history.

The Preoperative Area

You will change into a hospital gown. An IV will be started in your arm. You will receive fluids and antibiotics prior to your surgery. You will meet the anesthesiologist. He/She will discuss the options for anesthetic. These include a spinal, which numbs you from the waist down, or a general anesthetic. If you elect to have a spinal, medicine can be given through your IV so you sleep during your operation. You may also have a femoral nerve block, which is performed after you are asleep, to assist with postop pain management. Your family and friends may wait with you, until your nurse takes you to the Operating Room.

Arrival at the Center for Joint Replacement

  • After you spend 1-2 hours in the Recovery Room, you will be transferred to the Center for Joint Replacement, where your family and friends can visit you.
  • The nurses will check your vital signs and pain control. If you are uncomfortable or have nausea, medications will be given to help.
  • A therapist will evaluate you and begin therapy, including sitting, standing, and walking. Patients who return to the Joint Center in the late afternoon will begin therapy the next morning.

The staff at the Center for Joint Replacement specialize in the care of patients with joint replacement surgery. They will make sure your recovery goes as smoothly as possible.

Waking Up After Surgery

You will wake up in the Recovery Room, and then will be taken to your room. There will be several things connected to you.

  • IV (intravenous line): This is a tiny catheter which is inserted into a vein in your hand or arm. It will be connected to a tubing and a bag of fluids.
  • OXYGEN You will have oxygen through a tubing with two small prongs into your nose. This doesn’t mean that you are not breathing well. The oxygen may be discontinued the evening of surgery or the following morning.
  • FOLEY CATHETER: A catheter may be inserted into your bladder during surgery. It will stay in for approximately one to two days.
  • DRAIN: You will have a drain tube into the knee after surgery. This removes excess blood from the knee after surgery. It will be removed the second day after surgery.
  • P.C.A. (Patient Controlled Anesthesias) MACHINE: This is a machine which may be used for your pain medication. It connects by tubing to your IV line. Attached to a small IV pole is the machine which contains a syringe of pain medicine. There is a button on a cord from the machine that will be within your reach. When you are having pain, push the button, and the medicine will deposit directly into your vein. This is a small dose. Therefore, you may have it often, if you need it. The machine is programmed so that you cannot give yourself too much medicine. You may take pain pills along with using the machine. This machine will be disconnected when the pain pills will relieve your pain.
  • KNEE IMMOBILIZER: Your knee will be in a soft splint after surgery. This will be worn at night when you’re not on your CPM and during the first 2-3 days to assist with walking. After Day 3, you will wear it at bedtime only to promote straightening. This will continue for 2 weeks after surgery.
  • BREATHING: The nurse will be asking you to take deep breaths and to use your spirometer, which is a small machine that you breathe into in order to clear your lungs.
  • DIET: You will be on a regular diet after surgery.

The Remainder of Your Hospital Stay

DAY 1 (the day after surgery)

  • Your oxygen will probably be removed.
  • Your operative leg will be put in a continuous passive motion machine, which will help you bend and straighten your knee. If you are out of the machine at night, your knee immobilizer will be put on to promote straightening.
  • The nurse will encourage you to lift your leg off the bed. It may be a few days before you will be able to lift your leg on your own.
  • You will get up to a chair with the assistance of the nursing staff. A soft splint will be on your leg to support it when you get up. When you can lift your leg off the bed on your own, the splint will be discontinued.
  • Your exercise program with the physical therapist will begin, helping you to bend, straighten and gain strength in your new knee. You will begin walking with your walker with the physical therapist.

DAY 2

  • If you have a drain, it will be removed by the nursing staff in the morning.
  • Your IV will probably be discontinued, and the needle will be capped for a few days.
  • Your exercise program will continue twice daily, helping you to bend, straighten and gain strength in your new knee. You will continue to walk further each day with your walker.

DAY 3-4

  • You will continue physical therapy twice daily. When you can get in and out of bed alone, walk safely with your walker, and you have shown that you can climb stairs, you will be able to leave the hospital. This is usually the 3rd or 4th day after surgery.

YOU are the most important player on your team of caregivers. Your doctor, or one of his assistants, will be seeing you daily, and your nurses and therapists will play their roles in supporting your care. Only YOU can do what needs to be done to make your knee its best.

Your hard work will be worth it!

After Discharge From The Hospital

If you live alone or do not have adequate help, you may go to a rehab facility for a while following surgery. We will discuss options for your care prior to your hospital admission. Whether at a rehab facility or at home, the following things are important for your care:

  • Knee Immobilizer: The knee immobilizer (splint) is to be worn two weeks to maintain extension while sleeping. Knee splint is not to be worn during the day.
  • Your Knee Incision: Staples will remain in place for one to two weeks. They will be removed in your surgeon’s office at first postop visit. Steri-Strips will be applied, which can be removed in one week.
  • Ice and Elevation:We encourage the application of ice packs following exercise and at least three times per day for 30 minutes at a time when resting with the foot and leg elevated on three pillows (at least 18 inches above the level of your heart). An easy schedule to follow is 10:00 am, 2:00 pm and 6:00 pm. This elevation is important. It helps reduce swelling and promotes better circulation.
  • Swilling/Bruising:: You are likely to see more swelling and discoloration on the outside portion of the knee. This is expected but can be reduced by lying down with leg elevated as described above.
  • Walker/Crutches:A walker or two crutches will be used to walk in two to three weeks. This is usually full weightbearing. Progression to a cane can begin at three weeks as pain allows. You should use the cane until you can walk without a limp. This usually takes two weeks.
  • Supervised Physical Therapy: Following discharge from the hospital, you will begin outpatient physical therapy two to three times per week for four to eight weeks. This will allow you to work with a therapist to maximize your range of motion and strength. This is very important to the success of your knee. You will perform exercises three times per day, seven days a week, for the first six to eight weeks after surgery.
  • Showering/Bathing: Showering is permitted as soon as the incision is free of drainage, usually by two to three days following surgery. You may shower and let the water run over the incision and then pat it dry with a towel, no rubbing. Immersing the leg in collected water such as a bathtub, hot tub or swimming pool is not permitted until 72 hours after the staples have been removed. A dry layer of gauze may be applied to cover the incision if desired. No ointments, lotions or oils are to be applied to the incision until the staples are removed.
  • Coumadin: : Most patients will be taking Coumadin for 14-21 days following discharge from hospital. This blood thinning medication is used to help prevent blood clots. A prescription for a specific dosage and time period is given to you at the time you leave the hospital. Your dose will be adjusted by the anti-coagulation clinic at VMC where weekly blood draws will be performed. Aspirin and arthritis medications MAY NOT be taken until 48 hours after the prescription has been completed. If you take aspirin for cardiac reasons, continue to do so while on the Coumadin. Tylenol or Tylenol ES every four to six hours may be used for pain relief in addition to the prescription narcotic analgesics (commonly Vicodin, Darvocet-N or Tylenol w/ codeine). Following the completion of the prescribed Coumadin, you should take one aspirin each morning for one month. Mark this on your calendar.

UNDERSTANDING THE RISKS

As with any surgery, there are certain risks. The following are some of the more common complications of which you need to be aware and things we do to try to prevent them.

  • INFECTION: There is always a risk of infection with any surgery. You will receive antibiotics in surgery and several doses after surgery to reduce this risk. The risk of infection after Total Knee Replacement is approximately one percent.
  • BLOOD CLOTS: When you have surgery on the knee, circulation is impaired during healing. A blood thinner medication will be prescribed for you, which will help to keep your blood a little thinner than normal to prevent blood clots. We begin the first dose on the evening of surgery. Each day in the hospital, blood will be drawn to check your blood thinning level. Another thing that will help to prevent blood clots is to elevate both feet while sitting to prevent blood pooling in the lower legs and perform ankle-pumping exercises.
  • PNEUMONIA: Breathing deeply after surgery and using an incentive spirometer are very important to prevent congestion in the lungs, which can lead to pneumonia. It is very important that you are up and out of bed often.
  • BLADDER INFECTIONS: Bladder infections are more common when you have had a catheter. It is very important to drink a lot of fluids to help prevent an infection.
  • NUMBNESS AROUND THE KNEE: It is important to know that you will experience some numbness on both sides of your knee. This is not a problem; it is very normal. During surgery the nerves around your knee are disturbed. You may feel tingling sensations as the nerves are healing. You may always feel some numbness around your incision, but this will not affect the function of your new knee. Rarely there can be permanent numbness or weakness as a result of trauma to the nerves.
  • STIFFNESS: In the early postoperative period, all patients with a total knee replacement experience pain and stiffness of the knee. Pain medication will ease the pain, but it is very important that you work to increase your motion daily. You will not damage your knee by working to increase motion, despite the soreness.
  • SEVERE COMPLICATIONS: Again, with any major surgery there is a possibility that any of the above complications, as well as problems with anesthesia, could be severe enough to result in death. If there are any questions or concerns regarding these complications, please feel free to discuss them with your surgeon.

FREQUENTLY ASKED QUESTIONS AFTER TOTAL KNEE REPLACEMENT

What is recovery time?

Everyone heals from their surgery at a different pace. In most cases, however, you will be restricted to using a walker or crutches for 2 to 3 weeks after your operation. You will then be allowed to advance to a cane outdoors and no support around the house for several weeks. You will gradually return to normal function without any assistive devices.

How long will I be on pain medications?

You will likely require some form of pain medication for about 2 months. Initially, you will be a stronger medication (such as a narcotic). Most people are able to wean off their strong medication after 1 month and are able to switch to an over-the-counter pain medication (such as Tylenol or ibuprofen). If you are on Coumadin (warfarin), avoid taking any NSAIDs (e.g. aspirin, ibuprofen, Advil, Motrin, Aleve, Naprosyn) without first consulting your internist.

Do I need physical therapy?

Yes! The physical therapist plays a very important role in your recovery. You will see a physical therapist soon after your operation and throughout your stay at the hospital. After discharge, you will be referred to an outpatient physical therapist. If you go to a rehabilitation hospital or ward, you will receive therapy there. The therapist will help you walk, regain motion, build strength, and help you reach your postoperative goals. Your therapist will keep your surgeon informed of your progress.

What exercises should I do?

You will be instructed by your physical therapist on appropriate exercises and given a list to follow. In general, swimming and a stationary bicycle are good exercise options. These exercises should be continued indefinitely, even after your recovery is complete.

What are good positions for my knee? What positions should I avoid?

You should spend some time each day working on straightening your knee (extension), as well as bending your knee (flexion). A good way to work on extension is to place a towel roll underneath your ankle when you are lying down. A good way to work on flexion is to sit on a chair or stationary bicycle and bend your knee. Avoid using a pillow or towel roll behind the knee for any length of time.

Can I use weights?

Generally, not for the first 4 weeks. However, as everyone’s strength varies, consult with your physical therapist before using weights. Use light weights to begin with, and gradually progress.

I am constipated. What should I do?

It is very common to have constipation postoperatively. This may be due to a variety of factors, but is especially common when taking a narcotic pain medication. A simple over-the-counter stool softener (such as Colace) is the best prevention for this problem. In rare instances, you may require a suppository or an enema.

When can I drive?

If you had surgery on your right knee, you should not drive for at least a month. After 1 month, you may return to driving as you feel comfortable. If you had surgery on your left knee, you may return to driving as you feel comfortable, as long as you have an automatic transmission.
DO NOT DRIVE IF TAKING NARCOTICS!

When can I return to work?

This depends on your profession. Typically, if your work is primarily sedentary, you may return after approximately 3 to 4 weeks. If your work is rigorous, you may require up to 2 to 3 months before you can return to full duty. In some cases, more time may be necessary.

When can I travel?

You may travel as soon as you feel comfortable. It is recommended that you get up and stretch or walk at least once an hour when taking long trips. This is important to help prevent blood clots.

What activities are permitted following surgery?

You may return to most activities as tolerated, including walking, gardening, hiking, and golf. Some of the best activities to help with motion and strengthening are swimming and riding a stationary bicycle.

What activities should I avoid?

You should avoid impact activities such as running and vigorous racquet sports, such as single’s tennis or squash.

Can I have sex?

Yes, as soon as you are comfortable.

Can I drink alcohol?

If you are on Coumadin, avoid alcohol intake. Otherwise, use in moderation at your own discretion. You should also avoid alcohol if you are taking narcotics or other medications.

Should I use heat or ice?

Ice should be used for the first several days, particularly if you have a lot of swelling or discomfort. Once the initial swelling has decreased, you may use ice and/or heat.

Can I go up and down stairs?

Yes. Initially, you will lead with your non-operated leg when going up stairs, and lead with your operated leg when going down stairs. You can use the phrase, “Up with the good, down with the bad” to help you remember. As your leg gets stronger, you will be able to perform stairs in a more regular pattern (about a month).

Can I kneel?

After 2 months, you may try to kneel. Although this may be uncomfortable initially, you will not injure your knee replacement by kneeling. Most people find the more you kneel, the easier it gets.

How much range of motion (ROM) do I need?

Most people require 70 degrees of flexion (bending the knee) to walk on level ground, 90 degrees to ascend stairs, 100 degrees to descend stairs, and 105 degrees to get out of a low chair. Your knee should also come to within 10 degrees of being fully straight to function well.

Do I need antibiotics before dental work or an invasive procedure?

Yes. You will be given a letter explaining this in detail at your first follow-up visit. Avoid any dental cleaning or non-urgent procedures for 6 weeks postoperatively.

I feel depressed. Is that normal?

It is not uncommon to have feelings of depression after your knee replacement. This may be due to a variety of factors, such as limited mobility, discomfort, increased dependency on others, and/or medication side effects. Feelings of depression will typically fade as you begin to return to your regular activities. If your feelings of depression persist, consult your internist.

I have insomnia. Is this normal? What I do about it?

This is a common complaint following knee replacement surgery. Nonprescription remedies, such as Benadryl or melatonin may be effective. If this continues to be a problem, medication may be prescribed for you.

How long will my total knee replacement last?

This varies from patient to patient. For each year following your knee replacement, you have a 1 percent chance of requiring additional surgery. For example, 10 years postoperatively, there is a 90 percent success rate.

When do I need to follow up with my surgeon?

Most patients are discharged from the hospital on the third or fourth postoperative day. Follow-up office visits are routinely advised for:

1. 1-2 weeks after surgery for staple removal.
2. 4 weeks after surgery for an x-ray and exam of knee motion.
3. 3 months after surgery for exam and assessment of activities.
4. 6 months, 1 year, and annually thereafter for x-ray and exam.

Please call our office appointment desk to schedule appointments: 425-656-5060

I’m out of pain medication.

Refills for pain medicines may be obtained by contacting our office during business hours. It is the policy of our office that narcotic pain relievers will not be refilled or phoned in after hours or on the weekends. Prescription anti-inflammatories may be resumed 48 hours following the last Coumadin dose.

Normal things about your new knee:

  • Clicking noise with knee motion.
  • Skin numbness on the outer (lateral) part of your knee.
  • Swelling around the knee and/or lower leg.
  • Warmth around the knee.
  • “Pins and needles” feeling at or near your incision.
  • Dark or red incision line. This will gradually fade to a lighter color.
  • Bumps under the skin along the incision. Occasionally, the sutures used to close the wound can be felt.

Abnormal things about your new knee:

Call the office immediately, if you experience any of these.

  • Increased bruising, if on Coumadin.
  • Increasing redness, particularly spreading from the incision.
  • Increasing pain and swelling.
  • Fevers > 101 degrees F.
  • Persistent drainage from your wound.
  • Calf swelling or pain, particularly associated with ankle motion.
  • Ankle swelling that does not decrease or resolve overnight.

Unicompartmental or Partial Knee Replacement

Frequently Asked Questions Prior To Unicompartmental (Or Partial) Knee Replacement

What is a partial or unicompartmental knee replacement?

This is a surgical procedure performed through a relatively small incision, which resurfaces only the worn-out compartment of the knee joint. Both the femur and tibia on the involved side of the knee are resurfaced with metal and plastic components. These are fixed to the bone with bone cement.

Is there an advantage compared to total knee replacement?

A unicompartmental replacement utilizes a smaller incision, results in a shorter hospital stay with a faster recovery period. There is better range of motion and a more normal feel to the knee. Conversion or revision of a failed unicompartmental replacement is easier than a revision of a total knee replacement.

What are the disadvantages?

This procedure is indicated in fewer individuals with arthritis when compared to a total knee arthroplasty. The durability of a partial knee replacement is somewhat less than a total knee replacement with a failure rate at 10 years follow-up for partial knee replacement of approximately 10 percent, compared to a failure rate of total knee replacement of approximately 5 percent.

How long will I be in the hospital?

Typically, one to two days, depending on your level of discomfort.

What do I need to do before surgery?

You will need to have a preoperative medical evaluation from your internist or primary care physician. You will need to see the preoperative nurse at Valley Medical Center and attend a seminar at the Joint Replacement Center.

When do I get admitted to the hospital?

You will come to the hospital two hours priori to your procedure. You will meet the anesthesiologist, who will discuss anesthetic options including a spinal versus general anesthetic. These will be supplemented by a femoral nerve block, which aids in postoperative pain relief.

How long does the surgery take?

The procedure generally takes 60 to 75 minutes.

What happens after surgery?

You will be in the Recovery Room following surgery. You will have an IV in your arm and an Ace wrap on your knee. You may or may not have a drain, which will be removed in 24 hours.

The remainder of your hospital stay:

After the Recovery Room, you will be transferred to the Center for Joint Replacement. The day of surgery, you will get up and begin walking in your room, putting as much weight as you are comfortable on your knee using a walker or crutches. You will begin range-of-motion exercises and apply ice to your knee. You will receive therapy twice a day until you are discharged home, one to two days after surgery.

Will I go to therapy after surgery?

Yes. You will attend therapy two to three times a week for three to six weeks, depending on your progress.

Will I use a walker or crutches?

You will use a walker or crutches for roughly five to seven days after surgery, then advance to a cane as tolerated.

When do my stitches come out?

Seven to 14 days. Steri-Strips will be placed over your incision.

When can I shower?

Two days following surgery.

What is the recovery time?

Everyone heals from surgery at a different pace. In most cases, you will be up and walking without support by two to four weeks after surgery. You will steadily increase weekly thereafter and continue to improve for six to 12 months after surgery.

When can I drive?

Three to four weeks for a right unicompartmental replacement, and after a left unicompartmental replacement, when you are comfortable.

Normal things about your new knee:

  • Clicking noise with certain motions of the knee.
  • Skin numbness on the outer (lateral) part of your knee.
  • Swelling about the knee or leg for several weeks following surgery.
  • Warmth about the knee for two to three months after surgery.
  • “Pins and needles” feeling at or near your incision.
  • Bumps under the skin along your incision. Occasionally, the sutures used to close the wound can be felt under the skin.

Abnormal things about your new knee:

  • Call the office immediately (426-656-5060), if you experience any of these:
  • Increasing redness, particularly spreading from your incision and/or drainage after five to seven days following the surgery.
  • Increasing pain and swelling.
  • Fevers greater than 101 degrees F.
  • Calf swelling or pain, particularly associated with ankle motion.

Request an Appointment

LOCATIONS

RENTON

4011 Talbot Rd S #300
Renton, WA 98055

Phone: 425.656.5060
Fax: 425.656.5047

COVINGTON

27005 168th Pl SE #201
Covington, WA 98042

Phone: 253.630.3660
Fax: 253.631.1591

Maple Valley

24060 SE Kent Kangley Rd,
Maple Valley, WA 98038

Phone: 425.358.7708
Fax: 425.656.5047

Bone and Joint Urgent Care

150 Andover Park W.
Tukwila, WA 98188

Phone: 425.979.BONE

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