Procedure for Knee Replacement

Having knee replacement surgery can be scary, to say the least. Despite the increase in its use, and the overall success rate, the surgery is still a huge one and has a long recovery time. Patients who are advised to get the surgery are often hesitant and have many questions. Educating yourself on any surgery you are advised to have is always an excellent idea. This article will give you some information on the actual procedure for knee replacement surgery, and hopefully answer some of the most common questions.

Pre-surgery

• As preparation for the surgery, you will be checked for any scratches, nicks, or skin lesions. If there is anything that could provide an opportunity for infection, the surgery will likely be delayed. This is why it is important not to shave the leg the week before the surgery. The hospital staff will do this either before you go into the operating room, or right after you are put to sleep. The day of the surgery, you will arrive and be prepped with questions concerning your general health, while you have an I.V. established. Once all is well and you are ready, you will be given a shot to relax you, then wheeled into the operating room. At this time, you will be anesthetized and go to sleep. While you are sleeping, your leg will be shaved if it has not already, and you will be draped. The instruments will be laid out and the surgeon will come in, verify all is well, and begin.

The incision

• Depending on what type of knee replacement surgery you are having, the incision can be directly over the knee (most common) or along the side of the knee (unicompartmental knee replacement surgery). The incision will be anywhere from four to ten inches long, depending on the needs of the surgeon and patient. The incision is made all the way through skin, muscle, and tissue, down to the bone itself. The joint is exposed, and retractors are placed on either side of the incision to hold it open. During the cutting, a cauterizing pen will be used to close any veins or bleeding tissue to keep blood loss at a minimum. Suction is used to keep the surgical site clear for the surgeon to have a a good view.

Removal of Bone

• Regardless of whether you are having a full knee replacement or partial knee replacement, you will be having some of your bone removed. The diseased bone and damaged tissue will be cut out using a bone saw and then smoothed and shaped to fit the prosthetic knee device with a grouting tool. Bleeding is controlled as well as possible, but there may be need for transfusion, which is one reason blood of the patient's type is always kept on hand for this surgery. In the case of a total knee replacement, the top of the lower leg bone (tibia) and the bottom of the upper leg bone (femur) are removed, along with the kneecap (patella). In the case of a partial knee replacement, only the part of the knee that is damaged is removed.

Placement of Prosthetic

• Once the living bone has been prepared, the prosthetic knee joint is placed into the joint and holes are drilled into the bone at key points to anchor the new knee joint into place. A layer of cement is applied to the bone and the joint is pressed into place, and then pins are hammered through the holes into the bone to secure the prosthetic to the joint. In the case of partial knee replacement, the steps are the same, just on a smaller scale. The knee joint is flexed to make sure all is in the right place, and then tissues, ligaments, tendons, and muscles are reattached to the joint.

Closing up

• Once the joint has been reconstructed, the layers of muscle, tissue and skin are closed with sutures and staples. Most of the sutures are permanent or absorbing, and the staples are for the outer layer of skin only and will be removed 14 days post op. The patient is take off anesthesia and wakened until responsive, then taken to recovery, where they remain until stabilized. A hospital stay of anywhere from three to five days is the normal time, with longer stays if needed.

Rehab

• Perhaps the most important part of knee replacement surgery is the rehabilitation. Having a good physical therapist and being determined to work through the pain and discomfort of learning how to use your new joint is essential to a successful recovery. Attending regular sessions of PT and doing all the exercises to the best of your ability will make a huge difference in how well you recover and the overall success of your replaced knee. So be sure you get a good PT and have the willpower to do what is needed to make an outstanding recovery.