Full Knee Replacement Information

Knee replacement surgery is one of the largest, most complex orthopedic surgeries that can be performed--yet it has become relatively common. It involves the cutting and removal of large sections of bone, and the placement of a prosthetic. Months of physical therapy are required, and the pain is significant. Yet for all these drawbacks, the surgery has become very safe, and usually makes huge improvements in the lives of those who have it. Following are some full knee replacement essentials that will provide some insight into the procedure.

Purpose

• Full knee replacement surgery is only performed as a last ditch effort to improve the quality of life of the chronic knee pain sufferer. In many cases of full knee replacement, the knee joint has been diseased for a long period of time with osteoarthritis, and has disintegrated to the point where bone is grinding painfully on bone with every flex of the knee. This happens most often in the case of the elderly, or in those who are very active, involved with sports, have heavy labor, or are morbidly obese for a long period of time. Once the cartilage around the knee joint has been destroyed, there is no restoring it, and once all other methods have been exhausted, the only choice to lessen pain and restore normal activity is to replace the degenerated knee joint.

The Surgery

• During knee replacement surgery an incision is made, usually directly over the knee, from above the kneecap to a few inches down the shinbone. This incision can be anywhere from 4 to 10 inches long, depending on the type of surgery and the needs of the patient and the surgeon. Once the joint is exposed, the top of the lower leg bones (tibia and fibula) and the bottom of the lower leg bone (femur) are removed with a bone saw, then smoothed and shaped to fit the prosthetic knee joint, which had been created for the patient by using MRI imagery and X-rays. The kneecap (patella) is removed, and the new joint screwed, hammered, pinned and glued into place. The knee replacement is flexed during this time to make sure it is working as it should, and then the joint is put back together. The incision is then closed with sutures and staples, and the patient is taken to recovery.

Recovery

• Recovery from this surgery is a long process. A hospital stay of anywhere from three to five days is the norm, but it can be longer if necessary. The patient will wake up on a constant motion machine, and physical therapy will begin within the first 12 hours. Pain is controlled for the first several days via intravenous injection, and is usually patient managed with a pump that administers the pain medication as needed at timed intervals. Once the patient is released from the hospital, pain management shifts to oral medication. This medication will continue for the first few weeks, and then be weaned off until over-the-counter medications are sufficient to handle any discomfort. Recovery from a total knee replacement can take anywhere from six months to a year, depending on the patient. The single most important part of recovery from knee replacement surgery is physical therapy.

Physical Therapy

• When you leave the hospital, you will have a prescription for physical therapy. Most often, the first sessions will be at home, and the remainder will be in office. The importance of physical therapy cannot be overstated. Get the best therapist you can, and be ready to work. You will have begun PT in the hospital, with quad sets and weight bearing exercises within 24 of your surgery, but it will only become more intense as the weeks progress. Exercises to re-engage your quad muscles will be the first focus, along with range-of-motion exercises. As the days go by, you will be asked to do more rigorous exercises that involve balance and resistance training. PT is very painful, and very difficult. Many patients find this much harder than the actual surgery. But it is imperative to do the best at PT that you possibly can, as this will make the largest difference in your overall outcome from your surgery.

Results

• In most cases, total knee replacement surgery is hugely successful. The patient has usually endured so much pain and limited activity before the surgery, that upon waking up and weight bearing, the patient already notices a lessening of pain from moving the joint. Results vary from patient to patient, but in nearly all cases, a normal life can be resumed. Heavy lifting, hard labor, intense physical activity, such as running and jumping are no longer an option, but normal activities, such as walking, swimming, biking and climbing stairs are all possible again, and in most cases pain-free. The restoration of a normal lifestyle is the goal for most knee replacement patients, so to achieve this level of activity is a success.