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knee replacement
 Why replace the knee?
What is total knee replacement?
Preparing for the surgery
The surgery
After surgery
Why replace the knee?
A normal knee joint bends smoothly and painlessly due to the fact that a smooth firm lining, known as cartilage, covers the bone ends. It acts like a cushion, absorbing the forces across the joint.
If the smooth cartilage that lines the bones in the knee joint is worn away, the bone surfaces become rough and increasingly damaged. This may result in a very painful, disabled knee.
Indications for Total Knee Replacement include:
Damage of the knee joint causes:
- Severe pain in the knee associated with activity
- Severe interference with daily activities and work
What is Total Knee Replacement?
Total Knee Replacement is an operation in which the damaged bone surfaces of the knee joint are removed and replaced with an artificial knee joint.
The artificial joint generally has three components. One is made of metal, usually cobalt-chrome or titanium. The other components are made from plastic material called polyethylene, which may be strengthened by a metal plate.
Preparing for surgery
Evaluation before the surgery
- Patients are generally asked to see their primary care physician for a general exam.
- The anesthesiologist will also evaluate the patient prior to the operation and discuss the type of anesthetic to be used.
- Routine tests are performed a week before surgery. These help establish if the patient is fit for surgery.
Precautions before the surgery
- Aspirin or other medications containing aspirin, or anti-inflammatories should be discontinued 1 to 2 weeks before surgery to minimize bleeding.
- If you are on a blood thinner, such as Coumadin, it should be discontinued at least several days prior to surgery, in consultation with your prescribing doctor.
- It is important to take vitamins and iron supplements before and after the operation.
- If you are overweight, try to lose weight in order to decrease the stress on the new knee.
- If you smoke, stop smoking.
- Knee surgery will not be performed when active infections are present elsewhere in the body, such as bladder or skin.
The surgery
Depending on its complexity, the operation itself usually takes 1 to 3 hours. If the knee has had prior surgery or severe deformity exists, it may take longer.
The steps of the operation include:
- A tourniquet is usually applied around the thigh so the surgeon works in a bloodless field.
- An 8 to 10 inch skin incision is made over the kneecap or along the inner side.
- Using specially designed instruments, the diseased bone-ends are removed. Precise cuts are made to accommodate the total knee replacement.
- The new artificial surfaces are then fitted to the bone ends. Cement may be used.
- The wound is closed with sutures or staples.
- A plastic drain may be left in the wound for a day or two to collect any oozing from the surgical wound.
- Depending on the preference of the surgeon, the knee may be wrapped in a splint or a strong supportive bandage immediately following the surgery.
After surgery
Most patients will be discharged from the hospital 3 to 4 days after knee surgery, depending on their age and physical ability. The patient will not be sent home until he or she is able to function at a certain level of independence.
If cement had been used in the procedure, depending on the surgeon's preference, patients may bear full weight through the leg when beginning to walk. Crutches or a walker are required for support for the first 3 to 4 weeks, and a cane for another 3 to 4 weeks.
If cement has not been used in the procedure, weight bearing is restricted for the first 6 weeks after surgery. Crutches or a walker are required for this period. This allows the new joint to become firmly fixed as the bone grows into the special surface of the new knee. A cane should be used for an additional 4 to 6 weeks.
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