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Total Knee Arthroplasty Procedure Steps

How Your New Knee Is Different

Procedure Steps: Posterior Cruciate-Retaining Total Knee Arthroplasty

Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery can be predicted by the range of motion you have in your knee before surgery. Most patients can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently to climb stairs and get in and out of a car. Kneeling is sometimes uncomfortable, but it is not harmful.

Most people feel some numbness in the skin around their incisions. You also may feel some stiffness, particularly with excessive bending activities.

Most people also feel or hear some clicking of the metal and plastic with knee bending or walking. This is normal. These differences often diminish with time and most patients find them to be tolerable when compared with the pain and limited function they experienced prior to surgery.

Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated.

Possible Complications Of Surgery

The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, occur in fewer than 2% of patients. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery.

Discuss your concerns thoroughly with your orthopaedic surgeon prior to surgery.

Infection. Infection may occur in the wound or deep around the prosthesis. It may happen within days or weeks of your surgery. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.

Blood clots. Blood clots in the leg veins are one of the most common complications of knee replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopaedic surgeon will outline a prevention program, which may include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings, and medication to thin your blood.

Blood clots may form in one of the deep veins of the body. While blood clots can occur in any deep vein, they most commonly form in the veins of the pelvis, calf, or thigh.

Total Knee Arthroplasty Procedure

The total knee replacement procedure is performed in a hospital under general anesthesia. During the procedure, an incision is made in the knee to access the joint so the damaged bone and cartilage can be removed. Once the damaged tissue is removed, the prosthetic device is inserted and may be either cemented or pressed into place. Cemented knee replacements are most commonly used, and are fixed into the joint for immediate support. Press-fit knee replacements are designed to have the surrounding bone grow into the implant for long-term joint stability.

Recent advances in surgical technology make it possible to perform minimally invasive joint replacements. Various minimally invasive techniques allow the joint to be replaced with less cutting and manipulation of muscles, tendons and ligaments around the joint. There are other potential advantages to minimally invasive surgery, including smaller incisions, less bleeding, less scarring, less pain and a speedier recovery.

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How Do I Know If I Need Knee Replacement Surgery

You may need surgery if:

  • Your knees are stiff and swollen.
  • There is pain throughout the day, even at rest.
  • Walking, getting up or climbing stairs is difficult and painful.
  • Medication and therapy do not offer enough relief.
  • Knee cartilage is so damaged and worn away that you are walking “bone on bone,” in which the bones of the joint are scraping together.

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Problems With Knee Implants

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Knee implants continue to get more sophisticated, but they are not perfect. They can wear down over time or may come loose from the bone. Scar tissue can grow around an implant, limiting its range of motion. And even when they work well, implants can cause a clicking sound as the knee bends back and forth.

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Shaping The Distal Femoral Bone

Once the knee joint is entered, a special, customized knee instrumentation device is placed on the end of the femur. This device is used to ensure that the bone is cut in the proper alignment to the leg’s original angles, even if the arthritis has made the patient bowlegged or knock-kneed. The custom device is used to cut several pieces of bone from the distal femur so the artificial knee can replace the worn surfaces with a metal surface.

Risks Of The Procedure

As with any surgical procedure, complications can occur. Some possiblecomplications may include, but are not limited to, the following:

  • Blood clots in the legs or lungs

  • Loosening or wearing out of the prosthesis

  • Continued pain or stiffness

The replacement knee joint may become loose, be dislodged, or may not workthe way it was intended. The joint may have to be replaced again in thefuture.

Nerves or blood vessels in the area of surgery may be injured, resulting inweakness or numbness. The joint pain may not be relieved by surgery.

There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.

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How The Operation Is Done

Knee replacement surgery is usually performed either under general anaesthetic or under spinal anaesthetic or epidural .

The worn ends of the bones in your knee joint are removed and replaced with metal and plastic parts which have been measured to fit.

You may have either a total or a partial knee replacement. This will depend on how damaged your knee is. Total knee replacements are the most common.

Read more information about what happens on the day of your operation.

Protecting Your Knee Implant

Total Knee Replacement Surgery (Arthroplasty) – University of Vermont Medical Center, Vermont

You can extend the life of your knee implant by doing several things. After surgery, use a cane or walker until your balance improves — taking a fall can cause serious damage to a new joint. High-impact exercise can also take a toll on knee implants, so most doctors warn against jogging, jumping, and contact sports.

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Who Should Consider Total Knee Replacement Surgery

It is usually reasonable to try a number of non-operative interventions before considering knee replacement surgery of any type. Prior to surgery an orthopedic surgeon may offer medications knee injections or exercises. A surgeon may talk to patients about activity modification weight loss or use of a cane.

The decision to undergo the total knee replacement is a “quality of life” choice. Patients typically have the procedure when they find themselves avoiding activities that they used to enjoy because of knee pain. When basic activities of daily life–like walking shopping or reasonable recreational pastimes–are inhibited or prevented by the knee pain it may be reasonable to consider the surgery.

Extending The Life Of Your Knee Implant

Currently, more than 90% of modern total knee replacements are still functioning well 15 years after the surgery. Following your orthopaedic surgeon’s instructions after surgery and taking care to protect your knee replacement and your general health are important ways you can contribute to the final success of your surgery.

To assist doctors in the surgical management of osteoarthritis of the knee, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These are recommendations only and may not apply to every case. For more information: Surgical Management of Osteoarthritis of the Knee – Clinical Practice Guideline | American Academy of Orthopaedic Surgeons

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Can I Avoid Or Postpone A Knee Replacement

The choice on whether to have surgery to address arthritis of the knee joint depends on multiple factors, including:

  • the condition of the knee joint
  • the patientâs age and activity level

In cases where the damage from arthritis is minimal, and/or if the patient does not have a very active lifestyle, nonsurgical treatments by be tried, including:

  • physical therapy
  • , such as ibuprofen
  • weight loss to reduce pressure on the knee

Types Of Arthritis That Affect The Knee

Right Total Knee Replacement Surgery

Inflammatory arthritis

This broad category includes a wide variety of diagnoses including rheumatoid arthritis, lupus, gout and many others. It is important that patients with these conditions be followed by a qualified rheumatologist as there are a number of exciting new treatments that may decrease the symptoms and perhaps even slow the progression of knee joint damage.

Patients with inflammatory arthritis of the knee usually have joint damage in all three compartments and therefore are not good candidates for partial knee replacement. However, inflammatory arthritis patients who decide to have total knee replacement have an extremely high likelihood of success. These patients often experience total, or near-total, pain relief following a well-performed joint replacement.

Osteoarthritis

Osteoarthritis is also called OA or degenerative joint disease. OA patients represent the large majority of arthritis sufferers. OA may affect multiple joints or it may be localized to the involved knee. Activity limitations due to pain are the hallmarks of this disease.

OA patients who have symptoms limited to one compartment of the knee sometimes are good candidates for minimally-invasive partial knee replacement .

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Recognizing The Signs Of A Blood Clot

Follow your orthopaedic surgeon’s instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. They may recommend that you continue taking the blood thinning medication you started in the hospital. Notify your doctor immediately if you develop any of the following warning signs.

Warning signs of blood clots. The warning signs of possible blood clots in your leg include:

  • Increasing pain in your calf
  • Tenderness or redness above or below your knee
  • New or increasing swelling in your calf, ankle, and foot

Warning signs of pulmonary embolism. The warning signs that a blood clot has traveled to your lung include:

  • Sudden shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing

Not All Hospitals Achieve The Same Results

Knee replacement is a surgery focused on reducing pain and getting you back to the activities you love. But not all hospitals achieve the same results. Some are more reliable than others. With the help of the HSS Hospital Reliability Scorecard, you can make sure you’re asking the critical questions to find the hospital that’s right for you. Understanding the data points will help you make the best decision for your care.

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What Can I Expect At Hss

Hospital for Special Surgery has been at the forefront of modern knee replacement since the operation was first introduced in the late 1960s. We have led the field ever since in a number of ways:

  • : HSS has been ranked the No. 1 hospital for orthopedics by U.S. News & World Report for 11 years straight.
  • Along with high rankings in patient satisfaction, HSS performs the most knee replacements with the lowest reported infection rates in the United States.
  • Research and advancement: Smaller incisions, new implant materials and design, and sophisticated instrumentation have been â and continue to be â the areas of expertise of the hip and knee replacement surgeons of the HSS .
  • HSS routinely uses the latest surgical techniques and technology, such as robotic-assisted and computer-assisted surgery.
  • : Isolating the anesthesia to a particular body area helps avoid the potential problems that may accompany a general anesthetic. These techniques have been developed and refined by the HSS . Learn more about

What Happens After Arthroplasty

Surgical Procedure for Total Knee Replacement

Depending on the type of procedure you have, you may go home the day of surgery, or you may need to stay in the hospital for a day or two. Talk to your provider about planning for recovery. You will need to have someone drive you home. You may also need help getting around or performing tasks like laundry or bathing.

After surgery, you will feel some pain. The first few days after your procedure, you should:

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What Happens During Arthroplasty

You may have your surgery in an outpatient clinic or at a hospital. The technique your surgeon uses varies depending on the type of surgery and the joint you need replaced. Right before your procedure, you will receive anesthesia. This ensures you wont feel pain during arthroplasty.

Your surgeon makes incisions and removes the damaged joint. Then they replace it with an artificial joint. They use stitches, staples or surgical glue to close the incisions. Your provider wraps the joint in a bandage. You may also need a brace or sling.

Surgeons can do some joint replacement procedures using minimally invasive techniques. These techniques use fewer incisions and special tools. The recovery time for minimally invasive procedures can be less than it is for traditional procedures. Your surgeon will recommend the most appropriate procedure for you.

Knee Replacement Recovery Time And Recuperation

Total knee replacement surgery generally takes about 60 to 90 minutes, but you should expect to be in the operating room for over two hours. Rehabilitation will begin within 24 hours of surgery.

After your surgery, the nursing staff will position you in bed and help you turn until you are able to move on your own. You may have a pillow between your legs if ordered by your surgeon.

Very soon after surgery, a physical therapist will come to your room to teach you appropriate exercises and review your progress. Gentle exercises to improve your range of motion can help prevent circulation problems as well as strengthen your muscles.

Your rehabilitation program will begin as soon as you are medically stable and there are orders from your doctor to begin postoperative mobility. All patients begin rehabilitation within 24 hours of their surgery. Your motivation and participation in your physical therapy program is key to the success of your surgery and recovery. The physical therapist will assist you in the following activities:

  • sitting at bedside with your feet on the floor
  • transferring in and out of bed safely
  • walking with the aid of a device
  • climbing stairs with aid of a device

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Technical Details Of Total Knee Replacement

Total knee replacement surgery begins by performing a sterile preparation of the skin over the knee to prevent infection. This is followed by inflation of a tourniquet to prevent blood loss during the operation.

Next, a well-positioned skin incision–typically 6-7 in length though this varies with the patients size and the complexity of the knee problem–is made down the front of the knee and the knee joint is inspected.

Next, specialized alignment rods and cutting jigs are used to remove enough bone from the end of the femur , the top of the tibia , and the underside of the patella to allow placement of the joint replacement implants. Proper sizing and alignment of the implants, as well as balancing of the knee ligaments, all are critical for normal post-operative function and good pain relief. Again, these steps are complex and considerable experience in total knee replacement is required in order to make sure they are done reliably, case after case. Provisional implant components are placed without bone cement to make sure they fit well against the bones and are well aligned. At this time, good function–including full flexion , extension , and ligament balance–is verified.

Finally, the bone is cleaned using saline solution and the joint replacement components are cemented into place using polymethylmethacrylate bone cement. The surgical incision is closed using stitches and staples.

Anesthetic

Length of total knee replacement surgery

Pain and pain management

How To Prepare For Knee Replacement

Right Total Knee Replacement Surgery

There are certain steps that can improve your recovery time and results. It is important to follow your knee replacement surgeonâs instructions both before and after surgery, as well as that of your rehabilitation therapistâs recommendations. Learn more about reparing for knee replacement by reading .

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New Quad Sparing Technique May Provide Faster Recovery For Patients With Arthritis Of The Knee

Edited by Seth S. Leopold, M.D., Professor, UW Orthopaedics & Hip & Knee

OverviewKnee replacement is a surgical procedure that decreases pain and improves the quality of life in many patients with severe knee arthritis. Typically patients undergo this surgery after non-operative treatments have failed to provide relief of arthritic symptoms. Surgeons have performed knee replacements for over three decades generally with excellent results most reports have ten-year success rates in excess of 90 percent.

Broadly speaking there are two types ways to insert a total knee replacement: the traditional approach and the newer minimally-invasive approach.

Traditional total knee replacement involves a roughly 8 incision over the knee a hospital stay of 3-5 days and sometimes an additional stay in an inpatient rehabilitation setting before going home. The recovery period typically lasting from one to three months. The large majority of patients report substantial or complete relief of their arthritic symptoms once they have recovered from a total knee replacement.

The main potential benefits of this new technique include:

  • Smaller incision. While this procedure would not be worth performing for cosmetic benefits many patients do prefer the shorter incision. Traditional knee replacement incisions often measure 8 or longer minimally-invasive quadriceps-sparing knee replacement incisions are about 4 in length for most patients.
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    Possible Benefits Of Total Knee Replacement Surgery

    Regardless of whether a traditional total knee replacement or a minimally-invasive partial knee replacement is performed the goals and possible benefits are the same: relief of pain and restoration of function.

    The large majority of total knee replacement patients experience substantial or complete relief of pain once they have recovered from the procedure. The large majority walk without a limp and most dont require a cane, even if they used one before the surgery. It is quite likely that you know someone with a knee replacement who walks so well that you dont know he even had surgery!

    Frequently the stiffness from arthritis is also relieved by the surgery. Very often the distance one can walk will improve as well because of diminished pain and stiffness. The enjoyment of reasonable recreational activities such as golf, dancing, traveling, and swimming almost always improves following total knee replacement.

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