CNY Orthopedic Sports Medicine, PC: TreatmentPrint: Total Knee Replacement
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Injuries and Conditions: Total Knee Replacement : Total Knee Replacement : Treatment Options
 

Overview
Knee replacement is very successful in reducing pain. Most artificial knee recipients are relieved of nearly all of their knee pain.
  • The surgical procedure to replace a knee is a major operation. The damaged contact points of the kneecap (patella), thigh bone (femur) and shin bone (tibia) are cut away. A metal cap is cemented to each of the leg bones and a plastic (polyethylene) implant is cemented to the underside of the kneecap. A plastic insert is also placed on top of the metal tibial component.
  • Some patients may have degenerative conditions in both knees. Surgery to replace each knee during the same operation may be an option under some circumstances. A simultaneous replacement however, will increase the strain on the body and require greater efforts during rehabilitation, but will eliminate the second knee replacement procedure. This type of surgery may not be suitable for all patients.
  • Knee replacement is an elective surgery and is considered one of the most effective and long-lasting options for the treatment of the degenerating knee.

    Treatment options:

    Total Knee Arthroplasty Overview
    Osteoarthritis, or other degenerative joint diseases, may be treated non-surgically during the early stages of the condition. Knee replacement surgery is considered for advanced conditions which cause severe pain and greatly reduce a patient's ability to be active. The degenerated joint cannot rebuild itself; surgery will be required to replace the surfaces of the knee with metals and plastics. A knee replacement will last 10-15 years in 90%-95% of patients.

    Evaluation of Patient for Surgery

  • Patients are given a complete physical examination to assess the patient's overall health.
  • An examination of the range of movement in both the knee with degenerative arthritis as well as the other knee of the patient.
  • X-rays of the knee while the patient is standing are obtained to provide proper alignment of the replaced knee

    Post Operative Recovery

  • Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, although the after-effects of anesthesia can vary greatly from patient to patient.
  • The knee will remain tender and slightly painful after surgery. However, the pain will tend to decrease as painkillers are administered and the knee recovers from the operation.

    Post Operative instructions
    Activity:
  • Follow general post-operative guidelines.
  • Be wary of any signs of infection.
  • Elevate the operative leg for 48 hours after surgery.
  • Use crutches to assist walking, place weight on the operative leg as much as can be tolerated by pain.
  • Return to sedentary work (school or desk work) as tolerable.
  • Avoid long periods of sitting and long distance traveling without frequent (hourly) breaks and only after receiving clearance to do so from your surgeon.
  • Do not drive until the knee feels natural enough to allow comfortable motion.

    Home Exercise:
  • Straight leg raises.
  • Quad sets.
  • Heel slides.
  • Ankle pumps.

    Ice Therapy:
  • Begin ice therapy immediately after surgery.
  • Use a cryocuff continuously or as tolerated for the first week after your operation or until your follow-up appointment with your doctor. If you have not been instructed to use a cryocuff, icing should be performed every two hours for twenty minutes swelling is controlled.

    Rehabilitation Program

  • The joint can be used immediately after surgery, but only to moderate capacity.
  • A period of time is required to acclimate the body to the replaced knee. Physical therapy will be required for three months to restore the muscle strength, flexibility and balance lost after surgery.
  • To help maintain a healthy knee, continued gentle use of the knee will be required.

    Surgical Procedure

  • Knee replacement is very successful in reducing pain. Most artificial knee recipients are relieved of nearly all of their pain.
  • The surgical procedure to replace a knee is a major operation. The damaged contact points of the kneecap (patella), thigh bone (femur) and shin bone (tibia) are cut away. A metal cap is cemented to each of the leg bones and a polyethylene (plastic) implant is cemented to the underside of the kneecap. A plastic insert is also placed on top of the metal tibial component.
  • Some patients may have degenerative conditions in both knees. Surgery to replace each knee during the same operation may be an option under some circumstances. However, a simultaneous replacement will increase the strain on the body and require greater efforts during rehabilitation. This type of surgery may not be suitable for all patients.
  • Knee replacement is an elective surgery, and is considered one of the most effective and long-lasting options for the treatment of the degenerating knee.

    Long Term Expectations for Recovery

  • A replaced knee will usually allow patients to regain stability, motion, and control of the knee.
  • The durability of the replaced knee is dependent upon the type of use and the stresses to which the replaced knee is subjected. High impact, shock-producing activities like running, jumping, or frequent kneeling should be avoided to insure a longer lasting knee.
  • Pain should be minimal throughout the life of the replaced knee, increasing only if the implants begin to separate or loosen from the bone. A second surgical procedure, or revision, may be necessary to replace the components if the pain or loosening becomes significant.
  • Under normal use a replaced knee can last more than 20 years.

    Possible Complications and Risks

  • Risks during and after surgery include problems that may develop in relation to bleeding, the possibility of infection and reactions to anesthesia.
  • DVT (Deep Vein Thrombasis) clots forming within the blood vessels of the legs are a potential complication during this type of major surgery.
  • The most common reason artificial joints fail is due to the loosening of the cement where the implants meet the bone. As the artificial joint wears, increasing pain may mean that a revision, or second surgery, is required to replace the loosened components.
  • Stiffness in the knee may result after surgery as scar tissue forms inside the joint and affects motion. If this is a severe problem, a second surgery may be required to remove the scar tissue.
  • The surgeon may also manually move the knee through a full range of motion while the patient is asleep (under anesthesia) to break-up scar tissue.