Total Knee Replacement

WHAT YOU SHOULD KNOW:

• Total knee replacement (TKR) is also called total knee arthroplasty. It is surgery that is done to remove and replace your knee joint. The knee joint is where your femur (thighbone) and tibia (large lower leg bone or shinbone) meet. A small triangular bone called the patella (kneecap) protects your knee joint. Arthritis, Paget’s disease, hemophilia, or an infection can damage your knee joint. Surgery that is done to fix a fractured (broken) femur can also damage your knee joint. Avascular necrosis is a condition that occurs when blood cannot flow well to certain body areas, causing bones to weaken. This can also harm your knee joint. These conditions may cause knee pain and decrease your ability to do sports and activities. You may still have knee pain after 3 to 6 months of treatment. Your knee pain may be so bad that you cannot sleep. If you have either of these problems, you may need to have a total knee replacement.
  
  
• During the TKR, the damaged parts of your knee joint are removed and replaced with an implant. This implant may be made of metal, ceramic, or plastic. You may need to have one or both of your knee joints replaced. TKR surgery may decrease or take away your knee pain, and make standing, sitting, and walking easier.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• You may be allergic to the medicine that you get during surgery. The nerves or tendons around your knee may be hurt during surgery. You may bleed more than expected, or get an infection. You may have problems with your heart. Certain problems can happen right after surgery, or up to two years later. After surgery, your knee may be stiff and painful. Your knee joint may swell. Your legs may not be the same length. Your implant may get loose or move out of place. The implant may get worn out over time and need to be replaced. After having surgery, you may lose your balance and be more likely to fall for a time.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• If you do not have a total knee replacement, you will keep having knee pain with exercise and activity. The pain may increase, and you may need to have surgery at a later time. Ask your caregiver any questions that you have about your knee surgery, your medicine, and what to expect after surgery.

WHILE YOU ARE HERE:

Before surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Anesthesia: This medicine is given to make you comfortable. You may not feel discomfort, pressure, or pain. An adult will need to drive you home and should stay with you for 24 hours. Ask your caregiver if you can drive or use machinery within 24 hours. Also ask if and when you can drink alcohol or use over-the-counter medicine. You may not want to make important decisions until 24 hours have passed.
  
  
  • Intravenous (IV) regional anesthesia: This is medicine put into an IV in the injured arm or leg. A pressure cuff is first put on your arm or leg. After the cuff is tightened, the medicine is put into the IV. The cuff keeps the medicine in the arm or leg so you will not have pain.
    
    
  • General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

During surgery:

• You will be taken on a stretcher to the operating room. You will be placed lying on your back with your knees slightly bent. Your caregiver will make a cut into your knee. Your kneecap will be removed. Your tendons and leg muscles are moved to the side. In some cases, the caregiver may need to cut into a tendon or muscle. The damaged parts of your femur and tibia will be removed. Rough areas in your knee may be made smooth.
  
  
• Your caregiver will measure, prepare and place the implants in your knee. He may secure the implants using screws, or special cement. The kneecap, muscles and other tissues around the joint will be moved back into place. A thin rubber tube may be placed on your skin to drain blood and other fluids away from your knee. The cut will be closed with stitches.

After surgery:

A bandage is used to cover your stitches to keep the area clean and help prevent infection. A caregiver will change the bandage and check your knee soon after surgery. You will be taken to a room where you can stay until you are fully awake. You may need an x-ray of your knee. Do not try to get out of bed until your caregiver says it is OK.

• Cold therapy: Ice that is put on your knee helps decrease swelling, pain, and redness. Ice may be placed on your knee for 15 to 20 minutes every hour. Ice may also be used before you do knee exercises.
  
  
• Compression stockings: Your caregiver may ask you to wear compression stockings. These tight elastic stockings put pressure on your legs after your surgery. Wearing pressure stockings helps blood flow through your blood vessels and prevents deep vein thrombosis (DVT). DVT occurs when blood clots form inside veins and block blood flow. Ask your caregiver for more information about blood clots, and what you can do to help prevent them.
  
  
• Deep breathing and coughing: This is an exercise to help decrease your risk for a lung infection after surgery. Do the following:
  
  
  • Hold a pillow tightly against your incision (cut) when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breathes help open the airways that lead to your lungs. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.
    
    
  • You may be given an incentive spirometer to help you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Let out your breath and cough. Repeat the steps 10 times every hour.
  
  
• Medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Anti-clotting medicines: This type of medicine is given to help prevent blood clots from forming in your legs. You may be given blood thinners before, during, and after your knee surgery. Medicine may also be given to help clots break apart. This type of medicine makes it easier for you to bleed and bruise. Use a soft toothbrush to help keep your gums from bleeding. If you shave, use an electric shaver.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Muscle relaxers: This medicine helps relax your muscles. It is also given to decrease pain and muscle spasms.
    
    
  • Nonsteroidal anti-inflammatory medicine: This family of medicine is also called NSAIDs. It may help decrease pain and swelling. This medicine can increase the risk of bleeding, stomach ulcers, or kidney problems in some people. Tell your caregiver if you have liver or kidney disease, or a history of bleeding in your stomach.
    
    
  • Pain medicines: Medicines will be given to you to decrease pain. Tell your caregiver if your pain does not decrease after you take the medicine. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work well to decrease your pain if you wait too long to take it. You may be given a PCA machine. With this machine, you will be able to press a button and give yourself pain medicine when you need it. Ask your caregiver for help getting out of bed if you feel tired or dizzy. If you take pain medicine before doing physical therapy, you may get through the therapy with less pain.
  
  
• Physical therapy: A physical therapist will help you with special exercises soon after your surgery. These will help strengthen the bones and muscles around your knee joint. You may need to wear a knee brace to help you bend your knee during exercises. A brace may be worn for 30 to 40 minutes, 2 to 3 times a day. You may also need to use a continuous passive motion (CPM) machine. This machine slowly bends and straightens your leg for you. You may need to use this machine three or more hours each day for ten days after surgery. Talk with your caregiver about starting on a walking program that is right for you. This could help strengthen your leg muscles and decrease pain. Walking can also help your knee get better, so that you can do more activities.
  
  
• Walking aids: You may need to use a cane, walker, or crutches to help you as you walk. A walking aid can help you keep your balance, and decrease your chance of falling. Ask your caregiver for more information about how to choose and use a walking aid.

Preventing blood clots:

Around the time of your surgery or procedure you may need to take medicine to thin your blood. Blood thinning medicine helps prevent blood clots from forming in your veins. This medicine makes it easier for a person to bruise and bleed. You will need regular blood tests while taking this medicine. If you have a bleeding disorder or a history of bleeding or blood clots, tell your caregiver. Talk to your caregiver about all of the medicines that you use. Physical activity helps prevent blood clots. Caregivers will help you be as active as possible after your surgery or procedure.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.