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.

Getting Ready

Before surgery:

• Ask someone to drive you home after your surgery. Do not drive yourself home.
  
  
• Tell your caregiver if you know or think you might be pregnant.
  
  
• If you smoke cigarettes, you should stop. Smoking can make you more likely to have problems during and after TKR surgery. Ask caregivers for more information about how to stop smoking.
  
  
• If you are overweight, your knee may take longer to heal. Ask your caregiver about diet changes that you can make now to help you heal after surgery.
  
  
• You may need to take nonsteroidal anti-inflammatory medicine before your surgery. This medicine can help decrease your pain. This medicine can increase the risk of bleeding, stomach ulcers or kidney problems in some people.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• You may need to have a computerized tomography (CT) scan or magnetic resonance imaging (MRI). You may also need x-rays of the knee and leg bones. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before surgery:

• Ask caregivers about directions for eating and drinking.
  
  

The day of surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

Treatment

What will happen:

• You will be taken on a stretcher to the operating room. Medicine is given to decrease your pain, or make you sleep during surgery. 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 will cover your knee to keep the area clean and help prevent infection. A caregiver will change the bandage and check your knee soon after your surgery. An x-ray of your knee may also be done. You will then be taken to a room where you will stay until you are fully awake. Do not try to get out of bed until your caregiver says it is OK. You may need to use a continuous passive motion (CPM) machine. This machine will slowly bend and straighten your knee for you as you lie in bed. A cast or splint may be placed on your leg. Caregivers may help you get out of bed to begin walking very soon after surgery.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your surgery on time.
  
  
• You get sick (a cold or the flu) or have a fever.
  
  
• You have a skin infection or a wound near the area where you are having the surgery.

Seek Care Immediately if

• Your leg feels warm, tender, and painful. It may look swollen and red.
  
  
• You have new and sudden trouble walking.

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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.