Total Knee Replacement

When the cartilage has worn away, an artificial knee (called a prosthesis) can take its place. The surgical options to implant the prosthesis are termed partial or total knee replacements. In this section, we discuss total knee replacement. The total knee replacement restores function of the knee by reducing pain and allowing patients to perform their activities of daily living. While the idea of getting an artificial knee joint may be frightening to some, it is one of the safest and most effective surgical procedures available. 

The goal of a total knee replacement is to relieve pain. It may also help to restore motion and straighten the limb. If you are looking for the best knee replacement surgery in Philadelphia and its surrounding regions that surgeons can provide, then you'll want to receive care from doctors at Rothman Institute.

Possible surgical complications of the knee include: loosening, wear or breakage of the prosthesis, infection, pain, stiffness, limp, leg length inequality, delayed healing of bone and soft tissues, and extra (heterotopic) bone formation. Other rare complications include fracture of the femur or tibia, nerve and blood vessel (vascular) injury.

Medical complications can include: phlebitis, pulmonary embolism, blood clots in the legs, bleeding, urological complications, and very rarely even death. Other rare complications, which can be encountered with any surgery, include cardiac, gastrointestinal, kidney/bladder and lung problems.

While inflammation of the leg veins (phlebitis) is not rare, the occurrence of symptomatic blood clots has been greatly reduced with the use of compression devices on your legs in the hospital and blood thinning medications such as aspirin. Early mobilization (walking and moving one’s foot up and down) is extremely important for helping to reduce the development of blood clots.
Long-term complications such as wear, stiffness or loosening of the parts relate as much to patient behavior as to surgical success. In the instances where one of these complications occurs, they can often be corrected with revision surgery.  

You will arrive in the morning of your surgery and get prepared for surgery. You will be taken down to the preoperative holding area where your surgeon or member of the team will mark the correct operative limb. You will meet the anesthesia team at that time and be taken back to surgery.

After surgery, you will recover in the post-anesthesia care unit (PACU) as your anesthesia wears off. You will then be transferred to your room.  Once your spinal anesthesia wears off and you can move your legs again, physical therapy will work with you on walking. Once you can walk, eat normal food and have your pain controlled, you can leave the hospital.  

Most patients go home within 1 day after total knee replacement surgery. Your discharge may be as early as the day of surgery, or rarely may be prolonged for other reasons.

How painful is knee replacement surgery?
No surgery is painless, and knee replacement surgery is no exception. However, postoperative pain from knee replacement surgery is usually manageable and newer advanced methods of pain management have helped control surgical pain while reducing use of narcotic pain medicines. Despite the surgical pain, daily and weekly improvements are typically made. 

How will my pain be managed?
Most patients getting knee replacement surgery undergo spinal anesthesia with sedation, so they are not awake during the surgery. This type of anesthesia has many benefits, not the least of which is the continuation of pain relief for several hours after surgery. Additionally, spinal anesthesia has been demonstrated in studies to have other benefits, such as decreased surgical blood loss and a decreased risk of developing lower extremity blood clots when compared with general anesthesia. The muscle relaxation provided by spinal anesthesia also makes performing the surgery easier and therefore less traumatic for the patient.

After surgery, patients are treated with other pain medicine, mostly taken by mouth. While it may seem surprising, often the postoperative pain from knee replacement can be managed simply with oral pain medicine. This spares patients from the side effects of stronger intravenous medicines. On occasion, injections of pain medicine may be needed, until the day after surgery. After this, most pain medicine is provided in pill form as needed. Patients are often discharged with a prescription of the pills that worked for them during their hospital stay.
Patients can also help relieve their pain with means other than pain medicine. For example, applying ice and elevating the knee after therapy can go a long way toward controlling the swelling that often causes discomfort after such activity. On the other hand, when patients have discomfort from stiffness, usually doing some exercises will help relieve this pain more than any medicine will.

How long will I have pain after surgery?
It is difficult to give a specific answer for this, but most patients notice good pain relief within the first 1-2 weeks after surgery, followed by continued recession of pain over the first 1-3 months. Surgical pain is usually at its worst for the first week after surgery. After this, patients are usually more comfortable. They may experience some increased pain when doing exercises or therapy, but this can be easily managed by taking pain medicine before therapy.

Is it OK to take pain medicine?
Many patients express concerns about taking pain medicine after surgery, particularly with respect to narcotic addiction.  While it is possible to become addicted to narcotic pain medication, this is rare when the medicine is taken appropriately after surgery.  Postoperatively, patients have a good reason to have pain and it is okay to take pain medicine at this time. It often takes less narcotic to control a person’s pain when the medicine is taken appropriately – that is, when the patient begins to experience real discomfort. In the early postoperative period, patients should not try to “hold off” on taking pain medicine because they think the pain will calm down in time. These patients who “hold off” until their pain becomes too severe often need more narcotic to control their pain than they otherwise would have needed if they had taken their pain medicine earlier.

What are the side effects of pain medicine?
Side effects of pain medicine and anesthesia include nausea, constipation, mood changes and sometimes a tired feeling. Having these side effects does not mean that a patient is allergic to the medication. If a patient has a problem with these side effects, often the medication can be adjusted or a different medication tried in order to minimize these effects.

When is my first post-operative office visit?
The 1st office visit after surgery is between 2 and 6 weeks from the date of surgery, depending on the surgeon’s discretion and protocol. If you have staples, the 1st office visit after surgery is often 2 weeks from date of surgery. Many patients have stitches under the skin and the incision is glued; these patients do not often have to be seen in 4-6 weeks.

When will my staples or sutures be removed?
Approximately 2 weeks after your surgical date, the staples or sutures will be removed. Some patients will have no visible staples or sutures and therefore will not need to have anything removed.

When will my dressing be removed?
If you have a specialized dressing that looks like a large band-aid, you may shower with the dressing in place. The dressing should be removed 5-7 days from the day of surgery. If you have a gauze dressing and tape on your hip, it will most likely be removed before you are discharged from the hospital. If not, it can be removed 2 days after surgery and the area should be kept clean and dry.

How long will I remain on anticoagulation (blood thinners that help avoid blood clots)?
Typically 2 to 6 weeks after surgery (the surgical team will specify the duration that they prefer for each individual patient). For most patients, who are at a standard risk for getting a blood clot, aspirin is prescribed. For other patients, especially those who are unable to take aspirin or who have a higher risk for getting a blood clot, low-molecular weight heparin (Lovenox) or warfarin (Coumadin) are used. If you are on warfarin, you will need bloodwork drawn 1 to 2 times a week and your medical consultant will adjust your medication dosage. If you are placed on aspirin or low-molecular weight heparin injections, you will not require blood testing.

Is swelling of my knee, leg, foot, and ankle normal?
Yes, swelling is normal for three to six months. To decrease swelling, elevate your leg and apply ice for 20 minutes at a time (3-4 times a day).

Is it normal to feel numbness around the knee?
Yes, it is normal to feel numbness around the incision and outer side of the knee, since the surgeon has to cut some microscopic nerves that provide sensation around the knee. This may persist forever, although the area of numbness may shrink over a few years.

Why is my leg bruised?
It is common to have bruising on the skin. It is from the normal accumulation of blood after your surgery. You can see bruising all the way down to your foot due to gravity.

What exercise should I perform at home?
Please do exercises as instructed by your surgeon. Remember, you are using your knee every time you stand up and walk around – this is actually doing physical therapy for your knee. Focus on walking as much as you can.  It is also very important to stretch your knee after surgery even though it may be uncomfortable.  Please do smooth straightening and bending stretches 5-10 times per day. This is often all that is necessary to appropriately heal from knee replacement. Additionally, you may have been given a link for FORCE Therapeutics that will help guide you on which exercises are safe after your total knee replacement. 

How long will I need to use a walker, cane, or crutches?
This varies with each patient. Patients usually use a walker or crutches for 2-3 weeks and a cane for an additional 2-3 weeks after surgery.

May I go outdoors prior to my first postoperative visit?
Yes, we encourage you to do so.

May I drive or ride in a car before my first postoperative visit?
Yes, you may ride in a car. However, you must be off all narcotic pain medications and a walker prior to driving. It is a patient's responsibility to determine his/her own safety. If your right knee is replaced, you may need to wait a month to six weeks before driving, depending on your ability to move your right foot from the gas pedal to the brake. If your left knee is replaced you can drive with your right foot once you are off pain medicines.

May I ride in an airplane before my first postoperative visit?
Yes, you may ride in an airplane. It is important to pump your feet and ankles frequently while sitting in the plane. Be sure to get up and move around at frequent intervals to prevent blood clot formation. You may find it more comfortable to sit in an aisle seat.

What is the maximum range of motion an artificial knee can achieve?
This depends on your preoperative range-of-motion. Your final range-of-motion will be close to the range-of-motion that you had before the surgery. Knees that were very stiff before surgery tend to end up a little stiffer than other patients who had more flexibility before surgery. It is important that you work on stretching exercises on your own.  Physical therapy can help improve range of motion, but it is the daily stretching you do that can have the biggest benefit.

What is the short-term outlook?
The short-term outlook of total knee replacement is excellent. Most patients can stand the afternoon of surgery and begin exercise that day. With the support of walkers, crutches and canes, patients can walk with confidence, climb stairs and ride in a car by the time they leave the hospital. Physical therapy and motion exercises are the key to good results, and these should continue for months. Some swelling, aching and bruising are normal during this time. Most patients are up and about within six weeks after surgery.

When can I return to work?
Most patients will return to work within 1-3 months after surgery.  This typically depends on the type of work you do and the speed of your recovery.  A more sedentary job can be performed even sooner than a month (as soon as a week). A more physically demanding job may require as much as 3 months for you to properly recover before returning.

Can I return to my normal activities after a knee replacement?
Fortunately, knee replacement surgery not only restores our patients' quality of life but, of equal importance, allows them to return to their activities of daily living. Please discuss specific activities with your surgeons, as some activities may need to be limited.

Please note:
All questions will be answered at your follow-up exam. For non-emergency questions, please call the allied health professional for your Rothman Institute Surgeon

Where can I find additional information on the Internet on Total Knee Replacements?
The American Academy of Orthopaedic Surgeons (AAOS) is an organization dedicated to caring for orthopaedic patients. This is a link to their website that provides additional information about Knee Replacements:

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