introduction jointunderstanding benefits of knee-replacement surgery

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Claire Cole
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introduction When knee pain becomes so severe that drugs do not provide relief or when knee problems make daily activities painful, difficult, or even impossible, surgeons can sometimes replace the

1 introduction When knee pain becomes so severe that drugs do not provide relief or when knee problems make daily activities painful, difficult, or even impossible, surgeons can sometimes replace the damaged joint with an artificial one. Today, over 300,000 total knee replacements are performed each year in the United States. Your healthcare team and this booklet can help answer many of the questions you may have about kneereplacement surgery. This booklet helps explain: How artificial knees work and the benefits of knee-replacement surgery benefits of knee-replacement surgery Successful knee-replacement surgery can give most people a new lease on life. Once your new joint has completely healed, you should expect the following benefits: benefits direct benefits Reduces or eliminates pain Restores lost range of motion Lets you resume many of your normal activities Improves appearance of deformed joints What to do before and after surgery to help achieve a speedy recovery How to help avoid complications after surgery Places to go for more information Before your surgery, please read and discuss this information with your healthcare team and your family or friends. 1

set up a home recovery station Place the remote control, radio, telephone, tissues, wastebasket, drinking glass, and other items you use every day next to the spot where you will spend the most time

2 set up a home recovery station Place the remote control, radio, telephone, tissues, wastebasket, drinking glass, and other items you use every day next to the spot where you will spend the most time while you recover from your surgery. jointunderstanding getting ready for surgery steps to get ready As soon as you decide to have a total knee replacement, you can look ahead and start planning for your recovery. health insurance coverage and prior authorization Surgeons and hospitals need to verify your health insurance benefits and obtain prior authorization or pre-certification for surgery. In the case of Medi-Cal or other state Medicaid programs, a treatment authorization request must be approved before surgery. Your surgeon s office will work with you to make sure that your surgery is authorized in advance. dental work You should have any dental work finished before your surgery to help reduce the risk of infection after your operation. blood storage Several weeks before surgery, your doctor may suggest that you store your own blood at the hospital where your surgery will be performed. Your surgeon will discuss this with you. pre-admission workup About 2 weeks before surgery, you will have a pre-admission workup at your doctor s office. During this visit: Routine blood and urine tests and a physical exam will be performed You may have a chest X-ray and an electrocardiogram Your orthopedic surgeon may consult with your primary care physician for medical clearance for your surgery prepare for recovery Arrange for transportation from the hospital to your home. If possible, have someone stay with you to help around the house for the first few weeks after surgery. Prepare food in advance and stock up on foods that are easy to make Tape down carpets and electrical cords and install an elevated toilet seat Place items you use every day in a common area and at arm level to avoid having to reach up or bend down after your surgery checklist Check your health insurance benefits Finish dental work Store blood Schedule preadmission workup Arrange for any medications you will need after surgery Arrange house and stock food 2 3

Knee replacement is one of the most successful joint surgeries performed Most artificial knee joints last 15 to 20 years On average, less than 10% of total knee replacements will ever need a

With general anesthesia, you will be asleep during the operation With spinal/epidural anesthesia, the anesthetic is injected to block sensation, allowing you to stay awake during the operation

3 Knee replacement is one of the most successful joint surgeries performed Most artificial knee joints last 15 to 20 years On average, less than 10% of total knee replacements will ever need a correction or revision your new knee anesthesia Knee replacement is a major surgical procedure and requires either general or spinal/epidural anesthesia. With general anesthesia, you will be asleep during the operation With spinal/epidural anesthesia, the anesthetic is injected to block sensation, allowing you to stay awake during the operation without feeling any pain You and the anesthesiologist will decide what type of anesthesia you will have. The risks of anesthesia are related to your general medical condition not your age. Newer and safer drugs, along with advances in monitoring equipment, help make today s anesthesia safer than ever before. the operation On the day of your surgery, you will be asked to arrive at the hospital without having had any food or drink after midnight on the night before your operation. After you ve settled in your room, your vital signs (blood pressure, breathing, pulse, and temperature) will be checked, and you will be given a medication to help you relax. Once you cannot feel any pain, the surgeon will: Make an incision to expose your knee joint Carefully trim the damaged parts and reshape the ends of the femur and tibia Secure the metal parts of the artificial joint to the femur and tibia Attach a plastic plate to the metal part of the artificial joint at the tibia Attach a plastic plate to the rear surface of the kneecap types of artificial joints Cemented Special bone cement fixes the new knee joint in place You may stand on the new joint almost immediately Non-cemented Instead of cement, the bone grows around the components of the artificial joint to secure it Your doctor will advise you when you are able to put full weight on your new joint Combination One end of the new joint is fixed in place with cement and the other is fixed without cement quick fact Your new knee joint will be precision fit cemented non-cemented 4 The operation itself typically lasts 2 hours. The surgeon will determine which type of insertion to use based on your age, the condition of the bone, and your lifestyle. combination 5

quick facts Pain medication will help you People in pain rarely become addicted to pain drugs Pain usually decreases rapidly during the first month jointunderstanding your work begins after the

4 quick facts Pain medication will help you People in pain rarely become addicted to pain drugs Pain usually decreases rapidly during the first month jointunderstanding your work begins after the operation Your recovery starts as soon as your operation is over. If you re like most people, you will be able to leave the hospital 3 to 4 days after your surgery. Full recovery will also depend on how well you follow your doctor s instructions during the first few weeks after surgery. Until you are able to use the bathroom, a tube may be used to collect your urine Another tube may be used to drain fluid from your knee A pressure pump or elastic stockings may be applied to stimulate muscle movement and keep blood flowing in the veins and thereby help prevent blood clots Your surgeon may order a continuous passive motion machine that will slowly move your knee to prevent stiffness while you are in bed managing pain after surgery You will be given medication that will help control any pain or discomfort after the operation. Sometimes people worry about becoming addicted to pain drugs and refuse to take them. The truth is that people with pain rarely become addicted to these drugs. Instead, with less pain, you can start walking and get your strength back more quickly. You may even leave the hospital sooner. helping to reduce the risk of blood clots After joint-replacement surgery, it is possible to develop a blood clot called a deep vein thrombosis (DVT) in the veins of the leg. Due to the surgery and decreased mobility, your blood may move sluggishly through your lower veins A blood clot can break off and cause a blockage in the lungs called a pulmonary embolism (PE) There are many ways to help reduce the risk of DVT and PE, but probably the most effective way is getting you moving as soon as possible! Your surgeon will prescribe a blood-thinning medication, called an anticoagulant, to help reduce the risk of blood clots helping to reduce the risk of infection After joint-replacement surgery, infection may occur in the wound or deep around the new joint and may spread to your joint replacement. Antibiotics may be given before surgery and for 1 to 2 days afterwards to help reduce the risk of infection Notify your surgeon if any other surgery or dental work is necessary after joint replacement 6 7

5 getting back in step rehabilitation Rehabilitation therapy starts soon after your knee-replacement surgery is completed. The goals of rehabilitation are to help you: Increase muscle strength Increase movement in the knee joint Protect the new knee joint Return to your normal activities of daily living physical therapy In most cases, your physical therapist may have you sitting and standing on the day after surgery. The physical therapist will show you exercises that will help you to regain your range of motion (the amount you can move), strength, and independence. Most of your range of motion will be regained during the first several weeks after your surgery If you do not follow your exercise program, it is possible that the tissue surrounding the new knee joint will become tight and may limit your motion permanently Many people find that it is helpful to continue therapy after leaving the hospital your nurse or the hospital s Social Services Department can help you make these arrangements before you leave the hospital Remember, physical therapy and your exercise program are critical for a successful outcome. Envision each exercise you perform as another step toward an independent, active lifestyle. occupational therapy An occupational therapist will make sure you can safely perform daily activities when you are back in your home. Your occupational therapist may: Order special equipment for you, such as a bath chair, a commode, and a reacher, to help you avoid movements that put too much strain on the new joint Teach you different ways to put your pants or shoes on if you find that difficult Show you ways to make your bathroom and other living areas safer and easier to use home recovery Home recovery begins before you even get home! Before you leave the hospital, make sure you know: How to take medications When your bandage or staples will be removed When to schedule follow-up visits The answers to any other questions you may have doing your part Successful recovery depends on you! Set goals and work toward them. 8 9

6 Call your doctor right away if you have any of the following warning signs Fever over 101 F Chest pain Coughing Trouble breathing Calf or thigh soreness More drainage, redness, or warmth around the incision Sudden or severe jointunderstanding helping to avoid complications at home infection The most common cause of infection after joint-replacement surgery is bacteria entering the bloodstream. Bacteria from dental procedures, urinary tract infections, and skin infections can lodge around your artificial joint and cause an infection. You should take antibiotics before dental work or any surgical procedure that could allow bacteria to enter your bloodstream blood clots Follow your surgeon s instructions carefully to reduce the risk of developing a DVT and/or PE, which can occur most frequently during the first several weeks of your recovery. Warning signs of possible DVT in your leg include: Increased pain in your calf or thigh Tenderness or redness above or below the incision area Increased swelling in your calf, ankle, or foot Warning signs of possible PE in your lung include: Sudden increased shortness of breath Sudden onset of chest pain Localized chest pain with coughing loosening Some artificial knee joints eventually fail because of loosening of the joint where the metal or cement meets the bone. A loose knee joint causes pain. If the pain becomes unbearable, you may need another operation to replace the knee. When you are ready to resume activities: Choose those that are easy on your knee Avoid heavy lifting, high heels, jumping, twisting, and activities that put too much strain on your knee If you feel sudden or severe knee pain, stop what you are doing and contact your doctor or physical therapist dislocation In rare cases, the knee joint may become dislocated after surgery. It is important to remember not to twist or turn your knee until the muscles, tendons, and ligaments have had time to heal doing your part Taking good care of yourself at home will help you heal faster and better. Be sure to follow the advice of your doctor and therapist. knee pain When riding in a car, sit on a firm 10 pillow and keep the leg with the new knee extended 11

7 frequently asked questions about knee replacement How long is the hospital stay? The average hospital stay for a knee replacement is approximately 3 to 4 days. How long does it take to get better? Recovery varies with each person. You will use a walker or crutches after the operation as instructed. Most people gradually increase their activities and are able to resume most of their normal activities in 6 to 12 weeks. Will I need a blood transfusion? Most people do not require a transfusion after surgery. Some people may want to store their own blood before surgery. Your surgeon will discuss this subject with you. What is the success rate? Knee-replacement surgery is one of the most successful joint surgeries performed. On average, less than 10% of total knee replacements will ever need a correction or revision. How long does an artificial knee last? An artificial knee typically lasts 15 to 20 years. However, like any piece of equipment, it can wear down over time and may need to be replaced. What about pain? Thanks to modern medicine, it is possible to keep you comfortable after surgery. After surgery, any temporary discomfort does not compare to the pain that you probably have suffered over the months and years before surgery. Will the artificial joint set off a metal detector? Since artificial joints are made of metal, there s a chance they could set off metal detectors. Write any questions you have for your surgeon, nurse, or therapists here and bring them to your next appointment. This information is provided for informational purposes only and is not intended to replace consultation with a physician. 12 Are there complications? As with any surgery, there is a risk of complications after knee-replacement surgery, such as the chance of infection, blood clots, and risks associated with the use of anesthesia. Your healthcare team will discuss possible complications with you and the precautions you can take against them. 13

HIP REPLACEMENT SURGERY

HIP REPLACEMENT SURGERY HOW TO PREPARE FOR SURGERY AND REC0VERY Before surgery: Arrange for someone to help you around the house for a week or two after coming home from the hospital. Arrange for transportation