Knee Replacement at NYU
Parts of the Body Involved
Knee
Reasons for Procedure
Knee replacement becomes an option for treating a damaged knee when pain and stiffness limit normal activities and are not relieved by other measures, such as rest, medications, or physical therapy. The procedure is most often performed to:
* Alleviate knee pain and disability due to osteoarthritis, rheumatoid arthritis, or previous severe knee injury
* Correct a knee deformity (knee bows in or out)
* Obesity
* Urinary tract infection or dental or gum disease (each will increase the risk of bacteria entering the bloodstream and infecting the joint)
* Diabetes
* Taking steroid medication
* X-rays of joint
* Blood tests
* Possibly, MRI scan - a test that uses magnetic waves to make pictures of the inside of the body
In the time leading up to your procedure:
* Patients often need blood during surgery; consider donating your own blood before the procedure
* Make home modifications to help make recovery easier:
o Install safety bars, a raised toilet seat with arms, a shower bench and shower hose, and handrails on stairways and steps
o Remove throw rugs and extension cords
o Purchase a stable, firm-backed arm chair and a footstool
o Consider creating a temporary living space on one floor, since climbing up and down stairs will be difficult at first
* Review your regular medications with the surgeon and follow instructions if asked to discontinue some drugs
* Arrange for a ride to and from the hospital and medical appointments
* Arrange for help at home after returning from the hospital
* The night before, eat a light meal and do not eat or drink anything after midnight the night before unless told otherwise by your doctor
During Procedure –
IV fluids, blood, anesthesia, possibly sedation
Anesthesia –
General, spinal, or epidural
Description of the Procedure –
The surgeon makes an incision and removes damaged cartilage and bone. The remaining bone is prepared to receive the new plastic and metal joint, which is placed in proper position and cemented within the bone. The incision is closed with stitches or staples and a drain is left in to allow extra fluid to flow out. A splint holds the knee in proper position.
Blood and fluid loss from this surgery are often significant, and may require blood transfusions. You will be given IV antibiotics just prior to the start of surgery and possibly during the procedure; antibiotics are generally discontinued within 24 hours of surgery.
After Procedure –
Urinary catheter, splint or brace
How Long Will It Take?
About two hours
Will It Hurt?
Anesthesia prevents pain during surgery. You may experience pain during recovery but you will receive pain medication to relieve this discomfort.
Possible Complications –
* Infection
* Blood clots in a leg or pelvic vein that may travel to the lungs
* Excessive swelling or bleeding
* Injury to nearby nerves or blood vessels
* Anesthesia-related problems
Average Hospital Stay –
3-6 days
Postoperative Care –
* Move your foot and ankle to increase venous blood flow back to your heart.
* Your leg may be placed in a continuous passive motion (CPM) machine that slowly moves your knee, restoring function, decreasing swelling, and improving circulation.
* You may be given special support hose to wear that may help prevent blood clots from forming in your legs.
* You may need to wear a brace or splint; you will be taught to use a walker, crutches, or other support device until your leg is healed enough to support your weight.
* A physical therapist will help you perform specific knee exercises, usually starting the day after surgery. You’ll be taught safe and painless ways to stand, sit, lie, walk, and otherwise move the knee and support your weight.
* You will gradually progress to walking and then to climbing stairs.
* Keep the incision area clean and dry, and place a dressing over the incision to protect it from irritation
* Stitches or staples will be removed in a few weeks
* You may be sent home with blood-thinning medications; be careful to take these medications exactly as prescribed
* Do not take over-the-counter remedies without your surgeon’s approval
Outcome
Within six weeks, you should be able to resume normal light activities and driving. You may feel a soft clicking in the joint when walking or bending. By following the recommended activity and rehabilitation program you can speed your recovery and protect future joint function.
Maintain a healthy weight, and refrain from jogging and other high-impact sports, which can increase wear on the joint, cause it to loosen, and increase pain.
You’ll need antibiotics before dental procedures to decrease the risk of bacteria entering the bloodstream and traveling to the prosthesis.
Call Your Doctor If Any of the Following Occurs
* Signs of infection, including fever and chills
* Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
* Cough, shortness of breath, chest pain, or severe nausea or vomiting
* Your leg, foot, or toes appear chalky white, blue, or black
* Numbness or tingling in your leg, foot, or toes
* Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
* Pain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain