Comprehensive Insights into Total Knee Replacement
Total knee replacement is a surgical procedure that involves the replacement of all three compartments of the knee joint with specialized components. This innovative approach includes a metal cap to resurface the end of the thigh bone (femur) and a metal plate to resurface the top of the shin (tibia) bone. A thin polyethylene piece is interposed between the metal components to recreate the knee joint. Typically, the surgery lasts for about an hour to an hour and a half, with many patients able to walk on the same day as the procedure. The recovery period for a knee replacement typically spans around 2 months.
Objectives and Candidacy
The primary goal of knee replacement surgery is to restore function and alleviate the majority of pain associated with knee arthritis. Candidates for knee replacement include individuals experiencing knee arthritis who no longer find relief from non-operative treatments and are significantly affected by their knee pain. It’s important to note that the decision to undergo knee replacement rests with the patient, who ultimately determines if the pain warrants such intervention. Alternative options, including living with arthritis pain and continuing non-operative treatments, remain viable choices.
Revision Knee Surgery
Revision knee surgery, involving the replacement of a previously implanted prosthesis, poses greater challenges and uncertainties compared to the initial surgery. Each case presents unique complexities and risks, with outcomes less predictable than in primary surgeries. While advancements have improved outcomes over time, recovery may be prolonged, and results less assured. Often, specialized implants with stems and bone graft materials are necessary to reconstruct the knee joint.
Pre-operative Preparation and Education
Studies indicate that pre-operative education enhances patient outcomes post-joint replacement surgery. Our hospital provides a complimentary pre-operative instructional class, which patients are required to attend before surgery. Medication adjustments, including cessation of aspirin and non-steroidal anti-inflammatory drugs, are advised, and patients are encouraged to consult their medical doctor regarding the discontinuation of blood thinners.
Day of Surgery Protocol
Patients are advised not to eat anything for 8 hours before surgery, with water permitted up to 2 hours prior to the procedure. Most regular medications should be taken the morning of surgery with a small sip of water, pending approval from the anesthesiologist during the pre-operative visit. Patients typically report to the admission office early in the morning for morning cases or around 8 am for afternoon cases. Anesthesia options include spinal or general anesthesia, with updates provided to family members post-surgery.
Post-operative Care and Recovery
Wound closure is considered a crucial aspect of the procedure, with both interrupted and running sutures utilized to evenly distribute force on the skin edges. Pain management strategies are tailored to individual needs, with oral and IV pain medications administered as required. IV antibiotics are provided for 24 hours post-surgery, and blood thinners are prescribed for 6 weeks with aspirin. Early mobilization and physical therapy are encouraged to facilitate recovery and prevent complications.
Follow-up and Risks
Patients undergo follow-up appointments approximately 2 weeks and 6 weeks after surgery, with subsequent assessments scheduled annually. Various risks associated with total knee replacement, including blood clots, wound complications, infection, stiffness, component loosening, nerve injury, bleeding, and fractures, are carefully monitored and addressed throughout the recovery process.
Preventive Measures
Patients are encouraged to promptly report any signs of infection and receive antibiotics before invasive procedures. Additionally, pre-procedure antibiotics are recommended for two years following surgery, with extended coverage for immune-compromised individuals. Communication with healthcare providers regarding prior joint replacement is essential to mitigate potential risks during invasive procedures.
By understanding the intricacies of total knee replacement and adhering to preventive measures, patients can navigate the surgical journey with confidence, aiming for optimal outcomes and enhanced quality of life.