The information below is excerpted from Your Pathway to Recovery: A Patient's Guide to Total Knee Replacement, which can be found in it's entirety at the bottom of this page or for download here.
To understand total knee replacement (TKR), you should be familiar with the structure of the knee, a complex joint consisting of three bones: the femur (thigh bone), the tibia (shin bone), and the patella (kneecap). When you bend or straighten your knee, the end of the femur rolls against the end of the tibia, and the patella glides in front of the femur.
With a healthy knee, smooth, weight-bearing surfaces allow for painless movement. Muscles and ligaments provide side-to-side stability.
A membrane lines the joint. Cartilage acts as a cushion between the femur and tibia and is lubricated by synovial fluid.
With an arthritic knee, the cartilage cushion wears out. The bones rub together and become rough. The resulting inflammation and pain cause reduced motion and difficulty in walking.
The weight-bearing surfaces of a total knee replacement are smooth, as in a normal knee. A femoral component covers the end of the thigh bone, a tibial component covers the top of the shin bone, and the patellar component covers the underside of the kneecap.
Most femoral components are metal alloys (cobalt chromium) or metal ceramic alloys (oxidized zirconium). The patellar component is plastic (polyethylene); the tibial insert component is also plastic (polyethylene); and the tibial tray component can be made of the following materials:
Clinical and biomechanical research has steadily refined knee replacement methods and materials. Prosthesis durability can vary from patient to patient because each patient’s body places slightly different stresses on the new knee. However, the average patient can expect to obtain greater mobility and freedom from pain, which will, in turn, improve ability to walk.
Be sure you understand all pre-operative instructions. If you have questions or concerns, please discuss them with your surgeon or call the HSS Patient Education team at 212.606.1263.
1. Before your total knee replacement surgery, the surgeon’s office staff will make an appointment for you with an internist at HSS who will:
2. Unless you are told otherwise, continue to take medicines already prescribed by your own physician.
3. The surgeon’s office staff will also make an appointment for you for pre-surgical testing approximately 7 to 14 days prior to surgery where:
4. The surgeon’s office staff will make an appointment for you to attend the pre-operative patient education class. The class is approximately 60 to 90 minutes long. During the class, patient educators will:
5. You may be asked to donate your blood for the surgery. If a donation is recommended, the surgeon’s office staff will provide information and schedule usually 1 to 2 weeks prior to date of surgery.
6. You may wish to review and plan your post-hospital care with Case Management Services (212.606.1271) before admission. The PreAdmission Program offers patients and their families the opportunity for assistance before the patient is admitted for surgery. This program enables you to begin understanding and planning your hospitalization and your discharge needs in a timely, comprehensive manner. It helps you maximize your options, and make decisions in a more relaxed way.
7. Prepare for your return home from the hospital.
8. Before your admission, please complete the Health Care Proxy form authorizing another person, designated by you, to make decisions with your physician about your care, should this become necessary.
9. A nurse from the Same Day Surgical (SDS) unit will contact you one business day, prior to your surgical date (Friday for Monday surgical cases) with more detailed instructions.
10. The night before your surgery and 2 hours after your dinner, administer your Fleet enema.
11. The surgical area from mid-thigh to mid-calf should be washed with the antiseptic soap solution at the end of your bath or shower on the night before surgery. The solution should be rinsed and removed after application. Specific instructions will be provided through the presurgical screening appointment, the preoperative education class, and pre-operative phone call.
12. The SDS nurse will review when you should stop eating and drinking, but realize that it is likely that only clear fluids (no milk products) after midnight (i.e., water, ginger ale, black coffee or tea) will be allowed on the day of your surgery and nothing should be consumed 3 hours prior to your surgical time. A detailed preoperative nutritional guideline is described in this booklet and will be reviewed during the preoperative education class.
13. For patients who have Sleep Apnea and use a Sleep Apnea device, please bring your mask attachment and a record of the settings you normally use. Please DO NOT bring the CPAP machine. Patients with sleep apnea are generally required to stay overnight in the PACU to be monitored and observed.
14. The use of nicotine products (i.e., cigarettes, cigars, gums, or patches) has been shown to increase risk of complications following surgery. They can inhibit bone and wound healing by decreasing blood flow to the surgical site. They can also increase the risk of deep vein thrombosis (a.k.a. blood clots). Please discuss smoking cessation with your doctor.
15. You and your family will be instructed to go to the Family Atrium on the 4th Floor of the hospital.
In the Post-Anesthesia Care Unit (PACU), also called the Recovery Room, you may be given oxygen, and your vital signs (respirations, heart rate, and blood pressure) and IV will be monitored. The team will also focus on managing your pain and will begin your rehabilitation. Once in the PACU, your family and friends will be provided an update. To maintain patient privacy, as well as to reduce the risk of infection, PACU visits are somewhat limited, but will be facilitated through the Family Atrium patient liaisons.
When the anesthesiologist determines that you are sufficiently recovered, approximately 4 to 5 hours after surgery, you will be transported to an inpatient unit. While most patients are transferred to inpatient units, some remain overnight in the PACU for observation.
Your knee will have a large, bulky elasticized bandaged dressing with a thin tube inserted at the surgical site during the operation and attached to a drain and suction device to prevent accumulation of blood around the muscles and bones of the knee. The tube and drain are removed the day after surgery, and the bandage is removed the second post-surgical day.
The IV will remain connected to you for approximately 48 hours. Some surgeons will recommend the use of a continuous passive motion machine (CPM), which helps the knee regain flexion. The CPM may begin in the PACU on the day of surgery or on the next day. Members of the nursing staff will position you in bed and help you turn until you are able to move on your own. Regional anesthesia may temporarily inhibit bladder function after surgery. A catheter may be inserted into the bladder to monitor your urinary output. When a patient regains function, usually one or two days after surgery, this catheter is removed.
In collaboration with you and your family, the the healthcare team will plan, provide, and monitor your care.
Soon after total knee replacement surgery, a physical therapist will visit you with an exercise program to increase range of motion and strength in your leg muscles.
The physical therapist will assist you in the following activities:
You will be seen by a physical therapist on the day of surgery or the next morning after your knee replacement surgery. Your therapist will instruct you in your exercise program, which is directed toward increasing range of motion and strength of your legs. For the first few days after surgery, some patients benefit from taking pain medication thirty minutes prior to their therapy session. You should discuss this with your nurse and/or therapist.
Your therapist or nurse will assist you in sitting up with your feet over the bedside (we call it dangling). You will then stand with the use of a walker and the continued help of your therapist. As soon as possible, you will be allowed to bear full weight on the operated leg and then attempt walking.
Gradually increase your walking distance daily over the next few weeks after surgery and remember not to walk with a “stiff” knee, bend it as you normally would when you walk. When you are sitting, it is important to sit with your knee flexed or bent to a comfortable range of motion. Do not sit for an extended period of time. After 30-45 minutes, it is recommended that you get up and walk around to avoid stiffness.
Cryotherapy, the use of cold to treat your Total Knee Replacement, is an important element of your post-operative rehabilitation. Cryotherapy can help decrease pain while reducing swelling and inflammation.
Swelling is common after knee replacement surgery. It is important to minimize the harmful effects of swelling to enhance your recovery. If you advance your activity too quickly or “over do it”, your operated knee or leg may become more swollen. The more swelling you have in your leg/knee, the more pain you may have, the more difficult it may be to bend, straighten or even lift your leg and it may be more uncomfortable to weight bear. Monitor the swelling and elevate your leg if this occurs. Also, you should continue to pump and move your ankles up and down while lying in bed. Please discuss with your surgeon or physical therapist if you have any specific concerns regarding post operative swelling.
Ice may be in the form of ice wrapped in bags or towels, commercial cold packs or cold compression cuffs.
You cannot take a bath or shower until your staples or sutures are removed which is generally 10-14 days after surgery. Your surgeon’s office will give you specific instructions.
Transferring in and out of the shower may be difficult initially after surgery. However, in both the short and long run, you should be concerned with safety as you enter and leave a tub/shower.You may want to equip your tub/shower with safety handrails and a non-slip surface to maximize your safety. Please arrange for this to be done before your surgery, if possible.
If you experience discomfort during your ongoing physical therapy, take your pain medication at least 45 minutes prior to your subsequent therapy sessions. This will allow enough time for the medication to take effect.
This guidebook is a comprehensive, essential overview of everything having to do with total knee replacement surgery at HSS, from an overview of the procedure and hospital maps to nutrition tips and illustrated physical therapy exercises.