Total Knee Replacement

Pre-operative counseling information

Before you decide to have a total knee replacement, you must be certain you understand the risks and benefits of total knee replacement.

Benefits:

Pain Relief
Greater than 95% of recipients attain excellent pain relief. Although the technology is marvelous, a knee replacement is not as good as a 20-year-old knee. Many recipients recognize the difference between their native knee and the replaced knee. In large studies, greater than 95% of recipients were glad they had the knee replacement and would recommend the operation to a friend. We have many recipients here in Grants Pass who have offered themselves as counselors for people contemplating the surgery. Upon request, we can provide you with names and telephone numbers.

Longevity
Depending upon the stresses placed on the prosthetic, it is possible for the knee replacement to last up to 15 years. Considering the fact that our knee cycles over two million times a year, this longevity is amazing. Although undesirable, it is possible to revise a worn knee replacement with a new prosthetic.

Activity
A total knee replacement will allow you to return to most of your daily functions without difficulty or restrictions. Many recipients enjoy an active lifestyle to include golfing, gardening, bowling, swimming and walking. We discourage pivoting sports such as tennis or basketball.

Risks of total knee replacement:

Infection
In Grants Pass, we have attained an infection rate one-fifth of the national average. The operation will be performed in a specialized joint replacement operating room with specialized airflow. In addition, the operative team will wear a “space suit.” Intravenous antibiotics will be administered before and after surgery.

Blood Clots
Blood clots can develop in the calf during any surgical procedure. Blood clots can be life threatening. We utilize state of the art precautionary measures. On the evening of surgery, you will be started on a blood thinner which will be continued while at home. We will encourage you to pump your ankles to promote circulation in the calf. In addition, we will place compression devices to your calf to improve calf circulation.

Knee Stiffness
The knee joint will stiffen rapidly after surgery. We have an excellent team of therapists to assist you in the restoration of knee mobility. At times, a stiff knee will develop after surgery. This is more frequent in individuals who have a stiff knee prior to surgery. A stiff knee is commonly a painful knee.

Nerve or Vascular Injury
Your nerves and blood vessels lie within millimeters of your knee joint. Although the risk is less than 1%, it is possible that an injury could occur. A nerve injury could cause loss of sensation or muscle strength temporarily or permanently below the knee joint. A vascular injury would be repaired. We take every precaution to avoid injury.

Blood Transfusion
Typically, total knee replacement recipients pre-donate two units of blood for use after surgery. Rarely, it is necessary to use additional blood from the community blood bank. The risk of contracting hepatitis is approximately on in 63,000 and the risk of contracting AIDS is one in 676.000 from the community blood bank. It is rare that community blood is needed, and we will make all efforts to avoid its use if possible.

Death
This is an extremely rare occurrence in healthy individuals. If pre-existing medical conditions are present, we will obtain the assistance of your regular doctor to assure a safe operation.

Pre-surgical Preparation:

History and physical evaluation
Our Physician Assistant will evaluate your medical history and examine your heart and lungs. At the time of this visit, please bring a record of your medical problems, hospitalizations, surgical procedures, medications (including dosages), and allergies.

Laboratory Testing
At the time of your visit with the Physician Assistant, arrangements will be made for blood tests, heart electrocardiograms and a chest x-ray. Additional leg x-rays will also be arranged if needed.

Per-operative Clinic
An appointment will be made with the hospital pre-operative clinic. At this appointment you will speak with an anesthesia provider, pre-register for your surgery, and have your lab tests completed.

Durable Medical Equipment
At the time of your history and physical examination you will be provided with prescriptions for walking aids and a raised toilet seat. Please obtain these prior to surgery. Please bring your walker to the hospital prior to your release from the hospital. This will allow the therapist to correctly size the walking aid. An ice container with a pump will need to be obtained prior to leaving the hospital. Most insurance covers the walking aid and raised toilet seat.

You may want to purchase a “grabber” and a long shoe horn at the medical equipment supplier. These are not covered by insurance plans. They will facilitate daily activities while your knee is healing and your mobility is restricted.

Medications
At the time of your appointment with the Physician Assistant, you will be provided with a prescription for pain medications and a stool softener for after surgery. Please obtain these prior to your surgery. You may also receive a prescription for a blood thinner call Arixtra or Lovenox. This is an expensive medication. Many insurance companies will not cover this medication. We will request a pre-authorization from your insurance. Your pharmacist will assist you with your insurance coverage. Please obtain this medication prior to your surgery. You will be instructed in its use at the time of your hospitalization.

Blood Donation
Arrangements will be made to pre-donate blood before surgery. Please obtain an over-the-counter iron supplement and begin taking iron one month before surgery. Your body needs iron to rebuild it’s blood supply. Normal dosage of iron sulfate is 325 mg twice a day. Be sure to add a stool softener also, since iron can cause some constipation.

Please stop taking aspirin (or arthritis pills), which can thin your blood, five full days prior to surgery. Tylenol is not a blood thinner. Please call us if you have any questions.

Surgery
You will need to come into the hospital on the morning of your surgery.

Hospital Stay
The average hospital stay is approximately 3 days. On the first day after surgery, you will be asked to sit in a chair at the side of your bed. On the ensuing days, we will progressively assist you in walking. Your therapist will help assist you in bending and straightening your knee. When you are safely able to enter and exit your bed and ambulate, you can be released from the hospital.

Pain control will initially be accomplished using a combination of oral or IV pain medicine and “nerve blocks.” Nerve blocks are shots of long-acting anesthetics around the nerve that supplies the knee. They can last 6 to 24 hours. Sometimes a tube will be inserted to provide a continuous block for the first couple of days after surgery. You will be transitioned to pain pills as you become more comfortable. A large bandage will be placed on your knee. This will be changed periodically. The skin clips will be removed by your therapist approximately two weeks after surgery. You may shower 48 hours after removal of the skin clips.

Initially, you will have an intravenous tube, a bladder catheter, nerve block tubes, a knee drainage tube and possibly a tube circulating ice water to a knee cooling pad. Each of these tubes will be removed as you recover from your surgery. A knee brace will be used to facilitate straightening of the knee. Long tight stocking will be used to control swelling.

It is not possible to take your blood thinner in a pill form. It will be necessary to place an injection under the skin. This is similar to the injection diabetics perform on a daily basis. You will be instructed on how to safely perform these injections. At first, these injections seem impossible. With coaching, you will find them to be easy.

After Surgery:

Therapy
Depending on your desires and your progress after surgery, you may return home from the hospital. Outpatient therapy will be arranged. You will be taught stretching and strengthening exercises. Much of this therapy will be self-directed and performed daily for the first three months after surgery. By doing these exercises daily, you will drastically shorten your recovery time.

Based on your discretion and your progress in therapy, you may benefit from a short stay in a local rehabilitation facility. These facilities such as Royale Gardens, Highland House, and Fairview have developed rehabilitation units. They allow you concentrated therapy while providing more recovery time prior to returning home. I encourage you to visit these rehabilitation facilities before surgery. The decision on whether to return home or to a rehabilitation facility can be made during your hospital stay. It is helpful to know prior to surgery if you desire a stay in the rehabilitation facilities. The sooner we make these arrangements, the better the transition from hospital to rehabilitation facility. This will be further discussed at your preoperative history and physical examination with the Physician Assistant.

Recovery
Full recovery takes one year. Frequently, the knee will have less pain than prior to surgery within four weeks after surgery. If you enjoy walking for exercise, you are encouraged to resume walking as early as two weeks after surgery. You will be unable to drive for at least six weeks after surgery. Many knee replacement recipients resume social activities at approximately eight weeks after surgery. These include dining out, shopping and visiting friends. It is impossible to outline an exact recovery time because the description of “recovered” and the general health in each individual is extremely variable.

Most Importantly
We are here to assist you. Please do not hesitate to ask for help or ask questions. A knee replacement is a large decision and a large event. Let us assist you through the process.

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