| Patient Education |
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| What is a knee replacement surgery? |
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Knee replacement,is a surgery for damaged knee because of arthritis. It is also called arthroplasty.Metal and plastic parts are used to cap the ends of the bones that form the knee joint, along with the kneecap. This surgery may be considered for someone who has severe pain in knees with swelling and instability, patient also complains of pain while walking. |
There are different type of conditions which can affect the knee joint, important onea are described below :-
Osteoarthritis, a degenerative joint disease that affects mostly middle-aged and older adults, may cause the breakdown of joint cartilage and adjacent bone in the knees. |
Rheumatoid arthritis, which causes inflammation of the synovial membrane and results in excessive synovial fluid, can lead to pain and stiffness.
Traumatic arthritis, arthritis due to injury, may cause damage to the cartilage of the knee. |
The goal of knee replacement surgery is to resurface the parts of the knee joint that have been damaged and to relieve knee pain that cannot be controlled by other treatments. |
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Joint consist of an area involving motion between two joint surfaces. Most joints are mobile, allowing the bones to move. Basically, the knee is 2 long leg bones held together by muscles, ligaments, and tendons. Each bone end is covered with a layer of cartilage that absorbs shock and protects the knee. |
Tendons are tough cords of connective tissue that connect muscles to bones. Ligaments are elastic bands of tissue that connect bone to bone. Some ligaments of the knee provide stability and protection of the joints, while other ligaments limit forward and backward movement of the tibia (shin bone). |
There are 2 groups of muscles involved in the knee, including the quadriceps muscles (located on the front of the thighs), which straighten the legs, and the hamstring muscles (located on the back of the thighs), which bend the leg at the knee. |
The knee consists of the following: |
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Tibia. This is the shin bone or larger bone of the lower leg. |
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Femur. This is the thighbone or upper leg bone. |
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Patella. This is the kneecap. |
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Cartilage. A type of tissue that covers the surface of a bone at a joint. Cartilage helps reduce the friction of movement within a joint. |
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Synovial membrane. A tissue that lines the joint and seals it into a joint capsule. The synovial membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it. |
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Ligament. A type of tough, elastic connective tissue that surrounds the joint to give support and limits the joint's movement. |
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Tendon. A type of tough connective tissue that connects muscles to bones and helps to control movement of the joint. |
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Meniscus. A curved part of cartilage in the knees and other joints that acts as a shock absorber, increases contact area, and deepens the knee joint. |
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| Reasons for the procedure |
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| The most common condition that results in the need for knee replacement surgery is osteoarthritis. |
Osteoarthritis is characterized by the breakdown of joint cartilage. Damage to the cartilage and bones limits movement and may cause pain. People with severe degenerative joint disease may be unable to do normal activities that involve bending at the knee, such as walking or climbing stairs, because they are painful. The knee may swell or "give-way" because the joint is not stable. |
Other forms of arthritis, such as rheumatoid arthritis and arthritis that results from a knee injury, may also lead to degeneration of the knee joint. In addition, fractures, torn cartilage, and/or torn ligaments may lead to irreversible damage to the knee joint. |
If medical treatments are not satisfactory, knee replacement surgery may be an effective treatment. Some medical treatments for degenerative joint disease may include, but are not limited to, the following: |
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Anti-inflammatory medications |
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Glucosamine and chondroitin sulfate |
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Diacerin |
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Pain medications |
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Limiting painful activities |
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Assistive devices for walking (such as a cane) |
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Braces |
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Physical therapy |
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Cortisone injections into the knee joint |
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Viscosupplementation injections (to add lubrication into the joint to make joint movement less painful) |
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Weight loss (for obese persons) |
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There may be other reasons for your doctor to recommend a knee replacement surgery. |
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As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:
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Bleeding |
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Infection |
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Blood clots in the legs or lungs |
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Loosening or wearing out of the prosthesis |
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Fracture |
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Continued pain or stiffness |
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| There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure. |
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Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure. |
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You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear. |
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In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests. |
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Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general). |
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Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking. |
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Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure. |
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If you are pregnant or suspect that you are pregnant, you should notify your doctor. |
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You will be asked to fast for eight hours before the procedure, generally after midnight. |
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You may receive a sedative prior to the procedure to help you relax. |
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You may meet with a physical therapist prior to your surgery to discuss rehabilitation. |
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Arrange for someone to help around the house for a week or two after you are discharged from the hospital. |
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Based on your medical condition, your doctor may request other specific preparation. |
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Knee replacement requires a stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.
Knee replacement surgery is most often performed while you are asleep under general anesthesia. Your anesthesiologist will discuss this with you in advance. |
Generally, knee replacement surgery follows this process: |
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You will be asked to remove clothing and will be given a gown to wear. |
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An intravenous (IV) line may be started in your arm or hand. |
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You will be positioned on the operating table. |
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A urinary catheter may be inserted. |
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If there is excessive hair at the surgical site, it may be clipped off. |
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The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. |
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The skin over the surgical site will be cleansed with an antiseptic solution. |
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The doctor will make an incision in the knee area. |
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The doctor will remove the damaged surfaces of the knee joint and resurface the knee joint with the prosthesis. The knee prosthesis is made up of metal and plastic. The most common type of artificial knee prosthesis is a cemented prosthesis. Uncemented prostheses are not commonly used anymore. A cemented prosthesis attaches to the bone with surgical cement. |
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The prosthesis is generally comprised of 3 components: the tibial component (to resurface the top of the tibia, or shin bone); the femoral [thigh bone] component (to resurface the end of the thighbone; and the patellar component (to resurface the bottom of the kneecap that rubs against the thighbone). |
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The incision will be closed with stitches or surgical staples. |
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A drain may be placed in the incision site to remove fluid. |
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A sterile bandage or dressing will be applied. |
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| In the Hospital |
| After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Your Post Operative x ray is taken. Knee replacement surgery usually requires an in-hospital stay of several days. |
| It is important to begin moving the new joint after surgery. A physical therapist will meet with you soon after your surgery and plan an exercise program for you. A continuous passive motion (CPM) machine may be used to begin the physical therapy. This machine moves your new knee joint through its range of motion while you are resting in bed. Your pain will be controlled with medication so that you can participate in the exercise. You will be given an exercise plan to follow both in the hospital and after discharge. |
| You will be discharged home or to a rehabilitation center. In either case, your doctor will arrange for continuation of physical therapy until you regain muscle strength and good range of motion. |
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| At Home |
| Once you are home, it is important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit. |
| To help reduce swelling, you may be asked to elevate your leg or apply ice to the knee. |
| Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications. |
| Notify your doctor to report any of the following: |
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Fever |
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Redness, swelling, bleeding, or other drainage from the incision site |
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Increased pain around the incision site |
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| You may resume your normal diet unless your doctor advises you differently. |
| You should not drive until your doctor tells you to. Other activity restrictions may apply. Full recovery from the surgery may take several months. |
| It is important that you avoid falls after your knee replacement surgery, because a fall can result in damage to the new joint. Your therapist may recommend an assistive device (cane or walker) to help you walk until your strength and balance improve. |
| Making certain modifications to your home may help you during your recovery. These modifications include, but are not limited to, the following: |
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Proper handrails along all stairs |
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Safety handrails in the shower or bath |
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Shower bench or chair |
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Raised toilet seat |
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Long-handled sponge and shower hose |
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Dressing stick |
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Sock aid |
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Long-handled shoe horn |
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Reaching stick to grab objects |
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Removing loose carpets and electrical cords that may cause you to trip |
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Avoiding stair-climbing until recommended by your doctor |
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| Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation. |
Disclaimer
The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition. |
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| What is Hip Replacement Surgery? |
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It is a surgical procedure to replace a worn out or damaged joint surfaces of a hip joint with an artificial joint (prosthesis). This surgery may be considered following avascular necrosis of femoral head leading to arthritis or a hip fracture (breaking of the bone) .
The goal of hip replacement surgery is to replace the parts of the hip joint that have been damaged, and to relieve hip pain that cannot be controlled by other treatments. |
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| Who might be a candidate for hip replacement? |
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The most common condition that results in the need for hip replacement surgery is arthritis. Osteoarthritis, a degenerative, joint disease that affects mostly middle-aged and older adults, causes the loss of joint cartilage and adjacent bone in the hips. Rheumatoid arthritis, which causes inflammation of the synovial membrane (the lining of the joint) and results in excessive fluid, can lead to severe pain and stiffness. Traumatic arthritis, arthritis due to injury, can cause damage to the articular cartilage of the hip. |
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People with severe degenerative joint disease may be having pain during walking, sitting crosslegged or squatting. Normal day to day activity of moving around in the home |
Also, hip replacement is one method of treating a hip fracture. A fracture is a traumatic event that may result from a fall. Pain from a fracture is severe and walking or even moving the leg is difficult. |
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Other conditions that may cause hip joint degeneration and require hip replacement include infections and hip deformities. |
The decision to replace the painful hip with an artificial one is a decision made by the patient and doctor. Other alternative treatments may first be used, including: |
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Anti-inflammatory medications |
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Pain medications |
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Limiting painful activities |
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Assistive devices for walking (such as a cane) |
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Physical therapy |
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In addition to a complete medical history, your doctor may perform a complete physical examination, including X-rays, to ensure you are in good health before undergoing surgery. In addition, you may also meet with a physical therapist to discuss rehabilitation after the surgery and undergo blood tests (or other tests). |
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| How is the surgery done ? |
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Although each procedure varies, generally, surgery to replace a hip joint usually lasts an hour or so. |
The two most common types of artificial hip prostheses used in replacement surgery are cemented prostheses or uncemented prostheses. Sometimes, a combination of the two types is used to replace a hip joint. A hip prosthesis is made up of metal and plastic. A cemented prosthesis is attached to the bone with a type of surgical cement. An uncemented prosthesis attaches to the bone with a fine mesh of holes on the surface, in order for the bone to grow into the mesh and attach naturally to the prosthesis. |
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| The prosthesis (artificial hip) is comprised of the following two components: |
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Metal stem component |
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Metal or ceramic ball component |
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Metal,ceramic or plastic (backed with metal) socket component |
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| A traditional hip replacement involves an incision (cut) about 6 to 8 inches long over the hip joint. Newer approaches and techniques have been developed that use one or two smaller incisions to perform the procedure, called minimal incision hip replacement or minimally invasive hip replacement. However, the minimally invasive procedure is not suited for all candidates for hip replacement. The doctor will determine the best procedure for a person, based on that individual's situation. |
| While undergoing surgery, the patient may be under general anesthesia or sedated with spinal anesthesia. |
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| Hip replacement surgeries usually require an in-hospital stay of several days. While in the hospital, the patient generally begins physical therapy exercises to regain range of motion and strength in the hip. Physical therapy will continue at home. Pain medication also will be administered to keep the patient comfortable. |
| The incision will have stitches or staples that will be removed after a few weeks. |
| Making certain modifications to your home may help you during your recovery. These modifications include the following: |
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Proper handrails along all stairs |
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Safety handrails in the shower or bath |
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Shower bench or chair |
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Raised toilet seat |
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Stable chair with firm seat cushion and firm back with two arms, which will allow your knees to be positioned lower than your hip |
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Reaching stick to grab objects |
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Firm pillows to raise the hips above the knees when sitting |
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Removing loose carpets and electrical cords that may cause you to trip |
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| (Left) In this x-ray of a normal knee, the space between the bones indicates healthy cartilage (arrow). (Right) This x-ray of an arthritic knee shows severe loss of joint space and bone spurs (arrows). |
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| Normal knee anatomy. |
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| Left) An x-ray of a severely arthritic knee. (Right) The x-ray appearance of a total knee replacement. Note that the plastic spacer between the bones does not show up in an x-ray. |
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