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PATIENT EDUCATION
TOTAL KNEE REPLACEMENT
W H Y O R T H O D E V E LO P M E N T ?
Ortho Development is passionate about making the
best, clinically proven, high-performance orthopedic
devices in the world. All of our implants are designed and
manufactured with pride in the United States using the
most advanced materials and technologies available, and
with a strong commitment to quality.
Ortho Development products are being used by hundreds
of surgeons throughout the United States and Japan at world-renowned orthopedic hospitals and teaching
universities, as well as in a widespread number of
regional and community hospitals.
The employees of Ortho Development strive
for excellence and work with integrity, respect,
accountability and attention to results. We collaborate
with skilled orthopedic surgeons to develop products
that can help restore mobility, enable faster recovery
and produce the best clinical outcomes. In short, we are
passionate about improving lives and are committed to
providing the best customer experience in orthopedics.
We think you will notice the Ortho Development
difference.
K N E E J O I N T A N AT O M Y A N D F U N C T I O N
The knee is a complex joint that connects the bones in the upper and lower leg and is
comprised of cartilage, muscle, ligaments, and tendons. The knee is the largest joint in
the body and it plays an essential role in movement related to normal daily activities.
The knee joint also provides stability and strength to support the weight of the body.
There are three bones that form the knee joint: the lower end of the femur (thighbone),
the upper end of the tibia (shinbone), and the patella (kneecap). The bones of the
knee joint are stabilized and connected by tough, fibrous tissue called ligaments.
These ligaments work with the muscles, bones, and tendons to allow the knee to bend
and straighten. The ends of the femur and tibia along with the back of the patella
are covered with articular cartilage, a flexible tissue which helps the bones of the
knee joint glide smoothly across each other. The meniscus is a cartilage that acts as
a cushion between the femur and tibia to help absorb the forces between the bones
during daily normal activities. Finally, the knee joint is enclosed by a capsule that has a
tough outer membrane and an inner synovial membrane which produces a lubricating
synovial fluid to help reduce joint friction and wear.
FEMUR
(THIGHBONE)
PATELLA
(KNEECAP)
ARTICULAR CARTILAGE
MENISCUS
MEDIAL COLLATERAL LIGAMENT
(MCL)
TIBIA
(SHINBONE)
LATERAL COLLATERAL LIGAMENT
(LCL)
C A U S E S O F PA I N
Knee pain can be the result of injury, disease, or biomechanical problems. Since
physical fitness and sports activities are integral to living a healthy lifestyle, injuries to
the knee can occur quite frequently among all age groups.
INJURY
A knee injury can affect any of the ligaments, muscles, or tendons that surround
the knee joint as well as the bones and cartilage that form the joint itself. The knee
is susceptible to twisting or stretching injuries that take the joint through a greater
range of motion than the joint can tolerate. The most common knee injuries include
fractures, dislocations, and sprains or tears of the cartilage, tissue, or ligaments of the
knee joint. Knee pain can also be a result of wear and tear or overuse of the knee joint
over time. The most typical signs of knee injury include pain, swelling, and instability
during daily normal activities.
DISEASE
One of the most common causes of knee pain is arthritis. Knee arthritis is
characterized by the cartilage of the knee joint progressively wearing away. As the
cartilage of the knee joint slowly wears away, the bones become exposed and rub
against each other resulting in pain, swelling, decreased mobility, and stiffness. There
are over 100 different types of arthritis that exist but the most common types that
affect the knee joint include:
Osteoarthritis is the most common form of arthritis that affects
the knee joint and is a chronic condition sometimes referred to as degenerative joint
disease or degenerative arthritis. Osteoarthritis affects approximately 27 million
people in the United States. Symptoms of osteoarthritis typically occur over the age of
45, in people who are genetically prone to the disease, or have suffered an injury to the
knee joint or obesity (1).
O S T E OA R T H R I T I S :
This form of arthritis is an autoimmune disease where
the body’s immune system mistakenly attacks the joints in the body. The abnormal
immune response causes inflammation that in turn causes damage to the body’s joints
and organs. Some of the key symptoms of rheumatoid arthritis (RA) include fatigue,
pain, and swollen joints. About 1.5 million people in the United States suffer from RA
with nearly three times as many women having the disease as men (2).
R H E U M AT O I D A R T H R I T I S :
BIOMECHANICAL PROBLEMS
Certain structural abnormalities can affect the function of the knee joint and cause
pain. Some of these underlying abnormalities that could be causing knee pain include
incorrect hip and foot function, weak muscles in the hip, or imbalance between the
muscles of the leg.
U N D E R S TA N D I N G K N E E PA I N
A healthcare provider will perform a physical examination to assess and determine the
proper treatment for your knee pain. Typically, a physical examination will focus on
the joint’s range of motion, ability to walk, pain levels, and joint swelling or tenderness.
A radiological examination (X-ray) may be completed to determine if there is a loss
of joint space in the affected knee. Blood, and other imaging tests, such as magnetic
resonance imaging (MRI) may also be required to complete the pain assessment.
T R E AT M E N T
Nonsurgical options are often the first-line approach for treatment in the early stages
of knee pain. There is a wide range of nonsurgical treatment options available to
help alleviate knee pain, increase joint function and mobility, and reduce symptoms.
The choice of treatment should be a mutual decision made between the healthcare
provider and the patient.
NONSURGICAL OPTIONS
Some of the nonsurgical treatment options that may be suggested by the healthcare
provider include:
Rehabilitation and rest of the knee joint is a common treatment option that can
help relieve knee pain. The general care to follow includes rest, ice, compression, and
elevation for the affected knee joint. The short-term rest and rehabilitation may help
to subside inflammation of the joint. In some cases, cold or heat therapy may also be
included as part of the rest and rehabilitation treatment based upon the cause of the
knee pain.
REST:
The stress of the weight-bearing knee joint may be reduced
through the management of diet and exercise. Based upon the condition of the
affected knee, a therapeutic exercise program may be designed to include strength
and flexibility as well as the incorporation of a balanced diet. Exercise may help to
restore function back to the knee joint, increase range of motion, and help strengthen
the muscles in the leg. Research has shown that a 5-10% reduction in body weight can
dramatically reduce joint pain and also improve exercise tolerance (3).
EXERCISE AND DIET:
In conjunction with a therapeutic exercise program, the
healthcare provider may recommend visiting a physical therapist. An evaluation
is conducted by a physical therapist that includes gathering information about the
history of the knee pain, past medical problems, aggravating and relieving factors, and
a physical examination. The physical examination may consist of a walking assessment
P H Y S I C A L T H E R A P Y:
and measurements to determine the joint’s range of motion, knee strength, and
swelling.
A treatment program will be developed based upon the condition of the affected knee
and often includes exercises that help strengthen and improve mobility within the
joint. The overall goal of physical therapy is to help eliminate knee pain, gain optimal
use of the knee joint, and learn skills to avoid future injuries or pain. In addition
to exercises, a physical therapist may use other methods to reduce pain including
alternating cold and heat therapy, use of ultrasound machines to increase blood flow
and to stimulate muscles, or the use of a supportive walking aid such as a cane or brace
(4) (5).
A healthcare provider may recommend medications to help make
knee pain more manageable. Over-the-counter (OTC) pain medications are typically
the first line of treatment while prescription medications are usually reserved for more
severe knee pain. Acetaminophen helps to alleviate mild to moderate pain and since
acetaminophen does not contain anti-inflammatory ingredients another medication
may be needed to reduce swelling. A Non-Steroidal Anti-Inflammatory Drug (NSAID)
may be recommended to help address swelling or inflammation of the knee joint.
NSAIDs are available OTC and include ibuprofen and naproxen sodium products. A
healthcare provider may have the patient try several NSAIDs to determine which one
works best to relieve pain. Topical analgesics or pain relievers may also be used to help
make knee pain more manageable. Topical medications are available in the form of
creams, patches, or lotions. Topical medications can help provide short-term relief to a
specific area of the knee joint.
M E D I C AT I O N S :
Corticosteroids are powerful anti-inflammatory agents that are related
to cortisone and are used to reduce inflammation. Cortisone can be injected directly
into the knee joint. The effects and relief from cortisone injections are short-term and
typically patients cannot receive more than four knee joint injections per year (6).
INJECTIONS:
Surgery may be recommended after all nonsurgical treatment options fail to provide
S
U R Gfrom
I C Apain
L OP
T I O N S Two of the many surgical options available include:
relief
symptoms.
Arthroscopic knee surgery is a procedure that involves the use
of fiber optic technology to view inside the knee joint. Arthroscopic surgery is often
called “scoping the knee” and repairs or removes damaged structures within the knee
joint. Some of the reasons to perform arthroscopy include the repair of torn cartilage
or ligaments, reconstruction of the anterior cruciate ligament (ACL), removal of loose
cartilage, or meniscus repair (7).
A R T H R O S C O P Y:
Total knee replacement (or arthroplasty) is one of
the most common and successful procedures performed. A total knee replacement
resurfaces the damaged joint within the knee and replaces it with an artificial joint
called a prosthesis. The prosthetic components are typically made of medical grade
plastic and metal. Together the components mimic the functionality of a healthy knee
joint. The surgical techniques and components of knee replacements have evolved over
the years to provide long-lasting results and superior functionality. More than 600,000
knee replacements are performed each year in the United States with over 90% of
patients having good results from the surgery (8) (9).
T O TA L K N E E R E P L AC E M E N T :
T O TA L K N E E R E P L AC E M E N T P R O C E D U R E
The decision to have total knee replacement surgery should be a mutual decision
between the patient and the surgeon. The recommendation to move forward with
a total knee replacement is based upon a patient’s pain and disability. Most patients
who undergo a total knee replacement are between the ages of 50-80. More than
90% of patients who have total knee replacement surgery experience a significant
improvement in the ability to perform normal daily activities and experience a
dramatic decrease in pain (10).
E X P E C TAT I O N S
The complication rate following a total knee replacement surgery is low, with serious
complications such as infection, occurring in fewer than 2% of patients. Some of the
complications that may occur following surgery include: infection, blood clots, knee
stiffness and implant complications.
P R E PA R AT I O N
Prior to a total knee replacement surgery, a complete physical examination may need
to be completed to ensure that the patient is healthy enough to have the surgery and
complete the recovery and rehabilitation process. Patients who have chronic medical
conditions such as heart disease may also be evaluated by a specialist prior to surgery.
Other preparation items include:
Several tests may be needed to plan for surgery such as blood and urine
samples and possibly an electrocardiogram.
TESTS:
It is important for the patient to notify the surgeon about current
medications as some medications shouldn’t be taken prior to surgery.
M E D I C AT I O N S :
D E N TA L P R O C E D U R E S :
The incidence of infection is very low after knee
replacement surgery but an infection can occur if bacteria enters the bloodstream.
Major dental procedures, such as periodontal work, should be completed prior to
surgery to reduce the risk of infection.
To help make the recovery easier the patient
should consider who will assist them with normal daily tasks at home whether it
is family, friends, or a social worker. If a patient does not have someone available to
assist post-surgery then an inpatient rehabilitation center may be an option. Since the
typical recovery time is around six weeks, the patient should also consider making
modifications to their environment by incorporating adaptive equipment, such as
secure handrails along stairways, to make the recovery easier.
P O S T- S U R G E R Y A S S I S TA N C E :
PROCEDURE
The day of the knee replacement surgery, the patient will be admitted to the hospital
and will be evaluated by a member of the anesthesia team. There are different types of
anesthesia that can be used during the surgery including general, spinal, epidural, or
regional nerve block. The anesthesia team will determine which type of anesthesia is
best for the patient.
A total knee replacement surgery typically takes between 1-2 hours. During the surgery
the affected bone or cartilage on the end of the femur (thigh bone) and the top of the
tibia (shin bone) are removed. A metal and plastic prosthesis is positioned to function
as the new knee joint. Depending upon the condition of the patella (kneecap), the
patellar surface may also be replaced.
Once the surgery is complete, the patient may be moved to the recovery room and will
remain there for several hours. While in the recovery room the patient’s anesthesia is
monitored. The patient may stay in the hospital post-surgery to manage pain properly,
actively prevent blood clots from occurring, and begin physical therapy. Most patients
will begin exercising their knee the day after surgery.
P O S T- O P E R AT I V E
It is important to restore normal knee motion and strength after a total knee
replacement. The recovery and rehabilitation process plays a crucial role in helping
the patient resume an active, pain-free lifestyle. Within the first 24 hours after surgery,
a physical therapist will monitor the strength and flexibility in the leg and will also
provide instructions and goals for the patient to complete in the hospital and at home.
A gradual return to everyday activities along with exercise may help restore
normal knee motion post surgery. During the early stages of rehabilitation it may
be recommended to exercise 2-3 times a day for 20-30 minutes. It is important for
the patient to be committed to the recovery and rehabilitation goals as the patient’s
commitment during this process can greatly improve the chances of long-term success.
An example of suggested goals for a post-operative rehabilitation timeline is below:
1-3 WEEKS
• Safe walking motion with an assistive device such as a cane or crutches
• Range of motion should be at 0-100 degrees
• Independent transfer of weight from one leg to the other
• Controlled pain, inflammation, and incision site effusion
4-6 WEEKS
• Safe walking motion with straight cane only
• Increase the strength of knee by continuing the physical therapy program and
exercise
• Range of motion should be at 0–120 degrees
• Decreased inflammation and swelling
3 MONTHS
• Safe walking motion on uneven surfaces with use of a cane
• Safe walking motion on a level surface without an assistive device
• Ability to ascend and descend stairs independently
• Return to normal daily activities including walking, swimming, or bicycling
• Decreased pain and joint stiffness
6-12 MONTHS
• Stay active with exercise and low-impact activities or sports
• Continue to improve muscular strength and endurance
• Work towards little or no pain or swelling with joint movement
• Maintain a healthy weight
• Complete required follow-up appointments to track progress
F R E Q U E N T LY A S K E D Q U E S T I O N S
H O W D O I K N O W I F I N E E D A T O TA L K N E E R E P L AC E M E N T ?
If you have tried nonsurgical treatments and are still experiencing knee pain or if your
pain is preventing you from performing daily normal activities then you should discuss
a total knee replacement surgery with your healthcare provider. Your healthcare
provider can assess your current diagnosis and determine if a total knee replacement is
a good option for you and your lifestyle.
H O W O L D I S T H E AV E R AG E PAT I E N T T H AT H A S A T O TA L K N E E
R E P L AC E M E N T ?
Most patients who undergo total knee replacement surgery are between the ages of
50-80 with the average patient being age 68. With the recent improvements in the
design of knee implants and the implant material, more active and younger patients
are receiving a total knee replacement and achieving long-lasting results with superior
functionality (13).
H O W W I L L I B E N E F I T F R O M A T O TA L K N E E R E P L AC E M E N T ?
After surgery and rehabilitation, the benefits of a total knee replacement may include:
• Reduction in joint pain and stiffness
• Improved range of motion
• Increased knee stability
H O W L O N G W I L L M Y K N E E R E P L AC E M E N T L A S T ?
Most knee implants last an average of about 20 years but the implant can loosen
or experience wear based upon the lifestyle of the patient and the demands on the
implanted joint.
W I L L M Y K N E E R E P L AC E M E N T S E T O F F M E TA L D E T E C T O R S ?
It is unlikely, but possible, that your knee replacement will set off a metal detector. To
take precaution, alert the appropriate security staff that you have a knee replacement.
D O I N E E D T O TA K E P R E C A U T I O N S T O P R O T E C T M Y K N E E R E P L AC E M E N T ?
To protect and extend the life of your knee replacement you may want to:
• Participate in recommended exercise to maintain strength and mobility
• Avoid falls and injuries
• Alert all doctors, including dentist, that you have a total knee replacement (do not
complete dental work in the first three months after surgery or as recommended by
your healthcare provider)
• Complete routine follow-up examinations with your healthcare provider
The information presented here is for educational purposes only. The information
does not replace the advice or counsel of a doctor or healthcare professional. Ortho
Development assumes no liability related to your decision to pursue joint replacement
surgery based upon any information provided here. Ortho Development strives to provide
information that is accurate, timely, and complete however, Ortho Development does not
make any guarantee in this regard. Always consult your doctor or healthcare professional
for medical advice, diagnosis, or decisions. Each patient will experience a different postoperative activity level based upon his or her clinical condition(s). Your doctor will
counsel you about how to best maintain your activity level to help prolong the lifetime of
the device. The lifetime of a joint replacement device is not infinite and varies based upon
each individual.
Sources
1) “Osteoarthritis.” Arthritis.org. Web. 30 July 2014.
2) “Rheumatoid Arthritis.” Arthritis.org. Web. 30 July 2014.
3) Cluett, Jonathan, M.D. “Does Weight Loss Help Symptoms of Arthritis and Joint Pain?”. About.com, 30 June 2014. Web. 30 July 2014.
4) Sears, Brett. “Physical Therapy for Knee Pain.” About.com, 16 May 2014. Web. 30 July 2014.
5) Yoffee, Lynn. “Physical Therapy for Knee Pain.” Everyday Health, 22 June 2009. Web. 30 July 2014.
6) Gentile, Julie, M. “Knee Osteoarthritis Medications.” Practicalpainmanagement.com, 11 October 2011. Web. 30 July 2014.
7) Cluett, Jonathan, M.D. “Arthroscopic Knee Surgery: A Treatment Option for Some Causes of Knee Pain.” About.com, 27 May 2014. Web. 30 July 2014.
8) “Total Knee Replacement.” AAOS.org, December 2011. Web. 30 July 2014.
9) Cluett, Jonathan, M.D. “Considering Knee Replacement Surgery? What You Need to Know About Knee Replacement.” About.com, 23 June 2014. Web. 30 July 2014.
10) “Total Knee Replacement.” AAOS.org, December 2011. Web. 30 July 2014.
11) Baldauf, Sarah. “Knee Replacements: Are You Too Young, Too Old, Too Fat, or Too ctive?”. USNews.com, 12 March
2010. U.S. News & World Report. Web. 30 July 2014.
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