Download Information for patients about total knee arthroplasty

INFORMATION FOR PATIENTS ABOUT TOTAL KNEE
ARTHROPLASTY
GENERAL INFORMATION
----------------------------------------------------------------------------------------------------Total Knee Arthroplasty (TKA) was first widely used in the 1970’s and it is one of the
most successful medical procedures ever developed.
-Patients have a general or a spinal anesthetic during surgery.
-The operation takes about 1 ½ hours in the usual case.
-Patients usually walk the day after surgery putting full weight on the new knee.
-The recovery period is about 3 months.
-Most patients stay in the hospital about 3 or 4 days, although the time in the hospital
depends on progress with walking.
-Most knee replacements will last for 20 years or longer, but the knee prosthesis may
wear out and may need replacement.
-Over 90 % of patients are happy with the results of the operation and have much less
pain than before the operation. Many are even pain-free.
-Most patients are able to resume usual activities, but patients should not run, jog or jump
with the new knee, even if they are able to.
WHAT TO EXPECT AFTER SURGERY
Below is a list of what most patients can expect after surgery.
-Patients are usually asked to walk with a physical therapist in the hospital starting the
day after surgery. The goal is for you to be able to get out of bed independently and walk
in the hallway with a walker before you go home. The number of days you spend in the
hospital depends on your progress.
-You can take a shower and get your incision wet when you get home from the hospital,
but be careful not to slip. Get help from a family member if needed.
-Do not take a tub bath until your staples are removed and your incision is completely dry
after surgery.
-It is O.K. to get in a swimming pool 2 days after your staples are removed if your
incision is not draining fluid.
-Usually the staples are removed 2 weeks after the surgery date. They may be removed
in the hospital, in the clinic, or in your home. Your surgeon will tell you before you
leave the hospital where the staples will be removed.
-Usually patients are allowed to drive about 1 month after surgery. Make sure you are
safe to drive before trying to drive. You need to have good control of your legs in order
to work the gas and brake pedals and you need to be alert.
-If you are sexually active, you may consider resuming sexual relations after you return
home from the hospital.
-Most patients will use a walker for 1 month and then a cane for 1 month after surgery.
Usually, patients are able to resume walking without a cane about 2 months after surgery.
-You need to come in for a checkup at 4 weeks, 3 months, 6 months, and 1 year after
surgery. Then, it is important to have a checkup and x-rays every other year for the rest
of your life to make sure that there are no signs of prosthesis loosening or bone loss.
-For 2 years after surgery, you should receive antibiotics by mouth for any dental work
you have on your teeth or for the examination of your colon with a scope (colonoscopy).
These two procedures can cause bacteria to travel through your blood stream to your
knee. If your immune system does not work normally or you are taking medications
(such as steroids or chemotherapy medications) that affect your immune system, then you
will have to take the antibiotics when you have dental work or colonoscopy for the rest of
your life. If you get a bacterial infection anywhere in your body, you need to be treated
with antibiotics as soon as possible to reduce the risk of the infection traveling to your
knee.
POSSIBLE RISKS
There are possible risks to any operation. Even if the success rate is 95%, that means that
1 in 20 patients is not happy with the result. Below, we will list the expected possible
complications after Total Knee Arthroplasty.
-There is a chance of dying during the operation or during the days following the
operation. Your chance of dying largely depends on your age and overall health, but
even young healthy patients have a small risk of dying. For patients who are in their
80’s, the risk of dying in the period around surgery is about 3%. The risk is less for
younger patients.
-Blood clots may form in your veins after surgery and it is possible to have a blood clot
form in your lungs and this can kill you. The chance of dying from a blood clot is about
1 in 2000 patients. The sooner you can resume walking after surgery, the smaller your
chance is of developing a blood clot. We will ask you to start moving your ankles and
toes after surgery to help circulation. We use a blood thinner or air pumps on your feet or
legs to reduce the risk of clots.
-The knee can become stiff after surgery. Most TKA patients are able to fully extend
their knee and flex the knee over a ninety degree angle. If you have a stiff knee before
surgery, you are more likely to have a stiff knee after surgery. During surgery, your
surgeon will free up your knee and get the knee to move fully; however, if you do not
move your knee after surgery, it will not end up with a good range of motion. After
surgery, a physical therapist will help you to work on your knee range of motion, but the
amount of motion you get depends on your effort, your pain tolerance, and how prone
your body is to make scar tissue. Occasionally, a patient may be taken back to the
operating room to manipulate the knee to get it moving again, but after the manipulation,
the ultimate range of motion depends at how hard the patient tries to keep the knee
moving.
-The risk of infection is about 2%. If the knee gets infected, you will need more surgery
to clean out the infection. Usually we need to remove the prosthesis to clean out the
bone, and then you will need to receive 4 to 6 weeks of antibiotics in a vein. After the
antibiotics are completed, you will need another operation to put in a new knee. Most of
the time, we can get rid of the infection. There is a small chance that we cannot get rid of
the infection. If we cannot get rid of the infection, you could end up with a chronic
infection, a knee which does not bend, or a knee which you cannot walk on. About 1 in a
1000 patients ends up with an amputation. You can reduce your risk of infection in
several ways: eat a well-balanced diet, if you have diabetes – keep your blood sugar
around 120 or less, do not smoke, do not touch or allow others to touch your incision area
without thorough hand-washing, and bathe with antibacterial soap for a few days before
surgery.
-There is a small chance of nerve injury that could cause loss of muscle function or
numbness. Most of the time, this is temporary and the nerve recovers.
-There is about a 50% chance that you will need a blood transfusion after surgery, and
there is about a 1 in 12,000 chance to become infected with the Hepatitis or the HIV virus
from the blood transfusion from the blood bank. If you are already anemic (have a low
blood count), you are more likely to need a transfusion after surgery. If you are not
anemic, you may be able to give 1 pint of your blood at the blood bank before surgery so
that you can receive your own blood after surgery if you need a transfusion.
-Many knee prostheses will last for 20 years, but the prosthesis may become loose during
your lifetime. If the prosthesis comes loose, it erodes the bone and usually causes pain.
It is easier to replace the prosthesis before the bone loss becomes severe; therefore, it is
important for you to have x-rays every two years for your entire life to make sure the
prosthesis is not becoming loose and that you are not losing bone.