Total Knee Replacement

What is Total Knee Replacement Surgery

Total knee replacement is a surgery to replace your knee joint with a man-made (prosthetic) joint. It may be made of plastic, metal, or ceramic parts. The man-made joint is called a prosthesis.

It replaces parts of the thigh bone (femur), lower leg bone (tibia), and kneecap (patella). This surgery is done to lessen pain and improve knee movement.

What happens before the procedure?

Staying hydrated

Follow instructions from your doctor about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your doctor about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

  • Ask your doctor about:
    • Changing or stopping your normal medicines. This is important if you take diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your doctor tells you not to.
  • You may be given antibiotic medicine to help prevent infection.

General instructions

  • Get all dental care that you need done before your procedure. Plan to not have dental work done for 3 months after your surgery.
  • Ask your doctor how your surgical site will be marked or identified.
  • If your doctor prescribes physical therapy, do exercises as told.
  • Do not use any tobacco products, such as cigarettes, chewing tobacco, or e-cigarettes. If you need help quitting, ask your doctor.
  • You may have a physical exam.
  • You may have tests, such as:
    • X-rays.
    • MRI.
    • CT scan.
    • Bone scans.
  • You may have a blood or urine sample taken.
  • Plan to have someone take you home after the procedure.
  • If you will be going home right after the procedure, plan to have someone with you for at least 24 hours. It is best to have someone help care for you for at least 4–6 weeks after surgery.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
  • An IV tube will be put into one of your veins.
  • You will be given one or more of the following:
    • Sedative. This is a medicine that makes you relaxed.
    • Local anesthetic. This is a medicine to numb the area.
    • General anesthetic. This is a medicine that makes you fall asleep.
    • Spinal anesthetic. This is a medicine that numbs your body below the waist.
    • Regional anesthetic. This is a medicine that numbs everything below the injection site.
  • A cut (incision) will be made in your knee.
  • Damaged parts of your thigh bone, lower leg bone, and kneecap will be removed.
  • A piece of material (liner) will be placed on your thigh bone. Material will be placed on your lower leg bone and the underside of your kneecap.
  • One or more small tubes (drains) may be placed near your cut to help drain fluid.
  • Your cut will be closed with stitches (sutures), skin glue, or skin tape (adhesive) strips. Medicine may be put on your cut.
  • A bandage (dressing) will be placed over your cut.

The procedure may vary among doctors and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
  • You may continue to get fluids and medicines through an IV tube.
  • You will have some pain. There will be medicines to help you.
  • You may have fluid coming from a drain.
  • You may have to wear special socks (compression stockings). These help to prevent blood clots and reduce swelling in your legs.
  • You will be told to move around as much as possible.
  • You may be given a continuous passive motion machine to use at home. You will be shown how to use this machine.
  • Do not drive for 24 hours if you received a sedative.

Total Knee Replacement, Care After

These instructions give you information about caring for yourself after your procedure. Your doctor may also give you more specific instructions. Call your doctor if you have any problems or questions after your procedure.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your doctor.
  • If you were prescribed an antibiotic medicine, take it as told by your doctor. Do not stop taking the antibiotic even if you start to feel better.
  • If you were prescribed a blood thinner (anticoagulant), take it as told by your doctor.

Bathing

  • Do not take baths, swim, or use a hot tub until your doctor says it is okay. Ask your doctor if you can take showers. You may only be allowed to take sponge baths for bathing.
  • If you have a splint or brace that is not waterproof, cover it with a watertight covering when you take a bath or a shower.
  • Keep your bandage (dressing) dry until your doctor says it can be taken off.

Incision care and drain care

  • Check your cut from surgery (incision) and your drain every day for signs of infection. Check for:
    • More redness, swelling, or pain.
    • More fluid or blood.
    • Warmth.
    • Pus or a bad smell.
  • Follow instructions from your doctor about how to take care of your cut from surgery. Make sure you:
    • Wash your hands with soap and water before you change your bandage. If you cannot use soap and water, use hand sanitizer.
    • Change your bandage as told by your doctor.
    • Leave stitches (sutures), skin glue, or skin tape (adhesive) strips in place. They may need to stay in place for 2 weeks or longer. If tape strips get loose and curl up, you may trim the loose edges. Do not remove tape strips completely unless your doctor says it is okay.
  • If you have a drain, follow instructions from your doctor about caring for it. Do not remove the drain tube or any bandages unless your doctor says it is okay.

Managing pain, stiffness, and swelling

  • If directed, put ice on your knee.
    • Put ice in a plastic bag or use the icing device (cold flow pad or cryocuff) that you were given. Follow your doctor’s directions about how to use the icing device.
    • Place a towel between your skin and the bag, or between your skin and the device.
    • Leave the ice on for 20 minutes, 2–3 times per day.
  • If directed, apply heat to the affected area as often as told by your doctor. Use the heat source that your doctor recommends, such as a moist heat pack or a heating pad.
    • Place a towel between your skin and the heat source.
    • Leave the heat on for 20–30 minutes.
    • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.
  • Move your toes often to avoid stiffness and to lessen swelling.
  • Raise (elevate) your knee above the level of your heart while you are sitting or lying down.
  • Wear elastic knee support for as long as told by your doctor.

Driving

  • Do not drive until your doctor says it is okay. Ask your doctor when it is safe to drive if you have a splint or brace on your knee.
  • Do not drive or use heavy machinery while taking prescription pain medicine.
  • Do not drive for 24 hours if you received a sedative.

Activity

  • Do not play contact sports until your doctor says it is okay.
  • Avoid high-impact activities, including running, jumping rope, and jumping jacks.
  • Avoid sitting for a long time without moving. Get up and move around at least every few hours.
  • If physical therapy was prescribed, do exercises as told by your doctor.
  • Return to your normal activities as told by your doctor. Ask your doctor what activities are safe for you.

Safety

  • Do not use your leg to support your body weight until your doctor says that you can. Use crutches or a walker as told by your doctor.

General instructions

  • Do not have any dental work done for at least 3 months after your surgery. When you do have dental work done, tell your dentist about your joint replacement.
  • Do not use any tobacco products, such as cigarettes, chewing tobacco, or e-cigarettes. If you need help quitting, ask your doctor.
  • Wear special socks (compression stockings) as told by your doctor.
  • If you have been sent home with a knee joint motion machine (continuous passive motion machine), use it as told by your doctor.
  • Drink enough fluid to keep your pee (urine) clear or pale yellow.
  • If you have been told to lose weight, follow instructions from your doctor about how to do this safely.
  • Keep all follow-up visits as told by your doctor. This is important.

Contact a doctor if:

  • You have more redness, swelling, or pain around your cut from surgery or your drain.
  • You have more fluid or blood coming from your cut from surgery or your drain.
  • Your cut from surgery or your drain area feels warm to the touch.
  • You have pus or a bad smell coming from your cut from surgery or your drain.
  • You have a fever.
  • Your cut breaks open after your doctor removes your stitches, skin glue, or skin tape strips.
  • Your new joint feels loose.
  • You have knee pain that does not go away.

Get help right away if:

  • You have a rash.
  • You have pain in your calf or thigh.
  • You have swelling in your calf or thigh.
  • You have shortness of breath.
  • You have trouble breathing.
  • You have chest pain.
  • Your ability to move your knee is getting worse.
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