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TOTAL KNEE REPLACEMENT

Arthritis is the loss of the cartilage, Teflon-like coating, on the ends of the bones.  As this smooth surface erodes, the joint becomes swollen and painful.  Arthritis is most frequent following some injury, but can also be seen due to wear and tear and with rheumatoid arthritis.  Initial treatment may involve medications, such as glucosamine and anti-inflammatories.  Other options include injections of cortisone, Hyalgan, bracing, and activity modifications.  In more severe cases, a replacement is required.  In this surgery the arthritis is removed and implants replace the ends of the bones. 

This surgery is performed in the hospital setting and requires 3-4 days stay in the hospital.  During the hospital stay a catheter is placed in your bladder and is taken out the second post-op day.  There is a large dressing on your knee and this is changed the second post-op day.  Your leg is placed in a CPM (continuous passive movement) machine following surgery to help with motion.  Usually this is stopped when you leave the hospital.  Physical therapy will start in the hospital and arrangements will be made for when you leave the hospital.  Following surgery you will be placed on a push-button PCA (patient controlled analgesic) pain machine and then you will be started on oral pain medication the next day.  The surgery is generally very successful at eliminating the pain.  

We will have you attend a pre-op teaching class at the hospital prior to your surgery.  As with any surgery there are risks, these include infection, bleeding, numbness, and limb length inequality.  We try hard to make your surgical experience as pleasant as possible and have found the following points helpful.

  1. There is a risk of blood clots with this surgery, so we place you on Coumadin (blood thinner) for twoweeks following surgery.  We therefore need to monitor your blood levels.  You need to have your blood drawn every Monday and Thursday and then we will notify you of how to take your Coumadin.  After the two weeks are done we recommend taking a baby aspirin for another four weeks.
  2. We use a re-circulating cold water unit called a polar pack.  Mark with Pacific Medical will contact you to pick this up.  Bring this with you to surgery as it will be applied then.  You need to turn the polar pack off every two hours for 15 minutes to prevent your leg from becoming too cold.
  3. Elevation is important to help with your swelling and decreasing pain.  You will have some swelling for six to nine months following surgery.
  4. You will start physical therapy in the hospital and then the therapist will come to your home three times a weeks to help you with your motion.  You will progress to out patient therapy when you are able.  Motion is very important to obtain in the first 10-14 days following surgery.  Flexion or bending of the knee is important but extension or straightening is most important.  This will take a lot of work on your part.
  5. Your energy level following surgery will be greatly decreased. This is normal and you may need to take naps throughout the day.
  6. You will begin weight bearing the day after surgery.  You will need to ambulate with a walker or a cane for the first six weeks following surgery.  Usually a walker for three weeks and then a cane for three weeks.  A list is attached of suppliers that rent these items.
  7. You will have an appointment 10-14 days following surgery.  At this appointment we will obtain x-rays.  You will have another appointment six weeks following surgery and another at 12 weeks following surgery.
  8. Following a total joint replacement you will need to take antibiotics prior to dental procedures and invasive (endoscopy and colonoscopy) procedures.  We will give you a prescription for these to have on hand.  You will need to take one pill one hour prior to the procedure and one pill six hours after the procedure.
  9. Below is a list of commonly used medications following surgery and their dosages:

If you have questions or concerns please feel free to contact your physician's nurse at
323-2600.