Knee Joint Replacement

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URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/002974.htm

Knee joint replacement is surgery to replace a knee joint with an artificial joint. The artificial joint is called a prosthesis.

Description

You may receive general anesthesia before this surgery. This means you will be unconscious and unable to feel pain.

Or, you may have a spinal or epidural anesthesia. In this kind of anesthesia, medicine is put into your back to make you

numb below your waist.

After you receive anesthesia, your surgeon will make an incision (cut) over your knee to open it up. Then your surgeon

will:

Move your kneecap (patella) out of the way, then shape the ends of your thigh bone and shin bone to fit the

prosthesis. Your surgeon will also cut the underside of your kneecap to prepare it for the artificial pieces that will

be attached there.

Fasten the two parts of the prosthesis to your bones. One part will be attached to the end of your thigh bone

and the other part will be attached to your shin bone. Both parts will then be attached to the underside of your

kneecap. Your surgeon will use a special bone cement to attach these parts.

Usually, artificial knees have metal parts. Now, though, some surgeons are using some different materials, including

metal on metal, ceramic on ceramic, or ceramic on plastic.

Why the Procedure is Performed

Knee joint replacement may be recommended for:

Severe arthritis (osteoarthritis or rheumatoid arthritis) of the knee that has not gotten better with medicine,

injections, and physical therapy after 6 months or more of treatment. Your doctor may recommend knee

replacement for these problems:

Inability to sleep through the night because of knee pain

Knee pain that has not improved with other treatment

Knee pain that limits or keeps you from being able to do your normal activities, especially your daily

activities such as bathing, preparing meals, household chores, and other things.

Some tumors that affect the knee

Even when a knee replacement is needed, some medical problems may lead your doctor to recommend that you not

have it done. Some of these problems are:

A knee infection

Morbid obesity (weighing over 300 pounds)

Very weak quadriceps, the muscles in the front of your thigh. Weak quadriceps could make it very hard for you

to walk and use your knee.

Unhealthy skin around your knee

Severe mental dysfunction

Poor blood flow in the leg from peripheral vascular disease. This could keep the incision from healing.

A terminal disease, such as cancer, that has spread

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Risks

Risks for any surgery are:

Breathing problems

Infection, including in the lungs, urinary tract, and chest

Bleeding

Heart attack or stroke during surgery

The risks of this surgery are:

Dislocation of the artificial joint

Infection that requires removing the joint

Loosening of the artificial joint over time

Pneumonia

Allergic reaction to the artificial joint

Injury to nerves or blood vessels

Blood clots that may form in your leg (deep vein thrombosis) or your lungs (pulmonary embolism)

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a

prescription

During the 2 weeks before your surgery:

Prepare your home.

Two weeks before surgery you may be asked to stop taking drugs that make it harder for your blood to clot.

These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.

Ask your doctor which drugs you should still take on the day of your surgery.

If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your doctorwho treats you for these conditions.

Tell your doctor if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.

If you smoke, you need to stop. Ask your doctor or nurse for help. Smoking will slow down wound and bone

healing. Your recovery overall may not be as good if you keep smoking.

Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before

your surgery.

You may want to visit a physical therapist to learn some exercises to do before surgery and to practice using

crutches or a walker.

On the day of your surgery:

You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.

Take your drugs your doctor told you to take with a small sip of water.

Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will stay in the hospital for 3 to 5 days, But full recovery will take from 2 to 3 months to a year.

After surgery:

You will have a large dressing (bandage) over your knee. A small drainage tube will be placed during surgery to

help drain fluids that build up in your knee joint after surgery. It will be removed when you no longer need it.You will have an IV (a catheter, or tube, that is inserted into a vein, usually in your arm).

You may have a Foley catheter inserted into your bladder to drain urine. Usually it is removed 2 or 3 days after

surgery.


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You will wear special compression stockings on your legs. These stockings improve blood flow and reduce your

risk of getting blood clots.

Most people will also receive blood-thinning medicine to reduce the risk of blood clots more.

You may be taught how to use a device called a spirometer and do deep breathing and coughing exercises.

Doing these exercises will help prevent pneumonia.

Your doctor will prescribe pain medicines to control your pain. Your doctor may also prescribe antibiotics to

prevent infection.

You will be encouraged to start moving and walking as soon as the first day after surgery.

You will be helped out of bed to a chair on the first day after surgery. When you are in bed, bend and straighten

your ankles often to prevent blood clots.

You will be encouraged to do as much you can for yourself as possible by the second day. This includes going to

the bathroom or taking walks in the hallways, always with someone helping you.

Some surgeons recommend using a continuous passive motion machine (CPM) while you are in bed. The CPM

bends your knee for you. Over time, the rate and amount of bending will increase. If you are using one, always

keep your leg in the CPM when you are in bed. It will help speed your recovery and reduce pain, bleeding, and

risk of infection.

Some people need a short stay in a rehabilitation center after they leave the hospital and before they go home. At arehab center, you will learn how to safely do your daily activities on your own.

Outlook (Prognosis)

The results of a total knee replacement are often excellent. The operation relieves pain for most people, and most

people do not need help walking after they fully recover. Most artificial knee joints last 10 to 15 years. Some last as

long as 20 years before they loosen and need to be replaced again.

Alternative Names

Total knee replacement; Knee arthroplasty; Knee replacement - total; Tricompartmental knee replacement

References

Crockarell JR, Guyton JL. Arthroplasty of the knee. In: Canale ST, Beatty JH, eds. Campbell's Operative

Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 6.

Jones CA, Beaupre LA, Johnston DW, Suarez-Almazor ME. Total joint arthroplasties: current concepts of patient

outcomes after surgery. Rheum Dis Clin North Am. 2007; 33(1): 71-86.

Update Date: 2/9/2009

Updated by: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of

Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission

(www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous

standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online

health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy.

A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation

(www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical

condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all

medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other

sites. Copyright 1997-2011, A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.


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Normal anatomy

The knee is a complex joint, which is made up of the distal end of the femur (the femoral condyles), andthe proximal end of the tibia (the tibial plateau). The femoral condyles usually glide smoothly on the tibial

plateau, allowing for smooth, painless motion of the lower leg.

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Updated by: Mark James Borigini, MD, Rheumatologist in the Washington, DC Metro area. Review

provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director,

A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare

Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that

A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve

this important distinction for online health information and services. Learn more about A.D.A.M.'s

editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics

and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis ortreatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment

of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided

for information only -- they do not constitute endorsements of those other sites. Copyright 1997-2011,

A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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Indications

The most common cause of knee damage requiring knee replacement is osteoarthritis, which is adegenerative disease of the bones of the knee which cause the surfaces of the knee joint to become

irregular and rough, preventing smooth painless motion of the knee joint.

Knee joint replacement may be recommended for:

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knee osteoarthritis or arthritis, which causes knee pain that has failed to respond to conservative

therapy (NSAID medication for 6 months or more)

decreased knee function caused by arthritis

inability to work because of knee pain

inability to sleep through the night because of knee pain

inability to walk more than 3 blocks because of knee pain

loose knee prosthesis

some knee fractures



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The information provided herein should not be used during any medical emergency or for the diagnosis or

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of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are providedfor information only -- they do not constitute endorsements of those other sites. Copyright 1997-2011,





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Procedure

The operation is performed under general anesthesia. The orthopedic surgeon makes an incision over theaffected knee. The patella (knee cap) is moved out of the way, and the heads of the femur and tibia are

shaved to eliminate any rough parts and to permit a better adhesion of the prosthesis. The two parts of the

prosthesis are implanted into the thigh bone and the tibia bone using a special bone cement.

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The information provided herein should not be used during any medical emergency or for the diagnosis ortreatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment







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Gradually, the rate and amount of flexion will be increased as tolerated. The leg should always be in this

device when in bed. The CPM device helps speed recovery, decreases post-operative pain, bleeding and

infection.

You will experience moderate pain after surgery. However, you may receive patient-controlled analgesia

(PCA), or epidural analgesics to control your pain for the first 3 days after surgery. The pain should

gradually decrease, and by the third day after surgery, oral analgesic medications may be sufficient to

control your pain.

Try to schedule your pain medications about one half hour before walking or position changes. You will

also return from surgery with several IV lines in place to provide hydration and nutrition. The IV will

remain in place until you are taking adequate amounts of oral fluids.

Prophylactic (preventive) antibiotics may be given to reduce the risk of developing an infection,

necessitating removal of the artificial joint.

You will also return from surgery wearing anti-embolism stockings or an inflatable pneumatic compression

stockings. These devices are used to reduce your risk of developing blood clots, which are more common

after lower extremity surgery.

Additionally, you will be encouraged to start moving and walking early after surgery. You will be assisted

out of bed to a chair on the first day after surgery. When in bed, bend and straighten your ankles

frequently to prevent development of blood clots.



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The information provided herein should not be used during any medical emergency or for the diagnosis or

treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment







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Page last updated: 15 December 2010


Knee Joint Replacement

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