Total Knee Replacement

A total knee replacement (TKR) or total knee arthroplasty is a surgery used to replace a knee joint that is affected by arthritis.

Total Knee Replacement surgery replaces the arthritic knee joint with an artificial metal or plastic replacement parts called the 'prostheses'. These include replacing the:
  • end of the femur (thigh bone)
  • end of the tibia (shin bone) 
  • plastic inserted between them and 
  • usually the patella (knee cap).
The artificial knee joint is made from a surgical-grade metal alloy with a special wear resistant plastic insert. Total Knee Replacement surgery is one of the most successful operations available today with over 90% still functioning well at 15 years.

Prior to surgery you will usually have tried some conservative treatments such as simple analgesics, weight loss, anti-inflammatory medications, modification of your activities, canes, or physical therapy.

Once these have failed it is time to consider surgery. 

Candidates for Total Knee Replacement

The procedure is usually recommended for older patients who suffer from pain and loss of function from arthritis and have failed results from other conservative methods of therapy.

Each patient is assessed individually but Total Knee Replacement candidature is far greater than partial knee replacement and can include candidates who are:
  • between 20 to over 80 years of age
  • suffering pain
  • restricted mobility interferes with your lifestyle
The outcome of the surgery can address patients with a greater range of arthritic stages and conditions.

Benefits of Total Knee Replacement Surgery

The decision to proceed with TKR surgery is a cooperative one between you, Dr Edward Graham, family and other medical professionals.

The benefits following surgery are relief of symptoms of arthritis. These include
  • Severe pain that limits your everyday activities including walking, shopping, visiting friends, getting in and out of chair, gardening, etc.
  • Pain waking you at night
  • Deformity- either bowleg or knock knees
  • Stiffness
The benefits are that older patients or severe arthritic patient have a clear solution to help relieve symptoms and pain.

Components - Prostheses

The artificial knee joint consists of:
  • An upper metal component shaped and sized to fit to femur bone contour
  • A flat metal tibial component made of metal alloys fixed to the bone 
  • A plastic insert designed to bear significant wear
  • A patellar button which resurfaces the back of your knee cap.

Total Knee Replacement Procedure

The procedure is designed to be performed with minimal local trauma;
  • Dr Edward Graham cuts down to the bone to expose the bones of the knee joint.
  • The damaged portions of the femur and tibia are then cut at the appropriate angles using specialized jigs. 
  • Trial components are then inserted to check the accuracy of these cuts and determine the thickness of plastic required to place in between these two components. 
  • The patella (knee cap) may be replaced depending on a number of factors and Dr Edward Graham’s choice.
  • The real components are then inserted with or without cement and the knee is again checked to make sure things are working properly. 
  • The knee is then carefully closed the knee is dressed and bandaged.
Each knee is individual and knee replacements take this into account by having different sizes for your knee. If there is more than the usual amount of bone loss, sometimes extra pieces of metal or bone are added.

Exercise Preparation

To help prepare you for the surgery a preoperative physiotherapist appointment is required to:
  • fit crutches.
  • instruction on partial weight-bearing  and crutches use.
  • learning how to reduce inflammation (icing of the knees), and 
  • learn postoperative exercise (co contractions, leg lifts with the knee extended, etc).

Post Op Instructions

Wound

Keep dressings on the wound and keep wound dry for 7 days or until there is no further discharge from the wound. If the dressing gets wet it should be removed and changed. It is normal to have some redness around the wound. It does not necessarily signal infection. However if you experience fever, sweats or any significant discharge from the wound then you should contact your doctor, the hospital or Dr Graham immediately. 

Walking and Exercises

You will be given exercises before your discharge from the hospital. You should continue these exercises at home. You may put full pressure on the leg unless otherwise advised. You may need the use of a walking stick or crutches in the first few weeks after surgery.

Driving

You should not drive until you have been reviewed by Dr Graham after your surgery.

Pain

It is normal to experience pain after any knee surgery. The amount of pain experienced varies between individuals and the type of surgery performed. Please make sure that you have been given some pain medication on your discharge from hospital. Take the medication as prescribed and as required.

Warning Signs

Contact Dr Graham, the hospital or your family doctor if any of these signs develop:
  • fresh bleeding from the wound
  • discharge from the wound
  • temperature, fever and chills
  • pain in the calf
  • shortness of breath

Return to Work

You may return to light work duties after 6 weeks. You will not be fit to perform work duties that involve:
  • prolonged standing, 
  • heavy lifting, 
  • bending or 
  • excessive stair climbing

Treatment Process

Preparation for Surgery

Once Dr Edward Graham decides that surgery is required, preparation is necessary to achieve the best results and a quick and problem free recovery. 

Preparing mentally and physically for surgery is an important step toward a successful result. 
  • Dr Edward Graham will create a treatment plan and 
  • patients will also need to understand the process and their role in it 
Dr Edward Graham will also need to:
  • discuss any medications being taken with your doctor or physician to see which ones should be stopped before surgery
  • stop taking aspirin, warfarin, anti-inflammatory medications or drugs that increase the risk of bleeding one week before surgery to minimise bleeding
  • review blood replacement options (including banking blood) with your doctor
  • consider alternate medical interventions and other treatments
  • eat a well-balanced diet, supplemented by a daily multivitamin with iron.
  • consider losing weight (if overweight) before surgery to help decrease the stress on the new joint. However, dieting one month before surgery.
  • stop or cut down smoking to reduce your surgery risks and improve your recovery
  • treat any tooth, gum, bladder or bowel problems before surgery to reduce the risk of infection
Report any infections to Dr Edward Graham prior to surgery as the procedure cannot be performed until all infections have cleared up.

Day of Surgery

  • Report any infections to me prior to surgery as the procedure cannot be performed until all infections have cleared up.
  • Do not consume alcohol - 24 hours prior to treatment,
  • Do not eat or drink anything, including water, for 6 hours before surgery
  • Avoid vigorous physical activity or exercise 24 hours prior to surgery,

During Surgery

  • Administration of general anesthesia or sedation and local anesthesia
  • The entire procedure can take 60 minutes to two hours.
  • Procedure is performed and sent to recovery room, for observation
  • Pain medications are prescribed to help with pain during the recovery phase. 

After Surgery

After your operation you will have a drip in your arm for pain medication and antibiotics.

You may need between 1 - 3 nights in hospital.

Crutches are required for 1 – 2 weeks following the replacement. Once you are off crutches, you can begin driving.

If any postoperative problems arise with your knee, such as redness, increasing pain or fevers, do not hesitate to contact Dr Edward Graham. If unavailable, seek advice from the hospital or your doctor.

Going home remember to arrange for someone to take you home, no driving is recommended.
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