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Total Knee Replacement – Dr. Alon Antebi, D.O.
 

Total Knee Replacement

If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down. If nonsurgical treatments like medications, injections, and walking supports are no longer helpful, you may want to consider total knee replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.

When Surgery is Recommended

There are several reasons why Dr. Antebi may recommend knee replacement surgery. People who benefit from total knee replacement often have:

  • Severe knee pain or stiffness that limits your everyday activities
  • Moderate or severe knee pain while resting, either day or night
  • Chronic knee inflammation and swelling that does not improve with rest or medications
  • Knee deformity — a bowing in or out of your knee
  • Inadequate pain relief from anti-inflammatory medications, injections, or physical therapy

Candidates for Surgery

There are no absolute age or weight restrictions for total knee replacement surgery.

Recommendations for surgery are based on a patient’s pain and disability, not age. Most patients who undergo total knee replacement are age 50 to 80, but Orthopedic surgeons evaluate patients individually. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

How Your New Knee Is Different

Improvement of knee motion is a goal of total knee replacement, but the restoration of full motion is uncommon. The motion of your knee Arthroplasty after surgery can be predicted by the range of motion you have in your knee before surgery. Most patients can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently to climb stairs and get in and out of a car. Kneeling is sometimes uncomfortable, but it is not harmful.

Most people feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities. Most people also feel or hear some clicking of the metal and plastic with knee bending or walking. This is normal. These differences often diminish with time and most patients find them to be tolerable when compared with the pain and limited function they experienced prior to surgery.

Extending the Life of Your New Knee Implant:

Currently, more than 90% of modern total knee replacements are still functioning well over 15 years after the surgery. Follow your surgeon’s instructions after surgery to take care of and protect your new knee replacement. After surgery, make sure you participate in regular light exercise programs to maintain proper strength and mobility of your new knee. Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery. See Dr. Antebi periodically for a routine follow-up examination and x-rays, usually once a year.

Preparing for Surgery

FOLLOW ALL PRE-OPERATIVE INSTRUCTIONS given to you by Dr. Antebi. Stop all aspirin, blood thinners, and anti-inflammatory medications (Motrin, Aleve) 10 days prior to surgery as they can cause bleeding during surgery. DO NOT STOP your blood thinners without consulting your primary care physician first.

Stop any naturopathic or herbal medication 10 days prior to surgery as these can also cause bleeding. Continue with all other medications unless otherwise specified. Bring a list of ALL medication with you on the day of surgery to give to the anesthesiologist. You are advised to STOP SMOKING for as long as possible prior to surgery.

Realistic Expectations

An important factor in deciding whether to have surgery is understanding what the procedure can and cannot do. More than 95% of people who have surgery experience a dramatic reduction of pain and a significant improvement in the ability to perform common activities of daily living. But surgery will not allow you to do more than you could before you developed arthritis. With normal use and activity, every replacement or implant begins to wear. Excessive activity or weight may speed up this normal wear and may cause the replacement or implant to loosen and become painful.

Medical Evaluation

Dr. Antebi may ask you to schedule a complete physical examination with your primary care physician four weeks before the operation especially if you preexisting medical conditions. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist such as a cardiologist, before the surgery.

Test: Several tests, such as blood and urine samples, and an electrocardiogram, may be needed to help Dr. Antebi plan your surgery.

Medications: Tell your surgeon about the medications you are taking. He will tell you which medications you should stop taking and which you should continue to take before surgery.

Diet: Losing weight prior to surgery can help minimize stress on the new knee and decrease surgical risks.

Dental Evaluation: Although the incidence of infection after surgery is very low, an infection can occur if bacteria enter your bloodstream. To reduce the risk of infection, major dental procedures (such as tooth extractions and periodontal work) should be completed before your surgery.

Urinary Evaluation: People with a history of recent or frequent urinary infections should have a urological evaluation before surgery. Older men with prostate disease should consider completing the required treatment before undertaking surgery.

Social Planning: Although you will be able to walk on crutches or a walker soon after surgery, you will need help for several weeks with such tasks as cooking, shopping, bathing, and doing laundry. If you live alone AVORS, a case manager, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at home.

After Surgery

Most patients go home the same day of surgery, but some may go home the following day.

Your Recovery at Home

The success of your surgery will depend largely on how well you follow Dr. Antebi’s specific instructions at home during the first few weeks after surgery. Elevate your leg on pillows several times a day to help reduce swelling. Do not place a heat-pad on your knee. It is important to have a balanced diet (often with an iron supplement) to promote proper tissue healing and restore muscle strength. Drink plenty of water!

Wound Care

You will be given wound care instructions when discharged home. It is normal to have some blood oozing under the dressing, however, if the dressing becomes saturated, you can change the dressing with gauze and an ace bandage. Remove the dressing 1 week after surgery. You will have stitches, staples, or a glued sterile mesh (most commonly used) on the skin. The stitches, staples, or mesh will be removed at your follow-up appointment usually 2 weeks after surgery. You can shower after you remove the dressing 1 week after surgery. Wash the wound gently with soap and water while showering. Avoid soaking the wound in water such as a bath or jacuzzi. You may continue to bandage the wound to prevent irritation from clothing or support stockings.

Pain

Surgery pain is a common concern for most patients. Dr. Antebi utilizes advanced techniques in treating post-operative pain. This includes medications given prior, during and after your surgery. After your surgery, you may experience a minimal amount of pain. Dr. Antebi will provide medication to make you feel as comfortable as possible. Ice packs should be used regularly to reduce swelling and pain.

Activity and Exercise

This is a critical component of healing, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within 3 to 6 weeks following surgery. Some pain with activity and at night is common for several weeks after surgery.

Your activity program should include:

  • A graduated walking program to slowly increase your mobility, initially in your home and later outside
  • Resuming other normal household activities, such as sitting, standing, and climbing stairs
  • Specific exercises several times a day to restore movement and strengthen your knee

You will most likely be able to resume driving when your knee bends enough that you can enter and sit comfortably in your car, and when your muscle control provides adequate reaction time for braking and acceleration. Most people resume driving approximately 4 to 6 weeks after surgery.

Time Off Work

This depends on your work requirements. Office workers usually require 2-3 weeks off and manual laborers 2-3 months off.

Preventing Pneumonia
It is common for patients to have shallow breathing in the early postoperative period. This is usually due to the effects of anesthesia, pain medications, and increased time spent in bed. This shallow breathing can lead to a partial collapse of the lungs (termed “atelectasis”) which can make patients susceptible to pneumonia. To help prevent this, it is important to take frequent deep breaths. Your nurse may provide a simple breathing apparatus called a spirometer to encourage you to take deep breaths.

Avoid Falls
A fall during the first few weeks after surgery can damage your new knee and may result in a need for further surgery. Stairs are a particular hazard until your knee is strong and mobile. You should use a cane, crutches, a walker, handrails, or have someone to help you until you have improved your balance, flexibility, and strength.

Home Planning
Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:

  • Safety bars or a secure handrail in your shower or bath & a stable shower bench or chair for bathing
  • Secure handrails along your stairways & removing all loose carpets and cords
  • A stable chair for your early recovery with a firm seat cushion, a firm back, two arms, and a footstool for intermittent leg elevation
  • A toilet seat riser with arms if you have a low toilet
  • A temporary living space on the same floor because stairs will be more difficult during your early recovery