Total Knee Replacement Surgery
Our own Dr. Schurman is an expert on total joint replacement. Hear from him on what to expect in a total knee replacement surgery.
"Total knee replacement is a procedure that replaces the surface of an arthritic joint with a prosthetic implant. Indications for the operation include advanced structural arthritis, inflammatory arthritis or post trauma deformity. Candidates complain of pain, diminished function, instability with walking, and loss of the ability to do the enjoyable and necessary things of life.
While called a total replacement, the procedure does not actually remove the whole knee joint. It typically removes just the joint surface and inserts a metal and plastic prosthetic implant in its place. This involves removal of 8-10 mm slivers of bone in precise locations. Where these painful arthritic surfaces once were a prosthetic implant is placed with a surface that has no pain sense. The same muscles that power the natural knee power the replacement. Also the same ligaments that stabilize the natural knee stabilize the replacement. During the procedure alignment, ligament balance, and stability are restored. Dramatic pain relief and restoration of mechanical function are the achievable goals of this type of surgery.
Generally total knee replacement takes about one hour to perform through an incision directly in the front of the knee. It can be done with either a general or a spinal anesthetic and usually requires a short hospital stay. Recovery is usually quite rapid as the patient regains knee motion and mobility with the help of physical therapy and restorative exercise. Doing the exercises is a very important requirement of the process and has a direct impact on the quality of the result. Full weight bearing walking without walking aids and functional motion usually occurs by 3 weeks. Eighty percent of final function is usually achieved by 6 weeks. Final outcome can usually be assessed by one year as strength, endurance, coordination and agility are achieved as long term goals. Successful surgery and follow-up commonly results in several decades of service for the patient."
What is a Total Knee Replacement?
A total knee replacement involves surgery to replace the knee, including capping the natural cartilage and bone at the ends of the thigh and lower leg, and replacing the kneecap itself, with artificial metal or plastic materials. This procedure is generally intended to restore function to a painful joint or to help recover from an injury, but the realistic goal should be to return to or improve normal everyday functions, not to improve performance for sports or endurance.
During the procedure, your doctor will make an incision at the knee cap to gain access to the patella. Your surgeon will resurface the femur, then the tibia, installing the new plastic or metal caps. These will act as the new joints for your knee, replacing the old bone and cartilage that have long since worn away. Before placing the patella back into position, your doctor will flex your knee to ensure the new implants are working correctly. The doctor may also cement a plastic component to the patella to help it fit with the implant and function smoothly, if necessary.
Planning for Total Knee Replacement Surgery
Will my Insurance Pay for Total Knee Replacement?
Every insurance company and individual policy differs as to which specific procedures are covered and how much of the total cost of surgery the patient is responsible for paying. Learn what your total out-of-pocket expenses are and what is included in your coverage before the surgery. Make sure to take into account the rehabilitation and physical therapy you may require after the surgery is performed.
Do I Need to Provide Insurance Information to Kansas Surgery & Recovery Hospital Prior to My Surgery?
Much of your insurance information comes from your physician's office. Many times, this is all the information we need. Should we need anything further, our Business Office will contact you approximately a week before surgery. However, please bring your insurance card with you the day of surgery.
What Should I do if I Have Questions About Medicare/Insurance Coverage for My Total Knee Replacement Procedure?
If you have any questions about coverage for your procedure, please feel free to contact our Business Office at (316) 634-0090. Ask to speak to one of our insurance verification persons; they will be happy to answer your questions.
Does Kansas Surgery & Recovery Hospital accept Visa and MasterCard?
Yes we do.
Preparing for Total Knee Replacement Surgery
Will I Receive a Preoperative Phone Call Prior to Surgery?
Yes. A registered nurse will contact you the day prior ot your scheduled surgery date. If your surgery is scheduled for a Monday, you will receive a phone call on Friday afternoon.
Do I Need to Bring My CPAP Machine for Sleep Apnea?
Yes. Since pain medication can cause drowsiness, you may need to use your CPAP machine during your hospital stay.
Should I Take My Medications the Morning of Surgery?
If you are taking heart or blood pressure medication, please take your regular morning dose with a sip of water on the morning of surgery. If you are diabetic, do not take insulin the morning of your surgery. If you take Metformin, do not take it for 24 hours prior to surgery. We will monitor your blood sugar preoperatively, during and after surgery. Please do not take any Ibuprofen, Aspirin, or anticoagulants, such as Plavix or Coumadin, prior to surgery unless instructed to do so by your Doctor. If you use inhalers, please bring them with you. Bring your home medications with you in their original, labeled bottles on the day of surgery because we refer to these bottles so we can accurately order these medications and resume their administration after your surgery.
Which Medications Can Interfere with Total Knee Replacement Surgery?
Avoiding infection is especially important when undergoing total knee replacement. Some drugs can increase the risk of developing infection. These include Enbrel and Methotrexate, along with any drug that works by suppressing the immune system. Other medications that need to be stopped two weeks before the surgery are blood thinners, like aspirin or Coumadin, which can prevent clotting of the blood needed to heal after surgery. Your doctor will tell you when to stop any of your medications and which ones it is important for you to keep taking.
I'm Taking an Herbal Product, Do I Need to Discontinue It?
Yes. Some herbal products can cause major problems during total knee replacement surgery. We are learning more about these products as they become more widely used. St. John's Wort and Gingko Biloba are two herbal products that can definitely cause major problems with blood pressure during surgery. Because herbal products are sold over-the-counter and are largely unregulated, it is difficult for us to know their dosage. We expect you to discontinue all herbal products two weeks before surgery, unless otherwise directed by your surgeon.
Should I Stop Taking my Vitamins?
Generally, you can continue taking your vitamins but if they contain additional herbal products, please discontinue them. Again, if you have questions, consult your physician's office.
Can I Eat, Drink or Smoke the Day of My Surgery?
You should not eat anything after midnight prior to your surgery. You may have clear liquids (water or black coffee, no sugar) up to six (6) hours prior to your scheduled check-in time. Your doctor’s office will inform you of your time to check in for your surgery. If you smoke, now is a good time to stop. Smoking slows the healing process, extending the recovery period. You should also refrain from drinking alcohol at least 48 hours prior to the surgery. You may also need to do some strengthening exercises to prepare for the surgery and for using crutches or a walker for support. Eat a well-balanced diet to help strengthen your body and make healing easier.
What Should I Do With My Suitcase When I Come In?
Leave your suitcase and belongings in the car when you come in to register. When we get you settled in your room after surgery, then your family or friends can bring your suitcases to your room. Please leave all valuables at home. However, please bring your insurance card, photo ID, and a credit card if you have a copay or deposit payment to make with you the day of surgery.
Anesthesia for Total Knee Replacement Surgery
Which is Better - General or Spinal Anesthesia?
Both types of anesthesia are safe and effective for total knee replacement surgery. Some doctors prefer one or another.
If I Have Spinal Anesthetic, Will I Be Aware of What's Going On?
Before surgery, many people tell us that they would not have spinal anesthesia because they don't want to know what is going on during surgery. We can give you supplemental medication that sedates you to a point that eliminates this problem.
Will I Have to Have a Spinal Anesthetic for Total Knee Replacement Surgery?
No. We may make a suggestion on a preference for anesthesia, but we will always respect your wishes. We will not force you to have a spinal anesthetic.
Implants Used in Total Knee Replacement Surgery
What are the Implants Made of and How Much do They Weigh?
A knee replacement implant consists of: femoral component - vitallum or zimaloy alloy tibial baseplate - vitallum or tivanium alloy tibial insert - polyethylene patella - polyethylene total weight - 1.6 lbs.
Do the Knee Replacement Implants Set Off the Airport Alarms?
Knee replacement implants do not set off the metal detector alarms at most airports. Some international airports have more sensitive devices and the implant will cause an alarm.
Recovery from Total Knee Replacement Surgery
What Will Total Knee Replacement Post-Op Be Like?
After the total knee replacement surgery, you will be given prescriptions for pain medication and a medicine to keep blood clots from forming. A bandage will be placed on your knee and you will likely have a drain that collects any excess fluid. A compression pump or stocking will be on your leg as well to keep your blood circulating properly. To ensure flexibility, you may have to wear a continuous passive motion machine (CPM), which helps speed recovery time. While you will be encouraged to walk the first day after surgery, you will need days and weeks of physical therapy to learn how to bear weight on that knee again. This rehab will help you with normal daily activities, such as walking and climbing stairs, so that you can function with ease.
Will I Have Pain Medication After Total Knee Replacement Surgery?
Yes. You will probably receive a nerve block following a total knee replacement surgery to control your pain. This will happen in the recovery room. Your pain will be managed through IV medication and/or oral medications the first night and oral medication throughout your stay. The doctor and nurse will work with you to control your pain while you are here. You will also get a prescription for pain medicine for after you leave Kansas Surgery & Recovery Hospital.
How Long Will I Take Pain Medication After Total Knee Replacement Surgery?
Most people go home on pain pills after a knee replacement procedure. Your doctor may also give you an anti-inflammatory medication such as aspirin or ibuprofen.
How Long Will I Be in the Hospital After Total Knee Replacement Surgery?
Average length of stay for patients who have had a total knee replacement is 2-3 nights.
What Type of Clothes Should I Bring?
Men should bring shorts and t-shirts and short pajamas. Women should bring shorts and t-shirts and short pajamas or gowns. No floor length gowns or long pajamas are recommended.
When Will I Start Getting Out of Bed After Total Knee Replacement Surgery?
This is dependent on your surgeon’s preference and what time you have surgery. Some patients will be getting out of bed in the afternoon the day of surgery. All other patients will be getting out of bed the next morning following a total knee procedure.
Can Children Visit?
Yes, but they must be well behaved, well supervised and they must be physically well.
Should I Bring My Home Medications With Me to the Hospital?
Physical Therapy After Total Knee Replacement Surgery
What Kinds of Activities Will I Do in Physical Therapy?
We will work with you on getting out of bed safely, transferring, walking with a walker safely, and of course, increasing movement in your new knee.
Will My Physical Therapy be in My Room?
Kansas Surgery & Recovery Hospital differs from a traditional hospital setting in that most of your physical therapy is done in your room. We do have a set of stairs for you to practice on, and we will help you with getting in and out of a car.
Does the Therapist Decide When I Can Go Home After Total Knee Replacement Surgery?
The therapist and nurses will communicate and give recommendations to your doctor regarding your level of function and when it is safe for you to go home.
Going Home After Total Knee Replacement Surgery
What Should I Do to Prepare My Home?
Some good ideas include removing knick-knacks that might get knocked off of furniture, and removing throw rugs that could trip you up. Before surgery, it may be wise to rearrange furniture so that you have enough space to get through with a walker.
How Long Will I be Using a Walker After Total Knee Replacement Surgery?
Patients who have had knee replacement surgery generally use a walker for four to six weeks.
Where Can I Get Medical Supplies to Use When I Get Home?
You can purchase these items from any medical supply company. You can purchase these before surgery, or a family member or friend can get them before you go home.