Total knee replacement, or arthroplasty, involves removing the diseased bone and cartilage, and then introducing a joint implant. The first total knee procedure was performed more than 30 years ago. Since then, millions of people have undergone them. A fairly routine procedure, surgeons perform more than 400,000 every year in the United States alone.
During surgery, the surgeon makes an incision to expose the joint. The damaged bone ends are then resurfaced with components designed to recreate the natural contours of the bones in a healthy knee. Metal and polyethylene (plastic) implants allow the bones to smoothly glide against each other, much like natural cartilage.
During a total knee replacement, an anesthesiologist puts the patient under complete anesthesia. The surgery typically lasts two hours, with an additional two to three hours of pre- and post-surgery care.
Though uncommon, any surgery patient risks complications such as infection, blood clots, implant breakage or failure, malalignment and premature wear. The surgeon may refer the patient to a physician before surgery in order to undergo tests; the patient must also have up-to-date dental work and prepare the home to avoid falls. Regardless of complications, no implant lasts forever. Factors such as the patient’s post-surgery activities and weight can affect longevity. Discuss these and other risks with the surgeon.
After surgery, the patient receives pain medication and begins physical therapy. It is important to start moving the new knee as soon as possible to promote blood flow, regain motion and facilitate the recovery process. Our experts will evaluate the patient and may get him out of bed and walking with crutches or a walker within 24 hours of surgery.
The patient will learn to safely climb and descend stairs, how to get into and out of a seated position and how to care for the knee at home. A therapist also will show the patient a variety of exercises for home, designed to help regain mobility and strength in the knee. We encourage the help of friends or family to help ease the transition home.
Most patients are ready to return home one to three days after surgery depending on progress; however, some may go to a separate rehabilitation facility, which the surgeon should discuss prior to surgery. Many will go directly home and begin supervised therapy either at home or as an outpatient.
Exercise is necessary for proper healing. The surgeon may recommend therapy to assist with gentle leg movement, strengthening and mobility exercises 24 to 48 hours after surgery. Therapy will begin in the hospital and usually continues after discharge for approximately six weeks.
Recovery time will vary for each patient. Diligent physical therapy, proper diet and a willingness to follow all of the surgeon’s recommendations will contribute to a more successful recovery after surgery. Most patients can walk without support and drive three to six weeks after surgery. The patient can typically resume activities such as golf, tennis and swimming, but only after the surgeon conducts a thorough evaluation. Some patients may have to wait weeks or months before returning to their sports. Ask the surgeon which activities to avoid after surgery.
The surgeon also will set a follow-up schedule for the first year after surgery to evaluate the patient’s progress. Complications can occur with implants; therefore, contact the surgeon immediately with any unusual changes regarding the new joint.
We realize that the decision to have surgery is sometimes difficult. Millions of others have made this choice, allowing them to return to more active lifestyles. This guide is not intended to replace the experience and counsel of a physician. If you have further questions, please speak with an orthopedic surgeon.