Alternative Names total knee replacement, TKR, total knee arthroplasty, total knee joint replacement
Definition Knee joint replacement is surgery to replace a damaged or diseased knee joint with an artificial joint, or prosthesis. The goal is to improve the mobility and function of the knee joint and reduce pain.
Who is a candidate for the procedure? Knee joint replacement may be used for long-standing knee pain or arthritis that has not responded to treatment with medication. It may also be used when arthritis causes the knee to function poorly, or for some knee fractures. The procedure is used for people who have a great deal of knee pain. This pain is so severe that the person cannot work, has trouble sleeping, and cannot walk more than 3 blocks. Most people who have a knee joint replacement are over the age of 55, but it can be done for anyone.
How is the procedure performed? Knee joint replacement is performed under general anaesthesia or regional anaesthesia. General anaesthesia means the person is put to sleep with medications. Regional anaesthesia means the person will be awake, but numb below the waist. A drug may be given to make the person drowsy. The ends of the thighbone, or femur, and the shinbone, or tibia, are removed. The underside of the kneecap, or patella, may also be removed. The new knee consists of a metal shell on the end of the femur and a metal and plastic piece on the tibia. If needed, there is also a plastic button in the kneecap. The surgery itself takes about 2 hours. In many cases people donate 2 units of their own blood in the weeks before surgery to be used during or shortly after the operation.
What happens right after the procedure? After the surgery, the person will be taken to the surgery recovery room to be watched closely for a short time. Vital signs, blood pressure, pulse, and breathing will be checked frequently. Close attention will be paid to the circulation and sensation in the legs and feet. The person will receive intravenous fluids to replace those lost during surgery. There may be a tube near the incision to drain fluid. There may also be a catheter to drain the urine until the person is able to use the bathroom. Analgesia will be available.
A continuous passive motion machine , or CPM, is often applied to the leg after surgery. This is used to gently bend and straighten the knee. That way, the range of motion is increased, and there is not as much stiffness.
While in the hospital the person will have physiotherapy to learn exercises to strengthen the knee. The person will start weight bearing on the knee, using a walker, the first day after surgery. He or she will also be taught how to use crutches and how to climb stairs at home. Most people are discharged from the hospital 4 to 6 days after the operation.
What happens later at home? By the time the person is ready to go home, he or she should be able to get around with a walker. People use a walker for 1 to 2 weeks, then use crutches, and then a cane. No walking aids are needed after 3 weeks to 2 months. Physiotherapy may be continued after leaving the hospital.
Sometimes people need to go to a rehabilitation centre after the hospital. There they can gain the independence they need to be able to get around at home. Recovery from knee joint replacement usually takes from 3 to 6 months.
About 90% of artificial knee joints last for 10 years, and 80% last for 20 years. This often depends on the person's activity level.
What are the potential complications after the procedure? There are complications with any surgery or anaesthesia. These include bleeding, infection, and reactions to the anaesthesia drugs. Other possible complications are urinary tract infections and blood clots in the leg or the lung. To prevent infection in the future, people will need to take antibiotics beforehand whenever they have any dental work done.
Author: Gail Hendrickson, RN, BS Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 16/10/2004 Contributors Potential conflict of interest information for reviewers available on request
