It is normal to feel anxious on
the day of surgery, but try to relax. You will meet several members
of the hospital staff, be checked-in, and asked to change into a
hospital gown. You will meet your Consultant and the Anaesthetist.
You will be taken to the pre-anaesthesia room where the
Anaesthetist will discuss the anaesthesia options. Two types of
anaesthesia are commonly used for knee replacement surgery. The
first is a general anaesthesia, which puts you in a deep sleep and
therefore requires assistance with your breathing. The risks are
small and usually are related to the heart or lungs. The second type
of anaesthesia (epidural anaesthesia) works by numbing your legs so
you do not feel the operation. This is done by placing numbing
medicine around the nerves that go to your legs using a small
catheter in your lower back. You are also given medicine to relax
you and you may fall asleep, but you can still breathe on your own.
The potential advantages of the epidural anaesthesia include less
blood loss and less risk of lung problems and blood clots in the
legs. Also, the epidural can be continued after your surgery to help
control the pain. If you are young and/or without vascular disease,
your surgeon and Anaesthetist may employ methods to lower blood
pressure (hypotensive anaesthesia) to conserve blood loss, and to
assist in obtaining optimal fixation when acrylic bone cement is
used. Following your discussion with the Anaesthetist, you will then
be taken to the operating room and devices will be placed on you to
monitor your heart, blood pressure, breathing and temperature. The
anaesthesia will be administered.
The total knee replacement procedure takes about two hours. Some
additional time is required for the Anaesthetist to prepare you for
surgery and then following surgery to transport you from surgery to
the recovery room. Depending upon the type of anaesthesia that you
receive, you may have no recollection of the operation. You may
awaken in the recovery room. There will be a nurse by your side to
help you awaken and recover from anaesthesia.
It is very likely that you will have pain in your knee. This is
normal and you should not be surprised or concerned. Remember, total
knee replacement is major surgery. Most of the pain that you
experience right after surgery is from the surgical incision and
dissection. You will be given strong pain medication through your
I.V. line. The pain will decrease over the first couple of days. You
may feel somewhat sick or nauseous. This is not unusual and
medication can be given to relieve these symptoms. Most patients
spend about an hour in the recovery room and then they are moved to
the nursing floor. Recovery from anaesthesia is highly variable.
Some patients are awake and alert within a couple of hours while
others remain groggy until the next day.
You will be given fluid and medication through the I.V. line until
you are able to drink and eat without upsetting your stomach. Most
patients are ready for breakfast or lunch the day after surgery.
Pain pills can be taken as needed. The most important aspect of your
recovery after knee replacement surgery is mobilisation. Starting
the day after surgery, the nurses and the physical therapists will
work with you and assist you in getting out of bed, sitting up in a
chair, and starting to walk. The knee is initially quite tender and
most patients use a walker to get started.
The fundamental goals of physical therapy and rehabilitation
following total knee replacement are :
- Full extension. Get the knee to straighten-out, all the way!
- Flex (bend) more than 90 degrees, and preferably to 120
- Strengthen the quadriceps muscle to be able to actively
extend (straighten) the knee all the way!
- Progressively increase your walking!
The therapist will work with you to be sure that you make
progress with every session. While you're in the hospital, the
therapist will try to work with you once in the morning and once in
the afternoon. Your doctors will check you each day to be sure that
you are getting better, as expected.
Each patient progresses at their own rate. In general, we expect
that the knee has full extension the day after surgery and has 90
degrees of flexion by three days after surgery. Quadriceps strength
and walking ability continue to improve over several months. Most
patients are able to walk without cane or crutch by three months.
Many are able to do so in less than six weeks. The use of continuous
passive motion (CPM) machines, which automatically bend and
straighten the knee following surgery, has relative advantages and
disadvantages, depending upon the individual patient and their knee.
Your doctor will decide whether or not CPM is beneficial for you.
You are ready for discharge from the hospital when you are able to
drink and eat without upsetting your stomach and you don't require
any medications that need to be administered through an I.V. line.
You need to be able to sit in a chair, stand up, and walk about 30
feet. In order to be discharged there cannot be any evidence of
infection, blood clots, or other complications. Obviously, you have
only just begun to recover from your knee replacement surgery and
there is much more work to be done in order to regain your
Most patients are able to go home from the hospital in 3 or 4 days,
however, our hospitals will take care of you for considerably
longer, up to 10 days. When you do return home, you should continue,
to do the exercises for your knee that you learned in the hospital.
It can also be arranged for a physical therapist to visit the home
and work with you. When at home, it is preferred that the patient
wear regular clothes and spend most of the day out of bed. You will
continue to wear TED hose for a minimum of two weeks following
surgery and until your leg/knee is not swollen. By three days after
surgery, it is all right to shower and get the incision wet. The
surgical staples are usually left in for about 10 days. While you
are recovering, you may go outside, go to the store, visit family
and friends, etc. if you feel well enough. Remember, the idea is to
live your life!
Some patients may have medical conditions or other arthritic joints
that make it difficult or impossible for them to go directly home
from the hospital. In other cases, there may not be family or
friends available to help the patient at home after surgery. In
these situations, the hospital staff should be notified in advance
as they can assist in making arrangements with a rehabilitation
facility or an extended care facility where the patient can stay for
a week or two.
Usually, about 2-3 weeks after surgery, patients can go to a
physical therapy facility on an outpatient basis. Continue on your
own with the physical therapy exercises that you learned in the
hospital. Remember, there are really only 4 goals for rehabilitation
following total knee replacement. The knee must come out completely
straight in full extension as shown in Figure 4a
; the knee
must bend to at least 90 degrees and preferably to 120 degrees as
shown in Figure 4b
; the quadriceps muscle must regain
strength to actively extended the knee as shown in Figure 4c
and you should be able to walk as far as you want without a cane or
crutch. Your doctor and your physical therapist may work with you,
but you are ultimately responsible for the rehabilitation of your