Total Knee Replacement at the
University of Chicago
(Download
this pamplet)
Is knee
replacement surgery right for me?
This pamphlet
is designed to repeat what your surgeon has already discussed
with you in the clinic, and help you answer the question: is
knee replacement surgery right for me? Knee replacement surgery
is an entirely elective procedure that is frequently offered to
patients with severe knee pain. The primary goal of knee
replacement surgery is to relieve knee pain. Relief of knee
pain is commonly associated with an improved ability to walk and
perform daily activities. If your surgeon has recommended knee
replacement surgery for you, then he believes that the potential
benefits far outweigh the potential risks of having surgery.
You are
considered a candidate for knee replacement surgery when you
have pain that significantly limits your ability to perform
normal daily activities, and the arthritis in your joint is no
longer controlled by arthritis medicines. However, the ultimate
decision to have knee replacement surgery is entirely yours.
When you feel that you are a candidate for knee replacement
surgery, and you feel that the potential benefits from surgery
are larger than the potential risks as explained to you by your
doctor, it is time to have surgery. If you do not feel that you
are a candidate for knee replacement surgery, or you feel that
the potential risks explained to you by your surgeon are too
great, then surgery may not be right for you at this time.
The remainder of this pamphlet will repeat much of what you have
already heard from your doctor in the clinic, and list the
potential benefits and the potential risks of having knee
replacement surgery. A list of frequently asked questions is
also provided. We suggest you discuss this information with
family and friends as you try to answer the question: is knee
replacement surgery right for me?
Potential
benefits of having knee replacement surgery:
1.
Pain relief: The relief of pain after having knee
replacement surgery is often dramatic. By replacing your knee
with a new artificial knee, the arthritis is removed and is no
longer a cause for pain. Other sources of pain such as a bad
back will not be relieved by having knee replacement surgery.
2.
Improved activity: Without pain, most patients with
knee replacements are able to walk better and farther. Also,
most patients with knee replacements more easily perform routine
daily activities. The most fit patients are able to return to
swimming, biking, skiing, and even doubles tennis.
Potential
risks of having knee replacement surgery:
It is
impossible to list every potential risk; therefore this list
includes the most common risks and complications associated with
knee replacement surgery.
1.
Infection:
The risk of infection exists any time you have any type of
surgery. The risk of infection after knee replacement surgery
is between one in 100 and one in 200 for otherwise healthy
people. Treatment of infection can be complex and include
prolonged antibiotic use and repeated surgery. It is even
possible that the new knee may need to be removed and possibly
put back in at a later date.
2.
Blood clots:
The risk of blood clots exists any time you have any type of
surgery on your legs. Blood clots are dangerous if they go to
your lungs. The risk of blood clots occurring and then going to
your lungs after knee replacement surgery is between one in 1000
and one in 5000. We reduce the likelihood of blood clots
forming by thinning your blood after surgery with a medication
for three weeks and by getting you up and walking as soon as
possible after surgery.
3.
Heart
problems:
Arthritis surgeries are often performed on people who are
middle-aged or older. Stress from the surgery may cause a heart
attack in people who already have heart disease. If a patient
has any signs of heart problems, we have them see a cardiologist
prior to surgery. With the help of a cardiologist, we are often
able to successfully operate on people with severe heart
disease. In some cases, heart disease is considered too severe
to allow surgery.
4.
Bleeding:
Minor bleeding for the first few days after knee replacement
surgery is normal. We monitor your blood counts every day and
you receive only the appropriate amount of blood thinning
medication. Blood transfusions are given only if absolutely
necessary and only after discussing the mater with you. Repeat
surgery for bleeding is extremely uncommon.
5.
Nerve Damage: In less than
1% of patients, knee replacement surgery may lead to nerve
damage.
6.
Stiffness and pain:
After your
knee has been replaced, rigorous physical therapy is necessary
to achieve full motion and strength. Knees without full motion
and strength can become stiff and painful. Occasionally stiff
knees must be manipulated under anesthesia in the operating
room. Your effort in physical therapy is vital in achieving a
good result after knee replacement surgery.
7.
Death:
Although extraordinarily uncommon (less than one in 1000), death
can occur during or after knee replacement surgery. Death is
usually related to other medical conditions present before
surgery.
Commonly asked questions:
How long does the surgery take?
The surgery
takes from 1 and ˝ to 2 and ˝ hours. After surgery you will be
in the recovery room for up to 4 hours before going to your
regular hospital room.
What kind of anesthesia will I have?
Most patients
have either “general anesthesia”, where you go to sleep, or
“spinal anesthesia” like mothers have when giving birth. You
will have an appointment with the anesthesia department to fully
discuss your options.
Should I bring a family member or friend with me the day of surgery?
Absolutely. Family and friends are very valuable during this
process and should be included whenever possible. Your surgeon
will call your family and friends in the waiting area after
surgery.
Are there certain medications I should avoid prior to surgery?
Yes. Coumadin, Aspirin, Plavix, Arthritis medications
and Ibuprofen products such as Motrin and Advil may
increase bleeding and must be stopped 7 days before surgery. If
you are on any of these medications for a heart condition
or due to a blood clot, we will contact your doctor regarding
the stopping of these medications. Other medications for
rheumatoid arthritis, except Prednisone, must be stopped
two weeks before surgery. Allopurinol, a medication for
gout should be stopped 2 weeks before surgery. If you
take blood pressure medication or medication to control your
heart rate you should continue to take them including the day of
surgery.
Do I have to stop using lotion and oil on my skin in the area of the
incision?
Yes. You should
not put lotion, oil, or any other skin product on your leg or
buttock for 5 days before surgery.
How long will I be in the hospital? Most patients are in the hospital for three days.
Where do I go after leaving the hospital?
Patients who have help at home may be able to go home.
Those who live
alone or have no help usually go to a rehabilitation center for
5 to 10 days. The choice of rehabilitation center is usually
dependent upon your insurance.
Will I have physical therapy after I leave the hospital or after I leave
the rehabilitation center? Yes. Out patient physical therapy will continue until your motion and
strength are adequate. We recommend that you go to physical
therapy and not have home therapy. Since therapy is such a
large part of your recovery, it is preferred that you have
access to all the facilities at the therapist disposal.
Will I be able to stand on my new knee after surgery?
All patients get out of bed the first day after surgery with
the assistance of a certified physical therapist. You will be
allowed to stand fully on your new knee immediately after
surgery.
Will I need a walker?
Yes. You will
need a walker or crutches. How fast you move to a cane and then
nothing at all depends upon your strength, your balance, and how
well you work with your therapist after surgery.
Will I have a motion machine for my knee after surgery?
Yes. You will have a machine you use two times a day that
bends your knee.
Can I have a pain pump after surgery?
In most cases,
yes. After surgery, you will be given a pain pump that has a
button you press to give yourself pain medication. The amount
you receive is preset to prevent overdose, and is controlled by
a small computer. This system is very safe and eliminates the
time you must wait for a nurse to give you a shot.
Will I need a blood transfusion? Those patients who need a blood transfusion after knee
replacement surgery usually have low blood counts to start. If
your blood counts are high you probably will not require a blood
transfusion. Your blood count will be checked before surgery
and every day you are in the hospital. Blood transfusions are
recommended for you if your blood counts get low enough to
potentially put strain on your heart.
Can I donate my own blood or have someone else donate for me?
Yes. However, patients who have low blood counts to start and
are at risk for needing a blood transfusion after surgery may
not be able to donate because their counts are too low. We do
not recommend having friends or family members donate blood for
you.
What is the risk of a blood transfusion?
Most patients’
concern is the risk of disease transmission. Blood bank blood
is tested for Hepatitis and the HIV virus. The risk of HIV
transmission is estimated at less than one in 500,000. The risk
of Hepatitis transmission is slightly higher.
Will I have pain medication when I go home?
Yes. You will get a prescription for the same medication you are
taking in the hospital before you leave.
How long will I have to take the blood thinner?
Most patients take the blood thinner for three weeks. You
will need to have your blood tested two to three times a week
while taking the medication to make sure that your blood is not
too thin.
When can I get the wound wet?
Once the
dressing is off and the wound is dry (not draining) for two
days, you can shower and let the water run over the wound. Do
not scrub the wound. Do not soak the wound in a bath or pool
until cleared by your surgeon.
When can I drive?
You can drive
when you are no longer taking pain medication and are able to
easily get in and out of your car. Be sensible. Avoid putting
yourself in a position where, in an accident, you could be
considered an impaired driver.
When will my surgeon want to see me after I leave the hospital?
Your surgeon will want to see you at 3 weeks, 6 weeks, 3
months, 12 months, and yearly after surgery.
Planning
before surgery:
Once you decide to have surgery, we set up appointments for you
to see an anesthesiologist and have necessary testing. These
tests will be performed in DCAM 2E. You may also need to go the
X-ray department to have special X-rays. You will also see a
physical therapist and learn how to prevent dislocation of your
new knee. Lastly, you should see your regular medical doctor
prior to surgery. Our office will help coordinate these
appointment times. In addition, you will be called by Jan
VanderMolen (Dr. Manning’s nurse) to determine any special needs
you may have before and after surgery.
Medications:
You should begin taking iron supplements 3 weeks
prior to your surgery to maintain an optimal blood count. You
will be instructed to take one Coumadin tablet the night before
surgery to reduce the risks of blood clots after surgery. You
will also be taking one Vioxx tablet for 5 days before surgery
to reduce pain and inflammation after surgery. If you have any
contraindications to these medications, please inform Dr.
Manning or Jan VanderMolen.
Infection after surgery:
After knee replacement surgery, there is some concern that
infections elsewhere in the body may settle in the replaced
knee. This concerns only bacterial infections. It does not
concern viral infections such as flu and colds. Patients with
knee replacements who get a bacterial infection should take
antibiotics. Either your family physicians or our office will
be happy to provide treatment. Although it is very unlikely,
there is a concern that bacteria may travel through the blood
stream during dental procedures. Currently, we are recommending
that patients with knee replacements take one antibiotic pill
one hour before any dental procedure. You will get a life long
prescription from our office at your 6 week appointment.
If you
are considering surgery, feel free to call our office at (773)
702-6216 with any further questions or concerns. We have found
that patients who have a clear understanding of what their
surgery will be like have less anxiety and easier recuperation.
Last update:
January 11, 2008 |
