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Learning About Total Knee Replacement Surgery

Picture of a knee joint with osteoarthritis

What is a total knee replacement?

A total knee replacement replaces the worn ends of the thigh bone (femur) and the lower leg bone (tibia) where they meet at the knee. Sometimes the surface of the patella (kneecap) is replaced too. You may want this surgery if you have knee pain, stiffness, swelling, or problems moving your knee that you cannot treat in other ways. For most people, these problems are caused by arthritis. They can also be caused by a knee injury.

If you need to have both knees replaced, you may have both surgeries at the same time. Or your doctor may recommend doing one knee at a time. Your doctor would replace the second knee after you recover from the first knee surgery. Recovery after a double knee replacement takes longer than after a single replacement.

How is a total knee replacement done?

Before surgery, you will get medicine to make you sleep or feel relaxed. If you will be awake during surgery, you will also get a shot of medicine into your spine to make your legs numb.

Your doctor makes a 10 to 25 centimetre cut, called an incision, on the front of your knee. Your doctor then:

  • Replaces the damaged part of your femur with a metal piece.
  • Replaces the damaged part of your tibia with a metal piece and plastic surface.
  • May replace part of your kneecap with plastic.

The doctor finishes the surgery by closing your incision with stitches, staples, tissue glue, or tape strips. If stitches or staples are used, they are removed 10 to 21 days after surgery. Glue or tape strips will fall off on their own over time. The incision will leave a scar that fades with time.

There are two types of replacement joints. They are:

  • Cemented joints. The cement acts as glue, attaching the new joint to the bone.
  • Uncemented joints. These have a metal coating with many small openings. Over time, new bone grows and fills up the openings. This new bone attaches the joint to the bone.

Your doctor may also use a combination of cemented and uncemented parts. Talk to your doctor about the best type of knee joint for you.

Knee replacement surgery may take about 2 to 3 hours.

What can you expect after a total knee replacement?

An artificial knee will allow you to do normal daily activities with little or no pain. You may be able to hike, dance, ride a bike, and play golf. Talk to your doctor about whether you can do more strenuous activities.

You will need to do months of physical rehabilitation (rehab) after a knee replacement. Rehab will help you strengthen the muscles of the knee and regain movement in your knee.

Your doctor will let you know if you will stay in the hospital or if you can go home the day of surgery. If you have both knees done at the same time, you may need to be in the hospital for a few days. Your rehabilitation program (rehab) will start before you leave the hospital. When you go home, you will be able to move around with crutches or a walker. But you will need someone to help you at home for the next few weeks until your energy level returns and you can get around more easily. If you need more extensive rehab, you may go to a specialized rehab centre for more treatment.

Your knee will be swollen and hurt when you move it. You will need to take pain medicine for a time after surgery. You will start to walk with a walker or crutches the day after surgery. You will also begin doing simple leg exercises. You will probably need about 6 to 12 weeks before you can get back to your job. Your knee may be sore for up to 3 months.

The rehab after a knee replacement takes a lot of time and effort. You will have to stretch and do exercises daily to strengthen your knee and regain movement. The goal of rehab is to bend the knee at a 90-degree angle, which is like the letter "L." But most people who complete all of the physiotherapy do better than that.

You need to remain active after you finish rehab to keep your new knee flexible and strong. You should be able to walk, swim, golf, dance, and ride a bicycle on flat ground. But you may not be able to run, ski, or ride a bicycle on hilly ground.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Where can you learn more?

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