The initial rehabilitation generally takes 5-7 days during your hospital stay. It is needed for your weak leg and thigh muscles which have notbeen used because of your knee problem. The surgery can correct theknee problem, but the muscles will remain weak and need to be strengthened through regular exercises. The therapist also focuses onhelping to increase the range of motion of knee with bending exercises.
Physical therapist along with you will work until you meet the following goals:
Independence in getting in and out of bed
Independence in walking with walker on a level surface
Independence in your home exercise program
Your doctor and therapist may modify these goals somewhat to fit yourparticular condition. If there are no complications after surgery, most patients stay in our hospital approximately for 1 week or less.
When you have made up your mind for knee replacement surgery, youwill be admitted a day before surgery. Your surgeon anaesthetist, physician and physiotherapist will do a complete medical evaluation.
X-ray images will be taken of your knees that help the surgeon plan yoursurgery. Chest X-rays, ECG, blood and urine test will be done prior to surgery to ensure that you are fit for surgery.
You will be required to scrub the surgical area with soap and water anight before and on the day of surgery, after which your leg will be covered with a sterile drape. You will be transported to the operatingroom in the morning.
You may have General Anaesthesia or Spinal Anaesthesia with sedation.The duration of surgery for one knee is about 2 hours. Your doctors will talk to your family after the surgery to report your progress.
You will be kept in recovery room for a few hours and then transferred tothe room or in some cases to ICU for the monitoring of vital parameters.
You will have drainage tubes at the operative site and the whole limb willbe covered with a bandage. After 3-6 hours depending upon the type ofanaesthesia given at the time of surgery, you will start with normal diet.
Next morning, you will be transferred to the room and physical therapyusually begins with most of the patients. On 1st post-operative day wewill remove the drainage tubes while on 3rd day your dressing will be changed. In some cases a knee immobilizer will be worn. Walking withsupport & independently using the toilet will be started from 2nd day on wards.
Following are the essential steps that will help you get into shape before knee replacement surgery:
Commit to the success of your surgery: Working as a team you andyour family must adopt a positive attitude towards the success of your surgery. Together with your doctor you will gain a clear understandingof the common goals and expectations of the surgery.
Lose excess weight: Because excess weight causes more strain on already damaged joints, losing weight is one of the best ways toimprove the condition of your knee and optimize surgical results. Your doctor’s approval : Before surgery we would like to make sure that yourcondition is well enough to undergo this operation and also to exclude
certain conditions such as dental infection, ear, nose and throat infection, skin infection, urine infection etc.
Stop smoking: If you have not already done so, it is suggested that youstop smoking. This will be good for you during and after your surgery. Routinely blood transfusion is not necessary after Single Total KneeReplacement. But if your hemoglobin is less than 10gm% then you may require 1-2 units of blood for your operation, so kindly arrange donorsfor this purpose. If both of your knees need replacement in the same sitting, then up to 2-3 units of blood may be required depending on yourhemoglobin levels.
If both knees are damaged, both can be replaced in the same sitting. Itmeans one time anaesthesia, one time hospital stay, one time medicines and one time physical therapy. It means saving the cost too. Your doctorcan advise you for the need of replacing both the knees simultaneously.
Surgeons and manufacturers have made remarkable advances in jointreplacement technology over the last few years. The materials are long lasting and durable. The surgical methods have been fine tuned and standardized. As a result, the chances for a successful outcome are excellent.
The operation will provide pain relief for at least 10-15 years. The majorlong term problem is loosening of the prosthesis. This occurs because either the cement crumbles (as old mortar in a brick building) or thebone loosens away (resorbs) from the cement. By 10 years, 25% of totalknee replacements may look loose on X-ray, and about 10% will be painful and require reoperation. By 15 years possibly 20% may requirere-operation.
These complications are more likely in very obese or hyper active people and really depends upon how careful you are about your artificialknee joint.