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    Total Knee Replacement

    When arthrits in the knee becomes severe and limits day-to-day activity, your doctor may recommend knee replacement surgery. Knee replacement surgery has been performed for more than 30 years. Recent advances in technology have made total knee replacement more durable.

    Total knee replacement can decrease pain, correct deformity, improve motion and improve function in people with arthritis. Knee replacement patients can return to many activities that they had stopped because of pain.


    What is a Total Knee Replacement?

    Total knee replacement surgery involves the removal of the diseased parts of the bones in the knee. The surfaces are replaced with man-made materials. Typically, the surfaces of the bones are shaved down to remove the worn cartilage. Next, the bones are fitted with knee replacement implants which are cemented in place. Then, a bearing surface made out of special, medical-grade polymer is inserted to act as the joint surface. This procedure removes the worn-out bone edges and replaces them with smooth materials. It also can correct the alignment of the knee.

    Knee replacement is done in a hospital. The surgery takes anywhere from one to three hours to perform, depending on the complexity of the operation. General or spinal anesthesia is used for the surgery.

    Most people stay in the hospital for 3 days after surgery. Everyone receives antibiotics to protect against infection. Everyone receives medicine to protect against blood clots. Pain medication is given to assist wtih pain control.

    In the hospital, physical therapy begins and the knee is also placed in a bending machine to assist with motion. Most patients use a walker or crutches for the first few weeks after surgery until they are strong enough to walk without gait aids.

    After the hospital stay, some patients go to an inpatient rehabilitation facility for a week or two. This allows the patient to focus on recovery and to receive nursing care as needed. Some insurance plans do not cover inpatient physical therapy. Please check with your insurance provider to learn what is covered. The hospital social worker can with these arrangements. It is extremely important to arrange your personal support network before joint replacement. Recovery can be difficult and patients will need help with everyday tasks (shopping, cooking) for a few weeks after surgery. Please arrange this with loved ones ahead of time.

    When should I consider knee replacement?

    When pain and decreased function from arthritis has limited day-to-day activity, it's time to think about knee replacement. Many patients will try physical therapy and medication without relief of symptoms. Other patients will notice increasing deformity of the knee (the knee becomes very "knock-kneed" or "bow-legged"). Other patients will experience loss of motion of the knee, where they can no longer straighten or bend the knee. Any of these are indications that knee replacement might be a good choice.

    What about my general health and knee replacement surgery?

    Total knee replacement is a major surgery. Your general doctor will need to perform a thorough physical examination, blood tests and other studies before surgery. Sometimes, other medical treatments are required before someone is able to undergo knee replacement surgery.

    If you have Diabetes or severe circulatory disease, the risk of complications from surgery are increased. Dr. Lajam will discuss this with you before surgery.

    Am I too fat for knee replacement?

    Patients who are severely overweight have a higher chance of having problems during and after total knee replacement. Studies have shown that risk for infection and blood clots can be 3 to 7 times higher than in patients without obesity. First of all, the fatty tissues in the leg make the actual operation more difficult. Surgery may require more time and larger incisions.

    After surgery, there is an increased chance for wound problems in obese patients. Dr. Lajam will ask for you to monitor your wound and to come in for more frequent evaluation if this is the case.

    Also, the total knee replacement materials are engineered to withstand certain loads. At higher loads (as with very heavy patients) these materials can wear out, loosen or fail faster than they would in lighter patients.

    Dr. Lajam and her team will discuss weight loss strategies for before surgery.  Patients are urged to work with a nutritionist to reduce weight before surgery so that surgical risks can be minimized.