Total Knee Replacement Surgery  

With your total knee replacement surgery, the damaged parts of your knee that need repair will be removed and replaced with artificial parts called prostheses. At surgery, an implant, especially selected to match your needs, will be affixed to the underlying bones.

For some patients, an acrylic cement called Polymethylmethacrylate (PMMA) will be used for the fixation. This cement has been used successfully by dentists for over 45 years. It is a strong material, well-tolerated by the body and sets or cures within 15 minutes after it is mixed. Before curing, the cement is pressure-injected and the implants are seated. Because the bond is strong, most patients are able to bear weight on the operated leg within several days after surgery.

For other patients, the implants are able to be affixed to the bones without cement. Special surgical instruments are used to precisely prepare the bones so as to enable a press fit. To supplement this joining, supportive screws or pegs are often used. Bone is a living and growing tissue. If an implant coated with metallic beads to form a porous undersurface is placed in very close contact to living bone, tissues can grow into the pores, further locking the implant in place. Porous-coated knee prostheses have been used for many years and have excellent results in many patients.

Preparing for Surgery  

Evening Before Surgery

• Do not eat or drink after midnight.
• Before bedtime, shower and scrub your surgical leg with the special soap provided.
• An intravenous (IV) line may be started the night before or the morning of surgery.
• A sleeping medication may be ordered.
• Anti-embolism stockings (elastic) may be provided to promote circulation to the legs. A sequential compression device may also be used for the same purpose.
• You will be instructed in breathing exercises to help reduce chest congestion.

Morning of Surgery

• The nursing staff will awaken you to take your temperature, pulse, respiration, and blood pressure.
• You may brush your teeth and rinse your mouth, but do not swallow any water.
• A clean hospital gown will be provided.
• An elastic stocking may be applied to the non-operative leg.

Going to Surgery

• You will be asked to empty your bladder.
• Remove all jewelry, dentures, contact lenses, and nail polish.
• Rings not removed will be taped.
• Relatives and friends will be given instruction on where to wait.
• A surgical orderly will take you on a cart to the preoperative waiting area.
• The operative leg will be scrubbed and shaved in preparation for surgery.
• The anesthesiologist will discuss the type of anesthesia to be used.
• You will be taken into the operating room.

What to Expect After Surgery  

Following surgery, you will be moved to post-anesthesia recovery. As soon as your blood pressure, pulse, and respirations are stable, you will be moved to your room.

Frequently during the first 24 hours following surgery, your blood pressure and pulse will be taken and the nurse will check the bandage on your leg. Also, the color, warmth, movement, and sensation of your leg and foot will be checked. Report any soreness, numbness, or tingling in your leg, foot, or heel to the nurse.

For the first couple of days after surgery, you will be given fluids intravenously. Once you can tolerate liquids, your diet will be increased accordingly.

If an antibiotic is prescribed as a preventative measure against infection, it may be given through an IV.

One or two small plastic suction tubes may be used to draw excess fluid from the area around your incision. The tubes are usually removed within 24 to 48 hours when the drainage decreases.

A moistened oxygen mask may be used to soothe your throat and loosen secretions in your lungs. This mask can be removed for short periods of time. A trapeze attached to your bed frame will assist you in moving more easily and the side rails of your bed may be raised for your safety. While it is normal to experience some pain or discomfort after surgery, medication is available and ice can be applied to reduce swelling and discomfort.

Your leg may be positioned in a Continuous Passive Motion (CPM) machine after surgery. Keep the center of your knee cap at the bend of the CPM machine and do not adjust the CPM machine yourself. While you are in bed, this machine will continuously bend and straighten your leg. The CPM machine keeps your joint from becoming stiff and speeds recovery.

Activity While in the Hospital  

Your surgeon will let you know when you can get out of bed to sit in a chair and when you can begin physical therapy. The nurse will help you out of bed and a trapeze may be used as an assistive device. A commode seat on wheels will help you walk to the bathroom and use the toilet.