Total Knee Replacement Surgery
The total knee replacement procedure has become a routine operation, boasting excellent success rates that consistently leave patients astonished at how it can significantly enhance their daily lives.
The goal of this operation is to eliminate the troublesome and painful symptoms that hinder common activities and often confine individuals to their homes.
For those suffering from knee arthritis, simple tasks such as grocery shopping, taking a stroll, or even sleeping can become nearly impossible. This operation aims to make these activities feasible once again.
Today, approximately 180,000 major joint replacement surgeries are performed annually in Italy, with around 90,000 of these being total knee replacements. This procedure is highly successful in improving the quality of life for eligible patients, with a satisfaction rate exceeding 92%. Despite its frequent success, total knee replacement surgery carries some risks.
We recommend reading this article for a better understanding of the topic.
Why might I need a total knee replacement?
You may need knee replacement surgery if the joint is severely damaged, and treatment with medications, physical activity, and physiotherapy alone has failed to control the symptoms. The knee is a hinge joint, consisting of the distal part of the femur and the proximal part of the tibia. The patella is also part of the knee joint.
Joint replacement with a knee prosthesis is a highly successful operation, with approximately 92% of patients reporting significant improvement after surgery.
The main advantage is a reduction in pain, and the benefit is immediate. You may also experience increased mobility, improving your ability to carry out daily activities.
However, it’s important to realize that an artificial knee will never be as good as a natural knee, and there are limitations compared to a healthy natural knee.
What happens during the operation?
An incision will be made along the front of the knee. The damaged cartilage on both bones will be removed and replaced with the prosthesis, usually made of metal. This metal is shaped to replicate the natural form of the knee. The prosthesis will replace the lower part of the femur, and a metal plate the upper part of the tibia. Usually, a plastic insert is fitted in between, and these parts will (in most cases) be held in place by a special bone cement.
What can I expect from my knee with the prosthesis?
The main advantage is a reduction in pain, usually noticeable shortly after the surgery. You may also experience increased mobility, depending on the condition of the knee before the operation, improving your ability to carry out your daily activities. However, it’s important to realize that an artificial knee is not as good as a natural one, and there will be some limitations.
Are there risks of complications?
As with all surgeries, there is a risk of complications. If the knee is severely damaged or worn, or if you have other medical conditions, the risk of complications may be higher.
Possible complications include:
– Wound infections
– Blood clots (thrombosis)
– Nerve damage
– Bleeding
– Joint stiffness
A wound infection can be treated with antibiotics. In the case of a deep wound infection, additional surgery may be necessary.
The possible formation of a blood clot in blood vessels can be prevented by administering medications, injections, or tablets for 4-6 weeks after surgery.
A fracture during surgery is unusual, and its treatment will be assessed and resolved during the same surgical session.
Nerves around the knee may be damaged during surgery; in this case, further investigations may be required. Usually, nerves heal over time, but sometimes symptoms persist.
What can I do to reduce the risk of complications?
To minimize complications, it’s crucial to be in optimal physical condition, reducing anesthetic and operative risks. It’s vital for those undergoing surgery to strive for peak fitness and avoid risky behaviors. If you feel unwell or your physical condition changes, inform your orthopedic surgeon.
Do weight and diet influence?
Being overweight negatively impacts the success of the operation, so losing weight before the procedure is recommended. Excess weight increases the prosthesis workload, reducing its lifespan. Overweight individuals should aim to lose weight through diet and exercise before the surgery.
Smoking
We recommend quitting smoking or significantly reducing it, ideally at least a week before the surgery.
What is the preoperative visit?
Before surgery, a preoperative visit may be required to assess your health and undergo diagnostic tests.
What happens during the preoperative visit?
You may undergo an electrocardiogram and X-ray of the affected hip and chest. Typically, blood pressure, pulse, and weight are checked. Blood tests may be necessary, and previous test results will be evaluated. A urine test may also be required to diagnose potential urinary infections.
How long before the operation should I stop eating and drinking?
You will be asked to stop food and fluid intake at least six hours before the surgery to avoid regurgitation and serious anesthetic difficulties.
On the day of admission?
On admission day, report to a designated area for various formalities. Bring your medications and all relevant medical documentation, including X-rays.
What time will the surgery be?
The optimal time for your surgery will be decided by our team and confirmed the day before. This schedule is indicative and may change on the day of surgery. In any case, you will be informed as soon as possible.
Can I take my medications before the surgery?
Yes, continue taking your medications as usual, with exceptions for certain drugs like aspirin, clopidogrel, methotrexate, hormone replacement therapies, and oral anticoagulants (warfarin, acenocoumarol, etc.). Consult your
What type of anesthesia will be administered?
The type of anesthesia will be decided by the anesthetist, considering your specific needs. The main options are general or spinal (epidural) anesthesia.
What happens at the end of the surgery?
After the surgery, you’ll be kept in a secure area until the anesthetist is satisfied with your condition. Then, you’ll be returned to your ward room for monitoring.
When will I recover from anesthesia?
If you undergo general anesthesia, you might not remember much before returning to the ward. You’ll likely wake up with an oxygen mask to aid post-anesthesia recovery. A saline drip may be used for hydration, and a pillow between your legs might restrict movements that could jeopardize the prosthesis.
Will I experience pain?
You’ll feel some pain at the wound site, but medications will be administered to alleviate it. Ask the nursing staff for more if necessary.
When can I eat or drink?
You should be able to eat or drink an hour after the surgery, as long as you feel well and follow specific instructions from your surgeon or anesthetist. After a few hours, you should be able to consume normal amounts of food and focus on ingesting ample fluids to stay hydrated.
What rehabilitation therapy will I undergo?
Rehabilitation therapy will start immediately. You’ll be encouraged to perform exercises and start walking on the same or the next day of the surgery. Of course, safety rules must be observed.
What should I expect in the first six weeks?
Swelling will reduce but not entirely within the first six weeks. If you have external stitches, they may be removed around two weeks. A follow-up visit will be scheduled at six weeks.
What happens to the surgical wound and stitches?
The wound will be covered with a surgical dressing, closed with stitches or metal staples. The removal of stitches, if required, will be scheduled 10 to 14 days after your operation and organized accordingly. Keep the dressing dry until the wound is fully healed.
How long will I stay in the hospital?
The average stay is 4-7 days. You’ll be able to go home once postoperative exams are conducted, and you can walk safely.
What clothes should I bring?
Bring easy-to-wear, comfortable clothes.
When can I go home after the surgery?
The medical staff will decide on your discharge.
If I need certifications?
Necessary certifications will be provided upon discharge.
When can I drive?
Avoid driving for at least six weeks after discharge, and only do so if you are confident in performing necessary maneuvers in case of an emergency. Consult your insurance to ensure coverage.
When can I return to work?
This depends on your job. If it doesn’t involve strenuous activities, you may return to work around eight weeks, with the average being around twelve weeks.
How can I stay fit before the operation for the best possible outcome?
Staying fit before the operation is crucial, optimizing surgical results, anesthesia recovery, and postoperative physical recovery. Regular physical exercise will be beneficial, and exercises that can be done while watching television can be demonstrated upon request. Losing weight, if overweight, is equally important.
For further information and online consultation, feel free to contact me.
