Orthopaedic Clinic: Hip and knee
KNEE REPLACEMENT
Total knee replacement surgery has evolved over the last 35 years due to improvements in surgical techniques and implant design. It is now one of the most successful orthopaedic procedures carried out today.
THE PROCEDURE
The bone surfaces and cartilage which have been damaged by arthritis are removed. Precision instruments and guides are used to help make sure the cuts are made at the correct angles so the bones will align properly after the implants (prostheses) are attached. Some small amounts of the bone surface are removed from the front end and back of the femur. This shapes the bone so the prostheses will fit properly. The amount of bone removed depends on the amount of bone that has been damaged by arthritis. A small portion of the top surface of the tibia is also removed making the end of the bone flat. The back surface of the patella (kneecap) is also removed.
The prostheses are attached to each of the three bones and are designed so that the knee joint will move in a way which is very similar to the way the joint moved when it was healthy. The implant which fits over the end of the femur is made of metal and its surface is rounded and very smooth covering the front and back of the bone as well as the end.
Knee implants come in many designs and your surgeon will choose the implant which best meets your needs. If necessary your surgeon may adjust the ligaments that surround the knee to achieve the best possible knee function.
AFTER THE OPERATION
After the operation you may take as much weight through the joint as pain allows, using crutches and/or sticks to ensure you learn to walk properly without a limp and give surrounding muscles and tissues time to heal.
A continuous passive motion machine (CPM) may be used to keep your knee flexible post-operatively. Ice therapy will also be used to reduced swelling
Most patients will get out of bed the day after the operation.
A physiotherapist will see you each day and you will be taught:
- Exercises to make your knee stronger and more flexible – to be done daily with the physiotherapist and then independently.
- How to walk with elbow crutches – you will be allowed to walk independently with crutches when the physiotherapist thinks you are safe to do so.
- Techniques to sit down and stand up from a chair.
- Techniques to get out of bed.
- How to go up and down stairs.
GENERAL ADVICE
- Getting In/Out Of The Car
- Put the seat back as far as it can go.
- Sit bottom first into the car, then lift yourself further in.
- Manoeuvre each leg in carefully, and then turn to face the right way. (A plastic bag on the seat may help).
- Do not step foot first into car.
- For the first 6 weeks avoid unnecessary car journeys.
Dressing
- Always remember your operated leg goes in first when dressing, and comes out last when undressing.
- Dressing is most safely done whilst sitting.
- Use your aids i.e: - Helping hand, long handled shoehorn to help.
- Wear slip on shoes where possible.
Gardening
- Use long handled tools but avoid digging.
- Do not kneel.
Sleeping
You can lie on either side, pain permitting, but you may like to put a pillow between the knees for comfort.
After discharge from hospital you will need to have out-patient physiotherapy to progress your exercises.
