What is knee replacement?
Knee replacement (also called knee arthroplasty) is a major surgical procedure where the worn out articulating surface of the knee joint is replaced by a prosthetic surface.
Who requires a knee replacement?
Knee joints may wear out and begin to cause pain and other symptoms, leading to dysfunction in day-to-day life. If the symptoms are not adequately controlled by simpler measures such as
- pain medications
- activity modification
- physiotherapy/splints etc
then replacing your native joint with a prosthetic one is indicated.
Joints may wear out from so called ‘wear-and-tear’ (also called primary arthritis), or from other causes such as trauma, infections, inflammation (so called secondary arthritis). Your surgeon will be able to discuss in relevant detail with you the specific disease affecting your joint.
What is a knee replacement prosthesis made of?
The prosthesis has several components, generally with metallic and polyethylene components. The metal is generally an alloy – a combination of different metals that produce a highly smooth surface that has good wear characteristics. The Polyethylene is likewise designed to have similar characteristics. Dr Ihsheish will measure the dimensions of your joint before and during the operation and implant prosthetic components that fit your bones, with the aim of reconstituting your normal knee dimensions, range of movement, and stability.
Dr Ihsheish uses only prosthetic devices that have excellent theoretical and clinically proven characteristics and outcomes, he is quite happy to discuss with you the relevant prosthetic device for your knee joint.
How to prepare for your surgery?
Firstly, it is important that you are clear in your mind about the reasons for your painful symptomatic knee joint, and the indications for such operation in your case specifically. You should talk to Dr Ihsheish about any concerns or questions you have before the surgery, it may also be helpful to read about the condition or operation, and talk to anyone you know who may have had the procedure.
Dr Ihsheish will discuss with you relevant detail at the time of booking your surgery.
You must have radiographs (x-rays) of the joint affected which your surgeon can organise, and you will be required to have blood and other tests before the day of your surgery.
Please look after your skin, make sure there are not scratches or breaks in your skin and look after your health in general. Try to keep your joint mobile and strong as that will help you have a smoother recovery.
The hospital will contact you before your surgery and provide you with information about fasting and medication, when and where to come, and what to bring with you.
How is the surgery done ?
The anaesthestist will discuss with you the details of your anaesthetic before the operation, various options are available.
Your surgical team will prepare your knee in the operating room. You will be given antibiotics to reduce the chance of infections. Your skin will be cleaned and sterile surgical drapes used to cover the skin.
The operation is performed through an incision over the knee joint. Dr Ihsheish will remove the damaged surface of the joint and replace it with a suitably sized and shaped prosthesis. He will aim to achieve a range of movement and stability to gain you maximum function from this new joint. At the end of the operation the skin is closed and a dressing applied.
What happens after the operation?
From the operating room you will be moved to the recovery room where you will slowly wake up under the supervision of specialised nursing staff. From there you will be moved to the ward where you may spend 3-5 days (average). During your stay on the ward you will be continually monitored and physiotherapy will begin. You will have various blood tests and xrays as part of this early recovery phase.
When you wake you may notice that you have a small urinary catheter or a wound drain. It is your surgeon’s preference not to use these tubes routinely, as he believes they have no proven advantage in the current literature, however in certain cases exceptions may be made. If these tubes are present they will generally be removed in the first 1-2 day after the operation.
You may also notice intravenous lines – tubes/needles that provide you with fluid in the early phase after your operation, these are also utilised to give you antibiotics and pain relieving medications as required.
When do I go home from hospital?
In general, you will be allowed to go home when you have fulfilled these three requirements
- you must be medically stable
- you must be comfortable, such that your pain is controlled with tablets (ie not requiring injections)
- you must satisfy the physiotherapy and nursing staff that you are safely mobile in and out of bed.
After leaving the hospital you will have physiotherapy arranged on an outpatient basis. This is a vital part of your recovery aimed at achieving a mobile, strong, and stable joint.
Will I require a stay in the rehabilitation ward?
The hospital stay for most patients undergoing joint replacement through our clinic is 3-5 days. Please note that there is no pre-determined length of stay for any of these patients, and that every patient’s recovery is different. Dr Ihsheish firmly believes that physiotherapy is a major factor in producing a good outcome, when your pain has improved and you are medically stable the team may determine that a short stint in the rehabilitation ward may be of benefit – rehabilitation aims to give you more intensive physiotherapy and functional recovery than you would receive on the standard hospital ward.
What follow-up will I have with my surgeon?
Dr Ihsheish will see you while you are in the hospital, and you will need to make an appointment to see him at approximately 2 weeks after the surgery to have your wound reviewed. Your surgeon does not routinely use visible sutures and so there will be no sutures to remove. Follow-up down the line, including any relevant tests, will be arranged for you in due course through the clinic.
How long is the recovery following knee replacement?
In hospital stay is generally 3-5 days.
At two weeks most patients have discarded the crutches, but this is variable for each individual patient.
Physiotherapy will continue for 6 weeks.
Hydrotherapy may commence after 2-3 weeks if your surgeon is happy with the wound.
You are allowed to drive 3-4 weeks after the surgery if you are walking without a walking aid at that time.
You are allowed to kneel on the operated side after six weeks if you so choose.
It is not unusual to experience some discomfort related to the surgery for several weeks, this should be different to your arthritis pain, and will gradually subside.
The operation site may be warm and swollen (compared to the normal side) for several weeks at least, this is quite normal and represents the increased blood flow to the area to heal the area after the surgery.
What if I have any concerns or questions?
Please contact our clinic on 6109 0002 if you have any questions or concerns at any point. If you are unable to contact us please contact your family doctor or your local hospital.