The knee is the largest joint in the body and carries almost half of your weight. In a healthy knee, the joint is lined with cartilage, acting as a cushion and a smooth surface for easy movement. Arthritis destroys the cartilage, and also alters the bone surfaces and ligaments in the knee, making movement difficult and painful.
The decision to proceed with knee replacement surgery is yours and does not need to be rushed. During the surgery, surgical instruments are used to resurface the ends of the femur and tibia. The knee cap (patella) may or may not be relined. This is done after making a vertical incision over the front of the knee to gain access to the joint surfaces. There are numerous tools including computer navigation, robotics and patient specific instrumentation to assist in the accuracy of your knee replacement.
In most cases you should continue with any regular prescribed medications. I need to know your medical history to plan the best treatment for you in hospital.
Particularly, please let me know if you:
Knee joint replacement can be performed under general or spinal anaesthesia. My assistant will give you the details of my anaesthetist at the time of your surgical booking. They will contact you prior to surgery to discuss the plan for your anaesthesia, and risks that may be specific to you.
You will be admitted to hospital on the day of surgery. My assistant will provide you with the admission time and fasting details.
Currently, hospital stays can range from 3-7 days. Some patients will be transferred to a rehabilitation centre after surgery for more care – this is organised during your inpatient stay, however most patients can go directly from hospital to home provided they have the right support.
First 2 Weeks
Your goals in the first 2 weeks after surgery are:
Overlying the surgical incision is an adhesive dressing, which if clean and dry can be left in place. The nursing staff in hospital will help you with any questions you have regarding your dressings, and I will check the healing of your wound at our follow-up appointment approximately 2 weeks after surgery.
Knee replacement surgery has traditionally been painful, although with current techniques patient comfort is greatly improved. In general you will require some regular pain relief each day, including regular paracetamol and anti-inflammatories (if indicated). For periods of increased pain during the day (breakthrough pain), you will have a faster acting pain reliever to take. Some of these pain relievers can have side effects such as nausea, stomach upset or sedation. It might be necessary to avoid certain activities (e.g. driving) if you are taking these types of pain relievers.
I will review you in the rooms approximately 2 weeks after surgery. If you are unsure of your follow-up appointment, please call my assistant on 08 9212 4292.
First 3 Months
The focus is on improving your function and comfort levels, with:
The exact time to return to driving is variable depending on your recovery and the leg you had operated on. The Australian Orthopaedic Association recommends a period of at least 6 weeks before you consider recommencing driving.
This will vary depending on the nature of work you do. You should have a least 2 weeks off to allow the incision to heal and your pain levels to reduce. Most patients will require more time off work.
I recommend you see a physiotherapist on a regular basis until you have recovered to a satisfactory level.
Any planned dental work or current dental problems should be dealt with prior to your knee replacement. If you have dental work at any time after your knee replacement, let your dentist or surgeon know that you’ve had joint surgery. The dentist may opt to prescribe you antibiotics to prevent infections that can spread from the mouth to the knee joint replacement via the bloodstream.
The risk of infection around the prosthesis is about 1 in 100. This can happen any time after surgery, as infection can spread to your knee from any part of your body via the bloodstream. In the event you do have a deep infection, it is important to seek treatment as soon as possible. Simple tablet antibiotics will not treat this problem and you will require surgery to wash the knee joint. If you have a resistant infection, you may require a surgery where the existing knee replacement is removed and a new replacement inserted after a period of antibiotics (Revision Knee Replacement).
If you are concerned about an infection, please contact me as soon as possible. During business hours the best point of contact is via my assistant on 08 9212 4292. After hours, please contact the hospital where you had your surgery, and ask them to get in touch with me. Failing this, present to your local Emergency Department for review.
Superficial Infection is not common, although can occur. Superficial infection occurs around the wound sites in the superficial tissue of the lower leg. It is important to contact me if this is the case, as it will need treatment to prevent infection spreading to the knee joint.
Stiffness Rarely, the knee replacement can become extremely stiff, requiring a manipulation of the knee replacement or even revision surgery.
Numbness over the front of the knee after surgery is common, although it is rarely a big problem and generally improves with time.
Foot and Ankle Swelling is normal to an extent, and generally reflects the effects of gravity on the swelling around your knee.
Blood clots can form in the deep veins of the calf or leg, and occasionally these clots can travel to your lungs (pulmonary embolus), affecting your breathing. During your inpatient stay I use blood thinners to help prevent clot formation. In the event you do have a large clot in your legs (DVT) or in your lungs, you will need to take longer term blood thinning medication until the clots have resolved.
Prosthesis wear and revision surgery For most people, a knee replacement will last for life. We know from experience that, at 10-15 years after surgery, 95 out of 100 knee replacements are still functioning well. However, if the prosthesis wears out or breaks, revision surgery will be required to remove the existing prosthesis – and insert a new one. Revision surgery is generally more complex than the initial surgery.
Damage to structures inside the knee is very rare, but there have been instances of damage to the bones, arteries, nerves and veins in the leg. Some of these require repair during surgery, and others will improve or resolve with time.
REPORT TO DR RADIC IF YOU EXPERIENCE ANY OF THE FOLLOWING:
If you are considering having a knee replacement, make an appointment with Dr Radic to discuss your treatment options.
For all appointments and enquiries, please contact us on:
Alternatively, please call the switchboard on 08 9212 4200 and ask for Dr Radic's rooms.
Perth Orthopaedic & Sports Medicine Centre
31 Outram Street
West Perth WA 6005
Antony Street Specialist Centre
6-8 Antony Street
Palmyra WA 6157
100 Stephenson Ave
Mount Claremont WA 6010