Total Knee Arthroplasty

Primary joint reconstruction is the treatment of choice for patients suffering from degenerative joint disease that has failed conservative treatment. Total knee arthroplasty is the reconstruction, or replacement, of the knee joint. This is often done for those with osteoarthritis or rheumatoid arthritis. In a total joint arthroplasty, the damaged joint is removed and replaced with an artificial joint. The objective of total joint replacement is to relieve the pain in the joint caused by the damaged cartilage. Since stiffness is a common symptom associated with joint disease, having one’s joint replaced will allow a patient better range of motion as well as the ability to walk or climb stairs without pain.

In a total knee replacement, the damaged cartilage and bone will be removed from your knee joint. A new metal surface will be fixed with cement to the end of the femur (thigh bone) and also to the top of the tibia (shin bone) that make up the knee joint. The surgeon will make sure that the alignment and function of your knee is restored at this point. A plastic spacer is then connected to the tibial component, which recreates the native joint space. The third component of the knee replacement is the knee cap (patella). The back of the knee cap is also fitted with a plastic implant that acts to resurface the back of the knee cap, allowing for smoother flexion and extension of the knee.

Postoperative Instructions:

MOVEMENT

  • You can put your full weight down on your operative leg immediately after surgery and use a walker or cane for assistance initially. The only limitation you have is pain. If you move your knee in a certain position and it hurts, ease up until you find a position that is comfortable for you.

ICE

  • An ice machine will be provided to you prior to your surgery. This will help decrease swelling and pain after your surgery. Use the ice machine as much as possible when you get home at intervals of 30 minutes on and off. The more you do it, the better you will feel. You should keep the ice machine for approximately two weeks. Do not use the ice machine while you are sleeping.

ACTIVITY

  • It is great for you and your new knee to go for a walk 2-3 times a day. However, don’t overdo it! Increase your activity level by small increments daily. You should end every day feeling like you could have done more and not like you did too much. If the next day you walk for longer and have pain, then you are doing too much. Every day you should feel a little better and experience a little less pain. When you have pain, be sure to ice your knee and rest.
  • Arrangements will be made by our office to have a physical therapist come to your house 2 times a week for the first two weeks after surgery. If you go to a rehab center, a therapist there will work with you. Once you come into the office for your post-op visit, we will give you a prescription for outpatient physical therapy. This will be twice a week and for approximately 6-12 weeks.

MEDICATIONS

  • While you are at the hospital your pain will be managed with IV and oral medications. When you go home, you will be given a prescription for pain medication (e.g. Percocet). This will prevent you from having severe pain. If you are not in pain, you do not need to take any.
  • Once you are home, you can take 600 mg of Ibuprofen (Advil/Motrin) every 6 hours to help with inflammation and pain. This medication will help cut down the use of narcotic-based pain medication. However, if you still have pain after taking the Ibuprofen, continue taking the pain medication every 4- 6 hours as needed.
  • A sleeping medication (e.g. Ambien) is also provided to help you sleep at night. Take one tablet 30 minutes before you plan to sleep.
  • A blood thinning medication will also be ordered for you. You will be giving yourself a small injection twice a day for 10 days after you are home. This medication will be supplied to you by Complete Infusion Care. They will contact you with the information.

DRESSING/BANDAGES

  • Your knee dressing is waterproof. You may shower the next day after surgery, but do not take a bath or submerge your knee in water until your incisions are checked at your first post-op visit.
  • Your stitches are buried under the skin and will dissolve away over time.
  • You will be given compression stockings at the hospital. You should wear them during the day and remove them at night. This will help decrease the swelling. It is a good idea to wear them on both legs even if you only had one knee replaced.
  • You may have bruising around your knee that can track down your leg. If you notice that there is bruising on your knee, calf, ankle, or foot (and you don’t have pain in these places), then don’t worry, this is normal.

DRIVING

  • You may drive 1 to 2 weeks after surgery if you are not taking pain medication. If your right leg is the operative side, then you must have good control of your leg prior to driving.

APPOINTMENT

  • Please call the office prior to, or immediately following, your surgery in order to schedule a postoperative appointment. This should be scheduled 7-10 days after surgery. At that visit your stitches will be removed and you will be given a prescription to begin physical therapy.

If you have any questions or concerns, please contact our assistant at (310) 659-2910 extension 3048. Download the postoperative instructions for your procedure (PDF) 

Recovery Timeline:

Day of surgery: Arrive one to two hours prior to surgery. Procedure will take approximately one to two hours, and recovery time is one hour. Expect to stay in the hospital for one to three days after surgery. For immediate post-op instructions, download the instruction sheet. Up to two weeks post-op: Physical therapy at home twice a week for the first two weeks after surgery will be arranged for you by our office. Walk every day for as long as you can without pain. You will be given an ice machine to use three to five times a day for 20–30 minutes at a time. You will also be administering injections to yourself twice a day for ten days after surgery to thin your blood so that you are not at risk for a blood clot. Two weeks post op: First follow-up visit with Dr. Snibbe/Jennifer. Your dressing will be removed, and an X-ray will be taken in the office. OK to get incisions wet at this time. Continue icing the surgical area two to three times a day (or more if needed). Physical therapy will be prescribed. Start physical therapy at an outpatient facility immediately. Progress from a walker to a cane as tolerated. Four weeks post-op: Second follow-up visit. Range of motion and strength test. Physical therapy will continue to improve range of motion. Mild stiffness is still common. You can start strengthening exercises. Eight weeks post-op: Third follow-up visit. Range of motion and strength testing. If additional range of motion or strength training needed, continue physical therapy to work on these. Pain should be mostly resolved at this point. Twelve weeks post-op: Fourth follow-up visit. Range of motion should be full/normal. You should feel stronger and have very little pain, if any. Near to full recovery is expected at this time.





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