Procedures
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Reproduced
with permission from Your Orthopaedic Connection. ©American
Academy of Orthopaedic Surgeons. |
Knee replacement is a procedure that is done
for the severely arthritic joint, and only
after other
forms of treatment, such as medication
and physical therapy, no longer have any benefit.
It is not
done for minor arthritic joint pain.
The knee is a "hinge" joint, although
it is not as simple a hinge found on doors. The knee
not only bends back and forth, but it also has some
ability to move in a rotational manner.
The knee, a major weight-bearing joint,
is surrounded and held together by muscles, ligaments
and other
soft tissues. Cartilage is the material
that "cushions" the
knee and allows the joint to move in a
smooth and free manner.
As the arthritic process develops, the
cartilage wears out, and the nerve endings
that lie
beneath the surface become irritated
and produce the
symptoms of pain. As the joint becomes
more and more destroyed,
the soft tissues offer less and less
support. At that point, it may be time to consider
surgical replacement.
The surgical procedure involves removing
the diseased portions of the joint
and replacing them with new
parts. Very accurate cuts are made
on the undersurface
of the femur (thighbone) to match the
undersurface of the femoral prosthesis
so that they
will fit together well and be both
solid and stable. Similarly, accurate
cuts are made to the top surface of
the tibia
(shinbone), and the
tibial component is anchored in place.
These components are then fitted together
to allow the knee to bend back and
forth and also
have some
of the rotational movement of the normal
knee.
The surgical procedure for total knee
replacement usually takes about one
to two hours,
and the new joint is often immediately
solid.
However, strengthening
the weakened muscles and soft tissue
surrounding and supporting the joint
requires a longer-term
program of exercise and physical
therapy. Although many patients
see and feel immediate benefits,
they must continue
to rehabilitate themselves for several
months to get the total benefit.
I was plagued for
years with osteoarthritis in my left
knee...I am now back to walking the dog,
and shoveling snow with ease. I even
helped my husband paint our house at
the end of the summer. I am totally enamored
of Mid Coast Hospital!”
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Anesthesiology has come a long way
in the last twenty-five years. There
are
newer,
more stable
drugs, and there
is more accurate and more complete
monitoring.
There are, however, some
risks involved that are largely related
to the severity
and amount
of underlying
diseases, such as heart disease,
atherosclerosis (hardening of the
arteries), or lung
problems. With an increase in the
severity of these
conditions, there is, naturally,
an increase in the risk.
Nevertheless, the safety record
of anesthesia today is very high. It is essential that patients tell
their surgeon and anesthesiologist
about all
of the medical
conditions they have as well as all
the medicines that they
are taking.
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Dr.
Van Orden checking a patient's knee
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Most patients are admitted to the
hospital the day of surgery.
Prior to surgery
the knee that
is being
replaced will be thoroughly cleaned
with an antibacterial surgical
sponge.
During the first few days after surgery there
is naturally some pain. However,
pain can be
adequately controlled by
medication.
In spite of any discomfort,
it is important that patients
make the
effort
to do the deep
breathing and physical therapy
exercises as instructed.
Patients who breathe well and work at
strengthening their muscles,
improve their lung
capacity and circulation,
and tend to get well faster.
One of the most frequently
asked question is, "When
can I start walking again?"
While patients are often
encouraged to stand and
sit (with assistance)
within
twenty-four
hours
after surgery, walking
is approached gradually and
in a
guided manner so as to
avoid injury and complications.
It is very important
to
rebuild and strengthen
the leg muscles through
isometric exercises. However, patients are typically
discharged three days after surgery and we work
extensively with them before discharge.
Many patients, especially
those who live alone,
are concerned
about whether
or
not they will
be able
to manage for themselves
in the first few weeks
after they
leave
the hospital.
In
addition, if they should
need assistance, they
are concerned about who
will pay for it.
Insurance
coverage for home care is generally
limited,
but there
are agencies
available
that can provide
some help. Someone
can visit the home and show
patients
how to arrange
furniture,
rugs, etc.,
to decrease
the risk of tripping
and falling. A
home health care agency can
assist with needs
like bathing and
dressing. The hospital Social Services
Department can
direct patients
to these agencies.
Mid Coast Hospital's
care coordinators
will work
with the patient
to ensure that the
transition from the
hospital to home
is as seamless
as possible.
Patients sometimes
benefit from going
to a rehabilitation
facility
after
they are
discharged
from the hospital.
The decision about
whether
to go to a rehab
facility or directly
home is
made
by the
patient, but
the orthopedic care
team will make
their recommendation
based on the progress
that a
patient makes
in the
first several days
after surgery.
Before
my surgery I was in constant pain...My
surgeries were performed two weeks apart
and went very well...Now I no longer
need my walker and can walk without pain
for the first time in 5 years.”
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With knee replacement,
the surgeon
replaces the diseased
knee joint
and, along
with the physical
therapist,
occupational
therapist and nursing staff,
guides the
patient through
the recovery
process. However,
rehabilitation
is up to the
patient. The
patient must
participate
fully in the
rebuilding
and
strengthening
of weakened muscles.
To get the
total benefit
of knee replacement,
the patient
must make a serious commitment
to doing
the prescribed
exercises
and developing
and
maintaining
an active life-style. |
