ameet pispati, m.d., orthopedic surgeon, jaslok hospital, mumbai, india

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Knee Joint Replacement Overview & Description

The operation is performed under grneral or regional anesthesia with a patient-controlled analgesia (PCA) or epidural catheter for postoperative pain relief. The orthopedic surgeon makes an incision over the affected knee. Dr Pispati makes as small an incision as possible (Minimally Invasive surgery) and has special instruments for this purpose The patella (knee cap) is moved out of the way, and the ends of the femur and tibia are cut to fit the prosthesis and to provide better adhesion of the prosthesis. Similarly, the undersurface of the knee cap is cut to allow for placement of an artificial component.

The two parts of the are implanted onto the ends of the thigh bone (femur), the shin bone (tibia), and the undersurface of the knee cap (patella) using a special bone cement. Usually, metal is used on the end of the femur, metal/plastic on the tibia and plastic on the patella, for the new knee surface.

You will return from surgery with a large dressing to the knee area. A small drainage tube will be placed during surgery to help drain excess fluids from the joint area.

Your leg may be placed in a continuous passive motion (CPM) device after surgery. This is a mechanical device that flexes (bends) and extends (straightens) the knee to keep the knee from getting stiff.

Gradually, the rate and amount of flexion will be increased as tolerated. The CPM device helps speed recovery, decreases post-operative pain, bleeding and infection.

You will experience moderate pain after surgery. However, you may receive injections of narcotic medications, patient-controlled analgesia (PCA) or epidural analgesics (spinal) to control your pain for the first 3 days after surgery.

The pain should gradually decrease, and by the third day after surgery, oral medications may be sufficient to control your pain. We try to schedule your pain medications about one half hour before walking or position changes.

You will also return from surgery with several IV lines in place to provide fluid and nutrition. The IV will remain in place until you are taking adequate amounts of fluids by mouth and till you receive Intravenous antibiotics. Antibiotics are given to reduce the risk of developing an infection.

You will receive daily injections of Low molecular weight heparin to prevent blood clots developing in the veins of your legs. Additionally, you will be encouraged to start moving and walking as early as the first/second day after surgery. When in bed, bend and straighten your ankles frequently to prevent development of blood clots.

A Foley catheter (for urine) is inserted during surgery to monitor the function of your kidneys and hydration level. This will be removed on the second or third day after surgery.

The patient can walk the next day after surgery and can go home in 5 to 7 days

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