Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
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The preoperative phase begins several weeks prior to your hospital admission. You will likely undergo a complete medical evaluation to ensure your heart and lungs are strong enough for anesthesia. This step step may include an EKG and chest X-ray. You will also meet with the anesthesia team to discuss your options.
Your surgeon may ask you to stop taking certain medications, such as blood thinners or anti-inflammatory drugs, to reduce the risk of bleeding. You may also be advised to lose weight or stop smoking, as both can significantly improve your recovery speed and reduce the risk of infection. Preparing your home is also vital—removing tripping hazards, setting up a recovery station, and arranging for help can make your return home much smoother.
On the day of surgery, you will be taken to the operating room. Once anesthesia is administered, the surgeon makes an incision on the front of your knee to access the joint. The damaged surfaces of the thighbone and shinbone are carefully removed. The surgeon uses precise instruments to shape the bones to fit the implant components.
Next, the metal implants are attached to the bone. They may be cemented in place or press-fit to allow bone to grow into them. A plastic spacer is inserted between the metal parts to create a smooth gliding surface. If the kneecap is damaged, a plastic button may be resurfaced on its underside. Finally, the surgeon checks the motion of the knee to ensure it is stable and balanced before closing the incision with stitches or staples.
Most knee replacements are done under regional anesthesia, such as a spinal block. This numbs you from the waist down. You remain awake but sedated and relaxed, breathing on your own.
Regional anesthesia is often preferred over general anesthesia (being put to sleep) because it has a lower risk of complications like blood clots and usually results in less pain and grogginess immediately after surgery.
The term “replacement” suggests removing the whole knee, but it is really a resurfacing. The surgeon removes only the damaged cartilage and a small amount of underlying bone.
The cuts are made at precise angles. This ensures the leg is straight and the ligaments are properly tensioned when the caps are put on. This precision is critical for the long-term survival of the implant.
Technology has advanced the precision of knee surgery. Robotic-assisted surgery allows the surgeon to use a robotic arm to perform the bone cuts. The surgeon is always in control; the robot does not operate alone.
Before surgery, a CT scan creates a 3D model of your knee. The surgeon uses this model to plan the implant placement within a fraction of a millimeter. During surgery, the robot ensures the bone cuts match this plan exactly. This technology can help protect the surrounding soft tissues and may lead to a more natural-feeling knee and a quicker recovery for some patients.
You will wake up in the recovery room as the anesthesia wears off. You will have a bandage on your knee and possibly a drain to remove excess fluid. Pain management will begin immediately.
Remarkably, you will likely be encouraged to stand and walk the same day of surgery. Physical therapists will help you take your first steps with a walker. This early movement is crucial. It reduces the risk of blood clots and helps prevent stiffness. Most patients stay in the hospital for 1 to 2 days, though some healthy patients may be eligible for outpatient surgery and go home the same day.
Managing pain is a priority. You cannot do the necessary physical therapy if you are in too much pain. Doctors use a “multimodal” approach, which means using different types of medication together to attack pain from different angles.
This usually includes a combination of oral pain relievers (like opioids and acetaminophen), anti-inflammatories, and possibly nerve blocks. A nerve block is an injection that numbs the nerves around the knee for several hours or days after surgery. Ice is also a powerful tool; applying cold packs regularly helps reduce swelling and numbs the area naturally.
You will likely be prescribed stronger pain medication for the first few weeks. It is important to take these as directed, usually before physical therapy sessions, to stay ahead of the pain.
As the healing progresses, you will wean off the strong drugs and transition to over-the-counter pain relievers. Avoiding long-term opioid use is a key goal of modern recovery protocols.
Swelling is a major cause of pain. Elevating your leg above the level of your heart helps drain fluid away from the knee.
Icing the knee for 20 minutes at a time, several times a day, constricts blood vessels and reduces inflammation. This simple mechanical management is just as important as the medication.
Safety is paramount during recovery. The two biggest risks are blood clots and infection. Because you are less active, blood can pool in your legs and form clots (deep vein thrombosis). To prevent this, you may take blood-thinning medication and wear compression stockings. Moving your ankles and walking frequently also helps pump blood.
Infection is rare but serious. You will likely receive antibiotics before and after surgery. Keep your incision clean and dry. Watch for signs of infection such as fever, increasing redness, or drainage from the wound. Following your surgeon’s instructions on wound care is the best way to keep the new joint safe.
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Most patients need prescription pain medication for 2 to 6 weeks after surgery. You should taper off as the pain improves. Many people switch to Tylenol or anti-inflammatories after the first month.
You can usually shower after 2 to 3 days if you have a waterproof dressing. If you have a standard dressing, you must keep it dry until the staples are removed, usually around 2 weeks. Do not soak in a bath until the incision is fully healed.
You can drive when you are off narcotic pain medication and have regained enough muscle control to brake safely. This is usually between 4 and 6 weeks after surgery. If your left knee was replaced and you drive an automatic, you may be able to drive sooner.
Signs of a blood clot include new or increasing pain in your calf, redness or tenderness in the calf, or swelling that does not go down with elevation. A lung clot is an emergency if you have chest pain or shortness of breath.
Blood transfusions are rarely needed for knee replacement surgery today. Minimally invasive techniques and medication to reduce bleeding have made blood loss much less of an issue than in the past.
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