Total Knee Arthroplasty
A total knee replacement is a surgery that involves resurfacing the ends of the thigh and shin bone with metal components and placing a specialized plastic in between these components. The metal implants are sized and cemented onto the ends of the bones after the bones are cut to accommodate the new components. This creates a new gliding surface for the knee joint, which alleviates pain and results in improved range of motion, function, and quality of life.
Why Knee Arthroplasty
A total knee arthroplasty is a knee replacement. An incision is made (about 8 in) in the front of a patient’s knee under clean conditions. Dr. Faulkner and his assistant will identify many anatomic structures and will place retractors that help protect those structures and allow for visualization. Guides are used to cut the bone to accommodate the implants that are placed at the ends of the bone and to correct the alignment. Dr. Faulkner will then trial several sizes of the new components to evaluate best anatomic fit for the patient. New components will be fixated to the remaining bone with cement. Several layers of tissue and the incision will be closed and dressings will be placed over the incision.
- This surgery is most often performed under a spinal with a nerve block and sedation, but is sometimes performed with a general anesthesia and nerve block. In either case, local anesthesia is injected into the knee to help control pain after surgery.
- This surgery is usually inpatient, which means the patient generally stays the night at the hospital to allow for nurses to closely monitor the patient. In some cases, the surgery may be performed as an outpatient procedure in which the patient can return home the same day.
- Surgery typically lasts 1.5-2 hours.
- The incisions are closed with absorbable suture. The dressing that is applied in the operating room is waterproof, which means patients can shower immediately after surgery as long as there is a good seal around the dressing.
We now utilize Mako robotic technology when performing most total knee replacements. This requires patients to obtain a preoperative CT scan, which is then loaded into software that helps accurately determine bony anatomy and precisely plan the appropriate size and position of the implants. We can also modify this plan intraoperatively to make sure the ligaments are appropriately tensioned and the knee is balanced. The Mako robot accounts each patient’s unique anatomy, which leads to more predictable outcomes as well as less pain and quicker return to activity. Please refer to this video to better understand how this technology works:
Why Knee Arthroplasty for Knee Arthritis
- Decrease pain
- Regain knee range of motion
- Regain knee strength
- Return to activities with improved function
- Patients who are no longer benefiting from conservative treatments including physical therapy, anti-inflammatory pain medication, and knee injections
- Patients who have a decreased quality of life due to their limited knee function
- Patients who want to reclaim their knee function
- Typically patients are over 60 years old
Recovery following a total knee arthroplasty is generally 6-12 months. Patients are able to walk as tolerated on their new knee the day of surgery. Physical therapists assist the patient in the hospital, training them how to walk with assistive devices such as a cane or walker and how to use stairs. A continuous passive movement (CPM) machine is frequently used at home to help prevent the build of scar tissue and maintain range of motion. Physical therapists may come to a patient’s home for a few weeks after surgery prior to the patient starting outpatient PT, which will last for 3-4 months, depending on the progress. Physical therapists follow a protocol that is outlined by Dr. Faulkner to regain your range of motion and strength. Physical therapy and home exercises are a critical part to a patient’s outcomes and quality of life after surgery. The patient should expect to continue to improve with range of motion and strength up to 1 years after surgery, with most of the gains occurring within the first few months after surgery. The patient should plan on being seen in clinic about every 6 weeks for 6 months after the surgery for close monitoring and to ensure any questions are answered. After that, X-rays will be obtained at 1 and 2 years postop to ensure there is no evidence of loosening or shifting of the components.
Yes! We encourage you to ambulate as much as possible after surgery to regain your range of motion. Physical therapists will work with you to help you regain your range of motion and strength.
You should not drive for 6 weeks if the operative leg is your right leg. If the operative leg is your left leg, we recommend not driving for a few days after surgery as long as you are not taking any narcotics.
A prescription for a narcotic will be given to you at your preoperative appointment. Dr. Faulkner or his PA, Cara, will review instructions for this medication and what other over the counter medications can be taken to control pain. Risks and side effects will also be discussed.
It may be arranged for physical therapists to come to a your home for the first few weeks after surgery. When you can drive or arrange transportation, we encourage you to transition to outpatient physical therapy.
TED hose are worn to prevent blood clots in the legs. These should be worn for several hours a day for the first 2 weeks after surgery.
Yes! You will need to take a blood thinner to help prevent blood clots. This will be prescribed at your preoperative appointment by Dr. Faulkner or his PA, Cara. The instructions for this medication will also be discussed at this appointment.
You may shower 24 hours after surgery. The dressing placed over the incision in surgery is waterproof. You may get this wet, but should not soak it in water. This dressing will be removed at your first postop appointment.