Knee replacement is performed in an operating room after you are given anaesthesia. The surgery takes two to three hours. After surgery, you will be monitored in a recovery area for several hours, until the effects of the anaesthesia wear off.
Most people stay in the hospital for one to four nights after surgery, although shorter stays are becoming more common. During this time, you will be given pain medicines.
Blood clots in the legs (called deep vein thromboses) are a common concern after knee replacement surgery.
To reduce the risk of blood clots:
- Mobilize early. Work with your physical therapist to try and get up the day of surgery or the day after. Learn exercises to do while in bed.
- You will take a medicine, either as a pill or a shot. Most patients continue to take this medicine for a few weeks after surgery.
- You will need to wear compression boots (devices that go around the legs and inflate periodically) while you are lying down.
- Once you are able to get up and walk, you will wear antiembolism stockings.
- These stockings fit snugly around the foot, ankle, lower leg, and knee to help prevent blood clots.
- Infection is another major concern, and you will be given antibiotics within an hour of the procedure and for up to 24 hours after.
- Eating a healthy diet, avoiding obesity, and smoking cessation all are helpful for minimizing infection risk.
- You will be encouraged to start moving your feet and ankles immediately after surgery. Some surgeons use a continuous passive motion device, which raises and slowly moves your leg while you are in bed. It is common to begin physical therapy the day of or one day after surgery, while you are still in the hospital.
- Physical therapy is an important part of the recovery process. After leaving the hospital, some people have physical therapy in their home or at a clinic, while others stay in a rehabilitation facility or nursing home for a few days.
- The rehabilitation program generally includes exercises to improve range of motion (how far you can bend and straighten your knee) and to strengthen your leg muscles. Your surgeon and physical therapist will help to set goals as you progress through rehabilitation.
- The goal of the rehabilitation period is to regain strength and movement in the knee; it is important to avoid overworking or straining the knee during this recovery period. You can usually resume your normal activities within three to six weeks after surgery.
- After several months of rehabilitation, you will be able to have a more active lifestyle. High-impact sports such as running and sports that involve heavy contact (football) are not recommended, but you should be able to participate in activities like walking, bicycling, and swimming.
Serious complications are not common after knee replacement. However, it is important to be aware of the major potential complications. Studies have shown that a successful joint replacement partially depends upon the experience of the surgeon and the hospital. In one study, outcomes were better in people who had:
A surgeon who performed more than six knee replacements each year Surgery performed in a hospital where more than 25 joint replacements were performed per year.
Better outcomes included better knee function and lower rates of complications after surgery.
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Blood clot: Having total knee replacement increases the risk of a blood clot forming in a vein (called a thrombosis). The most common place for a thrombosis to develop after knee surgery is in the deep veins of the leg (called a deep vein thrombosis [DVT]). Symptoms of a DVT include leg pain and swelling. Call your doctor's office if you are worried that you could have a DVT.
Infection: Infection following knee replacement is a relatively uncommon but serious complication. Signs of infection include fever, chills, pain in the knee that gets worse suddenly, increasing redness, or swelling. Call your doctor's office if you are worried that you could have an infection. Wound infections are treated with antibiotics and occasionally by draining excess fluid from the joint. If an infection becomes deep or extensive, the prosthetic joint may need to be removed and reimplanted later, after the infection has cleared.
Stiffness: Occasionally, despite physical therapy, a patient’s knee may get stiff and may not bend or straighten properly. If this occurs, then the patient may return to the operating room in order to bend and/or straighten the knee under anaesthesia.
Early failure: Although most studies demonstrate that 80 to 90 per cent of total knees will last between 15 to 20 years, early failures may occur due to a variety of reasons. These include loosening of the implants, infection, fractures of the bone around the implants, and instability. When early failures occur, revision surgery may be necessary.