TotalKneeArthroplasty(TKA)Totalkneereplacement,ortotalkneearthroplasty,isasurgicalprocedureinwhichpartsofthekneejointarereplacedwithartificialparts(prostheses).Mostkneereplacementjointsattempttoreplicateyourknee'snaturalabilitytorollandglideasitbends.
Anormalkneefunctionsasahingejointbetweentheupperlegbone(femur)andlowerlegbones(tibiaandfibula).Thesurfaceswherethesebonesmeetcanbecomewornoutovertime,oftenduetoarthritis,whichcancausepainandswelling.
Themostcommonreasonforkneereplacementisthatothertreatments(weightloss,medicines,andinjections)havefailedtorelievearthritis-associatedkneepain.
Thegoalofkneereplacementistorelievepain,improveyourqualityoflife,andmaintainorimprovekneefunction.Mostpeoplewhohaveakneereplacementexperiencesignificantpainrelief,improvedmobilityandabetteroverallqualityoflife.
InHospitalCareandPhysicalTherapy:Earlyeffortsatmobilizingthepatientaremadeonthedayaftersurgery.UsuallyaContinuousPassiveMotionmachine(CPMmachine)isappliedtotheoperativelegonthedayordayaftersurgerytostartearlyrangeofmotion.Thepatientishelpeduptoachairtheeveningofsurgery.Extensivewalkingisavoidedfor12to18hourspost-operativelytilltheeffectsofthenerveblockswearoffandmuscularcontroloftheleghasreturned(asmallpricetopayforthecomfortprovided).Onthedayfollowingsurgery,thesurgicaldrain(ifutilized)isremoved.Thepost-opcompressivedressingischangedtoalightdressingonpost-opday#2.Immediatefullweightbearingisallowed.Rangeofmotionandstrengtheningexercisesarebegun.Ambulationisencouraged.Stairclimbingistaught.Thegoaloftherapyistoreduceswellingandpain,normalizegait,restorestrength,rangeofmotionandbalance.HospitalStay:Thehospitalstayisbrief.Manypatientsareusuallydischargedhomeortoarehabilitationfacilityonthethirddayaftersurgery.ShoweringPost-operatively:Itissafetogetthewoundwetafterthesutures/stapleshavebeenremovedatthe1stpost-opvisit,untilthenshowersareallowedwithawaterproofdressing.Ifanydrainagepersists,thewoundshouldbekeptcleananddrywithasterilegauzedressingappliedandchangedasnecessaryandtheincisioncleanedwithalcoholtillitcompletelystops.
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PhysicalTherapyafterHospitalDischarge:Threeoptionsareavailableforposthospitaltherapy.
1.Hometherapy–Thisisnowthemostcommonlyemployedoption.Mostpatientshaveinsurancecoverageforhometherapy.Thequalityofhometherapyisquiteexcellent.Durationvaries,butisgenerallyemployedfor1to2weeks.
2.Outpatienttherapy-Outpatienttherapyinaphysicaltherapydepartmenthastheadvantageofbetterequipmentvs.whatisavailableinhome.Moremobilepatientsoftenoptforoutpatientcare.Patientsoftenmigratefromhometooutpatienttherapyastheybecomemoremobile.
3.Rehabfacilitytransfer–Directtransferfromthehospitaltoarehabfacilityaftertotalkneereplacementsurgery.Thisoptionismostappropriateforolderpatientswholivealone.Insurancecoverageforrehabstayvariesandneedstobeinvestigatedinadvance.Durationofrehabstaycanbeasshortafewdaysoraslongasacoupleofweeksanddependsonthespeedofrecoveryandtheamountofsupporteachpatientwillhavewhenreturninghome.
PreventionofBloodClots:Sometypeofbloodthinnerisusedinallcasestopreventtheformationofbloodclots.OralCoumadin(Warfarin)orfractionatedHeparin(Fragmin)subcutaneousinjectionsfor2weekswillbeutilized.IfCoumadinisusedtwiceweeklybloodworkisperformedtoensurethatthebloodisnot“toothin”andthedosingiscorrecttoreducetheriskofbloodclots.ECASA325mgtwicedailyisrecommendedforthenext2weeksaftertheCoumadinorFragminisstopped.Compressivestockings(TEDS)willbeutilizedfor1monthaftersurgery.TimeonWalkerorCrutches:Fullweightbearingisallowedimmediatelyaftersurgery.Mostpatientscanweanoffthewalkerorcrutchesastheirmusclefunction,swellingandsorenessallows.Manypatientshavemovedtotheuseofacaneby7to14dayspost-op.TimeonaCane:Onceoffthewalkerorcrutches,theuseofacaneintheoppositehandishelpfulforanotherweekortwo.Mostphysicallyfitpatientsareoffallambulatoryaidsincludingacaneby2to3weekspost-op.TimeuntilReturntoDriving:Patientsshouldnotreturntodrivinguntilclearedtodosopost-op.Inpartthisisduetoliabilityissuesifanaccidentshouldoccur.Drivingispossibleinfourtosixweekspost-operativelyifyoucanbendyourkneefarenoughtositinacarandyouhaveenoughmusclecontroltoproperlyoperatethebrakesandaccelerator(shorterforaleftknee,longerforarightknee).Youcannotdriveifyouarestilltakingnarcoticanalgesics!TimeuntilReturningtoWork:Predictingareturntoworkdateisdifficult.Motivationalissuesplayanimportantrole.Greatvariabilityexists.Ingeneral,patientsreturningtoasedentaryjobtendtoreturntowork2to4weekspost-opandthosewithmorephysicallydemandingjobstendtoreturnat2to3monthspost-op.TimeuntilReturningtoRecreationalAthletics:Patientscanbegintoreturntolightrecreationalsportssuchasgolfby6to8weekspost-op.Morestrenuoussports,suchastennismayrequire12weeksorlongerbeforeareturnispossible.Afteryou'verecovered,youcanenjoyavarietyoflow-impactactivities,suchaswalking,swimming,playinggolforbiking.Buthigherimpactactivities,suchasjogging,skiing,tennis(unlessdoubles),andsportsthatinvolvecontactorjumping,maybeout.
