The knee, the largest joint in the body, is a hinge joint consisting of three parts. The lower end of the thigh bone, called the femur, rotates on the upper end of the shin bone, called the tibia, and the knee cap, or patella, which slides in a groove on the end of the femur.
Common diseases, such as arthritis, can damage your knee bone surfaces and surrounding cartilage, causing pain and impairing function. Total knee replacement can lead to dramatic improvements in your quality of life and health. More than 90 percent of people who undergo total knee replacement surgery experience a significant reduction of knee pain and return to their normal daily activities.
The decision to have total knee replacement surgery, however, should be made very carefully after consulting your doctor and learning as much as you can about the knee joint, your condition and the surgery.
Most patients who undergo total knee replacement are between the ages of 50 and 80, although people of all ages successfully undergo this procedure. Recommendations for surgery are based on your level of pain and disability, rather than your age. If after undergoing an orthopedic evaluation, you and your surgeon decide that knee replacement surgery is the best possible treatment, we will provide you with information on how to prepare for the procedure.
To learn more about the procedure, see the illustrated piece on Total Knee Replacement.
In some cases, arthritis may be localized to a single compartment in the knee. If your surgeon believes your knee has this type of localized arthritis, you may be a candidate for a partial knee replacement. This type of knee replacement is done through a smaller incision and a less invasive approach, which may result in a shorter hospitalization and earlier return to function following surgery. Your surgeon will discuss these techniques with you if he thinks you might be a candidate for a partial knee replacement.
A few weeks before your procedure, you will undergo a complete physical by your primary care doctor to rule out other medical problems that may interfere with your surgery. Your doctor will take your medical history and order tests that must be performed before surgery, such as blood tests, urinalysis, chest X-rays and electrocardiograms (EKG or ECG).
Tell your orthopedic surgeon about all medications you're taking. Your doctor will advise you regarding medications you should continue or stop taking prior to surgery. If you develop any infection prior to surgery, such as a cold or the flu, notify your surgeon immediately.
You should be in the best possible health before your surgery. If you're overweight, your doctor may suggest that you lose weight. If you smoke, it is highly recommended that you stop because smoking can change blood flow patterns and delay healing and recovery.
Seven days prior to surgery, you should stop taking all aspirin or other non-steroidal anti-inflammatory drugs, such as NSAIDS like Aleve, Motrin, Ibuprofen, Advil and Naproxen. You may continue taking Cox-II inhibitors such as Vioxx, Celebrex and Bextra. You may take Tylenol for pain and discomfort.
Total knee replacement can result in blood loss that may require a blood transfusion. It is suggested that you donate your own blood before surgery. If you're unable to donate blood for yourself, your family or friends may donate for you. They must have the same blood type and meet criteria for donation. Otherwise, banked blood is available. Banked blood, donated by volunteers, is screened for viral diseases and is matched to your blood type.
If you're having surgery due to an infected prosthesis, you're not allowed to donate your own blood for surgery. In this case, you must have family or friends donate blood or receive blood from a volunteer.
Significant dental conditions and problems should be treated prior to surgery. Although uncommon, an infection can occur as a result of these dental procedures if bacteria enter your bloodstream. If necessary, be sure to schedule an appointment with your dentist before your joint replacement surgery to treat any problems you may have.
Once your surgery has been scheduled, call your insurance company to inform your health plan of your upcoming procedure. You'll need to provide the date of your surgery, procedure type and the phone number for our office. You should discuss the type of post-surgery services, such as rehabilitation hospital care and home physical therapy, as well as equipment, such as a commode and walker, your insurance plan covers.
Prepare for your return home prior to your surgery so you are as comfortable as possible. We recommend that a family member or friend be with you 24 hours a day for the first week. Make sure you have rides planned from the hospital and to all follow-up visits, which will be at three, six and 12 weeks after surgery.
If you have crutches or a walker, bring them to the hospital. If you don't already have walking aids, let us know and we will help you to rent or purchase these and other recommended devices, such as a raised toilet seat, bedside commode and tub chair, at the hospital.
After surgery, you'll need help caring for yourself at home. Plan who will assist you and talk with them about your concerns. If no one is available to care for you, please let us know and a discharge-planning nurse can help make arrangements for skilled nursing or caregivers to help you at home.
Arranging meals that can be stored and frozen and stocking up on prepared foods will eliminate extra work for your caregiver. Organize your home with safety features to prevent accidents. These include making pathways in crowded areas, eliminating all throw rugs, securing extension cords and telephone cords strung across the floor, securing handrails in your bathtub and stairways, and placing all needed items at a level so that you can easily reach them. You also should be sure that your house is equipped with the following:
Pack a small suitcase for your hospital stay that includes a list of your personal hygiene items, comfortable and loose clothing, a knee-length robe and slip-on shoes. Please leave all of your valuables, including jewelry, wallet and watches, at home. It is not necessary to bring your medications, but please bring a list of your medications and their dosages, as the hospital will provide you with your medications. We recommend that you bring a phone card, if you plan to make long-distance calls.
Our hospital staff will call to notify you of your surgery and scheduled admission times. You may not eat or drink anything after midnight the night before your surgery. Please take a shower or bath and wash your body thoroughly. Try to rest and go to bed early.
Reviewed by health care specialists at UCSF Medical Center.
This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.
Arthritis & Joint Replacement Center
1500 Owens St., Suite 430
San Francisco, CA 94158
Phone: (415) 353–2808
Fax: (415) 885–3862
Prepare Program at Mission Bay
1825 Fourth St., Third Floor, 3B
San Francisco, CA 94158
Phone: (415) 514-5590
Prepare Program at Parnassus
505 Parnassus Ave., Suite L-171
San Francisco, CA 94143-0210
Phone: (415) 353-1480
Fax: (415) 353-8577