Total Knee Replacement
Total knee replacement surgery is most commonly done for people with severe knee arthritis and associated pain that significantly affects their daily activity and sleep.
Knee replacement surgery is a highly successful procedure, however it is important that we assess your suitability for this operation.
Total knee replacement surgery is a common surgery which relieves the pain of severe knee arthritis.
You are most likely to benefit from total knee replacement surgery if you are experiencing:
- Arthritis pain which is significantly affecting your ability to
- carry out normal daily activities
- walking to the shops
- playing golf, tennis or go bowling
- get a good night’s sleep.
- Pain even though you have tried combinations of
- Pain-killers
- Anti-inflammatories
- Physiotherapy
- weight loss
- Changing your activities.
The aim of Total knee replacement surgery is relieve your pain and give you a knee that you can trust while you get back to the activities that make you happy.
A total knee replacement surgery is rarely an urgent surgery and results are generally better with proper preparation. It is vital that you work with your physiotherapist to maximise your range of motion and hip strength to be prepared for the rehab and recovery. Our MTP Health Knee programs can help you with this.
It is important to consider the rehabilitation and recovery time from the surgery and what effect the timing of surgery will have on:
- Family events and holidays
- Work trips or busy periods
At MTP Health, we take your preparation for surgery very seriously. It is our policy to prepare you over a minimum period of 4-6 weeks in order to ensure that you get the best outcome through being psychologically prepared, physically strong and medically safe enough to undergo this procedure.
These tests will include -
- Planning imaging including a CT scan
- Routine blood tests
- Swabs for MRSA
If there are any specific concerns or medical issues, we will ensure that they are optimised prior to the surgery and to do this we will also organise for you to be seen by:
- A Cardiologist to ensure there are no issues with your heart during the anaesthetic
- Any other of your treating physicians e.g.: for your diabetes or lung conditions
Finally and importantly, we will help you to get strong:
- Our team of physiotherapists and exercise physiologists will assess your level of function
- You will be given a personal program in the lead up to your operation to make sure you are ready to start recovering as soon as you wake up from the anaesthetic
Please see the “Preparing for joint replacement surgery” for more detail.
We need to know about all your medications but especially those for diabetes, blood pressure or blood thinning as we may need you to stop some or all of them up to 1 week before surgery. It is highly recommended that if you are a smoker, that you refrain from smoking for as long as possible prior to surgery to ensure the best outcomes.
You must ensure that your knee area remains free from scratches in the weeks before surgeries - NO LAST MINUTE GARDENING. If this occurs, please tell us as it increases your infection risk and your surgery may need to be delayed. This can happen in the anaesthetic bay if we don;t know about it beforehand. If not sure, send us a picture.
The hospital will contact you in the week of surgery and they will confirm with you on the day before your surgery, the time you need to arrive and when you need to start fasting.
For our patients, if you are on a morning list you need to stop all food from midnight and stop clear fluids from 0530 or 2 hours before the planned start of the list, whichever comes first.
For afternoon lists that time is 11am.
Acceptable clear fluids include water, ‘see through’ apple juice with no bits or ‘see through’ energy drink such as gatorade. It does not include milk or cloudy juice with bits.
You will arrive at the hospital between 1 and 2 hours before your surgery. You will have your knee area prepared by a nurse who will shave the skin and paint on a coloured antiseptic solution. You will then meet one of our anaesthetic team. They will make sure you are comfortable and safe during the procedure.
Before your anaesthetic, your surgeon will see you and ask you “Which JOINT and What SIDE?” This is critical as they will then check this matches your consent form and draw an arrow on the knee that you specify and point to. This is the most effective way of stopping ‘Wrong Side surgery.”
At the start of the procedure you are transferred from your nice warm bed to lie on your back on a hard and cold operating table - apologies in advance. The most common anaesthetic for a joint replacement surgery is a spinal block with a light general anaesthetic. This means you will be asleep. A urinary catheter is placed before the operation but this will be removed in recovery in most cases. The Surgical team then performs the “Time-out” procedure to Double check that your name band, imaging and the arrow drawn on your knee all match with your signed consent form.
The procedure is done under sterile conditions with you lying on your back. The incision will be approximately 10-20 cm down the middle of the knee where we expose the bones of the knee. Using specialised equipment, we then remove the damaged bone and cartilage at the end of the femur (thighbone) and tibia (shin bone). The metal knee components are then fixed into place on both the femur and tibia. A durable polyethylene plastic insert is placed between the metal components to act as a cushion and allow smooth bending of the knee. The new knee will be tested to make sure it is stable and bending correctly before we close your wounds with a dissolvable stitch to minimise scarring. Dressings and a bandage will then be applied to protect the wound for the weeks following the operation.
The surgery takes between 90 minutes to 2 hours on average with additional time before for anaesthetics and after for recovery. For the waiting relatives or partners, it is usually between 3-5 hours from leaving the admissions area to getting back to the ward.
After the operation, you wake up in the recovery room, where you are monitored for approximately 1 hour. During this time, your surgeon will call your relative. It is important that they realise that this may be more than 4 hours from the time you were ‘taken into the operating theatres’ due to waiting and preparation times.
Once stable, you can be transferred to the ward to begin your post-surgical recovery. The knee replacement that has been placed is strong enough for you to walk on it straight away with all your weight and the team will have you walking within 4 hours of waking up. If you are light headed or nauseated, they will help you to stand and march on the spot.
WALKING - The knee replacement that has been placed is strong enough for you to walk on it straight away with all your weight and the team will have you walking within 4 hours of waking up. If you are light headed or nauseated, they will help you to stand and march on the spot. You are encouraged to bend it as much as you can tolerate.
DRESSINGS - The bulky dressings can be removed the morning after surgery. You will have a waterproof dressing that you should leave on until you have your wound check at 10-14 days. It is common for a small amount of ooze to dry into the dressings over the first 24-48 hours..
You can shower with this dressing but avoid soaking in the bath, a pool or the ocean. If it comes loose or gets soaked, please replace it. We do not allow hydrotherapy within the first 3 weeks of joint replacement surgery until the wound is healed and watertight.
GAME READY - If you have been supplied with a Game Ready machine, we advise that you use it on program 2 or 3 and for up to 2 hours at a time. You can use it as often as you like in a day as long as you manage to complete your rehabilitation exercises. If your pain and swelling are well controlled then you don’t need to use it. When rented from MTP Health you have the Game Ready for 2 weeks. At the end of this time it will be picked up by a courier unless you would like additional rental time.
LENGTH OF STAY - We call the day after surgery ‘Day 1 post surgery.’ Your aim on this first day is to pass all your discharge tests from the hospital physiotherapists and plan for going home. We will organise an x-ray of the knee if not done in recovery and a blood test to check for blood loss and kidney function. It is safe for some to go home on the same day of surgery but more usually, patients stay overnight and possibly a second night.
SURGEON FOLLOW UP
Your first post-operative visit will be with your surgeon at 2 weeks. This appointment is critical for checking your wound healing and to assess your new knee as well as to answer any questions you may have.
Further follow up with your surgeon with x-rays at some visits to check the prosthesis -
- 6 weeks after surgery + XR
- 12 weeks after surgery
- 6 months after surgery
- 1 year after surgery and annually ongoing + XR
Your recovery starts the minute you are awake from the anaesthetic. You start with the simple exercises including ‘Pumping’ your calf muscles to encourage blood movement through the legs which will reduce your risk of DVT and contracting your thigh muscles to squash the back of your knee into the bed. The physiotherapist will assist you in getting out of bed and sitting out in a chair. A walking aide such as a tall walking frame is used to help you balance initially and this is progressed quickly to a smaller frame and then crutches, as shown at the Jointworks Preop Joint Clinic.
Your job is to get the physiotherapists to sign you off as ‘READY FOR DISCHARGE HOME’ on DAY 1 which needs you to be safe on crutches and able to climb stairs.
Your main focus in the first 2 weeks following the operation is to take the painkillers you need to be able to do your exercises that will help you get the flexibility back into the knee and strengthen up your thigh muscles again.
Most patients do not need inpatient rehabilitation services but they are very useful for those that live alone or have many stairs to get into their house. We have many options for helping you to successfully rehabilitate at home and we will go through all these in your preparation sessions.
Two weeks following the operation, we will examine your surgical wound and ensure that it is healing well. The dressings can then be removed, and you will be able to shower without covering the wound. The sutures are dissolvable and will not need to be removed.
Six weeks from the operation, we will ask you to get an x-ray where we can check that the prosthesis is still secure and functioning well.
Returning to work and sport depends on your line of work, recovery speed and reliance on transport.
Work
Office based jobs can be restarted as soon as you are comfortable and no longer taking strong pain killers. Although sitting for long periods may be uncomfortable, there are no restrictions on doing so. It takes longer to return to more Physically demanding jobs for healing and safety reasons. Activities such as climbing ladders and carrying heavy loads are to be avoided for a minimum of 12 weeks.
Sport
Return to sport is a gradual process that is guided by your pain levels and recovery progress with physiotherapy. It is also very dependant on the activity you wish to return to. Swimming for example can be restarted after 3 weeks when the surgical wound has healed and you are comfortable, though it is recommended this is supervised or in water in which you can stand initially. More intensive sports such as bush walking, golf etc will take at least 6 weeks to return to and again this is a gradual return. It is not recommended that you run on any knee replacement unless previously discussed with your surgeon.
Driving
It is recommended that you do not recommence driving until you can safely perform an “emergency stop” and are no longer taking strong pain killers. On average, this is a minimum of 2 weeks from a left knee replacement and 6 week from a right knee replacement. Please check with your surgeon and your car insurance company.
All surgery involves a risk of complications. Fortunately, serious complications are uncommon.
In general, the risks during the operation involve those related to the anaesthetic - heart, lung and brain problems which can include allergic reactions, blood loss requiring transfusion, kidney injury, heart attack, stroke and death.
The surgical complications include the general risks of:
- Blood clots (DVT/PE) in the veins (Note to vividus - DR NEGUS to add % to all these - different for each type of surgery)
- Infection and wound breakdown
- Injury to blood vessels
- Injury to nerves
- Damage to the bone including fractures
Specific surgical complications relating to knee replacement include:
- The most common risk is damaging the small branches of the saphenous nerve that supplies the sensation over the front of the knee causing numbness on the outer part of the scar. It usually gets better over time, but in many cases this area remains permanently numb and can cause discomfort when kneeling. It does not cause any muscle weakness
- Knee stiffness - Nearly all knees are stiff following replacement surgery but some stay stiff even after 2 months and can require further procedures to help them bend again
- Over time the plastic components can wear out and need replacing
- The metal components can become loose from the bone needing replacing
- Dislocation - the kneecap can become unstable or even dislocate following surgery
- The common peroneal nerve can be damaged by retractors or from straightening up a knee that was very stiff, especially when the arthritis had caused a knock-kneed (valgus) deformity. Stretching or damaging this nerve damage can lead to ‘foot drop’ and numbness which can be permanent.
- Leg length discrepancy - It is uncommon to change the length of the leg after knee replacement surgery
As always with the health system, the answer is ‘It depends.’
However, at Jointworks our mission is to simplify healthcare through a better understanding of the system upfront. Therefore, while you can discuss the options specific to you with the team when you see your specialist -
If you are having your surgery using your private health cover then the standard fees for the surgeon, the anaesthetist and the assistant will usually lead to a total out of pocket payment of approximately $4,500-5,000.
This is the ‘GAP’ that is left after Medicare and your insurance company have given you back their rebates. It is important to stress that the anesthetist is an independent practitioner and can charge a different gap which could affect this figure. We always provide you with their details and recommend you check their quote before committing to surgery.
The surgeons at Jointworks do participate in the various reduced gap schemes run by different health insurance providers. However, please check for availability of surgical time slots first as there is often a wait of many months for this option.
Your insurance may also have an excess to pay so please check. This is usually $500.
If you are having the operation under the public system there is no out of pocket cost. Unfortunately, you are likely to have to wait up to a year for surgery and you MUST LIVE on the NORTHERN BEACHES of Sydney to be eligible.