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URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/002974.htm
Knee joint replacement is surgery to replace a knee joint with an artificial joint. The artificial joint is called a prosthesis.
Description
You may receive general anesthesia before this surgery. This means you will be unconscious and unable to feel pain.
Or, you may have a spinal or epidural anesthesia. In this kind of anesthesia, medicine is put into your back to make you
numb below your waist.
After you receive anesthesia, your surgeon will make an incision (cut) over your knee to open it up. Then your surgeon
will:
Move your kneecap (patella) out of the way, then shape the ends of your thigh bone and shin bone to fit the
prosthesis. Your surgeon will also cut the underside of your kneecap to prepare it for the artificial pieces that will
be attached there.
Fasten the two parts of the prosthesis to your bones. One part will be attached to the end of your thigh bone
and the other part will be attached to your shin bone. Both parts will then be attached to the underside of your
kneecap. Your surgeon will use a special bone cement to attach these parts.
Usually, artificial knees have metal parts. Now, though, some surgeons are using some different materials, including
metal on metal, ceramic on ceramic, or ceramic on plastic.
Why the Procedure is Performed
Knee joint replacement may be recommended for:
Severe arthritis (osteoarthritis or rheumatoid arthritis) of the knee that has not gotten better with medicine,
injections, and physical therapy after 6 months or more of treatment. Your doctor may recommend knee
replacement for these problems:
Inability to sleep through the night because of knee pain
Knee pain that has not improved with other treatment
Knee pain that limits or keeps you from being able to do your normal activities, especially your daily
activities such as bathing, preparing meals, household chores, and other things.
Some tumors that affect the knee
Even when a knee replacement is needed, some medical problems may lead your doctor to recommend that you not
have it done. Some of these problems are:
A knee infection
Morbid obesity (weighing over 300 pounds)
Very weak quadriceps, the muscles in the front of your thigh. Weak quadriceps could make it very hard for you
to walk and use your knee.
Unhealthy skin around your knee
Severe mental dysfunction
Poor blood flow in the leg from peripheral vascular disease. This could keep the incision from healing.
A terminal disease, such as cancer, that has spread
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Risks
Risks for any surgery are:
Breathing problems
Infection, including in the lungs, urinary tract, and chest
Bleeding
Heart attack or stroke during surgery
The risks of this surgery are:
Dislocation of the artificial joint
Infection that requires removing the joint
Loosening of the artificial joint over time
Pneumonia
Allergic reaction to the artificial joint
Injury to nerves or blood vessels
Blood clots that may form in your leg (deep vein thrombosis) or your lungs (pulmonary embolism)
Before the Procedure
Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a
prescription
During the 2 weeks before your surgery:
Prepare your home.
Two weeks before surgery you may be asked to stop taking drugs that make it harder for your blood to clot.
These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
Ask your doctor which drugs you should still take on the day of your surgery.
If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your doctorwho treats you for these conditions.
Tell your doctor if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
If you smoke, you need to stop. Ask your doctor or nurse for help. Smoking will slow down wound and bone
healing. Your recovery overall may not be as good if you keep smoking.
Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before
your surgery.
You may want to visit a physical therapist to learn some exercises to do before surgery and to practice using
crutches or a walker.
On the day of your surgery:
You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
Take your drugs your doctor told you to take with a small sip of water.
Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure
You will stay in the hospital for 3 to 5 days, But full recovery will take from 2 to 3 months to a year.
After surgery:
You will have a large dressing (bandage) over your knee. A small drainage tube will be placed during surgery to
help drain fluids that build up in your knee joint after surgery. It will be removed when you no longer need it.You will have an IV (a catheter, or tube, that is inserted into a vein, usually in your arm).
You may have a Foley catheter inserted into your bladder to drain urine. Usually it is removed 2 or 3 days after
surgery.
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You will wear special compression stockings on your legs. These stockings improve blood flow and reduce your
risk of getting blood clots.
Most people will also receive blood-thinning medicine to reduce the risk of blood clots more.
You may be taught how to use a device called a spirometer and do deep breathing and coughing exercises.
Doing these exercises will help prevent pneumonia.
Your doctor will prescribe pain medicines to control your pain. Your doctor may also prescribe antibiotics to
prevent infection.
You will be encouraged to start moving and walking as soon as the first day after surgery.
You will be helped out of bed to a chair on the first day after surgery. When you are in bed, bend and straighten
your ankles often to prevent blood clots.
You will be encouraged to do as much you can for yourself as possible by the second day. This includes going to
the bathroom or taking walks in the hallways, always with someone helping you.
Some surgeons recommend using a continuous passive motion machine (CPM) while you are in bed. The CPM
bends your knee for you. Over time, the rate and amount of bending will increase. If you are using one, always
keep your leg in the CPM when you are in bed. It will help speed your recovery and reduce pain, bleeding, and
risk of infection.
Some people need a short stay in a rehabilitation center after they leave the hospital and before they go home. At arehab center, you will learn how to safely do your daily activities on your own.
Outlook (Prognosis)
The results of a total knee replacement are often excellent. The operation relieves pain for most people, and most
people do not need help walking after they fully recover. Most artificial knee joints last 10 to 15 years. Some last as
long as 20 years before they loosen and need to be replaced again.
Alternative Names
Total knee replacement; Knee arthroplasty; Knee replacement - total; Tricompartmental knee replacement
References
Crockarell JR, Guyton JL. Arthroplasty of the knee. In: Canale ST, Beatty JH, eds. Campbell's Operative
Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 6.
Jones CA, Beaupre LA, Johnston DW, Suarez-Almazor ME. Total joint arthroplasties: current concepts of patient
outcomes after surgery. Rheum Dis Clin North Am. 2007; 33(1): 71-86.
Update Date: 2/9/2009
Updated by: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of
Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission
(www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous
standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online
health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy.
A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation
(www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical
condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all
medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other
sites. Copyright 1997-2011, A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Normal anatomy
The knee is a complex joint, which is made up of the distal end of the femur (the femoral condyles), andthe proximal end of the tibia (the tibial plateau). The femoral condyles usually glide smoothly on the tibial
plateau, allowing for smooth, painless motion of the lower leg.
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Updated by: Mark James Borigini, MD, Rheumatologist in the Washington, DC Metro area. Review
provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director,
A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare
Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that
A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve
this important distinction for online health information and services. Learn more about A.D.A.M.'s
editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics
and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis ortreatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment
of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided
for information only -- they do not constitute endorsements of those other sites. Copyright 1997-2011,
A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Indications
The most common cause of knee damage requiring knee replacement is osteoarthritis, which is adegenerative disease of the bones of the knee which cause the surfaces of the knee joint to become
irregular and rough, preventing smooth painless motion of the knee joint.
Knee joint replacement may be recommended for:
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knee osteoarthritis or arthritis, which causes knee pain that has failed to respond to conservative
therapy (NSAID medication for 6 months or more)
decreased knee function caused by arthritis
inability to work because of knee pain
inability to sleep through the night because of knee pain
inability to walk more than 3 blocks because of knee pain
loose knee prosthesis
some knee fractures
Updated by: Mark James Borigini, MD, Rheumatologist in the Washington, DC Metro area. Review
provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director,
A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare
Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that
A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve
this important distinction for online health information and services. Learn more about A.D.A.M.'s
editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics
and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or
treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment
of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are providedfor information only -- they do not constitute endorsements of those other sites. Copyright 1997-2011,
A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Mobile versionGet email updatesSubscribe to RSSFollow us on Twitter
DisclaimersCopyrightPrivacyAccessibilityQuality Guidelines
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Procedure
The operation is performed under general anesthesia. The orthopedic surgeon makes an incision over theaffected knee. The patella (knee cap) is moved out of the way, and the heads of the femur and tibia are
shaved to eliminate any rough parts and to permit a better adhesion of the prosthesis. The two parts of the
prosthesis are implanted into the thigh bone and the tibia bone using a special bone cement.
Health Topics
Drugs & Supplements
Videos & Cool Tools
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Updated by: Mark James Borigini, MD, Rheumatologist in the Washington, DC Metro area. Review
provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director,
A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare
Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that
A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve
this important distinction for online health information and services. Learn more about A.D.A.M.'s
editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics
and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis ortreatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment
of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided
for information only -- they do not constitute endorsements of those other sites. Copyright 1997-2011,
A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Mobile versionGet email updatesSubscribe to RSSFollow us on Twitter
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Gradually, the rate and amount of flexion will be increased as tolerated. The leg should always be in this
device when in bed. The CPM device helps speed recovery, decreases post-operative pain, bleeding and
infection.
You will experience moderate pain after surgery. However, you may receive patient-controlled analgesia
(PCA), or epidural analgesics to control your pain for the first 3 days after surgery. The pain should
gradually decrease, and by the third day after surgery, oral analgesic medications may be sufficient to
control your pain.
Try to schedule your pain medications about one half hour before walking or position changes. You will
also return from surgery with several IV lines in place to provide hydration and nutrition. The IV will
remain in place until you are taking adequate amounts of oral fluids.
Prophylactic (preventive) antibiotics may be given to reduce the risk of developing an infection,
necessitating removal of the artificial joint.
You will also return from surgery wearing anti-embolism stockings or an inflatable pneumatic compression
stockings. These devices are used to reduce your risk of developing blood clots, which are more common
after lower extremity surgery.
Additionally, you will be encouraged to start moving and walking early after surgery. You will be assisted
out of bed to a chair on the first day after surgery. When in bed, bend and straighten your ankles
frequently to prevent development of blood clots.
Updated by: Mark James Borigini, MD, Rheumatologist in the Washington, DC Metro area. Review
provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director,
A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare
Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that
A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve
this important distinction for online health information and services. Learn more about A.D.A.M.'s
editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics
and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or
treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment
of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided
for information only -- they do not constitute endorsements of those other sites. Copyright 1997-2011,
A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Mobile versionGet email updatesSubscribe to RSSFollow us on Twitter
DisclaimersCopyrightPrivacyAccessibilityQuality Guidelines
U.S. National Library of Medicine8600 Rockville Pike, Bethesda, MD 20894U.S. Department of Health
and Human ServicesNational Institutes of Health
Page last updated: 15 December 2010
e joint replacement - series: MedlinePlus Medical Encyclopedia http://www.nlm.nih.gov/medlineplus/ency/presentations/100088_4.ht