|
There are many types of arthritis
(rheumatoid, degenerative, post-traumatic,
auto-immune induced, etc.). The most common form
is osteoarthritis. It is also known as
degenerative joint disease (DJD). While the exact
cause is unknown, there are known to be several
possible causes including: injury, age, congenital
predisposition and obesity. It is characterized by
the breakdown of the articular cartilage within
the joint.
Articular cartilage is a firm rubbery protein
material covering the end of a bone. It acts as a
cushion or shock absorber between the bones. When
articular cartilage breaks down, this cushion is
lost, and the bones will grind together. This
causes the development of symptoms such as pain,
swelling, bone spur formation and decreased
motion. Osteoarthritis commonly affects weight
bearing joints such as the knee, but it may affect
any joint.
For more information on basic joint anatomy and
articular cartilage:
Initially, arthritis of the knee is usually
treated non-operatively. The treatment methods may
involve weight loss, anti-inflammatory
medications, physical therapy, injection of the
joint with cortisone, injection of the joint with
a type of synthetic joint fluid designed to
lubricate the arthritic surfaces (Hyalgan), and
arthroscopic debridement of the damaged tissue
within the joint.
ntually, a knee replacement may be indicated,
after the other treatment methods have failed.
Typically, the TKR is delayed as long as possible.
This is primarily because the total knee
replacements will eventually fail and the
replacement may need to be replaced.
Unfortunately, when this occurs, the quality of
the result, and the amount of function in the
reconstructed knee decreases. Currently, most
total knee replacements have a life span of
approximately 10 years. While the replacements
typically work very well in a person who has a
severely arthritic knee, the replacement is not
like a normal knee joint. The types of activities
that a person may do after surgery are limited.
For example, jogging and skiing place too much
stress on the total joint replacement and will
increase the likelihood of failure of the joint,
thereby requiring a revision (replacement of the
TKR).
For a TKR, the preparations often start about a
month before surgery. Most patients who have a
total knee replacement will require blood
transfusions after surgery. If the patient wishes
to be transfused with his own blood, then the
patient will often donate 1 unit of blood per week
for the three weeks prior to surgery. During this
time, the person is often doing physical therapy
to get ready for the surgery. Usually, the patient
is admitted the morning of surgery, taken to
surgery where the knee replacement is performed,
and then starts in physical therapy the morning
after surgery. Most patients will stay in the
hospital for approximately 5 days.
WHAT TO EXPECT AFTER YOUR
SURGERY
After surgery, you will go to the Recovery Room
where you will be watched closely while you wake
up from your anesthesia. Usually, you stay in the
Recovery Room for about 1-2 hours before going to
your room.
Your health care team will use different types
of equipment and procedures to measure your
progress and help you recover from your surgery.
- VITAL SIGNS & CIRCULATION: Your
temperature, pulse, respiration and blood
pressure will be checked along with the pulses
on the top of your foot. You will be asked to
wiggle your toes and foot frequently to help
circulate your blood and use your leg muscles.
- TED HOSE: Specially-designed
stockings may be used after your surgery to help
increase the blood flow in your legs while you
are in bed. These help prevent blood clots from
forming in your legs. They should be taken off
every 8 hours for about 1/2 hour and then put
back on. You will want to wear these when you go
home from the hospital also.
- FOOT PUMPS: For the first few days
after surgery, special foot wraps will be used
while you are in bed. These wraps attach to an
air pump so that they inflate and deflate about
every 5 minutes. These pumps increase the blood
flow in your legs and help to prevent blood
clots from forming.
- SURGICAL DRESSING: Your surgical site
will be covered with a rather bulky dressing at
first. Your nurse will look at your dressing
periodically. Usually, this dressing is replaced
by a lighter one several days after surgery.
- WOUND DRAINS: Sometimes a small tube
is placed inside your incision during your
surgery to collect any extra fluid or blood so
it doesn't build up in your knee. The fluid
drains into a container that the nurses will
measure and empty periodically. Usually the
drain is removed the second day after surgery.
- URINARY CATHETER: Sometimes, a small
tube, or catheter, will be temporarily placed
into your bladder during surgery to drain your
urine into a collection bag. If you do not have
a catheter, then you will use a bedpan or urinal
to empty your bladder until you are able to get
up to the bathroom. If you have difficulty
urinating after surgery, then a catheter may be
inserted after arrival to the floor.
- IV: Just before surgery, a needle
will be placed in one of your veins, usually in
your arm or hand. This needle, called an IV,
will be used to give fluids and medicines during
and after surgery. Once in place, it shouldn't
be painful to you. Let your nurse know if you
have any discomfort from the IV needle.
- INCENTIVE SPIROMETER: The Incentive
Spirometer is a small device that helps you take
deep breaths. This will help your lungs expand
more fully helping to prevent pneumonia after
surgery. Your nurse or Respiratory Therapist
will teach you how to use this device. You may
get a chance to see how to use this before
surgery. It is very important to breathe into
this device at least 10 times every hour while
you are awake for the first few days after your
surgery.
- OXYGEN: Sometimes, a little extra
oxygen may be used after your surgery to help
you breathe easier. Usually, if oxygen is used,
it is only needed for the first day or so after
surgery. The oxygen may be given through prongs
placed close to your nose or through a mask over
your mouth. A Respiratory Therapist will be
working with you if you should need oxygen after
your surgery.
- CONTINUOUS PASSIVE MOTION DEVICE (CPM):
After surgery, it is advisable to begin moving
the knee as soon as possible. This is done with
a device known as a CPM unit which is applied to
your leg after surgery. This device moves very
slowly. By starting early motion, it is possible
to shorten the rehabilitation time.
Surprisingly, studies have shown that early
motion allows for more rapid healing and lessens
the pain after surgery. The CPM device should be
used as often as possible.
- NAUSEA MEDICATIONS: Some people
experience some nausea, or even vomiting, after
surgery. Anesthesia causes nausea for some
people, but this usually goes away during the
first day. Your doctor will order medication to
treat this, just in case it is a problem for
you. Let your nurse know how you feel.
- PAIN MEDICATIONS: You will be able to
discuss with your doctor or anesthesiologist the
best way to control your pain after surgery.
Several types of pain medications may be used.
These include:
- PCA pump: PCA stands for "Patient
Controlled Analgesia". This is a machine that
allows you to give your own pain medication
within certain ranges set by your doctor.
Don't worry, you can't give yourself too much
medication, but because you know best when you
need something for pain, you can control when
your pain medication is given. The machine is
connected to your IV and contains a vial
filled with the type of pain medication your
doctor has ordered for you. You will be given
a control button to push when you need the
machine to give your pain medicine. It is very
important to give this medicine before your
pain gets too bad, but it is also important
that you, and not your family members, are the
only one to operate your machine. Your nurse
will give you more instructions on how to
operate your PCA pump after your surgery.
- Pain Shots and Pain Pills: Sometimes, pain
shots or pain pills might work best to relieve
your pain. Your doctor will determine which
will work best for you. When using this type
of medication, it works best if you take them
before your pain is too severe, since they
take at least 20-30 minutes to start working.
- BLOOD THINNERS: Many patients will
need a "blood thinner" temporarily after surgery
to help prevent blood clots. Some "blood
thinners" can only by given by an injection,
while others may be given in a pill form.
Special blood tests will help your doctor give
the exact amount of medicine that your body
needs. Some people will need to take blood
thinners for a while after surgery.
- ANTIBIOTICS: Antibiotics are special
medicines which help treat or prevent
infections. These will be given through your IV,
usually for the first 48 hours after your
surgery. Your doctor might decide to use them
for longer depending on your needs.
- CONSTIPATION: After surgery,
constipation is a problem for many people. Pain
medications, decreased activity and changes in
your diet all interfere with your normal bowel
pattern. Stool softeners or laxatives can be
given if you need them. Please don't be
embarrassed to discuss this with your nurse.
- THERAPY: Therapy will begin the day
of your surgery unless otherwise ordered by your
doctor. Some pain should be expected when
starting activities after surgery, but it is
very important to begin as early as possible.
Your doctor will prescribe medications to help
minimize the pain you experience.
The Physical Therapist will assist you in
learning how to safely get in and out of bed and
walk with your walker or crutches. The therapist
will also assist you in regaining the strength
in your leg. After surgery, you will be allowed
to put as much weight as you can tolerate on
your leg when walking.
The Occupational Therapist will assist you in
learning how to safely perform your daily
activities like bathing, dressing, and getting
in and out of the bath tub. The therapist will
also assist you in increasing the strength in
your arms.
At the time of discharge, patients are usually
using crutches or a walker. The sutures or staples
are usually removed at about 2 weeks after
surgery. By 6 weeks, most patients are using a
cane to walk. After being discharged from the
hospital, most patients will be involved in a
outpatient rehabilitation program several times a
week. This is a physical therapy program that
involves supervised PT visits as well as a program
of home exercises that the patient must do. The
purpose of these exercises is to regain motion of
the knee joint, regain strength, and speed the
recovery process. After recovery from the surgery,
there may be activity limitations that a patient
may have placed upon them. Your surgeon will
usually go over these in detail. In addition, once
a person has a total joint replacement, it is
necessary to occasionally take antibiotics to
prevent infection of the joint. Usually this is
necessary for some dental procedures and some
types of surgery. Your surgeon will also discuss
this with you.
Finally, after discharge from the hospital, it
will be necessary to have follow-up visits with
your surgeon. However, if at any time during your
care you have any questions, you should contact
your surgeon. In addition, contact your surgeon
if any of the following occur:
- Fever over 100 degrees
- Drainage from incision
- Redness around incision
- Chest pain
- Chest congestion
- Shortness of breath or difficulty breathing
- Calf pain or swelling in your legs
- Dizziness or confusion
- Any other questions or concerns that you may
have
|
