Total & Partial Knee Replacement Surgery

05 December 2017 / By Andrea

What to expect

Total Knee Replacement

During total knee replacement surgery, Dr. Berger creates a small, 3- to 4-inch incision along the kneecap to reveal the end of the thigh bone, the top of the shin bone, and the back of the kneecap: the arthritic knee. While preserving the soft tissues, Dr. Berger begins by removing the arthritis on the bottom of the thigh bone, using special guides to help shape the bone so the prosthesis fits securely. He then removes arthritic bone from the top of the shin and the back of the kneecap. At this time any bone spurs or scar tissue that may have formed will be removed.

Next, Dr. Berger uses sizer pieces that range in increments of millimeters to measure the patient’s bone and determine the perfect-fit prosthesis. Upon reaching the optimal size, he secures the first part of the prosthesis to the end of the thigh bone using cement. The second part of the prosthesis is cemented to the top of the shin bone. He then snaps a polyethylene liner to the top of the shin bone component. This liner acts as cartilage and facilitates smooth and fluid movement. The final piece of the prosthesis is a polyethylene liner that is cemented to the back of the kneecap.

 

Partial Knee Replacement

During partial knee replacement, Dr. Berger follows the same procedure with one major difference. Dr. Berger carefully replaces the arthritic compartment of the knee while leaving the healthy side of the knee untouched.

Once all prosthesis pieces are in place, range of motion is tested by manually straightening and bending the patient’s knee. Surgery is finished by cleansing the inside of the knee with an antibiotic wash to prevent infection before closing the incision. On average, the whole process takes just over an hour.

After surgery, the patient is sent to a recovery room where they are cared for by one of Dr. Berger’s nurses.  A physical therapist will assist the patient to walk, climb stairs, and will provide the appropriate assistive device, such as a cane. Once the patient has been thoroughly examined, they are discharged from the hospital the same day of surgery.

Patient Guide

Prepping for Surgery

  • Cancel any dental appointments that fall between 3 weeks prior to surgery and three months after surgery.
  • Avoid any injections into your surgical joint for 3 months prior to surgery.

 

Pre-op Exercises

Therapy

In-home physical therapy

  • Dr. Berger’s patient services coordinator, DeAnna, will contact you prior to surgery to arrange your discharge plan. This includes services at your hotel as well as at your home, if applicable.
  • Home Health Services will be set up for 3x/week for two weeks or until you are ready to progress into outpatient physical therapy.

Outpatient physical therapy

  • You are responsible for setting up your outpatient physical therapy visits.  Select an outpatient facility that is convenient for you and takes your insurance.
  • You will be given an outpatient physical therapy prescription from our office; there is also a copy in your spiral-bound book.
  • You will go to outpatient physical therapy 3 times a week for 6 weeks.

Goals to Achieve by 3 Weeks

  1. Bend your knee at least 110 degrees (flexion)
  2. Straighten knee to 0 degrees (extension)
  3. Ambulate at least 2 blocks without an assistive device
  4. Independent with activities of daily living (i.e. showering, dressing, etc.)

Post Operative Medications

Dr. Berger will prescribe post-operative medications for each patient after surgery. A multi-modal approach is utilized to adequately control pain and minimize risk factors after surgery for a desirable recovery and ideal outcome.

When you are ready for prescription refills, contact one of the nurses in the office during normal business hours (Monday through Friday, 7 am – 5 pm). Refills can be authorized to your local pharmacy. You will need to provide us with your local pharmacy phone number, the name of the medication you need to be refilled, and your birthdate.

What to Expect After Surgery

WEEK 1:

RICE

  • R = Rest 
    We want you to be up and moving but do this in moderation. We recommend you rest the first 5-7 days after surgery. DO NOT OVERDO IT. Increased activity means increased swelling. By decreasing the swelling early you will recover quicker. We recommend small bouts of activity throughout the day. Get up and walk around the house a little bit every hour-to-hour and a half that you are awake.
  • I = Ice
    Ice as much as possible the first week to two weeks. ice is a great anti-inflammatory and helps minimize swelling. you may apply an ice massage over the knee, the quadriceps muscle (muscle located on the front of the thigh), the hamstring muscle (muscle located on the back of the thigh) and the calf.

      • We will provide you with an ice machine the day of your surgery.
  • C = Compress
    The TED hose compression stockings provide compression and help minimize swelling. Keep the stockings on during the day and take them off at night for the first 3 weeks after your surgery. The stockings go on both legs.
  • E = Elevate
    Elevating your leg will help reduce swelling. To reduce significant amounts of swelling elevate your leg 4-5 times a day for 15-30 minutes each time. Do this by lying flat with the ankle above your knee and your knee above your heart.

WEEK 2:

  • You may start using heat to help decrease bruising. Place a hot pack/heating pad over the front and back of the thigh (quadricep and hamstring muscles) and on the calf muscle. Try heat 3 times a day for 20 minutes each time. Using heat will increase your flexibility and make exercising easier. Alternate the heat and ice. Heat before you stretch/exercise and use ice after activity.
  • Start outpatient physical therapy.
  • Focus on range of motion, exercises, initiate strengthening and increase walking distance.
  • Return to driving.

WEEKS 3-6:

  • Ease into physical activity.
  • Continue outpatient physical therapy.
  • Return to work.
  • Significant reduction in swelling.

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