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Total Knee Replacement


Entrance Survey

Before we begin, please take this short survey.

Reasons 

This is my grandmother.

She presented with symptoms of knee pain and stiffness, and it continued to grow worse to the point where she could not walk without severe pain. The doctor diagnosed her with osteoarthritis and recommended that she have knee replacement surgery. Upon an X-ray, it was found that her cartilage was almost completely gone, and it affected her entire knee joint. She then went in for total knee replacement surgery. It has been 8 weeks since surgery and she is recovering nicely. She goes to physical therapy twice a week and can now take short walks around the neighborhood without assistance.

During this process, we were confused and overwhelmed by the large amount of information that we found online, some of it contradictory. Our experience allowed us to sift through what was correct and what was incorrect. Therefore, for this project, I would like to consolidate all of our information into an easy to read format.

Disclaimer: All of my experiences should not speak for yours. We live in an affluent part of a big city with an established, good hospital system. Please do not take any of this as the gospel. Rather, think of this as a supplement to your doctor’s recommendations. This is merely meant to be educational and to raise awareness.

Background Information

I will be talking about any and all background information you will want to know on the reasons for a total knee replacement, what a knee replacement is, and whether to get a total or partial knee replacement. Obviously, none of this takes the place of a doctor’s visit and evaluation and if you are experiencing any of these symptoms please contact a doctor before making any serious lifestyle changes.

First, let me tell you about the anatomy of the knee.

  • Thighbone (femur), kneecap (patella), and shin (tibia) are the bones that form your kneecap
  • Articular cartilage covers the ends of femur and tibia to help bones glide smoothly across one another
  • Meniscus are two wedge-shaped discs that stabilize the joint
  • Ligaments connect bone to bone for stability
    • Collateral ligaments are on the sides of your knee and control sideways motion
    • Cruciate ligaments are in your knee joint and control back and forth motion of the knee
  • Tendons connect muscle to bone
    • Quadriceps tendon connects thigh muscles to kneecap
    • The patellar tendon goes from kneecap to the shin.
  • Here is a video that provides more detail:
  • Underlying Question: Which parts of the knee do you think are most necessary for movement?

 

Next, I’m going to talk about the cause of total knee replacement which is osteoarthritis.

  • Osteoarthritis is the most common type of arthritis
    • Can be caused by excessive weight, family history, age, and previous history
    • When the cartilage wears away with time, the bone rubs against the other bone, causing symptoms such as:
      • Joint Pain
      • Swelling of Joints
      • Joint Stiffness
      • Decreased Range of Motion
    • Mild cases can be solved by rest, hot and cold therapies, healthy weight loss, muscle strengthening, pain medicines, and avoiding repetitive movements.
    • Severe cases usually require joint replacement
    • Underlying Question: Has your answer to question 1 changed?

There are two different kinds of knee replacement: partial and total

Total Partial
Ligaments have to be removed and balanced The ligaments are preserved

 

More blood loss 

Less blood loss
Slower recovery Fast recovery
More complications Fewer complications

 

Lower chance of do-over

Higher chance of having to do it again
Everyone can do it 
  • Not for everybody (some arthritis is so severe it needs total)
    • Good candidate: older than 60, less than 180 lbs, less active, good range of motion, minimal deformity

Underlying question: What do you think is the better method?

Preparation 

Pre-admission testing:

    • physical exam
      • will check your medical history, blood pressure, heart rate, respiration rate, and temperature
      • heart exam and lung exam
      • head and neck exam
      • reflexes and examination of the knee
          • noises when you move your joints
          • swelling of the joints
          • a loss of range of motion
          • tenderness in the joints
          • pain during movement
    • questionnaire (example below) 
    • blood count for anemia
      • The complete blood count test measures the quantity of all the different types of cells in the blood.
      • The complete blood count test is performed by drawing a few milliliters of blood from a visible vein.
      • The CBC tests red blood cell count, hematocrit, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, red cell distribution width, platelet count, and mean platelet volume
      • A white blood cell count is done to check if there is an infection or problem with bone marrow
        • Normal WBC count 4,500 to 11,000 g of WBC per microliter
      • Hemoglobin is a complex protein found in red blood cells that contains iron that carries oxygen to the lungs and waste away from it
        • Normal hemoglobin is 13.6 to 17.7 g/dl
      • Hematocrit determines the percentage of red blood cells in the blood
        • The normal percentage is around 42 to 54% for adult males
    • urine test
      • can differentiate between different types of arthritis
        • infectious arthritis
        • autoimmune arthritis
        • inflammatory arthritis
        • metabolic arthritis
    • blood clot test
      • Platelets help clot blood
        • Normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood
        • measure the time it takes for a blood clot to form after certain activating chemicals are added to the blood sample
        • a tiny cut is made in your earlobe or forearm and the time taken for the bleeding to stop is measured.
          • It is normally 3-8 minutes
    • metabolic analysis
      • A metabolic panel is a blood test that measures the sugar, electrolyte balance, fluid balance, and kidney and liver function. This panel measures the blood levels of albumin, blood urea nitrogen, calcium, carbon dioxide, chloride, creatinine, glucose, potassium, sodium, total bilirubin and protein, and liver enzymes. The panel can show if a patient has kidney failure, liver disease, breathing problems, and diabetes complications to name a few.
    • electrolyte count
      • A blood sample is drawn in order to see if you have an electrolyte imbalance
      • Measures sodium (Na+), potassium (K+), chloride (Cl-), and bicarbonate (HCO3; sometimes reported as total CO2).
    • EKG to check heart health
      • a test that records the electrical activity of the heart through small electrode patches that a technician attaches to the skin of the chest, arms, and legs.
    • The anesthesiologist will figure out what anesthesia to give
      • General (whole body asleep) or spinal (awake waist down asleep) 
    • X-Ray/MRI of the knee
      • to check how extensive the damage is and to figure out whether to recommend total or partial knee replacement
      • An MRI or a magnetic resonance imaging makes clear images with a magnetic field, radio waves, and a computer.  An MRI does not use ionizing radiation. An MRI machine looks like a large tube with a circular magnet surrounding it. The patient lies on an examination table that slides into the tube.
      • X-rays are a type of radiation called electromagnetic waves. X-ray imaging creates pictures of the inside of the body. The images show the parts of the body in different shades of black and white. They use radiation. More about them can be found here https://medlineplus.gov/xrays.html
    • Leg strengthening exercises
      • Before the surgery, the doctor will recommend leg strengthening exercises, so your leg has the best possible chance of fully recovering from the surgery.
      • Here is a good video of a lot of the exercises
  • My Personal Experience: my hospital had an information session, which was really helpful about what to expect. Please go to it; it is very informative and the nurses are very good with both the patient and the family. Because they have so much experience with people similar to the patient, they can recommend the best treatment options. Be sure to ask them plenty of question and they are almost guaranteed to have answers. Also, make sure to do the knee exercises because they are very helpful and help prepare the patient well. The most important thing is to make sure that the patient is 100% on board with doing this, knows about, and accepts any of the side effects and consequences of the surgery. They should also be clear about their options.
  • Underlying Question: What are the most important things to do before a total knee replacement surgery?

The Surgery

  • Surgery takes 1-2 hours.
  • The surgeon takes damaged cartilage and bone out of the knee joint and replaces them with a man-made joint, made of metal implants to the ends of the thigh and calf bones.
  • A plastic spacer goes between the metal pieces and helps the new joint move smoothly.
  • Here is a video if you want to learn more:
  • My Personal Experience: Unfortunately, I was not able to be present for the surgery as I had school. I can tell you that family members were allowed to help our grandmother until they went into the operation room. We accompanied my grandma to a room where she undressed and had some final checks from the nurse. Then she was taken to the operation room. She was a little nervous, but she was ready. In fact, we might have been more nervous than she was. The most important thing is to focus on the fact that the doctors are capable, and they will make sure that nothing untoward happens.
  • Underlying Question: How does total knee replacement affect the knee?

Post-Op Care

  • Rehab begins right after waking up from surgery
    • Begin standing and walking with the physical therapist and using an assistive device in the first 24 hours
    • Uses a continuous passive motion machine to help with movement
  • Discharge happens after doctor decreases pain meds
    • Should be able to bend knee well, dress and bathe on your own, minimally rely on the assistive device
  • Should continue to improve, with pain and swelling decreasing over the weeks
  • A very important thing to do is to use the knee as much as you can. This is crucial in having as short of a recovery time as possible.
  • It is critical to do the exercises recommended to you by the physical therapist. Here are a few good videos to show you how to do these exercises; however, do not do any exercises not recommended to you by your physical therapist as they know what is best for you.
  • Most people are fully recovered after a year
  • Another important thing to know about is medications
    • Common pain medicines include
      • Morphine, hydromorphone (Dilaudid), hydrocodone, which is found in Norco and Vicodin, oxycodon, which is found in Percocet, meperidine (Demerol)
      • Side effects of these medicines include constipation, drowsiness, nausea, slowed breathing, confusion, a loss of balance, an unsteady gait, addiction
      • You may also receive medicines that help against blood clots and nausea
      • All of these medications are extremely strong, so it is important to take the exact dosage your doctor prescribes you. You should not get an unrecommended refill or else you risk addiction.
  • My Personal Experience: If you are taking care of someone, they are going to need a lot of your help in these first few months. Be sure not to leave any items on the floor in the way because the patient could trip and hurt themselves and stunt their recovery. The patient will be in a lot of pain so make sure that you are there for them both emotionally and physically. Help them figure out the medicines, do the exercises, and change bandages. The nurse and the physical therapist will tell you exactly what to do, what to buy, when to do exercises, when to give the medicine etc. We bought a cane after my grandmother grew out of the walker. We bought the Medline Offset Handle Cane, and it worked really well.
  •   We also were prescribed morphine and oxycodone. We did not have to go over the prescribed amount, and my grandmother did not experience any side effects. 
  • Underlying Question: What are the most important things to do during post-op care?

More About Our Experience

Here is an interview I had with my grandmother. She talks about things she used to get through this difficult time and her thought process when deciding to do the surgery.

Here is a transcript of the interview:

Underlying Question: What are the psychological effects of total knee replacement?

How You Can Help

Here are some ways that I helped; I really just tried to make her life as easy as possible.

I hope this can provide you with ideas about how you can help someone who has had a total knee replacement surgery!

Underlying Question: What are some new ways you can help someone with total knee replacement?

Reflection 

Before you go, please take this brief survey!

I hope that you learned a lot and that you will better able help someone with total knee replacement now! Please comment any more helpful tips if you or a family member has had a total knee replacement!

Sources 

http://www.arthritis.org/about-arthritis/understanding-arthritis/what-is-arthritis.php

http://orthoinfo.aaos.org/topic.cfm?topic=a00325https://www.verywell.com/total-partial-knee-replacement-2552271

https://www.healthline.com/health/total-knee-replacement-surgery/before-tkr#outlook5

https://www.allinahealth.org/Health-Conditions-and-Treatments/Health-library/Patient-education/Total-Knee-Replacement/After-surgery/Knee-exercises/

https://www.healthline.com/health/total-knee-replacement-surgery/medications#takeaway5

https://www.amazon.com/Medline-Offset-Handle-Cane-Black/dp/B000BJBH3Y/ref=sr_1_4_s_it?s=hpc&ie=UTF8&qid=1523139074&sr=1-4&keywords=cane

https://www.youtube.com/watch?v=L5EkDkoSiNQ

https://www.youtube.com/watch?v=tKji04oFGdU&t=15s

https://www.youtube.com/watch?v=UST32Ff9A_E

https://www.youtube.com/watch?v=2bjt-0FevRY

https://www.youtube.com/watch?v=frVPv3NpHYI

https://www.healthline.com/health/total-knee-replacement-surgery/rehabilitation-timeline

https://medlineplus.gov/xrays.html

https://www.webmd.com/heart-disease/electrocardiogram-ekgs#1

https://labtestsonline.org/tests/electrolytes

 

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COMMENTS: 4
  1. April 27, 2018 by Sidney Derzon

    Hi Rhea! I found your topic extremely interested especially because my project focused on the mental aspect of serious injuries (mostly about people who had knee surgery). Your project is very well researched and organized which made it really easy to follow and learn new information. I especially like how you included so many videos and interactive elements; it really helped the user reflect on the information that had just learned. Your personal story also adds another depth to your project. Great job!

    • April 28, 2018 by Rhea Zoya Niyyar

      Hi Sidney. Thank you so much! I will definitely check out your project because that was something we were worried about with my grandmother if everything did not turn out okay. Luckily, it did, and she is happy and healthy. Thank you so much for all your sweet comments, and I really appreciate your feedback.

  2. April 29, 2018 by Emily.Ecclestone

    Hi! I loved reading through your piece! I found it very engaging and interactive. You clearly put a lot of thought and work into your piece. I also got interested in my topic through a family member!

  3. April 29, 2018 by Abhay.Katyal

    Wow! This looks so amazing! It was really interesting to see your personal connection to this topic and why you chose this unique topic for your project. I can personally relate to this project because I have really bad knee problems, so I really enjoyed reading your project. The different visuals and surveys you added were a great addition that enhanced your website. Overall, this is really good!

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