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About Joint Replacement

Joint replacement is one of the most consistently successful therapeutic measures in all of medicine and surgery today. In general, patient satisfaction with pain relief and enhanced mobility is extremely high.

However, as in all major surgical procedures, there are significant risks that patients will want to discuss carefully and thoughtfully with their surgeons. Patients should ask their surgeons to explain any risks or benefits, which will help patients make informed decisions.

This page explains the key points about knee replacement surgery and hospital stay. If you need additional materials about knee replacement, videotapes and other brochures are available.
Just ask.

Please keep in mind that procedures and protocols vary, sometimes widely, from surgeon to surgeon, hospital to hospital and even patient to patient. Nevertheless, the goals of the process—to reduce pain and enhance mobility—are essentially the same.

We will be more than happy to answer your specific questions and explain how these procedures will be tailored to fit your personal condition and needs.

 
 

Procedures

Knee Replacement | Hip Replacement | Shoulder Replacement | Joint Health

Knee replacement

Reproduced with permission from Your Orthopaedic Connection. ©American
Academy of Orthopaedic Surgeons.

Knee replacement is a procedure that is done for the severely arthritic joint, and only after other forms of treatment, such as medication and physical therapy, no longer have any benefit. It is not done for minor arthritic joint pain.

The knee is a "hinge" joint, although it is not as simple a hinge found on doors. The knee not only bends back and forth, but it also has some ability to move in a rotational manner. The knee, a major weight-bearing joint, is surrounded and held together by muscles, ligaments and other soft tissues. Cartilage is the material that "cushions" the knee and allows the joint to move in a smooth and free manner.

Knee with arthritis

As the arthritic process develops, the cartilage wears out, and the nerve endings that lie beneath the surface become irritated and produce the symptoms of pain. As the joint becomes more and more destroyed, the soft tissues offer less and less support. At that point, it may be time to consider surgical replacement.

The surgical procedure

The surgical procedure involves removing the diseased portions of the joint and replacing them with new parts. Very accurate cuts are made on the undersurface of the femur (thighbone) to match the undersurface of the femoral prosthesis so that they will fit together well and be both solid and stable. Similarly, accurate cuts are made to the top surface of the tibia (shinbone), and the tibial component is anchored in place.

These components are then fitted together to allow the knee to bend back and forth and also have some of the rotational movement of the normal knee.

The surgical procedure for total knee replacement usually takes about one to two hours, and the new joint is often immediately solid. However, strengthening the weakened muscles and soft tissue surrounding and supporting the joint requires a longer-term program of exercise and physical therapy. Although many patients see and feel immediate benefits, they must continue to rehabilitate themselves for several months to get the total benefit.

I was plagued for years with osteoarthritis in my left knee...I am now back to walking the dog, and shoveling snow with ease. I even helped my husband paint our house at the end of the summer. I am totally enamored of Mid Coast Hospital!”
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Anesthesia

Anesthesiology has come a long way in the last twenty-five years. There are newer, more stable drugs, and there is more accurate and more complete monitoring.

There are, however, some risks involved that are largely related to the severity and amount of underlying diseases, such as heart disease, atherosclerosis (hardening of the arteries), or lung problems. With an increase in the severity of these conditions, there is, naturally, an increase in the risk. Nevertheless, the safety record of anesthesia today is very high.

It is essential that patients tell their surgeon and anesthesiologist about all of the medical conditions they have as well as all the medicines that they are taking.

Hospital stay

Before surgery

Most patients are admitted to the hospital the day of surgery. Prior to surgery the knee that is being replaced will be thoroughly cleaned with an antibacterial surgical sponge.

After surgery

During the first few days after surgery there is naturally some pain. However, pain can be adequately controlled by medication.

In spite of any discomfort, it is important that patients make the effort to do the deep breathing and physical therapy exercises as instructed. Patients who breathe well and work at strengthening their muscles, improve their lung capacity and circulation, and tend to get well faster.

Exercise and physical therapy

One of the most frequently asked question is, "When can I start walking again?"

While patients are often encouraged to stand and sit (with assistance) within twenty-four hours after surgery, walking is approached gradually and in a guided manner so as to avoid injury and complications. It is very important to rebuild and strengthen the leg muscles through isometric exercises. However, patients are typically discharged three days after surgery and we work extensively with them before discharge.

Social services

Many patients, especially those who live alone, are concerned about whether or not they will be able to manage for themselves in the first few weeks after they leave the hospital. In addition, if they should need assistance, they are concerned about who will pay for it.

Insurance coverage for home care is generally limited, but there are agencies available that can provide some help. Someone can visit the home and show patients how to arrange furniture, rugs, etc., to decrease the risk of tripping and falling. A home health care agency can assist with needs like bathing and dressing. The hospital Social Services Department can direct patients to these agencies.

Mid Coast Hospital's care coordinators will work with the patient to ensure that the transition from the hospital to home is as seamless as possible.

Patients sometimes benefit from going to a rehabilitation facility after they are discharged from the hospital. The decision about whether to go to a rehab facility or directly home is made by the patient, but the orthopedic care team will make their recommendation based on the progress that a patient makes in the first several days after surgery.

Before my surgery I was in constant pain...My surgeries were performed two weeks apart and went very well...Now I no longer need my walker and can walk without pain for the first time in 5 years.”
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Patient involvement and commitment

With knee replacement, the surgeon replaces the diseased knee joint and, along with the physical therapist, occupational therapist and nursing staff, guides the patient through the recovery process. However, rehabilitation is up to the patient. The patient must participate fully in the rebuilding and strengthening of weakened muscles. To get the total benefit of knee replacement, the patient must make a serious commitment to doing the prescribed exercises and developing and maintaining an active life-style.

 
 
The Mid Coast Center for Joint Replacement
123 Medical Center Drive, Brunswick, Maine 04011
Phone: (207) 386-0418
Mid Coast Medical Group-Orthopedics
430 Bath Road, Brunswick, Maine 04011
Phone: (207) 442-0350