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ORTHOPAEDIC SPECIALISTSOF CENTRAL ARIZONATotal Knee Arthroplasty(Total Knee Replacement)A Patient’s Guide

Total Knee Arthroplasty: A Patient’s Guide2Table of ContentsForeword3Introduction4Surgical Overview5Prosthesis Information6Robotic Assisted Knee Replacement7Pre-admission Evaluation8Helpful Hints in Preparation for Surgery10The Day of Your Surgery11After Your Surgery12Physical Therapy15Going Home16Surgical Risks17Frequently Asked Questions19Long-term Care of Your Total Knee Replacement20Orthopaedic Specialists of Central Arizonawww.ScottsdaleOrthoSpecialist.com

Total Knee Arthroplasty: A Patient’s Guide3ForewordThis booklet has been developed by Dr. Kaper for his orthopaedic surgery patients atOrthopaedic Specialists of Central Arizona. It is used in conjunction with instructionfrom the rehabilitation and nursing staff. This booklet should not be given to patientsunder the care of other orthopaedic surgeons, whose surgical approaches and postoperative management of total knee replacements may vary from ours.Orthopaedic Specialists of Central Arizonawww.ScottsdaleOrthoSpecialist.com

Total Knee Arthroplasty: A Patient’s Guide4IntroductionWelcome to Orthopaedic Specialists of Central Arizona. In preparation for your surgery,we have provided you with this information booklet to help answer some of yourquestions and concerns about Total Knee Replacement or Arthroplasty. We hope thatyou find this booklet helpful. If after reading this guide, you still have any concernsabout the surgery, aftercare, or other aspects, we encourage you to contact us. Our officetelephone #’s are: (480) 305-0034 or (928) 778-9250. Further helpful information is alsoavailable at our website: www.ScottsdaleOrthoSpecialist.com.Please remember that each patient will respond and recover from total knee replacementsurgery according to their own individual situation. It is helpful to “compare notes” withothers who have undergone or are undergoing the same surgery. However, becauseeveryone is different in terms of their medical and orthopaedic condition and needs, donot place undo importance on “keeping up” with your neighbor/friend/relative.Anatomy of the KneeOrthopaedic Specialists of Central Arizonawww.ScottsdaleOrthoSpecialist.com

Total Knee Arthroplasty: A Patient’s Guide5Surgical OverviewKnee replacement, or “arthroplasty” surgery, is a surgical procedure to replace thedamaged cartilage within a knee with an artificial prosthesis or implant. This surgery isan option for patients who have severe arthritis of the knee. Arthritis means that thecartilage cushioning designed so that the bones do not rub against each other is severelydamaged or worn out. Patients with severe arthritis of the knee are often challenged byeven simple activities, such as walking or climbing stairs. Surgery can be consideredwhen all other available treatment options have been exhausted and your quality of life issignificantly affected by your arthritic knee.Various types of arthritis may affect the knee joint. Osteoarthritis, a degenerative diseaseof the joints, is the most common form of arthritis. It affects mostly middle-aged andolder adults with breakdown of the joint cartilage. Rheumatoid arthritis causesinflammation of the synovial membrane of the joint with secondary deterioration of thejoint cartilage. Previous injury or trauma to the knee may result in post-traumaticarthritis, with significant damage to the joint cartilage. Any of these forms of arthritiscan lead to irreversible damage to the knee joint, resulting in pain, swelling, stiffness,weakness, or even instability in which the knee may “give-way”.Knee replacement surgery is a treatment option for knee pain and disability. The surgeryis designed to replace the damaged cartilage of the knee. Think of it as getting new tireson your car. The goal of knee replacement surgery is to reduce or relieve pain in theknee. Realistically speaking, knee replacement surgery does not give you the knee youhad when you were twenty-one. It does, however, significantly improve the quality ofyour life, which is often severely limited by the pain of knee arthritis.Orthopaedic Specialists of Central Arizonawww.ScottsdaleOrthoSpecialist.com

Total Knee Arthroplasty: A Patient’s Guide6Knee Replacement ProsthesisMany knee replacement systems have been developed over the past 50 years. There aremany different orthopaedic implant manufacturers whose products do vary in design andmaterials utilized. There is a lot of information online that patients can read and researchabout all the different prostheses available. This can be confusing to try and understand.Dr. Kaper uses the” Verilast” Journey II Total Knee Replacement, made by Smith &Nephew. This choice reflects what Dr. Kaper believes to be the best designed prosthesison the market today. In both design and biomechanics, it most closely replicates theanatomy and function of the normal human knee. The materials used to manufacture theprostheses are made from the combination of Oxidized Zirconium (“Oxinium”), highlycross-linked polyethylene (XLPE) and titanium. This combination of materials isreferred to as a “VERILAST” TKA and has proven to be extremely durable for kneeimplants.For specific implant information, please ask us or visit their website:www.rediscoveryourgo.com.Orthopaedic Specialists of Central Arizonawww.ScottsdaleOrthoSpecialist.com

Total Knee Arthroplasty: A Patient’s Guide7Robotic Assisted Knee Replacement SurgeryThe option of Robotic Assisted Total Knee Replacement is now also available. Thistechnology is known as the NAVIO system. This technology incorporates a platformknown as “Augmented Reality”, a computer/robotic enhanced imaging capability thathelps surgeons improve the accuracy and precision of the surgical technique. The goal,obviously, is to improve the clinical outcome and long-term function of your new knee.For more information about the NAVIO system, please ask us or visit the icrosites/navio/.Orthopaedic Specialists of Central Arizonawww.ScottsdaleOrthoSpecialist.com

Total Knee Arthroplasty: A Patient’s Guide8Pre-Admission EvaluationBefore your scheduled surgery date, arrangements will be made for pre-operative testing.This will give us the opportunity to have all necessary medical testing and registration donebefore your surgery. Total knee replacement is a major procedure that can stress even thehealthiest body. For this reason, it is important that we check and optimize your overallmedical condition prior to surgery.Typical testing before surgery may include: Laboratory tests EKG (heart tracing)A thorough physical examination with your family physician is recommended. If there arespecific medical concerns, additional pre-operative evaluation may be necessary.You will have the opportunity to meet with the anesthesiologist on the day of your surgeryto discuss the different types of anesthesia available. These include: General anesthesia – when you are “asleep” for the surgery. Spinal or Epidural anesthesia – when you are “numb” from the waist down;Discuss any questions you may have with the anesthesiologist. Do not feel that yourquestions are “silly”. To be informed and knowledgeable about your surgery is importantand will help you to understand what to expect during and after your surgery.Orthopaedic Specialists of Central Arizonawww.ScottsdaleOrthoSpecialist.com

Total Knee Arthroplasty: A Patient’s Guide9Blood transfusions are rarely necessary after knee replacement surgery. Statistically, lessthan 1% of all patients undergoing total knee replacement develop anemia that may needa blood transfusion. A blood transfusion will only be recommended if Dr. Kaper feelsthat you absolutely require it. All patients are recommended to use a pre-op Iron orFerrous sulfate supplement.Dr. Kaper may also make an individual assessment to determine whether you will be ableto return home after surgery, or whether you may be a candidate for a rehabilitationcenter. A majority of patients are able to go home after surgery. Typical questions are:1.Do you live alone?2.Do you require assistance for daily living?3.Do you have any concerns about returning home after your surgery?4.Are you interested in information about facilities that can provide care andrehabilitation before returning home?Alternatives to discharge directly home include: rehabilitation centers and skilled nursingfacilities (also known as extended care facilities). Please be aware that many insurancecompanies, including Medicare, will not typically authorize the use of an acute rehabcenter after surgery.Orthopaedic Specialists of Central Arizonawww.ScottsdaleOrthoSpecialist.com

Total Knee Arthroplasty: A Patient’s Guide10Helpful Hints in Preparation for Your SurgerySTARTING NOW:Prepare yourself: Stop smoking Eat well-balanced meals and take the recommended vitamins andsupplements Get plenty of rest Exercise to improve and maintain muscle strength Stop or cut-back on alcohol consumption Keep a notebook handy to write down any questions you may have forthe doctor, therapist or staffPrepare your home: Stock your refrigerator and pantry (e.g. pre-cooked or frozen dinners) Obtain or rent a walker and/or crutches, a raised toilet seat / shower chair Arrange for support from family and/or friends for everyday activitiesTHE DAY BEFORE SURGERY: Confirm your surgery time- you will be contacted by the nurse to confirm yoursurgery time. Make sure we have an up-to-date telephone number tocontact you, if there are any changes in your surgery schedule. You may have your regular dinner Do not eat or drink after midnight (this includes hard candy and gum). Wash your body from the neck down with Hibiclens soap as instructed. Consult with the nurse or your doctor to determine if you should take yourmorning medications the day of surgery. Make sure you have filled any prescriptions that you were given at your preoperative visit.Orthopaedic Specialists of Central Arizonawww.ScottsdaleOrthoSpecialist.com

Total Knee Arthroplasty: A Patient’s Guide11The Day of Your SurgeryOn the day of your surgery, you will report to the Admitting office at the hospital.Remember: Do not eat or drink anything. You may brush your teeth but do not swallow any water Wash the affected leg and hip with Hibiclens soap as instructed. Please do not wear or use any skin moisturizers, cream, lotions or make-up. Remove any nail polish. Wear comfortable, loose-fitting clothing that does not go over your head. Remove hairpins, wigs, and jewelry. Please do not bring any valuables with you.From the admitting office, you will be brought to the Pre-op area. The nursing staff willbe there to assist and prepare you for surgery. You will typically be asked on severaloccasions which knee will be operated on- this is simply a precautionary step to preventany confusion whatsoever.To reduce the risk of phlebitis (swelling of your veins) and deep venous thrombosis(DVT or blood clots), sequential compression stockings will be placed on your legs.These will help maintain good circulation. The compressive stockings will be used whileyou are in bed in the hospital.Enteric-coated Aspirin (E.C. ASA) 325 mg taken daily is routinely used as a bloodthinning medication after surgery. For patients determined to be at higher risk for bloodclots, a medication such as Coumadin, Xarelto, or Fragmin may be used instead ofAspirin. These medications, when used in conjunction with regular movement andexercise, will maintain good circulation in your legs. This will minimize the risk of bloodclots.Orthopaedic Specialists of Central Arizonawww.ScottsdaleOrthoSpecialist.com

Total Knee Arthroplasty: A Patient’s Guide12After Your SurgeryRecovery RoomWhen your surgery is completed, you will be taken to the recovery room, also called thePost-Anesthesia Care Unit (PACU). You will have your blood pressure and pulsechecked frequently. The nurses will check your dressing, ask you to wiggle your toes,and have you take deep breaths.Dr. Kaper will meet with your immediate family when the surgery has been completed.Please inform your family that even if your surgery takes only a short time, you will haveto remain in the recovery room until you are awake and considered to be “stable”.MovementPerforming simple ankle pumps and circles is recommended after surgery. Your nurseand therapist will remind you of this. This movement helps promote good circulation toyour legs and feet.After surgery, our goal is to mobilize our patients as soon as possible. Depending on thetiming of your surgery, this will mean that the therapist will either get you out of bed theafternoon of your surgery, or first thing the next morning. You will be taught how towalk using a walker. The walker is initially recommended to reduce of falling. Duringyour hospitalization, the therapist will work with you on your knee exercise program.Most patients can be “weight-bearing as tolerated” on their operated leg. Your surgeonand therapist will instruct you in this regard.BreathingTo prevent respiratory (lung) complications, such as pneumonia, after surgery, you willbe encouraged to take deep breaths and cough regularly.Orthopaedic Specialists of Central Arizonawww.ScottsdaleOrthoSpecialist.com

Total Knee Arthroplasty: A Patient’s Guide13Wound CareYour knee will initially be wrapped with an Ace Wrap, which helps provide compressionto the knee to minimize swelling. The Ace wrap may be changed the next day aftersurgery. Your incision will be covered with a clear, occlusive surgical dressing. Underthis dressing you will see a dark gray/black “silver nitrate” dressing used to reduce therisk of infection. This entire dressing will be removed at your postoperative visit- you donot need to change the dressing prior to that time. The incision used for kneereplacement surgery is usually between four to seven inches long and will be clos