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Some of the important complications include infections, blood clots, inadvertent injury to blood vessels or nerves, problems regaining flexion or extension of the knee and difficulties with wound healing. Deep infec-tion may require removal of the implant, prolonged antibiotics and later surgery to insert a new implant. Major clots are rare but can be fatal. All surgery and anaesthesia carries risks and it is not entered into lightly. Dr Coolican and his surgical team work very hard to prevent complications and it is important that you cooperate with all medical and paramedical staff to achieve an optimum result. If you have any questions concerning complications, please feel free to speak with Dr Coolican. If you develop unexplained calf pain, chest pain, fever or wound redness, please notify Dr Coolican or the hospital staff. Precautions after Surgery:
You should avoid impact and jarring activities. You are not able to run with your prosthesis. Dr Coolican will be happy to provide you with a list of activities which you can carry out safely after knee replacement but it is important that you have one foot on the ground at all Repl acem ent
times. Accordingly, you should not run or jump. In the first year or two after surgery, you should tell your dentist if you have any dental work, so that antibi-otics can be provided to prevent secondary infection in the knee. This is the case for any open surgery and you should ensure prompt antibiotic treatment of any skin infection or urinary tract infection. Dr Coolican’s fees are above the Medicare schedule. This will produce a gap payment for your surgery and Dr Coolican’s secretary will inform you of the gap. If you have any questions concerning your forthcom- ing knee replacement, including risks, complications or likely outcome, please do not hesitate to contact Dr Introduction
Rehabilitation
care are carried out. You will also be given a PCA button Total knee replacement (TKR) is major surgery and a which delivers a small volume of narcotic intravenously. Most patients require a more prolonged stay in hospital decision to proceed with the operation is made only for intensive physiotherapy. This is usually arranged if after a thorough consideration of the symptoms you are Surgery is carried out through an incision over the front of the necessary in a rehabilitation hospital. We utilize a num- suffering and the likely risks and benefits of surgery. knee and takes approximately one to two hours, depending ber of different hospitals, depending on your needs and on what is required. Small parts of the ends of the bones Prior to booking surgery, Dr Coolican will question you the area where you live. Most patients require some (femur and tibia) are removed and replaced with prostheses on your general health. If there is a history of medical form of walking aid – crutches, frame or a stick for the matched for size and side. The patella may be resurfaced, problems, such as troubles with your heart, lungs, blood first three months or thereabouts although people vary depending on the findings at surgery and your preoperative pressure, kidneys, circulation or other health issues, with this. It is entirely up to the patient’s confidence al- clinical features. The prostheses are fixed to your bone either you may be referred to an appropriate specialist for an though a stick outside the home is a good idea for the by bone cement or a press fit where the bone grows into po- opinion on whether you are fit for the surgery and first three months as it alerts others that you are not fully rous surface on the undersurface of the prosthesis. There is whether any special precautions are required. If you mobile and able bodied. Injections of low molecular not yet a clear consensus that either form of fixation gives are considered unfit or the specialist considers the risk weight heparin (usually Clexane) continue until transfer to better long term results. A low pressure suction drain is util- of surgery to be great, it may still be possible to proceed rehabilitation and you should continue with the white ized to remove shed blood from the joint and the shed blood with surgery but only after you and your relatives are (TED) stockings until the 6 week postoperative check. At can be stored, filtered and retransfused if suitable. aware of and are prepared to accept the risks. this appointment, further radiographs are taken of your Most patients recovering from total knee replacement find the Please stop any aspirin containing medication that you knee to be quite uncomfortable in the first two weeks. A vari- have been taking 10 days prior to surgery. Non- Most patients can safely drive at 6 weeks and gradually ety of measures are used to control pain, including continu- steroidal anti-inflammatories should also be stopped 10 increasing walking distances occur around this time. ous epidural infusion (similar to that used in childbirth), pa- days prior to surgery. These drugs interfere with the Bowls and golf can be resumed whenever you feel confi- tient controlled analgesia, nerve block injections, ice and oral clotting mechanism. You should continue with all your dent, usually somewhere between 3 and 6 months. Run- medications. It usually takes between 2 and 12 months be- other medications and bring them to hospital, so that ning is not permitted at any time after the operation as fore the patient agrees that the replaced knee feels better the staff can arrange ongoing prescription at the appro- wear of the prosthesis occurs very quickly. You may be than before surgery but this is variable. Some patients will priate dose. You must also bring your x-rays and other able to drive an automatic car sooner than 6 weeks post- have very little pain after surgery and wonder what all the imaging scans. If you are taking aspirin or Plavix for a operatively if your left knee has been replaced but stud- fuss is about whilst others, are troubled by quite severe night special reason that makes it dangerous to stop, it may ies are suggestive that it takes most patients around 6 pain for two or three months after surgery. be necessary to continue with this medication up to weeks before they can confidently operate the pedals surgery but this should be discussed with Dr Coolican. The day after surgery, the nursing staff will remove the drain with sufficient power and speed to drive safely. If you are taking Warfarin, specific arrangement, de- and dressings and apply TED stockings. Although this is a pending on the requirements for Warfarin will be made. relative rest day, it is important to wiggle your ankles up and Results and Complications:
It is usual to stop the Warfarin 5 days or thereabouts down a few times, every 20 minutes or so whilst you are before surgery and continue without anticoagulation or awake. This helps the calf muscle pump and prevents clots. Overall, 95% of patients are happy with the knee replace- possibly continue with some form of anticoagulation Usually, the nursing staff and physiotherapist will sit you over ment. Approximately 90 – 95% are relieved of the major- injection in the period up to the surgery. the side of the bed on the first postoperative day and you may ity of their pain. The deformity (crookedness) of the leg is corrected and mobility is improved. Range of motion Hospital
averages around 115° but patients with poor motion prior On the second postoperative day, rehabilitation begins in to surgery seldom achieve a large improvement. earnest. This is supervised by the physiotherapist and in- You are usually admitted to hospital the day before sur- volves a series of exercises to achieve two goals. These are Should the prosthesis wear out, revision knee replace- gery or occasionally on the same day. Prior to this, you to get the knee bending and to improve independent mobility. ment is possible but is more complex surgery than the will attend a preadmission clinic which will involve blood A continuous passive motion (CPM) machine may be used in first replacement with results not being in general as sat- tests, an ECG and chest X-ray. You will also meet the order to obtain knee bend. These are electric operated ma- isfactory as first time surgery. The risks of revision sur- chines placed on the bed with the machine moving the knee On the day of surgery, your leg is washed, shaved if up and down. Controls determine the degree of motion and The prosthesis is a mechanical device with a bearing necessary and painted with antiseptic solution. The leg the patient holds a stop button. CPM machines are not al- surface which wears out over time. Mostly the implant is then wrapped in a sterile towel. You will meet the ways utilized and depends on progress with range of motion. will out survive the patient. Failure occurs due to wearing anaesthetist prior to surgery who will discuss the anaes- Discharge from hospital occurs when the knee is bending out of the plastic component or the implant works loose in thetic with you. This usually takes the form of a general adequately and you are mobile, either on crutches or a frame the bone. Too high an activity level and soft bone (e.g. anaesthetic and something else to control pain after the and can safely get about. The average length of hospital stay due to rheumatoid arthritis) are factors in an implant re- surgery. This may be an epidural or spinal injection, is a week or a shade under and has reduced over time. You quiring revision. Avoiding excessive weight gain is also nerve block, nerve catheter or local anaesthetic around may be required to stay in hospital longer if complications or the knee. Varieties of these forms of postoperative pain

Source: http://www.sydneyortho.com.au/TKRMC.pdf

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