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Total Knee Replacement Now a Surgical Option at Health Center
Anyone who has lived with the pain of degenerative joint disease of the knee comes to the decision to have total knee replacement surgery from a very personal point of view. For some, the slow and steady wearing away of cartilage to the point of bone-on-bone friction causing excruciating pain when walking is enough to consider total joint replacement of the knee. For others, arthritis pain reducing knee movement resulting in lifestyle changes is enough to opt for total knee replacement surgery. For Eleanor Glesinger of Spalding, the decision to have her right knee replaced in March was due to all of that and more. “I was in a lot of pain, when I walked, my knee constantly hurt. My doctors said my knee wasn’t going to get better, so I decided to do something about it,” said Glesinger.
In partnership with Dr. Richard Cimpl, medical staff from the Health Center began performing total knee replacement surgery in December of 2005. “This is a very good surgical option for the service area. Our patients can have total knee replacement surgery supported by comprehensive physical and occupational rehabilitation services all locally, making it easier on our patients and their families,” stated Dr. Joel Travis, chief of medical staff at the Health Center.
What to Expect Before, During and After Surgery
Although there are over 200,000 total knee replacement surgeries performed annually in the United States, no two are exactly alike. At the Health Center in Albion, the process begins up to a week in advance with patients attending a pre-admission teaching session with a surgical nurse, respiratory therapist and physical therapist. At the session patients and family members are given information regarding what to expect with the surgery including postoperative breathing exercises, rehabilitating the new knee, pain management after the surgery, lifetime considerations and one-on-one time with each staff member to answer any questions or concerns. At this session, patients also undergo laboratory tests, an electrocardiogram (a diagnostic tool that analyzes electrical activity in the heart) and a chest x-ray. These tests are necessary to ensure there are no underlying conditions that could affect your surgery. The actual day of surgery, patients can expect to check in up to an hour early to begin preparation for their surgery. During this time, an intravenous line is started and a nurse anesthetist goes over anesthesia and pain management concerns. Once a patient is completely prepped and in the surgical suite, actual surgery time lasts on average one to two hours.
During surgery, the orthopedic surgeon makes an approximate eight-inch incision over the front of the kneecap. He then works to remove bone and cartilage from the end of the femur (thigh bone) and the tibia (shin bone). Medical instruments precisely prepare the new bone surface to create an exact new bone surface, which will accommodate the new knee implant. Either a metal or plastic knee implant-depending on the recommendation of your surgeon- is put into place with medical cement or screws. Once the implant is aligned and secured, bone tissue can regrow into the porous surface, which will provide long-term stability. The procedure is completed with a patella button cemented behind the existing kneecap and the incision is closed. Orthopedic surgeons use either stainless steel staples or conventional sutures to close the incision.
Pain Management After Surgery
It is natural to be concerned about how much pain is involved with a knee replacement surgery. People used to think that severe pain after surgery was something they had to put up with. But with current treatments, this is no longer true. Patients can work with their doctors and nurses before and after surgery to prevent and relieve pain. Because most patients having knee replacement surgery have already learned to cope with pain associated with arthritis, they find the type of pain associated with knee replacement surgery tolerable and manageable. Pain management usually begins with an injection of a long acting numbing medicine into the knee done at the end of surgery, which can last between 12 and 18 hours. Before waiting for surgical pain to break through, nurses in the recovery suite will give pain medicine at set times to keep the pain under control. Patient controlled analgesia (PCA) pumps are also used. PCA pumps allow the patient to control the timing and dosage of pain medication.
After a several days, a PCA pump is replaced with a combination of injections, pain pills and anti-inflammatory medications as needed. Most patients chose to have a prescription for pain medicine before leaving the hospital. And while everyone is different, some patients report that after a few weeks, they only use pain medication to sleep or after physical therapy.
Rehabilitation: Critical to Total Recovery
The potential to return to a normal lifestyle with less pain and greater mobility than before a knee replacement is great. Recovery and rehabilitation take time and effort on the patient’s part. “Rehabbing a knee is important to restoring independence and an active lifestyle. Patients are surprised to learn that rehabilitation starts the same day as surgery with the use of the continuous passive motion machine,” stated Jim Meyer, Physical Therapist at the Health Center. A continuous passive motion (CPM) machine is used postoperative on patients to move the new knee joint. A Physical Therapist will put your leg in the CPM with the goal of achieving range of motion and to prevent the joint from tightening and scar tissue from forming. During a patient’s hospitalization, both physical and occupational therapists will work one-on-one with patients to teach them gait movement, how to transfer weight from sitting to standing, how to use a walker, how to progress to crutches, and teach them adaptive lifestyle skills to regain independence and ultimately, pain free lifestyle. “I was acquainted with the medical staff and all of my doctors, and I pleased to be able to have both the surgery and rehabilitation services close to home. Although surgery is never easy, the staff was wonderful, especially Jim Meyer, my physical therapist. He made my therapy very manageable,” said Eleanor Glesinger.