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In the U.S., when a physician recommends knee replacement surgery, he also provides the patient with a pre-surgery strengthening program. This program consists of a series of exercises that the patient can do at home to strengthen the muscles surrounding the knee and to improve overall fitness. The patient’s general health is checked by physicians on an out-patient basis, and he (or she) arrives at the hospital the day of the surgery. Knee replacement surgery takes approximately one to two hours. Immediately after the surgery, foot and ankle movement is encouraged to increase blood flow and prevent swelling and blood clots in the leg. In addition, many patients use a continuous passive motion (CPM) machine, which is designed to gently bend and straighten the knee. Physical therapy begins the day after surgery.

Most patients spend three or four nights in the hospital, by which time they are able to walk with a walking aid (a walker or crutches). When patients are discharged they usually go home, although some patients go to a rehabilitation center. A nurse visits patients at home two or three times during the first week and once or twice during the second week. The nurse checks the patient’s general condition, heart and blood, and closely inspects the knee to ensure that it is healing properly. A physical therapist visits three times a week for about four weeks. Physical therapy enables the patient to gradually increase the new knee’s strength and flexibility. The patient should perform physical therapy exercises, an extremely important part of the healing process, at least three times a day, after which ice must be applied to the knee to reduce swelling.

A variety of medications are used throughout the surgery and recovery periods. Usually general anesthesia is used during the surgery. After surgery, physicians choose the most appropriate pain control medicine based on the patient’s needs (I.V.’s, pills or injections). Anti-inflammatory drugs such as celecoxib and anti-coagulants such as warfarin may also be prescribed. The patient performs respiratory exercises to prevent lung congestion and is encouraged to eat a nutritious diet. Protein, zinc, fluids, calcium, iron, vitamin A and vitamin C are especially important to the healing process. By eating a healthy diet and diligently doing physical therapy the patient can usually resume his normal daily activities within a short period, and his quality of life greatly improves due to his increased mobility and decreased pain.

Knee replacement surgery, first performed in 1968, is one of the most important orthopedic surgical advances of the twentieth century.⁷ Knee replacement techniques, prostheses and care have improved significantly during the past few decades. In the future, the prevalence of knee replacement surgery is expected to increase due to the aging population and increasing trends in overweight and obesity.

Discussion questions

1. Please summarize the article. What is the main point of the article?
2. How do patients prepare for surgery?
3. What happens after the surgery?
4. Why is physical therapy important?
5. What medications are used during knee replacement surgery and the recovery period?
6. What should a patient do to ensure a full recovery?
7. Are there any differences between knee replacement surgery as described in this article and as performed in Japan? What are they?

References:

• Maturity Health Matters, FDA News for Older Adults, their Families and Caregivers. Issue 3, summer 2006. (Accessed December 1, 2006)
• American Academy of Orthopaedic Surgeons. (Accessed December 1, 2006)
• Bren, Linda. Joint Replacement: An Inside Look. FDA Consumer Magazine. March-April 2004 Issue. (Accessed December 21, 2006)