What to Expect in the Hospital before, during and after the Operation?

Before the operation

It is important that you enter the hospital in an optimal state of health. If you have any cardiovascular disorders – or high blood pressure or diabetes – these conditions should be brought under control with medication.

Any infections you might have - e.g. tooth abscesses, bladder infections, ulcers (sores) on the legs, etc. - must be investigated and treated before the operation. Because knee joint replacement is usually a scheduled procedure, you have a chance to prepare well. You should watch your weight, for example. In addition, you should discuss the possibility of an autologous blood donation with your physician. The operation will be performed under general or regional anesthesia. The anesthesiologist will talk with you before the operation to discuss which anesthesia method is best in your case.

During the operation

As a rule the operation is carried out as follows:
The knee joint is opened from the front and then bent far enough to permit a good view of all parts. After removing any menisci and filing down any bone spurs, the bone is prepared with suitable templates so that the components of the artificial knee joint will be well seated. After the mobility of the joint is checked with test implants, the original implant is inserted without cement or fixed in place with special bone cement. The operation is generally performed in an exsanguinated leg; the flow of blood into the leg is interrupted temporarily via an inflatable cuff placed around the patient's thigh. The cuff is released at the end of the operation. Any minor bleeding which still occurs is stopped and drains are inserted. The wound is sutured layer by layer and wrapped with a tight bandage.

After the operation

Any blood seeping into the wound flows through the narrow drainage tubes placed in the wound; this prevents the formation of hematomas. As soon as possible after the operation, the leg is exercised to increase the mobility of the joint. An exercise program developed especially for you will be carried out so that you learn to move your knee joint, strengthen your muscles, and walk again.

The first days after the operation

Although postoperative treatment varies somewhat from hospital to hospital after a knee joint replacement procedure, there is a basic postoperative regimen. The leg that has been operated on is placed in a splint which is moved slowly so that the knee is bent and extended; in the manner the range of movement is continuously expanded.

The drains placed in the wounds are removed on the first or second day after the operation. The results of the operation are checked by x-ray and blood tests are carried out for several days consecutively. Since pain is to be expected in the first days after an operation of this kind, you can request painkilling medication. In addition, you will be given an injection every day (usually in the abdomen) to prevent thromboses or embolisms.

In addition to the passive movement with the splint, a physiotherapist will guide you through exercises aimed at increasing the mobility of your knee joint and strengthening the muscles so that they will actively stabilize the knee joint again. Between the third and fifth day, you can take your first steps in the company of your physiotherapist. When you feel secure enough, you can walk without assistance. It is important to remember that the leg that was operated on will not be able to bear your full weight for between four and six weeks. For this reason, you must walk with two crutches so that the leg that was operated on only has to bear part of your weight. After you have gained enough confidence walking with crutches on level ground, you will be shown how to climb stairs. Between the 10th and 14th day after the operation, the sutures or clips will be removed. Soon after this you will be discharged and either transferred to a rehabilitation clinic or sent home with instructions for follow-treatment in your own surroundings.