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Total Knee Replacement. MATTHEW E. MITCHELL, M.D. Disclaimer.

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total knee replacement

Total Knee Replacement


  • The opinions in this presentation are based on my personal experience and review of the literature. Decisions should only be made after consultation with your primary doctor or orthopedic surgeon. More information can be gained from the American Academy of Orthopedic Surgeons Website.

knee arthritis


1. Previous Injury

2. Disease such as rheumatoid arthritis

3. Many times the cause is uncertain


1. Progressive pain with activities

2. Loss of motion

3. “Crunching” sensation in the knee

4. Pain at the start of activity that gets better “warms up over time”

5. Over time deformity can occur in the knee

  • Anti-inflammatories such as motrin or aspirin
  • Physical Therapy
  • Activity modifications such as using a cane
  • Injections
  • Surgery

  • Steroids
    • Takes up to 7 days to take effect
    • Possibility of infection (extremely rare)
    • May last more than 6 months
  • Visco supplements
    • Hyalgan and Synvisc
    • Multiple injections
    • Usually used for early arthritis

  • Used to correct deformity due to arthritis
  • Useful in younger patients
  • Indications are more limited than knee replacement
  • Some patients are candidates for osteotomies

knee replacement
Knee Replacement
  • Unicompartmental replacement
    • Replaces half of the knee

knee replacement9
Knee Replacement
  • Total Knee Replacement
    • Replaces all of the knee

minimally invasive surgery
Minimally Invasive Surgery
  • About ½ of patients are candidates
  • May allow earlier discharge from hospital
  • No studies to date show that MIS (minimally invasive surgery) gives better long term results than traditional surgery
  • Some institutions have noted higher complication rates with MIS

before surgery
Before Surgery
  • Talk with your physician about stopping anti-inflammatory medication
  • You may need a clearance from your medical doctor
  • Expect hospitalization for 3-5 days
  • It is a good idea to visit your physical therapy location before surgery

after surgery
After Surgery
  • You will usually be on some type of clot prevention medication (lovenox or coumadin)
  • Physical therapy should begin immediately after surgery
  • You will need a cane for 4-6 weeks after surgery
  • I like to take sutures out of the incision at 14 days after the day of surgery

follow up and expectations
Follow Up and Expectations
  • My preference is to see patients at 6 weeks, 3 months, and 6 months after surgery
  • You should also be given yearly follow up for xrays
  • Most people are doing well by 3 months and by 6 months can resume most activities

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