TOTAL KNEE REPLACEMENT
Consent
A Total Knee Replacement (TKR) is a procedure which replaces all or part of
the knee joint with an artificial device (prosthesis). The goal of the surgery
is to relieve your knee pain and allow you to do normal activities like
walking more easily.
This brochure will provide information as to the nature, risks and benefits of knee replacement
surgery. It is important that you read it fully and ask questions if there is anything you do not
understand.
Normal Knee Anatomy
Your knee is a weight bearing joint which acts like a hinge: the tibia (shin bone) moves on the
femur (thigh bone). The bones are held together with ligaments and tendons and supported by
the muscles. The patella (knee cap) sits at the front of the knee in a groove made by the joint
between the femur and tibia.
A durable, smooth soft tissue called articular cartilage coats the joint surface of the femur and
tibia bones, and the underside of the patella. It cushions them and enables them to move
smoothly on one another.
Arthritis occurs when the cartilage wears away, exposing the underlying bone. These rough joint
surfaces cause swelling, pain, and loss of movement.
A healthy knee, an arthritic knee and a total knee replacement Source: American
Academy of Orthopaedic Surgeons www.orthoinfo.aaos.org
Total Knee Replacement
A total knee replacement replaces the rough joint surfaces. It consists of up to four parts, which
are usually fixed with special cement.
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The end of the thigh bone is made of metal and shaped to provide a groove where the
knee cap can sit.
The end of the shin bone is usually made up of two parts – a metal tray that is fitted onto
the bone, and a plastic spacer in the middle that takes most of the weight.
Often the underside of the knee cap is also replaced by a smooth piece of plastic (patella
resurfacing).
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Expectations of Surgery
Patients must remember your surgeon cannot guarantee that this surgery will meet all of your
expectations or is free from risk. It is important to ask your surgeon if you are unsure or seek the
opinion of another surgeon if you remain unsure. Not everyone will get the same results. The goal
is to relieve your pain and improve your knee function.
Risks and Complications
General complications can occur after any operation and can include: allergic reaction to
medications / implants, loss of blood during surgery that may require a blood transfusion, nausea,
heart attack, stroke, kidney failure, pneumonia (chest infection) and urine infection.
SPECIFIC RISKS OF KNEE REPLACEMENT SURGERY
Damage to nerves or blood vessels: The required surgical incision will damage the skin
nerves. This will result in a permanent area of skin numbness on the outside of the knee. Other
nerve damage is rare, but can lead to weakness in part of the leg. Damage to blood vessels may
require further surgery if bleeding is ongoing.
Infection: Occurs in about 1% of knee replacements. It can be treated with antibiotics but may
require further surgery. Eradication of some deep infections may require implants to be removed
for a period.
Blood clots: (Deep Venous Thrombosis): Can form in the leg veins and travel to the lungs
(Pulmonary Embolism). They can occur after any type of surgery, or even without any surgery at
all, but are more common with lower limb surgery. We will use treatments to reduce this risk (calf
compressors, blood thinners like aspirin). Rarely they can cause serious problems and even be
life threatening. If you get calf pain or shortness of breath at any stage, you should see a doctor.
Wear or loosening of the implants: The implant may become loose or wear out. In
general, more than 90% of knee replacements last at least 10 years.
Implant failure: Rarely, the artificial joint may break. Another operation will usually be needed.
Bone Fracture around the implant: Rarely the bone may fracture around the implant,
particularly if you have or develop osteoporosis. Another operation will usually be needed.
Loss of blood supply: Rarely complications due to a severely impaired blood supply may
result in an amputation of the leg. The risk increases in the elderly and those in poor health. The
risk is about one in 6000 patients.
Stiffness: The knee can be stiff after surgery especially if the knee was particularly stiff prior to
surgery.
Failure to relieve pain: Pain that persists after knee replacement is not uncommon,
occurring in a small percentage of patients. This may be due to other causes of pain, such as the
spine, or from wound or nerve sensitivity.
Swelling: A build up of fluid may accumulate in the knee that requires drainage.
Allergy to metal implant: Allergies to the metal implants have been reported but are rare.
BEFORE YOUR SURGERY
Pre Admission Clinic (PAC)
Approximately 6 weeks prior to your planned surgery date, you will attend the Pre-Admission
Clinic to receive more information about your hospital stay, commence planning for discharge
from hospital and to ensure you are fit for surgery. The clinic appointment can take up to 3 hours
and you will be reviewed by the anaesthetist, orthopaedic doctor, a nurse, and a physiotherapist
or occupational therapist.
Patients will be required to have blood tests done at a Melbourne Health Collection Centre or with
the local general practitioner prior to this appointment (please bring a copy of your blood test
results with you). Further reviews in the clinic may be required to treat conditions such as
anaemia (low blood iron levels).
What sort of anaesthetic will I have?
The anaesthetist will discuss with you which type of anaesthetic is best for you (general or spinal
anaesthesia) at the PAC appointment and then again on the day of your surgery. Any questions
regarding your anaesthetic can be asked prior to your surgery.
Smoking: It is important you stop smoking at least two weeks before surgery. Smoking increases
surgical and anaesthetic risk and impairs healing. You are strongly advised to quit. Stopping
smoking is not easy but help and support are available which will increase your chances of
success. Call Quit line on 137848 for advice and information about these resources.
After your surgery
Following the surgery you will be transferred to the ward to begin your rehabilitation. The nursing
staff and physiotherapist will assist you to get out of bed, usually on the day of surgery. You will
commence walking either on the same day (morning operations) or the day after surgery
(afternoon operations).
There is usually no weight bearing restriction after the operation and you can put as much weight
through the knee as is comfortable. Most patients use crutches or other walking aids for comfort
for a period. You should gradually reintroduce and build up activities as symptoms allow and as
directed by your surgeon and therapists.
How long will I be in hospital?
The expected length of hospital stay at The Royal Melbourne is up to FOUR days. Most patients
are discharged home with community therapy. A small number of patients will be transferred to
the RMH Rehabilitation ward at RMH Royal Park Campus if progressing slowly or if there is not
enough support at home.
What kind of pain relief will I need?
The method of pain relief to be used for you will be decided by the surgeon and anaesthetist as
part of the pre-admission assessments, then again on the day of your operation. A combination of
tablets (paracetamol, anti-inflammatory, a strong opioid based analgesic and a nerve drug) and
injectable medications (local anaesthetic, opioid) will be started just before the operation and
continue for up to 10 days after your surgery. You will be reviewed by the Pain Team on the ward
following the operation.
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When can I drive?
You can NOT drive until you have been review by your surgeon at your 6 week post surgery
outpatient appointment. Your surgeon will state when you can drive again.
What happens when I go home?
Follow up therapy will be organised for you at a facility close to home. The physiotherapist and
occupational therapist will assist you with gaining independence with daily activities, hobbies and
work duties if you are employed.
When will I see the doctor?
A follow up appointment will be made for you to return to the hospital. Information will be sent to
your general practitioner regarding the date and type of surgery.
What happens now?
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You will receive a letter confirming you have been placed on The Royal Melbourne
Hospital elective surgery waiting list
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A Pre-Admission Clinic appointment will be organised approximately 6 weeks prior your
planned surgery
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Please ensure that you complete all the forms you are sent by the hospital and have your
blood tests prior to attending the Pre-Admission Clinic
Contact
If you are unwell and unable to attend the hospital for your surgery, please contact
Elective Bookings Service: 9342 8400
If you have any queries about your operation prior to your surgery, please contact the
Unit Liaison Nurse John Gardiner on 9342 4081.
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