KNEE REPLACEMENT MELBOURNE

Knee Replacement  Surgery Melbourne – A patient’s guide

Dr Arash Riazi – MBBS, BSc (Med), FRACS (Ortho), F.A.Orth.A.
Orthopaedic Surgeon.

This guide is to help you understand the benefits and limitations of knee replacement surgery.

It explains what knee replacement surgery is, who could benefit, what to expect, potential complications and recovery information that may help you get the best results from your surgery.

If you have any questions about knee replacement surgery, please contact my offices using the details below.”

 Dr Arash Riazi – Orthopaedic Surgeon

If you have any questions please call
(03) 9898 4216

New patients welcome.
Please bring a referral from your GP or Specialist.

What is knee replacement surgery

Total knee replacement surgery involves replacing parts of the knee joint which are damaged, arthritic or diseased with artificial metal and plastic components (known as a prosthesis). The prothesis enables the knee joint to move naturally.

The knee is the largest joint in the body. It comprises of the lower part of the thighbone (femur) and upper part of the shinbone (tibia) as well as the kneecap (patella).

Covering all three bones is a smooth coating called cartilage which protects the bones and enables them to move easily.

Dr Riazi uses computer navigation, 3-D printed templates and the latest technology to prepare patient tailored and specific implants with high flexion or bendability.

Knee Anatomy

Why consider knee replacement surgery

Significant pain from a damaged or arthritic knee can make simple activities such as walking or climbing stairs painful and difficult to perform. You may even feel pain when at rest.

Dr Riazi will discuss non surgical measures with you such as painkillers and walking aids as well as weight loss. He may also discuss temporary injections of hyaluronic acid or steroids which can sometimes help with inflammation and pain relief.

If non-surgical measures are not managing your symptoms effectively then you may consider total knee replacement surgery. The main potential benefit of this type of surgery will be relief of your knee pain. You may also have improved knee function allowing you to walk further and with greater ease. The aim is to have you resume normal daily activities. Many patients report a better quality of life after post surgery rehabilitation.

The most common cause for chronic knee pain is arthritis. When arthritis occurs the smooth coating (cartilage) wears away and becomes rough. This stops the knee from moving properly and becomes stiff and swollen. Eventually the joint wears out and the bone of the femur grinds against the bone of the tibia. This leads to pain and fatigue and can significantly restrict activity such as walking and climbing stairs.

Knee Replacement Surgery Melbourne

Dr Arash Riazi – Orthopaedic Surgeon

If you have any questions about Knee Replacement Surgery please contact my offices:

CONTACT DR RIAZI

What happens during surgery

Your anaesthetist will assess you and decide on the most suitable form of anaesthetic. Usually you are given a general anaesthetic so that you are completely asleep during the operation. However a spinal anaesthetic in combination with local anaesthetic and sedation is another safe approach. Dr Riazi will see you before the operation to answer any questions you may have and mark the site of surgery.

Every knee is different and Dr Riazi takes this into account by having different size options available for your knee. A tourniquet will be applied to your upper thigh as this helps reduce blood loss. Pre-operative planning usually includes state of the art 3-dimensional modelling of the implant or the use of intraoperative computer navigation which enables Dr Riazi to align your knee replacement in the most optimal mechanical axis alignment.

Dr Riazi will then make an incision at the front of the knee. The damaged parts of the femur and tibia will be cut and removed. The remaining bone is carefully and precisely shaped using special instruments so that the prosthesis sits firmly on the bone. Different types of knee implants are used to tailor to your needs. The femoral replacement is a smooth metal component which fits over the end of the bone. The tibia replacement is in two parts; a metal base plate and a polyethylene liner. Trial components are inserted to ascertain the perfect ‘fit’ and thickness of plastic needed between the components. If necessary your patella may also be replaced but this depends on various factors and is not always needed. Dr Riazi will make this decision with you before or during surgery.

Total Knee Replacement

Once Dr Riazi is happy, the real prosthesis is implanted either with or without special bone cement. He will bend and flex your knee to make sure that it is stable, moving smoothly and that the alignment and positioning is correct. The incision is then carefully closed with dissolvable sutures and bandaged, ready for recovery.

The procedure usually takes about 1-2 hours and every patient has intravenous antibiotics prior to surgery and for 24 hours post-operatively to minimise the chances of infection. You will wake up in the recovery room and remain there for a couple of hours before being transferred to the ward.

Preparing for surgery

Once the decision is made between yourself and Dr Riazi to have surgery, we will help guide you to prepare for the operation. It is often helpful to make a checklist for yourself.

1. Medical Conditions

Make sure that you let Dr Riazi know about any medical conditions you may have. It is a good idea to make an appointment with your GP so that they can perform a general evaluation prior to the procedure and assess fitness for surgery and anaesthesia. You may need to take some pre-operative tests such as blood tests, cardiogram and/or chest x-ray.

If you have any dental work planned, make sure that it is completed well in advance of surgery. It is important that any dental infections are dealt with prior to joint surgery, this is because of the risk of infection

2. Medication

If you are taking any medication, including herbal medicines please let Dr Riazi know. It is a good idea to bring in a list of your medication to the consultation and when you come into hospital for surgery. Medicines that thin the blood will need to be stopped before surgery. Also some other types of medication such as corticosteroids and insulin will also need to be managed before and after surgery. If you have any questions about your medicines please contact Dr Riazi.

3. Smoking

Smoking has a significant effect on your health and also increases your risks of problems during and after surgery, including risk of infection. Stopping smoking before your procedure and staying smoke free during recovery can substantially improve wound healing as well as your general health. If you are a smoker then now is a good time to quit for good, please contact your GP for help in quitting smoking.

4. Keeping fit

It is important to try and be as fit as possible before surgery to reduce the chance of complications and reduce the length of recovery. If it is difficult to move around then a gentle exercise such as swimming and hydrotherapy are good options.

5. Fasting

Dr Riazi’s team will advise you regarding the fasting recommendations. Generally speaking, for morning surgery we advise to fast from midnight the night before the procedure and for surgery scheduled for the afternoon patients should fast from 6am on the day of surgery. You can have clear fluids up until 4 hours before surgery.

6. Home Preparation

There are a number of measures you can take to prepare for coming home after surgery.

  • Furniture – Make sure you can easily move throughout your home
  • Trip hazards – Remove any rugs or throws that may cause a fall
  • Special equipment – Shower chair, handrails or raised toilet seat.
  • Single floor living space – Walking up and down stairs may be difficult during early recovery
  • Household chores assistance –  Plan ahead for cooking and shopping
  • Freeze some meals – Have food you can prepare quickly and easily  or arrange for someone to bring you meals.

Possible complications

Dr Arash Riazi – Help centre

There are risks associated with any surgical procedure. I will discuss the risks with you before you make the decision to undertake hip replacement surgery.

The list below is not exhaustive but covers some of the more common complications:

Bleeding

There is a risk of blood loss during the procedure and sometimes a blood transfusion is required

Venous Thromboembolism (VTE)

A VTE is when there is a blood clot inside a blood vessel. There are two types of VTE:

  1. Deep Vein Thrombosis (DVT) – This is a blood clot that forms in a vein, usually in the leg. Signs and symptoms include redness, swelling and pain but sometimes there are no symptoms at all.
  2. Pulmonary Embolism (PE) – Is when the blood clot becomes dislodged and travels to the lung. Symptoms of a PE include chest pain, breathlessness and coughing.

All patients are given measures to prevent a VTE from happening. These may include blood thinning medications and below the knee compression stockings. It is important to move around as soon as possible after surgery and the nurses and physiotherapists will help you do that.

Infection

There is a risk of infection in the wound site however you will be given antibiotics both during and after the procedure to help prevent this. If an infection does still occur, you will be given antibiotics to help clear it up.

Pain

As with any surgical procedure, you may experience some pain. We use various anaesthetic techniques to minimise this and provide you with painkillers to help manage your pain. It is important that you get adequate pain relief so that you are able to move around as soon as possible after your operation. Dr Riazi and his team use a multimodal pain management regimen with a combination of opioids and non-steroidal anti-inflammatory drugs (in those patients for whom it is safe and appropriate) to provide optimum pain relief whilst minimising side effects.

Anaesthesia risks

Your anaesthetist will meet with you before the operation and discuss the risks with you as well as the best option for you.

Knee stiffness

Some people may experience knee stiffness after surgery. This will usually improve with exercise and as the swelling is reduced.

Nerve, ligament and blood vessel damage

There is a very small risk that these structures can be injured during the operation. Usually they will recover but occasionally patients may experience extensive bruising or even have difficulty moving their foot up and down. Nerve damage can cause a loss of feeling or movement below the knee and can be permanent.

Dislocation

There is an extremely small risk of dislocation of the knee where the ends of the knee joint lose contact with each other.

Leg length inequality

The corrected knee will be straighter than the other knee and can appear slightly  longer. This is unavoidable.

Post-Operative Recovery

Please contact hospital staff or Dr Riazi immediately if:

(1) Your wound become more swollen, red and/or hotter than before
(2) There is any discharge from the wound
(3) There is any new numbness, tingling or discolouration in your foot, which lasts for more than 24 hours.

After your operation

After the operation you will be transferred to recovery and then to a surgical ward where you will be looked after by nursing staff. We aim to have you out of bed as soon as possible after the procedure as this will really help speed up your recovery as well as reducing the chances of a blood clot. You will be seen by a physiotherapist who will help get you out of bed and moving short distances. Some patients are able to start moving on the same day as the procedure whilst others start moving on day 1 post operatively. The physiotherapist will help you progress until you are mobilising independently.

Active recovery participation

It is really important that you play an active role in your own recovery. You can contribute greatly to the success of the operation by following the advice of your healthcare team whilst in hospital and when you go home. Our physiotherapist will teach you exercises that will help strengthen your muscles. These can cause some discomfort and swelling. You will be prescribed painkillers to take home and it is important to take these as instructed as managing your pain effectively will also help you mobilise and carry out these exercises to ensure your recovery.

Your recovery at home: (print out)

It is really important to follow the advice given to you by Dr Riazi and his team in order to rehabilitate.

After you leave hospital your knee may still be painful and swollen. Continue to take your prescribed painkillers, these will help manage your pain so that you can move your knee.

It is normal for your knee to be swollen for a few weeks after surgery. You can use ice packs to help reduce the swelling. Placing a pillow under your heel to raise your leg whilst you are resting can also help ease swelling but do not place it under the knee.

Try to change knee position every hour whilst you are awake so to reduce stiffness.

Wound healing

As the wound heals it may feel itchy, this is a normal part of the healing process and will ease with time. You should not submerge your knee in water (avoid swimming) until the wounds are completely healed which can take approximately 10-14 days. You will have sutures running along the wound which will dissolve on their own.

If your wound becomes more swollen, increasingly hot or red contact Dr Riazi. Also watch out for any tingling, numbness in your foot that lasts longer than 24 hours.

Exercises

You will be given a regimen of exercises to perform by your physiotherapist. You should aim to do 30 minutes of exercise two to three times a day. These are very important for your recovery.

Walking

By the time you are discharged you will be walking short distances safely with a walking aid which can either be a walker, crutches or a walking stick. You should start to move around freely and become less and less dependent on the walking aid that you are using. So that if you were initially using a walker, you can progress to a walking stick within a few weeks. Walking is a really good exercise for your knee and once your new knee becomes more comfortable you will be able to go for longer walks

Driving

You can normally start to drive around 6 weeks after surgery as this will be when most patients are comfortable walking.

IMPORTANT NOTE

This information is designed to be a guide only. Every patient has unique needs and will react differently to surgery, pain management and recovery approaches.

If you would like more details or have any worries or questions about hip replacement surgery please contact my offices so I may address your concerns.

Knee Replacement Surgery Melbourne

Dr Arash Riazi – Orthopaedic Surgeon

If you have any questions about Knee Replacement Surgery please contact my offices:

CONTACT DR RIAZI
KNEE REPLACEMENT SURGERY MELBOURNE

Dr Riazi consults with public and private orthopaedic patients from all over Melbourne. His current consulting locations include Epworth Eastern Hospital in Box Hill and Box Hill Hospital (Eastern Health) in Box Hill.