TEACHER’S
GUIDE
Direct From the
Operating Room:
Total Knee Replacement
CONTENTS
Online Resources 3
Total Knee Replacement Surgery Overview
4
Tools Overview
5
Vocabulary 8
Further Content
9
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ONLINE RESOURCES
There is a considerable amount of quality content available online designed to educate and prepare patients for total
knee replacement surgery, much of which can be useful for students. Here are a set of resources you may find helpful:
My.Health.Alberta.ca –
Government of Alberta Personal
Health Portal
The Alberta Bone and Joint Health
Institute
Canadian Orthopedic Foundation
Videos
https://myhealth.alberta.ca
www.albertaboneandjoint.com
http://www.orthoconnect.
org/index.php/en/videos
Knee Replacement Surgery
Overview
The Alberta Bone and Joint Health
Institute - Patient guide
MedlinePlus - U.S. National
Library of Medicine
https://myhealth.alberta.
ca/health/Pages/conditions.
aspx?hwid=aa14776
http://www.albertaboneandjoint.
com/patients/
about-your-treatment/
www.nlm.nih.gov/medlineplus
TOTAL KNEE REPLACEMENT
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TOTAL KNEE REPLACEMENT SURGERY - OVERVIEW
Total Knee Replacement surgery is one of the largest and most complex surgeries that can be performed by an
orthopedic surgeon. Although it has become almost commonplace, it is still a serious and major surgery that involves
the cutting and removal of large sections of bone, the implantation of a prosthetic device, and long and painful
rehabilitation. Despite the drawbacks of the surgery, it is reported that over 95 percent of those who undergo the
operation experience significant pain reduction and an increase in quality of life.
The Surgery:
Stage 1
Stage 3
In the first stage of the operation, the surgeon will use
general anesthetic to put the patient to sleep, and
monitors will be used throughout the operation to make
sure all the vitals of the patient are stable. Once the
patient is properly draped and prepared, the surgeon will
use a scalpel to open an incision anywhere from 10 to 20
cm long. Once the incision has been made, tools called
retractors are used to hold open the cut and keep the
skin and soft tissues away from the surgical site. During
this stage a cautery is used to cauterize any blood
vessels that are bleeding. Once the knee joint is exposed
and the retractors set up, the next stage begins.
A bone saw is employed to shape the ends of the
exposed bones to better fit the prosthetic. Once
a proper fit is made, a drill is used to drill into the
remaining bone to secure the prosthetic to the living
bone. A thick layer of cement is applied to the exposed
bone, and the prosthetic is fit into the joint. A mallet
and metal pins are then hammered through the
prosthetic and into the upper and lower leg bones of the
patient, securing it with both pins and cement.
Stage 2
At this point the surgeon examines the joint and will
use a rongeur to rasp away bone spurs that will not be
removed during the surgery itself. Next, the surgeon
employs a set of “jigs” or bone cutting instruments,
which will be used to cut the patella, the tibia, and the
femoral bones and remove the bone fragments from
the patient. The cautery is used to keep bleeding to a
minimum. The trial components are placed into the
hollow knee joint and marks are made where holes are
to be drilled.
Stage 4
The surgeon then begins the tedious process closing the
layers of muscle and tissue that have been realigned to
the new knee. Various types of sutures are used for this
process. Most of them will remain in the patient until
they are either absorbed, or are permanent sutures. The
final outer layer of skin and tissue is usually closed with
staples. These are removed around 12 to 14 days after
the surgery.
Misconceptions
A misconception about knee replacement surgery is that because it has become more common, and usually does not
take more than a couple of hours at most, it is a simple procedure and not dangerous. This could not be further from
the truth. The shock to the body is significant, as large sections of bone are being cut and removed, and the rough
handling that is a necessity when dealing with joint replacement causes damage to the surrounding tissues. Bleeding
can become profuse, and blood transfusions during this surgery are common. Infection is a real possibility as well,
and there is always a small chance that the results of the surgery will be less than ideal. In a vast majority of cases,
however, knee replacement surgery is safe and significantly improves the patient’s quality of life.
From www.ehow.com/about_5292371_instruments-used-total-knee-replacement.html
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TOOLS – OVERVIEW
SCALPEL
A very sharp blade used in dissection.
TOURNIQUET
A compression device using air designed to cut off blood flow to
the area being operated on.
CAUTERIZING
PEN
A hand held instrument used to control blood loss by burning some
of the tissue.
RAKE
RETRACTOR
An instrument to separate the incision of a surgical wound (not a
fork!).
HOHMANN
RETRACTOR
A metal pry tool for retracting tissue and protecting important
structures, like the collateral ligaments.
RONGEUR
Tool used for grabbing bone and soft tissue. In french, “rongeur”
means rodent.
TOTAL KNEE REPLACEMENT
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MALLET
Used like a hammer to drive chisels, wedges or nails into a bone.
SAW
Used with cutting blocks and cutting jigs to create proper
alignment for the components.
DRILL
Used with cutting blocks and cutting jigs to create proper
alignment for the components.
JIG PINS
Pins used to hold cutting jigs in place.
TIBIAL CUTTING
JIG
The lower part is lined up with the ankle with the platform at the
top of the jig is level with the tibia to ensure proper alignment.
DISTAL
FEMORAL
CUTTING JIG
Used on the femur as a reference point to ensure proper alignment.
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PATELLAR
CUTTING JIG
Helps measure the amount of patella to be removed and helps
maintain alignment of the cut.
SIZING JIG
Sizes and helps external rotation of the femoral component.
FEMORAL
CUTTING BLOCK
Assists in creating proper cuts to shape the femur.
BONE CEMENT
Used to hold the components in place.
OSTEOTOMES
Chisels for shaping bone.
KNEE
REPLACEMENT
COMPONENTS
Femoral component, patellar component and tibial component.
TOTAL KNEE REPLACEMENT
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VOCABULARY
Surgery Terminology
Ligament – A fibrous tissue that connects
bones to bones.
Tendon – A fibrous connective tissue that
connects muscle to bone.
Femur – Thigh bone.
Tibia – Shinbone. Stronger of the two bones
in the lower leg.
Fibula – Smaller of the two bones in the leg below
the knee. Located on the outside of the leg.
Patella – Knee cap.
Varus – Inward angulation of the distal segment
of a bone or joint. A varus knee makes a patient
“bow legged.”
Valgus – Outward angulation of the distal
segment of a bone or joint. A valgus knee
makes a patient “knock kneed.”
Proximal – Referring to a position closer to the head.
Meniscus – A horseshoe of fibrous cartilage in
the knee that provides a cushion and structural
support between the femur and the tibia.
MCL – Medial Collateral Ligament- A stabilizing
ligament situated on the medial (inner) side of the knee.
PCL – Posterior Cruciate Ligament- major ligament
running from the front to the posterior (back) of the knee.
LCL – Lateral Collateral Ligament- Stabilizing ligament
on the lateral (outside) of the knee.
ACL – Anterior Cruciate Ligament- Major ligament in
the centre of knee running from back to front (anterior).
Commonly involved in sports injury.
Flexion – The act of bending a joint.
Extension – The act of straightening a joint.
Arthritis – When the cartilage covering the ends of
the bones at a joint starts to wear away causing
pain and stiffness .
Distal – Referring to a position away from the head.
Bone Spur – “Osteophytes”- Bony projections that
form along margins of arthritic joints.
Lateral – Away from the midline of the body.
Resect – Cutting back or resurfacing.
Posterior – Referring to a position in back or behind.
Dissect – To cut apart or separate.
Anterior – Referring to a position before or in front.
Cortical bone – The dense, hard, outer shell of
bone providing strength and stiffness.
Medial – Referring to a position towards the midline
or middle of the body.
Collateral – Situated or running side by side (parallel).
Cruciate Ligaments – A pair of ligaments in the knee
that are arranged in the letter X (cruciate = cross).
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Cancellous bone – The spongy honeycomb-like
central type of bone.
Synovial fluid – The lubricating fluid inside a joint.
FURTHER CONTENT
Videos – YouTube
In addition to anatomy tutorials of the knee and patient education videos covering knee replacement and arthritis,
numerous complete knee replacement surgeries are available to view on YouTube.
Interactive activities
There are a number of online activities where students can
play the role of the Surgeon throughout a knee replacement
surgery. For example: www.edheads.org/activities/knee/
TOTAL KNEE REPLACEMENT
9
220 St. George’s Drive NE
Calgary, AB, T2E 5T2
P: 403.817.6800
E: [email protected]