Knee Surgery
What is arthritis, and why does my knee hurt?
In the knee joint there is a layer of smooth cartilage on the lower end of the thighbone (femur), the upper end of the shin bone (tibia) and the under surface of the kneecap (patella). This cartilage serves as a cushion and allows for smooth motion of the knee. Arthritis is a wearing away of this smooth cartilage. Eventually, it wears down to the bone. Rubbing of bone against bone causes discomfort, swelling and stiffness.
What is a total knee replacement?
A total knee replacement really is a cartilage replacement with an artificial surface. The knee itself is not replaced, as is commonly thought, but rather an artificial substitute for the cartilage is inserted on the end of the bones. This is done with a metal alloy on the femur and plastic spacer on the tibia and patella. This creates a new, smooth cushion and a functioning joint that does not hurt.
What are the results of total knee replacement?
Ninety-95 percent of patients achieve good to excellent results with relief of discomfort and significantly increased activity and mobility.
When should I have this type of surgery?
Your orthopaedic surgeon will decide if you are a candidate for the surgery. This will be based on your history, exam, X-rays and response to conservative treatment. The decision will then be yours.
Am I too old for this surgery?
Age is not a factor if you are in reasonable health and have the desire to continue living a productive, active life. You may be asked to see your primary care provider for his/her opinion about your general health and readiness for surgery.
How long will my new knee last and can a second replacement be done?
All implants have a limited life expectancy depending on an individual’s age, weight, activity level and medical condition(s). A total joint implant’s longevity will vary in every patient. It is important to remember that an implant is a medical device subject to wear that may lead to mechanical failure. While it is important to follow all of your surgeon’s recommendations after surgery, there is no guarantee that your particular implant will last for any specific length of time.
Why would I need a revision?
Just as your original joint wears out, a joint replacement will wear over time as well. The most common reason for revision is loosening of the artificial surface from the bone. Wearing of the plastic spacer also may result in the need for a new spacer. Your surgeon will explain the possible complications associated with total knee replacement.
What happens if I get a scratch, cut, or bite on the leg on which I am having surgery?
Call the physician right away; he may want to see it or prescribe an ointment to use on it. If an infection starts, it will delay your surgery at least one week.
What are the major risks?
Most surgeries go well, without any complications. Infection and blood clots are two serious complications that concern us the most. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce the risk of infections. The chances of this happening are one percent or less.
Should I exercise before the surgery?
Yes. Please consult an outpatient physical therapist or follow the exercises listed in your preoperative packet.
Will I need blood?
You may need blood after the surgery. You may donate your own blood if you are able, use the community blood supply, or have your relatives donate for you. Bank blood is considered safe, but we understand if you prefer to use your own.
How do I donate my own blood?
Your surgeon’s office will arrange to have you donate your own blood.
How long will I be incapacitated?
You will be able to get out of bed and walk a short distance in your room the day of surgery. In one-two days you will be walking more than 100 feet.
How long will I be in the hospital?
Most knee patients will be hospitalized for three days after their surgery. There are several goals you must achieve before you can be discharged.
What if I live alone?
Two options usually are available to you. You may return home and receive help from a relative or friend, or you can have a home health nurse and physical therapist assist you at home for two to three weeks. You also may stay at a subacute facility following your hospital stay, depending on your insurance.
How long does the surgery take?
We reserve approximately 2-2 ½ hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery.
Do I need to be put to sleep for this surgery?
You may have a general anesthetic, which most people call “being put to sleep.” Some patients prefer to have a spinal or epidural anesthetic, which numbs your legs only and does not require you to be asleep. The choice is between you, your surgeon and the anesthesiologist.
Will the surgery be painful?
You will have discomfort following the surgery, but we will keep you comfortable with the appropriate medication. Generally, most patients are able to stop very strong medication within one day. Most patients control their own medicine with a special pump that delivers the drug directly into their IV.
Who will be performing the surgery?
Your orthopaedic surgeon will perform the surgery with the assistance of a dedicated surgical team.
How long, and where, will my scar be?
The scar will be approximately six inches long. It will be straight down the center of your knee, unless you have previous scars, in which case we may use the existing scar. There may be some lasting numbness around the scar, which will not cause any problems.
Will I need a private nurse?
No, you do not need a private nurse.
Will I need a walker, crutches, or a cane?
Yes, for approximately four to six weeks, we recommend you use a walker, cane or crutches. A case manager can arrange for them if necessary. The orthopaedic coordinator will be working with a case manager to facilitate your postop care and equipment needs.
Will I need other equipment?
A raised toilet seat or three-in-one bedside commode is recommended. A tub bench and grab bars I the tub or shower also may be necessary. Your physical or occupational therapist can help you determine this before surgery.
Will I need help at home?
For the first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, etc. Preparing ahead of time, before your surgery, can minimize the amount of help required. Having the laundry done, house cleaned, yard work completed, clean linens on the bed, and single-portion frozen meals will help reduce the need for extra help.
Will I need physical therapy when I go home?
Physical therapy is a vital part of your recovery, and usually last four-six weeks, depending on your progress. The options for physical therapy include an outpatient facility, your home (if you are homebound) or a skilled nursing facility.
How long until I can drive and get back to normal?
The ability to drive depends on whether surgery was on your right or left leg, and the type of car you have. If the surgery was on your left leg and you have an automatic transmission, you could be driving at two weeks. If the surgery was on your right leg, your driving could be restricted as long as six weeks. Getting “back to normal” will depend on your progress. Consult with your surgeon or therapist for his/her advice on your activity.
When will I be able to get back to work?
We recommend that most people take at least one month off from work, unless their jobs are quite sedentary and they can return to work with crutches or a walker. An occupational therapist can make recommendations for joint protection and energy conservation on the job.
When can I have sexual intercourse?
The time to resume sexual intercourse should be discussed with your orthopaedic surgeon.
How often will I need to be seen by my doctor following the surgery?
Two to three weeks after discharge, you will be seen for your first postoperative office visit. The frequency of follow-up visits will depend on your progress. Many patients are seen at six weeks, 12 weeks, and then yearly.
What physical/recreational activities may I participate in after my recovery?
You are encouraged to participate in low-impact activities such as walking, dancing, golf, hiking, swimming, bowling and gardening.
How long will my knee continue to hurt and swell?
Swelling usually increases during the first few days at home from the hospital. This is improved by spending one hour in the morning and one hour in the evening with the feet elevated each day.
The pain after joint replacement usually decreases rapidly during the first month. Sometimes there is a dull ache after long walks, which can occur for up to 18 months. “Start-up” pain (pain with the first few steps after standing up) may present for a while. This improves without treatment and does not mean the implants are loosening or failing.
How much exercise should I do, and how can I tell if I have done too much?
Mild to moderate exercise is beneficial. Twenty minutes, four times daily should be devoted to performing your exercises. A significant increase in the amount of swelling, and pain in your knee, not alleviated by elevating your feet, are good indicators you may have done too much.
Will I notice anything different about my knee?
You may have a small area of numbness to the outside of the scar, which may last a year or more. Kneeling may be uncomfortable for a year or more. Some patients notice some clicking when they move their knee. This is the result of the artificial surfaces.
When can I go up and down stairs?
It is important that the Nursing staff and physical therapist be aware of any stairs you will need to climb to get into your house. This way the physical therapist can instruct you on proper technique prior to discharge from the hospital.
How long should I continue taking my medication after I go home?
Blood thinning medication (Coumadin) should be taken until your surgeon has instructed you to stop. All pain medications may be taken as directed for pain. If you have any questions, consult your doctor.
Do you recommend any restrictions following this surgery?
High-impact activities such as running, singles tennis and basketball are not recommended. Injury-prone sports such as downhill skiing also are restricted.
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