General Knee Replacement Information | Before Surgery | Surgery | After Surgery
General Knee Replacement Information
Q: What is arthritis and why does my knee hurt?
A: In the knee joint, there is a layer of smooth cartilage on the lower end of the femur (thighbone), the upper end of the tibia (shinbone) and the undersurface of the patella (kneecap). This cartilage serves as a cushion and allows for smooth motion of the knee. Arthritis is a wearing away of the smooth cartilage. Eventually, the cartilage wears down to bone. Rubbing of bone against bone causes discomfort, swelling and stiffness.
Q: What is a total knee replacement?
A: A total knee replacement is really 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 kneecap (patella). This creates a new, smooth cushion and a functioning joint that does not hurt.
Q: What are the results of total knee replacement?
A: Results will vary depending on the quality of the surrounding tissue, the severity of the arthritis at the time of surgery, the patient's activity level and the patient's adherence to the doctor's orders.
Q: When should I have this type of surgery?
A: Your orthopedic 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.
Q: Am I too old for this surgery?
A: 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 personal physician for his/her opinion about your general health and readiness for surgery and to obtain medical clearance for surgery.
Q: How long will my new knee last and can a second replacement be done?
A: 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.
Q: Why might I require a revision?
A: 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 may also result in the need for a new spacer. Your surgeon will explain the possible complications associated with total knee replacement.
Q: What are the major risks?
A: Most surgeries go well, without any complications. Infection and blood clots are two serious potential complications. 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.
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Q: Should I exercise before the surgery?
A: Yes, consult your surgeon about the exercises appropriate for you.
Q: How long will I be incapacitated?
A: Some patients will be able to get up on the day of surgery. By the next morning most patients will get up, sit in a chair or recliner and should be walking with a walker or crutches later that day.
Q: How long will I be in the hospital?
A: Most knee patients will be hospitalized for two to four days after their surgery. There are several goals that you must achieve before you can be discharged.
Q: What if I live alone?
A: Two options are usually available to you. You may return home and receive help from a relative or friend. You can have a home health nurse and physical therapist assist you at home for two to four weeks. You may also stay at a rehab facility following your hospital stay, depending on your insurance, and if you qualify.
Q: Will I need a second opinion prior to the surgery?
A: The surgeon's office surgery scheduler will contact your insurance company to pre-authorize your surgery. If a second opinion is required, you will be notified.
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Q: How long does the surgery take?
A: We reserve approximately two to two and a half hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery.
Q: Do I need to be put to sleep for this surgery?
A: 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.
Q: Will the surgery be painful?
A: You will have discomfort following the surgery, but we will try to 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.
Q: Who will be performing the surgery?
A: Your orthopedic surgeon will perform the surgery. An assistant often helps during the surgery and that assistant will bill you separately.
Q: Where will my scar be located?
A: Your scar will be straight down the center of your knee, unless you have previous scars, in which case we may use the existing scar.
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Q: Will I need a walker, crutches, or a cane?
A: Yes, for about six weeks we do recommend that you use a walker, a cane or crutches. The physical therapist can arrange for them if necessary.
Q: Where will I go after discharge from the hospital?
A: Most patients are able to go home directly after discharge. Some patients may transfer to a rehab or skilled nursing facility. The discharge planner will help you with this decision and make the necessary arrangements. You should check with your insurance company to see if you have rehab or skilled nursing facility benefits.
Q: Will I need help at home?
A: Yes, for the first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, etc. If you go directly home from the hospital, the Home Health nurse will assist you in making the necessary arrangements. Family or friends need to be available to help if possible. Preparing ahead of time, before your surgery, can minimize the amount of help needed. Having the laundry done, house cleaned, yard work completed, clean linens put on the bed and single portion frozen meals will help reduce the need for extra help.
Q: Will I need physical therapy when I go home?
A: Yes, you will have either outpatient or in-home physical therapy. The discharge planner will help you arrange for home therapy or outpatient therapy services.
Q: How long until I can drive and get back to normal?
A: The ability to drive depends on whether surgery was on your right leg or your 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 three to four weeks. If the surgery was on your right leg, your driving could be restricted as long as six weeks. Please note, patients are instructed to avoid driving if taking narcotic pain medications. Getting "back to normal" will depend somewhat on your progress. Consult with your surgeon or therapist for their advice on your activity.
Q: When will I be able to get back to work?
A: We recommend that most people take at least four to six weeks off from work. Return to work status will be discussed at the first post-op visit with your surgeon.
Q: When can I have sexual intercourse?
A: The time to resume sexual intercourse should be discussed with your orthopedic physician.
Q: How often will I need to be seen by my doctor following the surgery?
A: Two to four weeks after discharge, you will be seen for your first postoperative office visit. The frequency of follow-up visits will depend on your progress. Follow-up is an important part of your care plan and visit frequency will be determined by your physician.
Q: Do you recommend any restrictions following this surgery?
A: Yes, high-impact activities, such as running, singles tennis and basketball are not recommended. Injury-prone sports such as downhill skiing are also dangerous for the new joint.
Q: What physical and recreational activities may I participate in after my recovery?
A: You are encouraged to participate in low-impact activities, such as walking, dancing, golf, hiking, swimming, bowling and gardening.
Q: Will I notice anything different about my knee?
A: Yes, you may have a small area of numbness to the outside of the scar, which may last permanently. 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.
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