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Total Knee Replacement

We are glad you are considering the Spine and Joint Surgery Center to care for your knee. Patients usually have many questions about total knee replacement. Below is a list of the most frequently asked questions along with helpful answers. If there are any other questions that you need answered, please call your surgeon. We want our patients to be completely informed about this procedure.

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 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.

What is a total knee replacement?
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.

What are the results of total knee replacement?
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 physician's orders.

When should I have this type of surgery?
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.

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 might I require 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 are the major risks?
Most surgeries go well without any complications. Infection and blood clots are two serious complications. To avoid these complications, we use antibiotics and blood thinners. Also, we take special precautions in the operating room to reduce the risk of infections.

Should I exercise before the surgery?
Yes, consult your surgeon about the exercises appropriate for you.

Will I need blood?
You may need blood after the surgery. Bank blood is safe, but we understand if you want to use your own.

How do I donate my own blood?
Most patients will not need to donate blood. If, however, your physician requests you to donate your own blood, it will be arranged by your surgeon’s office.

How long will I be incapacitated?
You will probably stay in bed the day of your surgery. However, 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.

How long will I be in the hospital?
Most knee patients will be hospitalized from one to three days after their surgery. There are several goals that you must achieve before you can be discharged.

What if I live alone?
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 or three weeks. You may also stay at a sub-acute facility following your hospital stay, depending on your insurance.

Will I need a second opinion prior to the surgery?
The physician’s office secretary will contact your insurance company to pre-authorize your surgery. If a second opinion is required, you will be notified.

How long does the surgery take?
We reserve approximately 2–2½ 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 spinal or epidural anesthetic, which numbs only your legs and does not require you to be asleep. Some patients prefer to have a general anesthetic, which most people call “being put to sleep.” 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 try to keep you comfortable with the appropriate medication. Generally, most patients are able to stop very strong medication within one day.

Who will be performing the surgery?
Your orthopedic surgeon will perform the surgery. An assistant often helps during the surgery and that assistant will bill you separately.

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.

Will I need a private nurse?
No, you do not need a private nurse, but if you want one, we can assist in making these arrangements for you.

Will I need a walker, crutches or a cane?
Yes, for about six weeks we do recommend that you use a walker, a cane or crutches. The joint care coordinator can arrange for them if necessary.

Where will I go after discharge from the hospital?
Most patients are able to go home directly after discharge. Some patients may transfer to a sub-acute facility, where they will stay from three to five days. The joint care coordinator will help you with this decision and make the necessary arrangements. You should check with your insurance company to see if you have sub-acute rehab benefits.

Will I need help at home?
Yes, for the first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, dressing, bathing, etc. If you go directly home from the hospital, the joint care coordinator may arrange for a home health care nurse to come to your house as needed. Family or friends need to be available to help, if possible.

Preparing ahead of time, before surgery, can minimize the amount of help needed. Having laundry done, house cleaned, yard work completed, clean linens on the bed and single-portion frozen meals ready, will help reduce the need for extra help.

Will I need physical therapy at home?
You may need this service when you go home. If so, you will have either outpatient or in-home physical therapy. Patients are encouraged to utilize outpatient physical therapy. The joint care coordinator will help you arrange for an outpatient physical therapy appointment. If you need home physical therapy, we will arrange for a physical therapist to provide therapy at your home. Following this, you may go to an outpatient facility three times a week to assist in your rehabilitation. The length of time required for this type of therapy varies with each patient.

How long until I can drive and get back to normal?
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 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 somewhat on your progress. Consult with your surgeon or therapist for their 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. An occupational therapist can make recommendations for joint protection and energy conservation on the job.

How often will I need to be seen by my physician 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.

Do you recommend any restrictions following this surgery?
Yes, high-impact activities, such as running, tennis and basketball are not recommended. Injury-prone sports such as downhill skiing are also dangerous for the new joint.

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.

Will I notice anything different about my knee?
Yes, 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.