Preparing For Knee Replacement Surgery
Before you go into hospital, find out as much as you can about what’s involved in your operation. Your hospital should provide written information or videos.
Stay as active as you can. Strengthening the muscles around your knee will aid your recovery. If you can, continue to do gentle exercise, such as walking and swimming, in the weeks and months before your operation. You can be referred to a physiotherapist, who will give you helpful exercises.
Read about preparing for surgery, including information on travel arrangements, what to bring with you and attending a pre-operative assessment.
Risks Of The Procedure
As with any surgical procedure, complications can occur. Some possiblecomplications may include, but are not limited to, the following:
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Bleeding
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Blood clots in the legs or lungs
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Loosening or wearing out of the prosthesis
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Fracture
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Continued pain or stiffness
The replacement knee joint may become loose, be dislodged, or may not workthe way it was intended. The joint may have to be replaced again in thefuture.
Nerves or blood vessels in the area of surgery may be injured, resulting inweakness or numbness. The joint pain may not be relieved by surgery.
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.
Patients Desiring Help And Information To Return To Work Were Not Routinely Discussed
- The patients in this study found that the advice they received from healthcare professionals focused on the needs of the elderly and retired population.
- Preoperative education reportedly focused on the inpatient stay and immediate postoperative period, but longer-term outcomes, such as return to work, were not routinely discussed.
- In summary: Patients found that work-related activities were not discussed and focused on people of a certain age and people who didnt work.
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Patients Are Concerned That Doctors Do Not Factor In The Patients Ability To Make A Living In Surgery Decisions
In other words, the question of when can I return to work was not satisfactorily addressed for many. Some patients went to work when they felt like they needed to, some stayed out of work waiting for doctors clearance.
- Doctors top priority in recommending knee replacement: Pain and Function
- Patients to priority: Function and get back to work
Researchers writing in the Medical Journal of Australia, wanted to know what influenced surgeons in determining the order in which patients are scheduled for surgery. In their study, they asked a group of surgeons to assess the patient profiles of 80 patients. They also asked a group of non-medical personal to assess the patient profiles for their lay recommendation.
- Both groups determined that the patients pain was the number one concern.
- For the surgeons, the other determining factors were physical limitations and other medical factors.
- The laypeople saw it a little differently. While agreeing on the physical limitation part, they were concerned with the patients socio-economic situation and the stress a prolonged wait would bring on the patients ability to make a living as well as the psychological distress that may bring.
While the surgeons did not consider socio-economic factors in determining priority in patients wait time for surgery, it is clear that for the layperson, the delay to surgery, the surgery, and the recovery time from a total knee replacement are important factors.
Summary of this video:
The National Joint Registry
The National Joint Registry collects details of knee replacements done in England, Wales, Northern Ireland and the Isle of Man. Although it’s voluntary, it’s worth registering. This enables the NJR to monitor knee replacements, so you can be identified if any problems emerge in the future.
The registry also gives you the chance to participate in a patient feedback survey.
It’s confidential and you have a right under the Data Protection Act to see what details are kept about you.
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Am I A Candidate For Total Knee Replacement
Urquhart: I always start by telling patients that total knee replacement surgery shouldnt be thought of as the only way to treat knee pain.
Patients who can walk on level ground without much difficulty, or who only have pain when going up and down stairs, are not good candidates for knee replacement surgery. Patients in their fifties or older who have a hard time walking, despite trying non-surgical treatments first, may be good candidates for knee replacement surgery.
Before considering knee replacement surgery, I always recommend patients start with improving their diet and exercise routine. Many Americans are overweight and just losing a few pounds can improve symptoms in the knee, which carries five times a persons body weight when going up a single stair. Targeted physical therapy and exercise can improve and strengthen the muscles in the knee, which may result in less pain symptoms.
We also recommend patients try non-steroidal medications such as ibuprofen or acetaminophen to reduce swelling and pain. For some patients, we recommend trying steroid injections, such as cortisone injections, before electing knee replacement surgery.
There Is Little In The Literature To Guide Clinicians In Advising Patients Regarding Their Return To Work Following A Primary Total Knee Replacement
One of the reasons the surgeons may not have prioritized this factor may be found in the literature. Researchers at the Case Western Reserve University School of Medicine. in their study published in the Journal of Joint and Bone Surgery, wrote:
There is little in the literature to guide clinicians in advising patients regarding their return to work following a primary total knee . aimed to identify which factors are important in estimating a patients time to return to workhow long patients can anticipate being off from work, and the types of jobs to which patients are able to return following primary total knee arthroplasty.
Information for patients to assess from the study scores were:
- The average time to return to work after the surgery was nine weeks.
- Patients who reported a sense of urgency about returning to work were found to return in half the time taken by other employees
- Other preoperative factors associated with a faster return to work included being female, self-employment, higher mental health scores, higher physical function scores, higher functional comorbidity, and a handicap accessible workplace.
- A slower return to work was associated with having less pain preoperatively, having a more physically demanding job, and receiving Workers Compensation
Information for patients to assess from the study scores were:
If you are on this page because you are seeking alternatives to knee replacement, lets continue on with these articles on your options:
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What Happens During Arthroscopic Meniscus Surgery
The most common procedure for a torn meniscus is knee arthroscopy. It usually takes less than an hour.
First, you receive anesthesia. The surgical team cleans the skin on your knee and covers the rest of your leg with a surgical drape. The team might place a clamp on your upper thigh to help with positioning during surgery.
The surgeon makes a few small stab incisions in your knee called portals. The team then fills the knee joint with a sterile fluid. The fluid helps control minor bleeding in the joint and washes away debris, which helps the surgeon see inside the joint.
The surgeon inserts a small tool called an arthroscope into the incision. An arthroscope is a thin tube with a small light and video camera at the end. The camera projects video images from inside your knee onto a monitor.
The surgeon uses the arthroscope to look at the tear and decide what surgical technique to perform:
- Meniscus repair: The surgeon sews torn pieces of cartilage back together so they can heal on their own. However, because of tear type and blood supply, less than 10%of tears are actually repairable.
- Partial meniscectomy: The surgeon trims and removes the damaged cartilage and leaves healthy meniscus tissue in place.
Your surgeon inserts other surgical tools depending on the technique used. When the meniscectomy or meniscus repair is complete, the surgeon closes the portals with stitches or surgical strips. Then the team will cover your knee with a bandage.
What Type Of Anesthesia Should I Use
Your choice of anesthetic depends on many factors, such as the surgery being performed, your risk factors, and your preferences. Your choice may affect the risk of complications, cost, and time spent in the medical facility. It also may affect how quickly you can begin physical therapy.
Always consult with your physician anesthesiologist on the best option for you.
- Regional anesthesia is a common option for arthroscopic surgery. It numbs only the area of the body that requires surgery. You remain awake and aware. Regional anesthesia includes spinal or epidural anesthesia and peripheral nerve blocks. Some research has found that regional anesthesia can provide better pain control and lead to faster rehabilitation and fewer complications than general anesthesia.
- Local anesthesia may be an option for arthroscopic surgery, although it is less commonly used. A one-time injection numbs just a small area around the surgical site. Advantages to local anesthesia include lower risk of complications, lower cost, and faster release from the medical facility.
- General anesthesia, which renders you unconscious during surgery, is sometimes used for knee replacement. But regional anesthesia can also be an option for this surgery.
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What About Exercise Following A Knee Replacement
Exercise and sport are recommended after knee replacement, apart from contact sports, which may weaken the cement and lead to loosening of the joint components. Recreational sports including golf, tennis and skiing will gradually become possible depending on how fit and sporty you were before the operation. Cycling is a very good way of building up strength and mobility after knee surgery.
Exercising the main muscle groups around your knee is very important both before and after having a knee replacement. You can download a selection of exercises that are designed to stretch, strengthen and stabilise the structures that support your knee. Try to perform these exercises regularly, for instance for 10 minutes six to eight times a day. However, its important to find a balance between rest and exercise so you dont overwork your knee. Its a good idea to get advice from your doctor or physiotherapist about specific exercises before you begin.
Knee Replacements Dont Work As Well As Hip Replacements True Or False
Some people with knee arthritis worry more about having a knee replacement than those with hip arthritis do about having a hip replacement. Why is this? Well the worry usually arises when people talk to others who have had a knee replacement or know someone who has had a knee replacement that hasn’t gone so well. But that’s not the whole story. As with most things in life, there can be some truth behind the concerns, but it is also true that modern knee replacements done by experienced specialist knee surgeons give reliable results in a vast majority of patients.
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Do You Have To Come To The Hospital For Total Knee Replacement Surgery
Urquhart: Knee replacements in healthy patients do not require a hospital stay. In fact, we now offer the surgery at the Brighton Center for Specialty Care, one of our outpatient specialty clinics.
Patients have the surgery performed in one of the operating rooms at the facility and then are moved into a recovery area where they are monitored and work with physical therapy to be safe to go home. The center has the ability and staffing to monitor patients overnight, if needed. Then the patient is able to finish their recovery at home.
Can Rehabilitation Be Done At Home
All patients are given a set of home exercises to do between supervised physical therapy sessions and the home exercises make up an important part of the recovery process. However, supervised therapy–which is best done in an outpatient physical therapy studio–is extremely helpful and those patients who are able to attend outpatient therapy are encouraged to do so.
For patients who are unable to attend outpatient physical therapy, home physical therapy is arranged.
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What Is A Total Knee Replacement
A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with artificial material. The knee is a hinge joint that provides motion at the point where the thigh meets the lower leg. The thighbone abuts the large bone of the lower leg at the knee joint.
During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The end of the lower leg bone is also removed and replaced with a channeled plastic piece with a metal stem. Depending on the condition of the kneecap portion of the knee joint, a plastic “button” may also be added under the kneecap surface. The artificial components of a total knee replacement are referred to as the prosthesis.
The posterior cruciate ligament is a tissue that normally stabilizes each side of the knee joint so that the lower leg cannot slide backward in relation to the thighbone. In total knee replacement surgery, this ligament is either retained, sacrificed, or substituted by a polyethylene post. Each of these various designs of total knee replacement has its own particular benefits and risks.
The Ability To Make A Living
The researchers made an interesting statement in their conclusion: Total knee replacement surgery is being performed on an increasingly younger population of knee osteoarthritis patients for whom participating in work is of critical importance. . . .clinicians should be aware that proxies for participating in work go beyond outcomes like pain or function.
In other words, patients will go back to work, if they can, regardless of pain and function improvements. We find that for many patients we see, it is the ability to make a living. They have to work.
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Getting Back To Normal
It will be some weeks before you recover from your operation and start to feel the benefits of your new knee joint. Make sure you have no major commitments including long-haul air travel for the first six weeks after the operation.
Keeping up your exercises will make a big difference to your recovery time. Youll probably need painkillers as the exercise can be painful at first. Gradually youll be able to build up the exercises to strengthen your muscles so that you can move more easily.
What Is Involved With The Pre
Before surgery, the joints adjacent to the diseased knee are carefully evaluated. This is important to ensure optimal outcome and recovery from the surgery. Replacing a knee joint that is adjacent to a severely damaged joint may not yield a significant improvement in function as the nearby joint may become more painful if it is abnormal.
- Furthermore, all medications that the patient is taking are reviewed. Blood-thinning medications such as warfarin and anti-inflammatory medications such as aspirin may have to be adjusted or discontinued prior to knee replacement surgery.
- Routine blood tests of liver and kidney function and urine tests are evaluated for signs of anemia, infection, or abnormal metabolism.
- Chest X-ray and EKG are performed to exclude significant heart and lung disease that may preclude surgery or anesthesia.
- Finally, a knee replacement surgery is less likely to have a good long-term outcome if the patient’s weight is greater than 200 pounds. Excess body weight simply puts the replaced knee at an increased risk of loosening and/or dislocation and makes recovery more difficult.
Another risk is encountered in younger patients who may tend to be more active, thereby adding trauma to the replaced joint.
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Knee Replacement Alternatives To Consider
Crunching sounds as you climb stairs, chronic aching and swelling: Knee osteoarthritis is a real pain. If youre suffering with it, you may be considering surgery.
Getting a knee replacement is one approach, but you may not need surgery, at least not right away. And some patients cannot undergo knee replacement surgery for various reasons. Other people with knee pain are too young for a knee replacement the artificial knee is only likely to last 15 or 20 years, after which the person may need revision surgery.
There are several things you can try first, on your own or with a professionals help, that can help with knee pain and even delay the need for replacement, says Daniel Valaik, M.D., orthopaedic hip and knee specialist at Suburban Hospital in Bethesda, Maryland.
Arthritis doesnt go away, he explains. Of the thousands and thousands of patients Ive treated, Ive never seen anyones X-rays improve in terms of arthritis, unfortunately. But there are things you can do to lessen pain and stay more active.
Injections For Knee Pain
Valaik says theres good science behind cortisone shots and other injections, such as hyaluronic acid injections, that lubricate the inner workings of the knee and help relieve arthritis pain.
According to Valaik, there is less evidence supporting the benefits of other injectable substances, including platelet-rich plasma and concentrated bone marrow or stem cells, but further studies will reveal more about their efficacy in treating knee arthritis.
Injections can provide temporary relief typically a few months which can help you stay on your feet and postpone surgery, he says.
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What To Expect After Knee Replacement
A patients recovery and rehabilitation plan is crucial to the overall success of knee replacement surgery. A recovery and rehabilitation plan can help the patient:
- Leave the hospital sooner
- Regain knee strength and range of motion more quickly
- Resume independent living sooner
- Avoid potential complications
Typically, knee replacement patients are able to leave the hospital within 1 to 5 days , and they can take care of themselves and resume most activities 6 weeks after surgery. The majority of patients are 90% recovered after 3 months, though it can take 6 months or longer before they are 100% recovered.
Some knee replacement patients do not follow the typical recovery timeline. For example:
- Patients who did knee-strengthening exercises in preparation for surgery sometimes recover more quickly.
- Patients who are older, smoke, or have other medical conditions may take longer to heal.
Deviation from the typical recovery timeline cannot always be predicted, but these differences are usually okay as long as the patient, doctor, and physical therapist, continue to work together towards a full recovery.