Who Can Get The Procedure And Who Shouldnt
Mr Henry BourkeThe ultimate decision on who is suitable for this procedure lies with the anaesthetist. We work with two anaesthetists regularly and patients will have an appointment with the anaesthetist prior to the operation assess their general health and to identify potential existing illnesses that may make the operation riskier. These comorbidities are usually bleeding disorders, prior cardiovascular problems such as previous heart attack and problems with the respiratory system . From the surgeons perspective we feel the patients need to have an overall fitness level to allow them to get up out of bed after the operation to mobilise with a frame or crutches. This requires a certain amount of upper body strength and muscle power in the legs to get going again quickly on two replaced knees. Having this procedure also requires a certain amount of family and/or social support as it can be quite tough in the first few weeks to get about on the two new knees, obviously if you are not able to rely on one that you have known for many years.
Mr Rakesh KucheriaAnyone who has got bad knees and are in reasonable health can have this procedure. Patients who should not have both knees done simultaneously are those with cardiac issues or other high-risk factors towards having surgery.
Preparation For Total Knee Replacement Surgery
Patients undergoing total knee replacement surgery usually will undergo a pre-operative surgical risk assessment. When necessary, further evaluation will be performed by an internal medicine physician who specializes in pre-operative evaluation and risk-factor modification. Some patients will also be evaluated by an anesthesiologist in advance of the surgery.
Routine blood tests are performed on all pre-operative patients. Chest X-rays and electrocardiograms are obtained in patients who meet certain age and health criteria as well.
Surgeons will often spend time with the patient in advance of the surgery, making certain that all the patient’s questions and concerns, as well as those of the family, are answered.
Costs
The surgeon’s office should provide a reasonable estimate of:
- the surgeon’s fee
- the degree to which these should be covered by the patient’s insurance.
Total Knee Replacement Surgical Team
The total knee requires an experienced orthopedic surgeon and the resources of a large medical center. Some patients have complex medical needs and around surgery often require immediate access to multiple medical and surgical specialties and in-house medical, physical therapy, and social support services.
Finding an experienced surgeon to perform your total knee replacement
Some questions to consider asking your knee surgeon:
- Are you board certified in orthopedic surgery?
- Have you done a fellowship in joint replacement surgery?
- How many knee replacements do you do each year?
Looking After Your Knee Replacement
Your new knee will continue to improve for as much as two years after your operation as the scar tissue heals and you exercise your muscles. You’ll need to look after yourself and pay attention to any of the following problems:
Stiffness Sometimes the knee can become very stiff in the weeks after the operation for no obvious reason. Try placing your foot on the first or second step of the stairs, hold on to the banister and lean into your knee. This should help to improve movement and flexibility in your knee. Its very important to continue with the exercises you were working on in the hospital.If the stiffness doesnt improve after about six weeks your surgeon may need to move or manipulate your knee. This will be done under anaesthetic.
Pain Pain caused by bruising from the operation is normal in the first two months, and you’ll probably still need to take painkillers at six weeks to help you sleep through the night. You may still have some pain for as long as six months. If you still have pain after this, speak to your physiotherapist or GP.
Infection You should speak to your GP or hospital if you notice any signs of infection, for example:
- breakdown of the wound with oozing/pus or sores
- increased pain
- redness and the affected area feeling warmer than usual or smelling unpleasant.
You should also look after your feet see a doctor or podiatrist if you notice any problems such as ingrown toenails that could become infected.
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Early On Focus On Range Of Motion
All exercise after knee replacement is important to strengthen the muscles and supporting structures of the knee. Strengthening the hip is important too.
However, the sooner you begin to see progress on your range of motion the better your recovery will be. Your therapist will have you doing range-of-motion exercises right off the bat.
You dont want scar tissue to build up. You want to avoid returning to your surgeon for manipulation under anesthesia or in extreme cases, surgery to remove scar tissue.
The range of motion exercises will hurt and cause discomfort but trust me the pain is worth the result. Dont get discouraged, take shortcuts or give up.
The 13 Best Exercises To Do Before A Hip Replacement
Has your doctor suggested a hip replacement to relieve your hip pain? Or maybe you already have a hip replacement surgery scheduled?
Doing exercises before your hip replacement surgery can help you get ready and improve your outcome during recovery, thanks to your increased strength. You might even reduce your odds of needing inpatient rehab. So what are you waiting for? Start working out now!
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The Support Of Family Friends And Peers
In a recent interview with Dr. Nima Mehran, a rising orthopaedic surgeon who has participated in hundreds of knee replacements, he expressed that the support of family and friends is one of the most important factors in determining the overall success and recovery time of a knee replacement. Not only will the support of family and friends be of great help post-surgery, it will actually help with physical and mental preparedness in the weeks prior.
Dr. Mehran added that a vital part of overall prehab and pre-op support is being connected with other patients who have recently undergone the surgery. Speaking with those who are a few months ahead of you in the knee replacement surgery and recovery cycle personalizes the procedure, offering a greater level of insight and alleviate anxiety.
Why the Support of Others Matters:
- If youre committed to PreHab and are setting goals like eating a nutritionally-rich diet or keeping up with daily exercises in order to reduce your risk and improve your outcome, the support of family, friends and peers is key for accountability.
- Youre more likely to remain motivated and focused on game-changing PreHab lessons when you have the support of a group.
- Connecting with knee replacement recipients will encourage you to follow-suit
A community of supportwhether it be family and friends, peers who will be undergoing a knee replacement, or those who are in recoveryis at the heart of PeerWells Prehab program.
What Is The Recovery Period Like For Such A Procedure
Mr Henry BourkeWe have not noticed that the recovery is that much different to having one knee replacement. We tell our patients to clear their diaries for six weeks after the procedure. The majority of this time is spent at home although in the latter few weeks you can get out of the house and do a little a bit of walking just gently. Unfortunately, you cannot drive a car in this period. We also do not let any of our patients fly in this period due to the increased risk of deep vein thrombosis. Most patients are mobile by six weeks, walking independently or just with a single stick. A return to gentle sporting activities such as golf usually is possible by three months.
Mr Rakesh KucheriaThe recovery period for bilateral knee replacement is between 8-12 weeks but most patients are in hospital for about 5-7 days.
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What Do Care Coordinators Do
Care Coordinators are regulated health professionals that are experts in nursing, home support, social work, occupational therapy, physiotherapy, and/or speech therapy. They act as your guide for your recovery once you are declared a patient. Your Care Coordinator will assess your health care needs based on your current living arrangements and support system, and develop a plan to make sure you receive the care that you require.
Services that your Care Coordinator may help you with include:
A Care Coordinator will be assigned to you and acts as your point-of-contact in obtaining health care services and information. If you find that your needs have changed prior to your surgery or during your recovery, your Care Coordinator is the person to contact.
What Is A Hip Replacement And Why Do People Get Them
A hip replacement is a surgical procedure that removes damaged sections of the hip joint and replaces them with a replacement hip joint and socket made of metal, ceramic, or hard plastic.1
The most common reason for a hip replacement is osteoarthritis, which damages the cartilage that covers the ends of the joint, enabling smooth movement.1
Hip replacement surgery is typically considered when a person has hip pain that interferes with daily activities and when nonsurgical treatments are no longer effective or have not helped.1
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Get Your Leg Knee And Muscles Ready For Surgery
Do your best to strengthen your knee before surgery. The stronger your muscles and supporting structures around your knee are pre-surgery the better your recovery will be.
I couldnt lift weights with my knee but I could ride a bike and swim without pain. Find some type of exercise that is comfortable for you and start exercising your leg months before your surgery.
Ohip: What It Does And Does Not Cover
Have you ever gone to a doctors appointment, or to get some form of medical test and asked, is this free, or do I have to pay anything? Ontarios government-run health plan is called the Ontario Health Insurance Plan . OHIP pays for various health care services that are considered to be medically necessary, such as visits to your family doctor, as well as emergency health care services.
Heres a quick list of all the services that are covered/not covered by OHIP:
For more information about each of these services, you can visit the Government of Ontarios webpage about What OHIP Covers.
To keep things focused on joint and hip replacement surgeries, the guide will look more closely at three of the thirteen services from the above chart, along with post-operative recovery services.
Lets take a closer look at what is covered, and what fees you might be responsible for.
Hospital Services and Stays
Prior to your surgery, youll likely be required to take various types of at the hospital. These test results will help the Surgeon and Anesthesiologist identify any precautions that need to be taken during your surgery. Thankfully, OHIP does cover all costs associated with these screenings.
Ambulance Services
Prescription Drugs
Post-op Recovery Services
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What Are The Alternatives To Knee Replacement
Mr Henry Bourke97% of knee replacements are done for osteoarthritis. Osteoarthritis is a disease that has a multi-factorial cause. This means there are many different contributing factors that cause it to affect your knees. Some of this is genetic, some of it environmental and some of it is due to previous trauma and the weight of the patient. Carrying extra weight above your normal body mass index will lead to earlier onset of the disease. The symptoms of osteoarthritis are mostly pain but also stiffness and giving way. The simple conservative measures for improving these symptoms are gentle regular exercise, simple painkillers and weight reduction. These three simple measures can keep the disease at bay for some years.
Arthroscopy has largely been phased out for osteoarthritis of the knee. Although it can improve the symptoms in the short-term, there may be some damage to the knee in the longer term by having the cartilage removed surgically. The main surgical options are realignment procedures which we tend to favour in younger patients with physical jobs, partial and total knee replacement. Partial knee replacement is an option if the arthritis is just affecting one side of the knee and the other side is well preserved. Mr Kucheria and I both offer this procedure and we have also done a number of bilateral simultaneous partial knee replacements. When these other options have been exhausted, total knee replacement is indicated.
Two Knee Replacements At Once: The Good And The Bad
So would you like one knee, or two?
It is called bilateral knee replacement. Two knees. At the same time. Usually, it is performed by one surgeon at times it is done simultaneously by two surgeons. And it is a massive trend in knee replacement nowadays. We discuss the merits of doing two knee replacements at once below. And we have included the stories of a few recent bilateral knee patients to help you decide if you want one lump or two.
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Simultaneous Bilateral Knee Replacement
With simultaneous bilateral knee replacement, both of your knees will be replaced during the same surgery. The primary advantage of a simultaneous procedure is that there is only one hospital stay and one rehabilitation period to heal both knees.
However, rehabilitation may be slower, as its more difficult to use both knees at the same time. In fact, many people who undergo simultaneous bilateral knee surgery need assistance at home as theyre recovering.
Simultaneous bilateral knee replacement also takes longer to perform. This procedure typically takes three to four hours to complete, while staged bilateral knee replacement only takes two hours.
Since simultaneous bilateral knee replacement requires more time and heavier doses of anesthesia, there is an increased risk of complications. The surgery isnt recommended for those with heart conditions or lung disease. These high-risk groups may experience heart problems or excessive blood loss during and after surgery.
Getting Prepared For Your Surgery And Recovery
Your Care Coordinator will help provide guidance for your recovery after your surgery however there are a few things that you should research and prepare for yourself prior to your initial consultation and surgery date, including: surgery wait times, how to prepare for your consultation, required pre surgery tests, and the decision between recovering in a short-term care facility vs. at home.
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Preparing For Knee Replacement Surgery
If you and your surgeon decide that knee replacement surgery is the best treatment for you, our medical team will give you the information you need to prepare, including personalized instructions, during appointments before your surgery. To get started, here are the basics.
Before Surgery Exercise Program
You may have discovered you have been less active because of your knee joint discomfort. When muscles are not used, they become weak and do not perform well in supporting and moving your body.
Having your knee surgery will correct the joint problem, but you will need a regular exercise program to strengthen and stretch your muscles to properly support your new joint.
Beginning an exercise program before surgery can greatly help your recovery.
There are several exercises listed below for you to work on before your surgery. Because everyone responds to exercise differently, you need to be the judge of how much exercise you can do each day. If an exercise causes an increase in discomfort, stop doing that exercise.
You should try to exercise one to two times a day, every day, before surgery. Work up to doing 10 to 20 repetitions of each exercise. It may be helpful to do these exercises on both legs.
For the most comfort, do the exercises lying down. Your bed is an excellent place to do your exercises.
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Place A Chair Or Stool Near The Shower Or In The Shower And Other Key Areas
Not many people think of this one! If you have a plastic chair or stool that you dont mind getting wet, its good to have it near the shower to sit in during or after bathing.
You might be able to stand for a few minutes in the shower, but you may need to sit while bathing during the first few days after surgery.
In fact, if you want to take things a step farther, you can place a few chairs in random places throughout the house. Place a chair in the kitchen, the bedroom, next to the shower, and maybe in the garage. You never know when youll need a break.
Knee Exercises Before Surgery
Ankle pumps and circles
Pump your feet up and down by pulling your feet up toward you, then pushing your feet down away from you. Next, rotate your feet clockwise and counterclockwise.
Thigh squeezes
Tighten the muscles on the top of your thigh by pushing the back of your knee down into the bed. Hold for 5 seconds and relax.
Heel slides
Bend your surgical hip and knee by sliding your heel up toward your buttocks while keeping your heel on the bed. Slide your heel back down to the starting position and relax. Keep your kneecap pointed up toward the ceiling during the exercise. You may want to use a plastic bag under your heel to help it slide easier.
Leg slides
Slide your surgical leg out to the side, keeping your kneecap pointed up toward the ceiling. Slide your leg back to the starting position. You may want to use a plastic bag under your heel to help it slide easier.
Lying kicks
Lie on your back with a rolled-up blanket or towel under the knee of your surgical leg. Straighten your surgical leg. Hold for 5 seconds. Slowly lower your leg down and relax. The back of your knee should stay in contact with the blanket or towel during the exercise.
Straight leg raises
Bend your other leg with your foot flat on the bed. Raise your surgical leg up , keeping your knee straight. Also bend your ankle up pulling your toes toward you. Work up to holding for 5 seconds. Slowly lower your leg down and relax.
Bed mobility exercise
Chair pushups
Knee bending stretch
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