Things No One Ever Tells You About Getting A Knee Replacement
Heres what you need to know thats not in the brochure:;1. You might not be a good candidate.A study published last year by researchers from Virginia Commonwealth University in Richmond questioned the value of knee replacement for some of the people rushing to get it. After analyzing data from a large study of men and women who had the operation, the researchers found that fully one-third of them were not actually good candidates for the surgery, which is why they got only a very modest benefita 2-point improvement on a common measure of knee function, compared with a 20-point improvement for people who started out with really bad knees.
“Pain that doesnt go away and moderate to severe arthritis are necessary for a knee replacement to do its job,” Lajam says. “If you have the surgery, but its actually a problem of nerve pain, hip pain, or circulation, its not going to help you.” The advice here is not to wait until your knees are completely destroyed before seeking surgery, but to make sure that youve tried other measures first and that you meet both criteriaconsistent pain and advanced arthritis.
Lose Weight To Lessen Stress On Your Knees
Number one on Valaiks list of ways to reduce;knee pain;and delay knee replacement: reaching and maintaining a healthy weight.
Extra weight puts pressure on the knees and increases stress on the joint, increasing pain and making it hard to exercise, Valaik explains.;Research;compiled by the;Johns Hopkins Arthritis Center;confirms that carrying extra pounds raises your risk of developing knee arthritis and speeds up the destruction of cartilage that cushions the joint.
I know its not easy, he says, but losing weight really helps, whether youre dealing with arthritis in one or both knees. If you are overweight or obese, consulting with a nutritionist or a bariatric specialist may be the right place to start.
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.
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?
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What Are Knee Replacement Implants Made Of
The selection of knee replacement prosthesis design and materials depends on each individual patient. The main implant components are made of metal â usually titanium or chrome-cobalt alloys. The implants are fixated in place either with a cement bonding agent or by osseointegration, in which a porous metal stem extends into the tibia and the patient’s natural bone grows into it. A plastic platform or spacer will be inserted between the tibial and femoral implant surfaces. The spacer is made of polyethylene.
Most femoral components are made of metal alloys or metal-ceramic alloys . The patellar component is plastic . The tibial insert component is also plastic . The tibial tray component can be made of the following materials:
- cobalt chromium
When Its Time For Knee Replacement Surgery
Knee arthritis can get worse in spite of treatment. If youve tried these methods and are still dealing with pain, it might be time to discuss knee replacement with an experienced orthopaedic surgeon. Total knee replacement is a major procedure, but it can offer better quality of life and improved mobility that last for many years.
A total knee replacement is more of a resurfacing of the bones in the knee: the end of the femur , the top of the tibia and the inward facing surface of the patella, or kneecap. The surgeon removes the bony surfaces and replaces them with metal and plastic implants. The plastic serves the same purpose as the cartilage, helping the implants glide against each other smoothly.
Valaik notes that there are constant innovations in the field of knee replacement. For instance, more surgeons are using regional anesthesia for the procedure, which can mean a shorter hospital stay compared with when general anesthesia is used.
New multimodal pain approaches, surgical techniques and physical therapy after these surgeries are all improving a patients knee replacement experience, he says.
Hip and Knee Replacement at Johns Hopkins
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Complications That Can Arise
Just like any surgical procedure, knee replacement surgery can have complications. Complications are more likely to occur when having a total knee replacement than a partial knee replacement. Some of these complications occur because of the surgery itself. Others occur because of a faulty implant and are the subject of ongoing litigation.
Common complications include:
- Nerve damage
- Different leg lengths
If the person has a chronic illness, the risk of complications increases. For example, a person with sleep apnea a sleep disorder that causes a person to have pauses in breathing while asleep has a higher in-hospital mortality risk following joint replacement surgery.
If the person has revision surgery a second surgery required to adjust or replace an implant if it fails the risk of complications increases.
More serious complications, like joint infection, occur in less than 2 percent of patients. Infection is considered one of the most serious complications that can occur after surgery. When organisms enter the wound during surgery, they can attach to the prosthesis and are difficult to kill with antibiotics.
Symptoms of early joint infection include pain and swelling in the joint, a leaking wound and fever. Depending on the type of bacteria, infections can be dealt with one of two ways: Debridement, washing out the infection, exchanging the plastic spacer and leaving the metal implants intact; and staged surgery, where the implant is completely removed.
How To Prepare For Knee Replacement
There are certain steps that can improve your recovery time and results. It is important to follow your knee replacement surgeonâs instructions both before and after surgery, as well as that of your rehabilitation therapistâs recommendations. Learn more about reparing for knee replacement by reading .
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How Do I Know If Can Have An Outpatient Knee Replacement
Patients who are in good general health, do not smoke, are motivated and have a good support team at home are the best candidates. Those who qualify are given special education on their recovery, which must be followed closely. HSS joint replacement specialists perform a thorough evaluation of each patients individual circumstance in order to determine their eligibility for outpatient knee replacement surgery.
If you can answer “yes” to all of the below questions, you may be able to have outpatient knee replacement surgery.
- Are you between the ages of 18 to 70?
- Will you have support at home from a family member or friend after your discharge?
- Are you generally healthy, with no significant medical conditions ?
Contact one of our treating physicians for knee replacement to find out if you are an appropriate candidate for ambulatory joint replacement. All patients who express interest in the ambulatory joint replacement surgery program are evaluated by both the orthopedic surgeon and our multidisciplinary team. HSS joint replacement specialists perform a thorough evaluation of each patients individual circumstance in order to determine their eligibility for same-day knee replacement surgery.
What To Expect For Recovery
Patients who have knee replacement surgery will typically be hospitalised and monitored for several days before being discharged. Some pain is to be expected, but it is recommended to move your foot and ankle to encourage blood flow and prevent blood clots. It is important to follow your doctors instructions on bathing and changing wound dressings. You will need to use crutches to move around for about six weeks after surgery. A follow-up appointment will be arranged for the removal of stitches or surgical staples. It may take three months or so for the pain to subside, and full recovery may take at least a year with the help of physical therapy.;
The good news? Individuals who had knee replacement surgery can go on to live active lifestyles, enjoying restored mobility and strength in their knee joint. It may be a daunting procedure, but it can be highly worthwhile as it offers you a pain-free life.;
If you have any questions about knee replacement surgery in Singapore, or if you would like to know whether you are suitable for it, reach out to us at OrthofootMD.;
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How Much Pain Will I Have After My Knee Surgery
This varies between patients, however, the advances in pain management have allowed our total knee patients sufficient pain relief to undergo this procedure on an outpatient basis. On average, the pain being reported is generally no more than four out of a 10-point scale. You will have one of us by your side when you wake up and throughout the day until you leave our facility. We can address any pain that you may have promptly and efficiently.
Injuries And Problems Of The Knee Joint
The knee joint is vulnerable to stresses, traumatic injury, overuse, and arthritis. The articular cartilage in the knee can be damaged by disease, injury, or normal wear and tear over time. When the cartilage is damaged, the joint surfaces may no longer be smooth. Moving bones along a rough, damaged joint surface is difficult and causes pain. Damaged cartilage can also lead to arthritis in the joint. Articular cartilage does not heal itself well, so sometimes surgical intervention is required. Also, damage to the shock absorbing meniscus, tendons, and ligaments can occur. This is common in traumatic injuries such as in sports, but also in falls. When the knee is not able to properly support the weight of the body, joint damage and arthritis can occur. Often, when there is pain and dysfunction, you will hear that the knee joint is bone on bone. This means that the articular cartilage and the meniscus have become damaged, and there is no more friction reduction or shock absorption in the knee. Additionally, certain conditions such as infections or diseases such as rheumatoid arthritis and avascular necrosis can lead to damage in the knee joint. Conditions like these may require surgical intervention to restore pain-free function of the knee joint.
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Other Forms Of Treatment
Without replacement surgery, a severely osteoarthritic knee joint may continue to deteriorate until it is impossible to go about your normal daily activities, such as standing up, walking or getting up from a seated position. Other forms of treatment include:
- The use of walking aids, such as frames or walking sticks
- Non-steroidal anti-inflammatory drugs
- Corticosteroid injections
- Other surgery, such as osteotomy an operation in which diseased bone is cut away in an attempt to properly align the malformed joint.
What Should I Do When I Get Home
We ask that you rest. Even though our patients typically feel good, it has still been a long day. On the day of your surgery you will learn how to safely transfer in and out of both the bed and the car. We ask that you use the bathroom as needed, eat dinner and rest. You will have nursing and therapy services the very next day. Wait for further instruction from them.
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About Knee Replacement Surgery
One of the most important orthopedic surgical advances of this century, knee replacement was first performed in 1968. Improvements in surgical materials and techniques since then have greatly increased the procedures effectiveness. According to the American Academy of Orthopaedic Surgeons. about 267,000 total knee replacements are performed each year in the United States.
Most Common Causes for Knee Replacement
- Arthritis: Arthritis is a wearing away of the surfaces of the joint, caused either by aging or disease. As the cartilage wears away, the raw bones rub together whenever the joint moves. This rubbing causes pain and a roughening of the surfaces of the bone.
- Osteonecrosis: If the blood supply to the thigh bone is decreased, part of the bone will die and break from weight-bearing activity. The result is a very painful joint.
- Injuries: Injuries include trauma and accidents, or continue abuse from sports injuries.
If medications, changing activity level, and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. By replacing the knee’s damaged and worn surfaces, total knee replacement surgery may relieve pain, correct leg deformity, and helps many patients to resume their normal activities.
Total Knee Replacement: Traditional Procedure
Partial Knee Replacement
Mini-Incision Knee Replacement
This careful placement of the knee replacement usually leads to the following benefits:
Technical Details Of Total Knee Replacement
Total knee replacement surgery begins by performing a sterile preparation of the skin over the knee to prevent infection. This is followed by inflation of a tourniquet to prevent blood loss during the operation.
Next, a well-positioned skin incision–typically 6-7 in length though this varies with the patients size and the complexity of the knee problem–is made down the front of the knee and the knee joint is inspected.
Next, specialized alignment rods and cutting jigs are used to remove enough bone from the end of the femur , the top of the tibia , and the underside of the patella to allow placement of the joint replacement implants. Proper sizing and alignment of the implants, as well as balancing of the knee ligaments, all are critical for normal post-operative function and good pain relief. Again, these steps are complex and considerable experience in total knee replacement is required in order to make sure they are done reliably, case after case. Provisional implant components are placed without bone cement to make sure they fit well against the bones and are well aligned. At this time, good function–including full flexion , extension , and ligament balance–is verified.
Finally, the bone is cleaned using saline solution and the joint replacement components are cemented into place using polymethylmethacrylate bone cement. The surgical incision is closed using stitches and staples.
Length of total knee replacement surgery
Pain and pain management
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When To Seek Emergency Care
Warning signs of a blood clot in the lungs include sudden shortness of breath, chest pain, and coughing. Signs of infection include fever, worsening redness or tenderness of the knee, and pus draining from the surgical wound. If you feel or see any of these symptoms after knee replacement, call your doctor immediately. Call 911 for chest pain or if you are having any trouble breathing.
Minimally Invasive Total Knee Replacement
Some medical centers perform minimally invasive surgery for a total knee replacement, also called min-incision joint replacement.
This surgery allows surgeons to cut less muscle and tissue, which leads to less blood loss, increased range of motion and a shorter hospital stay. Many patients go home the same day and the recovery process is usually much quicker than traditional total knee surgery.
However, minimally invasive knee replacement is not for everyone. In general, the best candidates for this kind of surgery are younger and in better health. Older patients, those who are overweight or patients who have undergone knee surgeries in the past may be less suitable for minimal incision procedures.
Because it uses a much smaller incision, minimally invasive knee replacements have a higher risk for poor implant placement compared to traditional total knee surgery. Other common complications include nerve and artery injuries, wound healing problems and infection.
Only specialized medical centers typically offer this surgical option. An orthopaedic surgeon should explain the complete process, the benefits and the potential risks to help the patient decide which surgical option is the best fit.
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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.