What Can I Expect At Hss
Hospital for Special Surgery has been at the forefront of modern knee replacement since the operation was first introduced in the late 1960s. We have led the field ever since in a number of ways:
- : HSS has been ranked the No. 1 hospital for orthopedics by U.S. News & World Report for 11 years straight.
- Along with high rankings in patient satisfaction, HSS performs the most knee replacements with the lowest reported infection rates in the United States.
- Research and advancement: Smaller incisions, new implant materials and design, and sophisticated instrumentation have been â and continue to be â the areas of expertise of the hip and knee replacement surgeons of the HSS .
- HSS routinely uses the latest surgical techniques and technology, such as robotic-assisted and computer-assisted surgery.
- : Isolating the anesthesia to a particular body area helps avoid the potential problems that may accompany a general anesthetic. These techniques have been developed and refined by the HSS . Learn more about
Have A Conversation With Your Doctor
Before you make up your mind about having your knee replaced, talk with your doctor about the possible risks of surgery. These can include infection, loosening of the knee replacement parts, and movement limitations. Also, talk about any health conditions you might have that could make the operation and your recovery more difficult.
Its also important to have realistic expectations for how quickly you will recover from the surgery. It can take several weeks to several months to feel back to normal after a knee replacement. Youll also need to commit to physical therapy and exercise. Your doctor can talk through the factors that can speed up or slow down recovery, and help you decide if the timing is right.
Under the right circumstances, a knee replacement can significantly boost your quality of life. More than 90% of people who get new knees are able to resume their normal activities shortly afterward and are happy with the results, according to the American Academy of Orthopaedic Surgeons. And pinpointing a good time to have a knee replacement is a key part of having success with the procedure.
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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Your Pain Prevents You From Doing Normal Activities Or Caring For Yourself
If you cant get relief from other treatments, your knee pain may start interfering with your daily life.
In general, the timing of a total knee replacement is determined by the impact the knee is having on your quality of life, says Jay Lieberman, MD, chief of orthopaedic surgery at Keck Medicine and chair and professor of orthopaedic surgery at the Keck School. If conservative treatments are not working and you have significant pain while walking, you may be a good candidate for surgery.
Types Of Arthritis That Affect The Knee
Inflammatory arthritis
This broad category includes a wide variety of diagnoses including rheumatoid arthritis, lupus, gout and many others. It is important that patients with these conditions be followed by a qualified rheumatologist as there are a number of exciting new treatments that may decrease the symptoms and perhaps even slow the progression of knee joint damage.
Patients with inflammatory arthritis of the knee usually have joint damage in all three compartments and therefore are not good candidates for partial knee replacement. However, inflammatory arthritis patients who decide to have total knee replacement have an extremely high likelihood of success. These patients often experience total, or near-total, pain relief following a well-performed joint replacement.
Osteoarthritis
Osteoarthritis is also called OA or degenerative joint disease. OA patients represent the large majority of arthritis sufferers. OA may affect multiple joints or it may be localized to the involved knee. Activity limitations due to pain are the hallmarks of this disease.
OA patients who have symptoms limited to one compartment of the knee sometimes are good candidates for minimally-invasive partial knee replacement .
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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.
What Is Recovery Like
You can start moving the knee the day of your surgery. Your knee function should return rapidly and with less pain than with total knee replacement. Youll work with a physical therapist to mobilize the knee while in the hospital and for two to four weeks after discharge. Youre usually discharged no later than one or two days after surgery.
Youll need medication to guard against formation of a blood clot while in the hospital and maybe for a period of time after youre discharged.
If all goes well, you should be back to full activity in about six to eight weeks. Impact exercises or jogging/running may not be recommended because the replacement includes a bearing surface that can wear. However, activities like tennis, skiing, and other sports are okay. This, of course, is why partial knee replacement is even being considered to return you to activities you enjoy.
Last reviewed by a Cleveland Clinic medical professional on 12/16/2020.
References
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How Implants Wear Out
Most knee replacements are made with metal caps that cover the end of the thigh bone and the top of the shin bone. Between these metal caps is a piece of plastic that provides a smooth surface for bending of the implant. The plastic can wear out over time, either as a slow, gradual wearing away, or a sudden catastrophic failure.
There are some situations where the wearing out can be accelerated. These situations include when the alignment of the implants was not ideal, when the knee is unstable , or if the patient performs activities that put too much stress on the implant. Knowing which activities can cause damage to knee replacement implants can help ensure the parts last as long as possible.
Understanding Why Some Joint Replacements Fail
We’re also supporting research to improve the outcome of knee replacement surgeries, such as a project aimed at increasing the understanding of why joint replacements sometimes fail by investigating whether there are genetic risk factors that influence surgery outcome. This research has the potential to improve patient experience and increase the life of the joint replacement.
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Are There Any Reasons Why I Cant Have A Knee Replacement
Unfortunately, some people may not be able to have a knee replacement even though their arthritis is very bad. This may be because:
- your thigh muscles are very weak and may not be able to support your new knee joint
- there are deep or long-lasting open sores in the skin below your knee, increasing your risk of infection.
Your Knee Is Always Swollen
Swelling is another sign your knee is not responding to other treatments.
A knee that is consistently swollen despite the use of anti-inflammatory medications, steroid injections and physical therapy suggests degeneration of the cartilage and/or instability of the knee, which can be confirmed with an X-ray, Lieberman explains. This can make you a candidate for a total knee replacement, he says.
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Who Might Need A Knee Replacement
Knee surgery may be suitable for patients who experience:
- Severe knee pain or stiffness that prevents them from carrying out everyday tasks and activities, such as walking, going upstairs, getting in and out of cars, getting up from a chair
- Moderate but continuous knee pain that continues while sleeping or resting
- Chronic knee inflammation and swelling that does not improve after taking medications or resting
- Knee deformity, where there is a noticeable arch on the inside or outside of the knee
- Depression, resulting from an inability to carry out daily or social activities
If the other available treatment options have not worked, surgery may be the best option.
Will I Need Any Treatments After Knee Replacement
Your healthcare team will prescribe medications to help you manage pain after surgery, such as:
- Acetaminophen.
To prevent blood clots and control swelling, your healthcare team might also recommend:
- Blood thinners, such as aspirin or injectable Enoxaparin based on individual risk of blood clot formation.
- Compression devices, usually used while hospitalized. These are mechanical devises which provide intermittent compression.
- Special support hose.
Your team will ask you to move your foot and ankle around frequently to maintain blood flow at home. Theyll also show you special exercises to help strengthen your knee and restore motion. Exercises are very important to the success of your knee replacement. Initially, physical therapy will be in the home. Arrangements for this in home PT are made at the time of discharge from the hospital.
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Knee Replacement Surgery Isnt Typically Recommended If Youre Younger Than 50
Recommendations for surgery are based on a patients level of pain and disability. Most patients who undergo a total knee replacement are age 50-80. This is because, knee replacements are not as durable as your own knee and eventually wear out. On average, a total knee replacement lasts about 15-20 years. So if you have the procedure in your 40s, youll likely need another or revision surgery later in life. Whats worse than having to go through another surgery, is that the second surgery is much harder than the first.
The goal of the second knee replacement surgery is the same as the first to relieve pain and improve function. However, revision surgery is a longer, more complex procedure that requires extensive planning, specialized implants and tools, prolonged operating times, and mastery of difficult surgical techniques. Youll also be older and less resilient when you need the second surgery which is why doctors dont usually recommend knee replacement for younger patients.
Reasons To Avoid Knee Replacement Surgery
- James Leiber, DO
Knee replacements are occurring far too often today and the simple truth is that they may be entirely unnecessary. This is mostly due to the fact that effective nonsurgical options now exist and that in some cases, the knee pain may actually be stemming from another part of the body, such as the spine. Even when using standard criteria for determining candidacy, about one-third of knee replacements are deemed inappropriate when evaluated by independent researchers. When knee pain is legitimately caused by a knee condition, many knee-replacement candidates seek out alternatives to surgery. There are many regenerative-medicine options, such as autologous stem cell injections, that could potentially relieve pain and increase activity levels without amputating the knee, sawing bones, snipping away pieces of meniscus or frayed cartilage, and replacing the knee with a foreign device. If it is determined that your knee pain is due to a spinal condition, there are also nonsurgical options for spinal treatment to consider.
Knee replacement surgery should really be a last resort in only the most extreme cases. For those who are still considering knee replacement despite the risks that it presents, here are six reasons to avoid knee replacement surgery.
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When Can I Go Home
You will usually be in hospital for 3 to 5 days, depending on what progress you make and what type of knee replacement you have. Patients who have a half knee replacement usually have a shorter hospital stay.
If you are generally fit and well, the surgeon may suggest an enhanced recovery programme where you start walking on the day of the operation and are discharged within 1 to 3 days.
Who Is Offered Knee Replacement Surgery
A knee replacement is major surgery, so is normally only recommended if other treatments, such as physiotherapy or steroid injections, have not reduced pain or improved mobility.
You may be offered knee replacement surgery if:
- you have severe pain, swelling and stiffness in your knee joint and your mobility is reduced
- your knee pain is so severe that it interferes with your quality of life and sleep
- everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
- you’re feeling depressed because of the pain and lack of mobility
- you cannot work or have a social life
You’ll also need to be well enough to cope with both a major operation and the rehabilitation afterwards.
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How Common Is Knee Replacement Surgery
The surgery is very common. Surgeons started doing it in the 1960s, with regular updates to techniques and implants along the way.
Almost 800,000 knee replacements currently get performed each year in the United States. The surgery is often done in older adults whose knees have worn down over time. But its also become popular in middle age, as people want to stay active.
They Rushed Into Surgery
There are times when getting stronger and exercising can help get rid of knee pain, but sometimes people jump into surgery when more conservative measures may have worked better for them, says Jasmine Marcus, a physical therapist with McCune and Murphy Physical Therapy.
What you can do: Marcus recommends exercising and building strength, enlisting the help of a physical therapist if necessary.
Even if you still end up needing surgery, getting stronger can help. Performing prehab exercises and getting the bodynot just the leg in questionas strong as possible tends to improve outcomes after surgery, says Tom Biggart, a physical therapist, athletic trainer, and strength and conditioning coach with EBM Fitness Solutions.
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How Your New Knee Is Different
Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery can be predicted by the range of motion you have in your knee before surgery. Most patients can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently to climb stairs and get in and out of a car. Kneeling is sometimes uncomfortable, but it is not harmful.
Most people feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities.
Most people also feel or hear some clicking of the metal and plastic with knee bending or walking. This is a normal. These differences often diminish with time and most patients find them to be tolerable when compared with the pain and limited function they experienced prior to surgery.
Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated.
Device Failure Caused By Allergies
In the past few years, multiple studies have discussed that the components of knee replacement prostheses can cause allergies. Two groups of people are at a significantly higher risk of potential rejection or loosening of their device and/or toxicity from wear particles.
- Those with any type of allergy. Even patients with allergies that are as simple as pollen or dander should avoid knee replacement surgery. People who are considered allergic have hyperactive immune systems and secrete antibodies inappropriately to rid their bodies of the thing that they have mistaken as harmful. If that one thing is a knee replacement device, this drastically affects the outcome of a surgery.
- Those with metal sensitivities. Patients who have more specific allergies to metal will likely have issues with the metals that are used in joint replacement prostheses.
Unfortunately, those who consider themselves to be an allergic person may experience more pain after a knee replacement because of an allergy related to the replacement device and the chronic inflammation that it causes. Those people who suffer from four or more different allergies may suffer from pain that is more prevalent. The cement used to bond the device to the bone can also cause an allergic reaction. In these cases, the device is more likely to fail, need to be replaced sooner, or causes chronic pain.
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