We’re glad for showing interest in knee care by Dr. Ashish Paul. Patients have asked many questions about total knee replacement. Below is a list of the most frequently asked questions along with their answers. If there are any other questions that you need answered, as you visit Dr. Paul he will further clear your doubts 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 under surface 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 tibia with plastic spacer in between. This creates a new, smooth cushion and a functioning joint that does not hurt.
WHAT ARE THE RESULTS OF A 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 doctor’s orders.
WHEN SHOULD I HAVE THIS TYPE OF SURGERY?
Dr. Ashish Paul orthopedic surgeon will decide as you come for consultation 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 personal physician for his/ her option about your general health and readiness for surgery. Or as you visit me my team will do thorough check up with review with physician, cardiologists, preop investigation and pre anaesthetic check up. After that you will be told about risk factors and complications involved, then only we will proceed further.
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 may also result in the need for a new spacer.
WHAT ARE THE MAJOR RISKS?
Most surgeries go well, without any complications. Infection and blood clots (DVT) are two serious complications. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce the risk of infections.
SHOULD I EXERCISE BEFORE THE SURGERY?
Yes, few exercises are started by physiotherapist before surgery.
WILL I NEED BLOOD?
You may need blood after the surgery. Bank blood is considered safe.
HOW LONG WILL I BE IN THE HOSPITAL?
Most knee patients will be hospitalized for three to five days after their surgery. There are several goals that you must achieve before you can be discharged.
HOW LONG DOES THE SURGERY TAKE?
We reserve approximately 2 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?
There are two types of anesthesia for knee surgery. A general anesthetic (being put to sleep), or a spinal anesthetic (which numbs your legs). The most common anesthetic is a spinal anesthetic with IV sedation. Your surgeon and anesthesiologist will be able to discuss in further detail the differences between your anesthesia choices.
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.
HOW LONG AND WHERE WILL MY SCAR BE?
The scar will vary in length depending upon your body makeup and size. 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, please call our discharge planner prior to surgery.
WILL I NEED A WALKER, CRUTCHES, OR A CANE?
Yes, a walker is recommended for 2-4 weeks, after that you will progress to a cane. A wheeled walker is preferred. Since you will not need a walker for too long, you may want to consider borrowing one from a friend or family member. Another option is borrowing one from a local service organization, club or church.
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 stray from 2-3 weeks. The discharge planner 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, etc. If you go directly home from the hospital, the discharge planner will arrange for a home health nurse to come to your house if appropriate. Family or friends need to be available for help if possible.
WILL I NEED PHYSICAL THERAPY WHEN I GO HOME?
Yes, you will have either outpatient or in-home physical therapy. Patients are encouraged to utilize outpatient physical therapy. It is recommended you set this up before your surgery date. A prescription for your physical therapy will be given to you. The length of time required for this type of therapy varies with each patient.
WHAT ARE THE CONSEQUENCES OF NOT FOLLOWING THROUGH WITH THE RECOMMENDED PHYSICAL THERAPY PROGRAM?
You may have difficulty walking and returning to the lifestyle that you were hoping for. You may experience pain, continued swelling, a stiff knee and inability to straighten it.
HOW LONG UNTIL I CAN DRIVE AND GET BACK TO NORMAL?
The ability to drive depends somewhat on your progress, as long as 6 weeks.
WHEN WILL I BE ABLE TO GET BACK TO WORK?
We recommend that most people take at least 1 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.
DO YOU RECOMMEND ANY RESTRICTIONS FOLLOWING THIS SURGERY?
Yes, high-impact activities such as running, singles 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, golfing, 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.
WILL THERE BE BRUISING WITH THE SURGERY?
There may be bruising around your incision, into your calf, and even into your thigh, which is normal after knee replacement surgery. We will use a tourniquet during your knee replacement, which is a tight band around the thigh itself, which can also cause bruising and some aching in the thigh itself. This is also normal.
SHOULD I BE CONCERNED THAT MY KNEE IS WARM DURING THE FIRST 6 MONTHS?
Warmth after a total joint replacement, especially knees, is very common for the first 6 months. If there are no signs of injection, such as redness, swelling, pain, or fevers, then the warmth is probably normal. However, if you have concerns during follow up thorough check up will be done.Tt
POSTOPERATIVE CONCERNS (LONG TERM)
HOW MUCH RANGE DO I NEED?
Most people require 70 degrees of flexion to walk normally on level ground, 90 degrees to ascend stairs, 100 degrees to descend stairs, and 105 degrees to get out of a low chair. To walk and stand efficiently, your knee should come within 10 degrees of being fully straight.
WHAT RANGE OF MOTION SHOULD I EXPECT FROM MY KNEE AFTER 6 WEEKS & AFTER ONE YEAR?
Everyone’s range of motion varies and depends on many individual factors. Your potential will be determined at the time of your surgery. The average patient achieves approximately 115 degrees of flexion by one year after surgery. Some patients achieve less, and others much more.
I THINK MY LEG FEELS LONGER NOW, IS THIS POSSIBLE?
In the majority of cases your leg length will essentially be unchanged. In some cases, however, the leg is lengthened. This is usually the result of straightening out a knee that preoperatively had a significant bow. At first the increased length may feel awkward. Most people become accustomed to the difference, but occasionally, a shoe lift may be necessary in the opposite extremity.
WILL I SET OFF THE SECURITY MONITORS AT AIRPORT?
You will probably set off the alarm as you progress through the security checkpoint. Be proactive and inform the security personnel that you have had a knee replacement and will most likely set off the alarm. Wear clothing that will allow you to show them your knee incision without difficulty. We do provide patients with a doctors letter mentioning them as having knee replacement; however, patients will usually be
screened by security as well.
DO I NEED ANTIBIOTICS BEFORE HAVING DENTAL WORK OR ANY OTHER INVASIVE MEDICAL PROCEDURE?
Yes. This is in order to limit the possibility of an infection occurring in the knee due to bacteria in our mouths getting into the bloodstream and traveling to the knee joint. Typically patients take 2 grams of amoxicillin or cefazolin 1 hour prior to dental work. Patients with a penicillin allergy often take clindamycin 600mg 1 hour prior to dental work.
WHEN IS IT OKAY TO GO TO THE DENTIST?
Avoid any dental cleaning and other non-urgent procedures for approximately 3 months AFTER knee replacement surgery.
MY KNEE MAKES AN INTERMITTENT CLICKING OR BUMBING NOISE
Yes. This is normal as the metal articulation is contacting the plastic. This is note a harmful situation and the majority of patients do experience this.
WHY DOESTHE SKIN AROUND MY KNEE FEEL NUMB
This is a normal and expected finding. The sensory nerves are interrupted with the knee incision resulting in an area of numbness around the knee, especially on the lateral aspect of the incision. Often, this improves over the course of one year, but may always feel somewhat different.