Knee Surgery
Q: Is knee replacement for me?
A: The first question many people have about knee replacement is if, and when, to have it done. You're the best judge of when to do it. Doctors can tell you if you have severe loss of cartilage and damage to the bones of your major joints. But only you know if the pain, and disability, is severe enough that you want to undergo major surgery to correct it.
One good measure of the right time to operate is when the pain is interfering with your ability to enjoy life and function normally-whether at home, at work, or in sports or hobbies you once enjoyed.
Another good time to consider joint replacement is when you've exhausted all other treatments short of surgery. If you haven't tried exercise, medication, injections of pain medicine, or other relatively less invasive treatments, then you should talk to your doctor about these treatments first.
The decision whether to have total knee replacement surgery should be a cooperative one between you, your family, your family physician, and your orthopaedic surgeon. Your physician may refer you to an orthopaedic surgeon for a thorough evaluation to determine if you could benefit from this surgery.
Reasons that you may benefit from total knee replacement commonly include:
- Severe knee pain that limits your everyday activities, including walking, going up and down stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker.
- Moderate or severe knee pain while resting, either day or night.
- Chronic knee inflammation and swelling that doesn't improve with rest or medications.
- Knee deformity-a bowing in or out of your knee.
- Knee stiffness-inability to bend and straighten your knee.
- Failure to obtain pain relief from non-steroidal anti-inflammatory drugs. These medications, including aspirin and ibuprofen, often are most effective in the early stages of arthritis. Their effectiveness in controlling knee pain varies greatly from person to person. These drugs may become less effective for patients with severe arthritis.
- Inability to tolerate or complications from pain medications.
- Failure to substantially improve with other treatments such as cortisone injections, physical therapy, or other surgeries.
Most patients who undergo total knee replacement are age 60 to 80, but orthopaedic surgeons evaluate patients individually. Recommendations for surgery are based on a patient's pain and disability, not age. Patients as young as age 16 and older than 90 have undergone successful total knee replacement.
Q: What will my stay in the hospital be like?
A: You will most likely stay in the hospital for several days. After surgery, you will feel some pain, but medication will be given to you to make you feel as comfortable as possible. Walking and knee movement are important to your recovery and will begin immediately after your surgery.
To avoid lung congestion after surgery, you should breathe deeply and cough frequently to clear your lungs.
Your orthopaedic surgeon may prescribe one or more measures to prevent blood clots and decrease leg swelling, such as special support hose, inflatable leg coverings (compression boots), and blood thinners. To restore movement in your knee and leg, your surgeon may use a knee support that slowly moves your knee while you are in bed. The device, called a continuous passive motion (CPM) machine, decreases leg swelling by elevating your leg and improves your venous circulation by moving the muscles of your leg.
Foot and ankle movement is encouraged immediately following surgery to also increase blood flow in your leg muscles to help prevent leg swelling and blood clots. Most patients begin exercising their knee the day after surgery. A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement to allow walking and other normal daily activities soon after your surgery.
Q: What will recovery at home be like?
A: The success of your surgery also will depend on how well you follow your orthopaedic surgeon's instructions at home during the first few weeks after surgery.
Wound care: You will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed several weeks after surgery. A suture beneath your skin will not require removal.
Avoid soaking the wound in water until the wound has thoroughly sealed and dried. A bandage may be placed over the wound to prevent irritation from clothing or support stockings.
Diet: Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength.
Activity: Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within three to six weeks following surgery. Some pain with activity and at night is common for several weeks after surgery.
Your activity program should include:
- A graduated walking program to slowly increase your mobility, initially in your home and later outside.
- Resuming other normal household activities, such as sitting and standing and walking up and down stairs.
- Specific exercises several times a day to restore movement and strengthen your knee. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery.
Driving usually begins when your knee bends sufficiently so you can enter and sit comfortably in your car and when your muscle control provides adequate reaction time for braking and acceleration. Most individuals resume driving about four to six weeks after surgery.
Q: How is my new knee different?
A: You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities. 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 is predicted by the motion of your knee prior to surgery. Most patients can expect to nearly fully straighten the replaced knee and to bend the knee sufficiently to go up and down stairs and get in and out of a car. Kneeling is usually uncomfortable, but it is not harmful. Occasionally, you may feel some soft clicking of the metal and plastic with knee bending or walking. These differences often diminish with time and most patients find these are minor, compared to 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.
After surgery, make sure you also do the following:
- Participate in regular light exercise programs to maintain proper strength and mobility of your new knee.
- Take special precautions to avoid falls and injuries. Individuals who have undergone total knee replacement surgery and suffer a fracture may require more surgery.
- Notify your dentist that you had a knee replacement. You should be given antibiotics before all dental surgery for the rest of your life.
See your orthopaedic surgeon periodically for a routine follow-up examination and X-rays, usually once a year.
Q: What kind of exercises can I do after knee surgery?
A: Recovery & Exercises.
Q: Am I a candidate for unicompartmental knee replacement?
A: Most arthritic knees should not be treated with "unis." However, many patients currently having total knee replacements would be good candidates for unis, they just are not aware of it. If your knee pain is only on one side of the knee, not painful under the kneecap and you are not "too" bowlegged or knock-kneed, then you may be an excellent candidate for a "uni."
