The phrase “knee replacement” is a bit of a misnomer. In actuality, a knee replacement is a resurfacing of the damaged ends of the femur (thigh bone) and tibia (shin bone). This is where cartilage loss has occurred. These two surfaces are separated by a polyethylene spacer. Every knee replacement is implanted according to the size of the patient.
Even though commercial advertising may attempt to persuade patients towards one particular knee replacement, no manufacture has ever demonstrated superiority over their competition. What does this means for you as a patient? You want the surgeon operating on your knee to use the system with which he or she is most comfortable. Studies show that when it comes to the success of a knee replacement, having a surgeon with a high skill level is more important than what implant is being used.
Postoperative pain is a topic of much conversation among orthopedic surgeons. Over the past 20 years, significant strides towards patient comfort have been taken. The term “multimodal pain management” has been established to describe this process of pain management. These modalities include selective nerve blocks, pain medications injected about the knee during the time of surgery, anti-inflammatory medications, narcotic pain medications, and Tylenol (acetaminophen). This technique of pain management ensures pain receptors, and the perception of pain is decreased at multiple sites of the body. Keeping you comfortable and safe is our #1 priority.
The complications associated with a knee replacement are very rare. They must, however, be discussed with you as part of the “informed consent” process. Complications typically discussed prior to surgery include infection (approximately 0.5-1%), fracture/broken bone, instability, persistent pain, stiffness, venous thromboembolism (DVT/PE), and the inability to meet a patient’s expectations. There is also a possibility that a patient may require a blood transfusion. These complications can be directly related to a patient’s medical problems. Medical conditions such as heart failure, diabetes, obesity, and tobacco use may increase the risk of a postoperative complication. Eating a healthy diet and getting plenty of exercise can increase the odds of having a successful knee replacement. As far as diabetes is concerned, appropriate glucose control under the guidance of your primary care physician is very important. We aim for a hemoglobin A1C of less than or equal to 6.5.
The goal of knee replacement is to return you to your activity level prior to arthritis. Some activities such as walking, doubles tennis, swimming, stationary biking, hiking, low-resistance rowing, and golfing are commonly enjoyed by the knee replacement population. Other activities such as running, jogging, and contact/collision sports should be discussed with your surgeon prior to taking place.
Prior to driving it is important to discontinue your narcotic pain medication during the day. These medications may slow your reflexes, affect your judgment, and potentially place you at a higher risk for a car accident. The commonly quoted time for return to driving with a right-sided total knee replacement is 6 to 8 weeks. It is important to discuss this with your surgeon for more details.
It is very common for a patient to spend 2-4 days in the hospital after surgery. From there it is determined if it will be suitable for the patient to be discharged home, discharged home with home healthcare, or discharge to a skilled nursing facility. Your surgeon, medical doctor, physical therapist, occupational therapist, and social worker will all discuss your case and provide you with options. You can expect to use a walker or crutches for up to 6 weeks. It is also common for patients to require pain medications for up to 6 weeks. One should anticipate approximately 6-12 weeks off from work. Finally, complete recovery is seen between 6 and 12 months and patients will continue to improve for up to 2 years.
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