Knee Replacement Surgery

Knee replacement is an elective procedure, so the ultimate decision is up to you. Your doctor will review your unique situation and discuss whether you have exhausted all non-surgical options.

Osteoarthritis occurs when cartilage on the ends of your bones deteriorates over time, causing bones to rub together. The rubbing can cause pain, swelling, and loss of joint motion. If left untreated, the joint can become stiff and prevent your knee from fully straightening or bending.

Total knee replacement is the procedure of removing damaged bone and cartilage from your thighbone, shinbone, and kneecap to replace them with artificial joints. It shapes the ends of your bones to accept the artificial implants and does not remove large sections of your bone.

Complications after knee replacement surgery are rare, but include:

• Infection
• Blood clots in the leg or lungs
• Heart attack
• Stroke
• Nerve damage

With improvements in the technology of joint replacements, the age range for people appropriate for knee replacement has expanded over the years. In the past, joint replacement was reserved for people older than 60. Technology has improved and, today, younger people can have knee replacement, remain active and expect the joint to last a long time.

Your doctor will discuss with you how active you plan to be, your overall health, and the expected success of your knee replacement.

Knee replacement surgery is a good option if you have knee damage from a condition such as:

• Osteoarthritis
• Avascular necrosis (loss of bone due to insufficient blood supply)
• Bone tumor or injury
• Rheumatoid arthritis

There are several factors that determine the life span of an artificial knee, including your level of physical activity, weight, and overall condition. A majority of knee replacements are still doing well at 15 years, and—based on laboratory testing—may continue to last as long as 25–30 years.

Your surgeon will make an incision on the front or side of your knee to access the joint. There are a variety of things that contribute to the length of the incision. These include, but are not limited to, patient size, muscularity, unusual anatomy of the knee joint, and the amount of stiffness of the knee prior to surgery.

Knee replacement implants are made of a variety of materials, including titanium metal (a highly porous metal), polyethylene, and cobalt chrome. Bone cement is often used to affix the implants to the bone, but cementless versions in which the one grows into the porous surface of the implants are also used.

If you are otherwise young and healthy, you may be able to run after a knee replacement. You should talk to your doctor about whether running is a good option for you and how it might affect your knee.

It is possible that that your artificial joint could cause metal detectors to go off. If this happens, do not panic. If you are in an airport, you do not need an ID card to confirm your artificial joint, but TSA may need to use a wand or pat you down. Be prepared to experience a short delay but it should not be a serious inconvenience.

If needed, your knee replacement can be repaired. This may include replacing part or all of the knee replacement. Your doctor will discuss the details of your particular revision with you.

Improvements in technology and surgical instruments have allowed incision sizes to become smaller, which may cause less soft tissue damage and allow for faster recovery.

Partial knee replacements replace only the part of the knee joint that is damaged and is an option for some people with specific joint damage and symptoms. This typically allows for a faster recovery and a more natural-feeling knee.

Most of the time, you can expect to be discharged from the hospital the same day or next day after surgery. The majority of your recovery will occur in the first few months, but you will continue to recover for the whole first year following surgery.

Patients with medical issues or more complicated surgical procedures may be required to stay in the hospital longer and take longer to recover fully.

A physical therapist will have you out of bed and moving on the day of your surgery. You will use crutches or a walker as you take your first steps.

Pain is handled and experienced very differently by everyone. With improvements in types of anesthesia, various blocks, and the use of a variety of pain medications designed to work together, the pain is typically very manageable after surgery.

After surgery—typically the same day—a physical therapist will teach you knee replacement exercises to help you gain strength and motion in your new knee. After leaving the hospital, you may work with a physical therapist at your home, in an outpatient physical therapy facility, or in a rehabilitation facility.

Everyone is different, and you will need to discuss the specifics with your doctor. Most patients experience some post surgical pain or discomfort for 4–12 weeks following surgery, but it typically decreases in severity each week.

You should focus on weaning off the pain medication as quickly as you are able. Pain medications have their own set of side effects, some of which can be very difficult to manage. Typically, you will have goal of weaning off prescription pain medications in 2–6 weeks.

Everyone recovers from surgery differently, but typically patients are clear to drive in 2–6 weeks, and—depending on the amount of physical activity your job requires—you can usually return to work 4–8 weeks after the procedure.

You should talk with your doctor before resuming activities like driving or working.

Everyone experiences pain differently, but improvements in types of anesthesia, various blocks, and the use of a variety of pain medications designed to work together mean the pain is typically manageable after surgery.

Knee replacement surgery, however, can be a difficult recovery and will take some time before you fully appreciate the benefits of it. Swelling and range of motion exercises contribute to the difficulty, although these are important for helping the joint to regain motion. The pain will likely be different than the pain you had before surgery, and it will get better. Pain medication, ice, and elevation will be keys to managing your pain while you recover.

Follow your doctor’s instructions in the early recovery period. Long term care of your knee replacement usually consists of avoiding repetitive, high impact activities, taking antibiotics an hour before dental appointments, maintaining your health, and properly managing any medical issues you may have.

Some patients are healthy enough to have both knees replaced at the same time. This is called bilateral total joint replacement. Otherwise, you should wait at least 3 months between surgeries to allow yourself time to recover from the initial procedure. Talk to your doctor about what is best for you.