Frequently asked questions about total knee replacement surgery

The knee joint has a layer of smooth cartilage on the lower end of the femur or thighbone; the upper end of the tibia or shinbone; and the undersurface of the patella or kneecap. This cartilage serves as a cushion and allows for smooth motion of the knee. Arthritis wears away this smooth cartilage. Eventually, the cartilage wears down to bone. Rubbing of bone against bone causes discomfort, swelling and stiffness.

A total knee replacement is really a cartilage replacement with an artificial surface. The knee itself isn’t replaced, as is commonly thought; 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 a plastic spacer on the tibia and kneecap or patella. This creates a new, smooth cushion and a painless, functioning joint.

Results will vary depending on the quality of the surrounding tissue, the severity of your arthritis at the time of surgery, your activity level and your adherence to the physician’s orders.

Your orthopedic surgeon will decide if you’re 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.

Age isn’t a factor if you’re in reasonable health and have the desire to continue living an active life. You may be asked to see your primary care provider for his or her opinion about your general health and readiness for surgery.

All implants have a limited life expectancy, depending on your age, weight, activity level and medical conditions. An implant is a medical device, subject to wear and tear that may lead to mechanical failure. While it’s important to follow all your surgeon’s recommendations after surgery, there’s no guarantee your particular implant will last for any specific length of time. The newer types of implants can potentially last for 20 to 30 years.

Just as your original joint wears out over time, so will a replacement joint. The most common reason for needing a revision is the artificial surface loosening from the bone. Wearing of the plastic spacer may result in the need for a new spacer as well. Your surgeon will explain the possible complications associated with total knee replacement.

While most surgeries go well without any complications, infection and blood clots are two of the most serious things that can go wrong. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce the risk of infection.

Many surgeons advise their patients to stop smoking before surgery and to think about quitting for good. Tobacco products have an adverse effect on blood vessels, which can affect the body’s way of healing wounds and bones. The risk of infection and lung problems after surgery is also greater for patients who use tobacco. There are many sources of information offered to help people quit smoking.

Yes. Please read the education materials provided by your surgeon’s office for more information.

Most patients will get up, sit in a chair or recliner and start to walk with a walker or crutches with their physical therapists or nursing staff on the day of surgery.

Most knee patients will be hospitalized from one to two days after surgery. There are several goals you must achieve before you can be discharged.

We have found that going through this program with a ”coach” leads to more successful outcomes for all patients, especially those who live alone. A coach can be a family member or friend, who is able to assist you throughout this program. Having a coach enables most patients to return to their own homes and get back to activity sooner. We encourage you to plan the timing of your surgery to coincide with when you will have a coach available. If no arrangements for a coach are possible, our staff will assist you with developing safe discharge plans based on your needs and insurance requirements.

We reserve approximately two to two and a half hours for surgery. Some of this time is used by the operating room staff to prepare for the surgery.

You may have a spinal or epidural anesthetic, which numbs only your legs and doesn’t require you to be asleep. Some patients prefer to have a general anesthetic. The choice is between you, your surgeon and the anesthesiologist.

You will have discomfort following the surgery, but we’ll try to keep you comfortable with the appropriate medication. Generally, most patients are able to stop very strong IV medication within one day.

Your heart will be monitored during surgery. If it is necessary, your heart will be monitored after surgery during your hospital stay.

Your orthopedic surgeon will perform the surgery. An assistant often helps during the surgery and that assistant will bill you separately.

The scar will be approximately six inches long. 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.

Yes, we do recommend you use a walker, cane or crutches for about six weeks.

With proper planning, most patients are able to return to their own homes after discharge. You are encouraged to discuss the timing of your surgery with your surgeon to ensure you will have time to prepare and have assistance arranged. Despite the best planning, some patients will need to discharge to a subacute facility for a short period before returning home. During the pre-operative education class and your hospital admission, our staff will help you determine if this is necessary for you. You should check with your insurance company to see if you have subacute rehab benefits.

For the first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, dressing, bathing, etc. Family or friends need to be available to help, if possible. Preparing ahead of time can minimize the amount of help required. You can reduce the need for extra help by doing laundry, cleaning the house, completing yard work, putting fresh linens on the bed and preparing single-portion frozen meals before your surgery.

Yes, you should expect to participate in continued physical therapy after being discharged from the hospital. The majority of patients resume physical therapy in an outpatient setting within a day or two of discharge from the hospital. Our care coordinator will help you make these arrangements, if they are not already in place prior to surgery. If attending outpatient physical therapy is not appropriate for medical or safety reasons, the care coordinator will help you make arrangements for in-home physical therapy as required.

The ability to drive depends on whether surgery was on your right leg or your left leg and the type of car you have. If the surgery was on your left leg and you have an automatic transmission, you could be driving at two weeks. If the surgery was on your right leg, your driving could be restricted as long as six weeks. Getting back to normal will depend somewhat on your progress. Consult with your surgeon or therapist for their advice on your activity.

We recommend that most people take at least one 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.

Two to three weeks after discharge, you will be seen for your first postoperative office visit. The frequency of follow-up visits will depend on your progress. Many patients are seen at six weeks, 12 weeks and then yearly.

Yes, high-impact activities, such as running, tennis and basketball, are not recommended. Injury-prone sports, such as downhill skiing, are also dangerous for the new joint.

You’re encouraged to participate in low-impact physical and recreational activities such as walking, dancing, golf, hiking, swimming, bowling and gardening.

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 moving the knee. This is the result of the artificial surfaces.