Knee Replacement FAQ
Listed below are frequently asked questions about Knee Replacement Surgery.
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 undersurface of the patella (kneecap). This cartilage serves as a cushion and allows for smooth motion of the knee. Arthritis is a wearing away of this smooth cartilage. Eventually it wears down to bone. Rubbing of bone against bone causes discomfort, swelling and stiffness. Arthritis is detected with x-rays.
What is a knee replacement?
A knee replacement is really a cartilage replacement with an artificial surface. The knee itself is not replaced, as 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 plastic spacer on the tibia and the patella (kneecap). This creates a new smooth cushion and a functioning joint that does not hurt.
What are the results of total knee replacement?
Ninety to ninety-five (90-95%) percent of patients achieve good to excellent results with relief of discomfort and significantly increased activity and mobility.
When should I have this type of surgery?
Your orthopedic surgeon will decide 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 problem, 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 opinion about your general health and readiness for surgery.
How long will my new knee last and can a second replacement be done?
We expect most knee replacements to last more than 15-20 years. However, there is no guarantee and 15-20 percent may not last that long. A second replacement may be done if necessary.
Why do they fail?
The most common reason for failure 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 are two serious complications that concern us the most. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce risk of infection and blood clots such as using space suits and special stockings to pump blood through your legs. Complications can also occur to your skin, arteries, veins, nerves, tendons, ligaments, and bones. Overall, the complications rates are historically between 10-15%. Your surgeon has already discussed these with you during your visit, but if you have any further questions or concerns, please ask us at anytime.
Should I exercise before the surgery?
Yes. You should either consult an outpatient physical therapist or follow the exercises listed in the information give to you by your surgeon. Exercises should begin as soon as possible.
Will I need blood?
Most patients do not require blood transfusions after knee replacement surgery. We use many techniques to reduce blood loss and the need for transfusion. You will have several tests, including blood work, done prior to surgery. The doctor will use these results to anticipate your need for blood products. If you do need blood following surgery, we recommend the blood from the blood bank. This blood is screened thoroughly for infectious disease. The American Red Cross recommends the blood bank, as they consider it safer and more effective than self-donation.
How long am I incapacitated?
The goal is to have you standing and walking the day of surgery.
How long will I be in the hospital?
Most knee patients will be hospitalized for one day of less after a total knee arthroplasty. There are several goals that you must achieve before you can be discharged. Ultimately, we want you to have a safe recovery. How long this takes varies with each patient.
What if I live alone?
Many of our patients who live alone have arranged for continual home care through their family, local church, or social group, during the first week after surgery. If you decide on private nursing services, we can provide a list of unendorsed service centers for you to review.
How do I make arrangements for surgery?
After your surgeon has scheduled your surgery, the surgical scheduler in our office will contact you. She will send you information in the mail detailing all of your upcoming appointments.
Do I need to be put to sleep for this surgery?
You may have a general anesthetic, which most people call "being put to sleep." However, an overwhelming majority of patients prefer to have a spinal anesthetic. Spinal anesthetic numbs your legs, providing you with prolonged pain relief, protecting you from blood clots and allowing for "twilight" sedation. The choice is between you and the anesthesiologist.
Will the surgery be painful?
You may have discomfort following the surgery, but we will keep you comfortable with appropriate medication and relaxation techniques. We continually improve and refine our pain control methods to assure a good recovery and fit the best method of pain relief to your specific needs.
Who will be performing the surgery?
Your orthopedic surgeon will do the surgery. An assistant often helps during the surgery and that assistant will bill your insurance separately.
How long, and where, will my scar be?
The scar will be approximately six inches long. Afterwards, there may be some numbness around the scar. This will not cause any functional problems. We use skill and care to make the scar as cosmetically appealing as possible.
Will I need a private nurse?
No. You do not need a private nurse, but if you want one, the Discharge Planning Nurse can help provide a list of references. If you do not have someone taking care of you at your home, you may also need to arrange for private nursing. Your insurance is unlikely to reimburse for this benefit.
Will I need a walker or crutches or cane?
Yes. For about six weeks, we do recommend that you use a walker, a cane or crutches. Arrangements for a walker or crutches will be made at orientation or during your hospital stay. However, you may bring your own or a borrowed one if you have one available to you.
Will I need any other equipment?
Yes, a raised toilet seat will be provided. A tub bench and grab bars in the tub or shower may also be necessary. An occupational therapist can help you decide. Some patients will use braces. This will be decided at the time of discharge and we will make all necessary arrangements for delivery.
Where will I go after discharge from the hospital?
Most patients are able to go home directly after discharge. Some may transfer to an extended care facility. Stays there are usually from one to three weeks long. Scheduling your stay at an extended care facility does not take place until after your surgery is performed. The Discharge Planner will help you with this decision and make the necessary arrangements. Check with your insurance company to see if you have extended care or rehab benefits.
Will I need help at home?
Yes. The first several weeks, depending on your progress, you will need someone to assist you with meal preparation, etc. We recommend that someone stay with you around the clock for the first week after surgery. Everyone recovers at different rates but we normally recommend one week of care. Family members or friends need to be available to help.
Preparing ahead of time can minimize the amount of help needed. Having the laundry done, house cleaned, yard work completed, clean linens put on bed and single portions of frozen meals will reduce the need for extra help.
Will I need physical therapy when I go home?
Yes. The hospital will arrange for physical therapy to be provided in your home or with a local physical therapist. Most patients choose to have therapy at our office. Following this, you may go to an outpatient facility such as our office, two-three times a week to assist in your rehabilitation. The length of time required for this type of therapy varies with each patient.
How long until I can drive and get back to normal?
The ability to drive depends on whether surgery was on your right knee or your left knee, and the type of car you have. If the surgery was on your left knee and you have an automatic transmission, you could be driving at three weeks. If your surgery was on your right knee, your driving could be restricted for six weeks. You must be off narcotics prior to driving.
When will I be able to get back to work?
We recommend that most people take at least one month off from work, unless their job is quite sedentary and they can go to work with crutches. However, some people require 6 to 12 weeks to return to more demanding work.
When can I have sexual intercourse?
You may resume sexual intercourse after surgery. Information is available on safe sex after a joint replacement from the Joint Care Coordinator.
How often will I need to be seen by my doctor following the surgery?
Four weeks after discharge, you will be seen for your first post-operative office visit. The frequency of follow-up visits will depend on your progress. Most patients are seen at three months and then yearly.
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. Most patients can return to stationary bike riding or elliptical machines in 3-4 weeks. Treadmills may be used on a low speed and with no incline at 4 weeks or later. Weight machines are used with your therapist after the 4th week and continue until you are discharged. Your physical therapist can answer specific questions about special exercises and machines.
Will I notice anything different about my knee?
Yes. You may have a small area of numbness to the outside of the scar that may last a year or more and is not serious. Sometimes, however, this numbness is permanent. Kneeling may be uncomfortable, but will not injure the knee replacement. Some patients notice some clicking when they move their knee. This is the result of the artificial surfaces coming together and is not any cause for concern. In addition, most patients have some swelling and warmth to the knee and leg that may last up to one year. This swelling is usually not associated with any pain.
Can I place a pillow under my knee to keep it bent and make it more comfortable?
No! Definitely not. We understand that after surgery it may seem like a good idea to put a pillow under your knee. However this is something you should not do. Placing a pillow under your knee would allow your knee to stay slightly flexed. This can cause contractures or problems with how far you are able to extend your knee in the future. To prevent this, we ask that you DO NOT place a pillow under your knee. To elevate the leg, you may use a pillow or stool under your ankle.
What are the "six week blues?"
Approximately 5-6 weeks after surgery many patients begin to feel both depressed and frustrated. It is normal to have these feelings during this period. During the first 6 weeks you make great strides in the reduction of pain and with your range of motion. However, at the 6 week mark, you often feel as though you have "hit a wall" in your progress. At this point, it is important to realize how far you have come. Don't be discouraged. The key to getting off of this plateau is building strength. Muscle strength takes at least 8 weeks to build. Thus, until you reach 8 weeks after surgery, you are on a plateau. You will get through this! It is important to remember that your exercises will pay off. Continue to build strength by focusing on the strengthening exercises located in the back of this book and from therapy, for at least another 4-6 weeks. As time passes, you will slowly notice that you will feel better. The next phase you will enter is the endurance phase. During this phase, you will feel more tired than usual at the end of the day or even after a few hours of work. This phase lasts anywhere from 3-6 months and even up to a year in some patients. Generally, you will see this get better.
What about some drainage from my incision?
A layer of stitches are placed just below the skin. This is in place of metal staples or outer sutures on your skin. Although this special plastic surgery suture makes your incision look better, it will dissolve and sometimes this causes fluid collections under and above the skin. During the dissolving process, there will be some redness and swelling. Do not apply any gels or lotions to the area. If you have ANY drainage from your incision, please contact our office and we will make every attempt to get you in for an incisional check as soon as possible.
A few days after I went home from the hospital, I noticed more bruising and swelling. Why?
Swelling and bruising, which occurs about 3-6 days after discharge from the hospital, is normal. This is due to the echymosis (or bruising) produced during the surgery itself. It works its way up to the surface of the skin, where it is visible. This is normal and will subside in about 8 weeks. During this time after surgery, it is very important to elevate above heart level. You should continue to use ice. If you notice any increasing calf pain, please call our office as soon as possible. Occasionally patients will notice some blisters on their surgical leg at their period of maximum swelling. This is because there is no room available for the swelling and fluid to go within the skin and therefore pockets or blisters form. These should not be popped. If they pop on their own, cleanse them with warm soapy water and leave them open to air. If you have any concerns of infection, contact us immediately
Why Make An Appointment With Us
Our practice is called Advanced Orthopedic Specialists for a reason. A Specialist in orthopedics implies that the physician has had fellowship training. Orthopedic surgeons attend 4 years of undergraduate college, 4 years of medical school and 5 years of residency training in general orthopedic surgery. Fellowship training is an additional year of training to specialize in a specific field of orthopedics. All of the doctors at AOS are fellowship trained, offering patients the best educated physicians to help address their problem.