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 kneecap (patella). 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.
What is a total hip replacement?
A total knee replacement is really a cartilage replacement with an artificial surface. The knee itself is not replaced, as is 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 kneecap (patella). This creates a new smooth cushion and a functioning joint that does not hurt.
What are the results of total knee replacement?
Ninety percent to 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 by new knee last and can a second replacement be done?
We expect most knees to last more than 10-15 years. However, there is no guarantee, and 10 percent to 15 percent may not last that long. A second replacement may be 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 infections. The chances of this happening in your lifetime are 1 percent or less.
Should I exercise before the surgery?
Absolutely. You should follow the exercises listed in this notebook. These will be reviewed with you during your scheduled pre-op education class. You also have the opportunity to participate in our supervised Wellness Connection Program at The Wellness Center. Please call (423) 431-5386 if you would like to participate.
Will I need blood?
You may need blood after surgery. Bank blood is considered safe, but we understand if you want to use your own. For more information, read "What I Need to Know About Blood Transfusions" in your notebook appendix.
How do I donate my own blood?
If you wish to donate blood for yourself, contact your orthopedic physician to see if you meet the requirements for donating your own blood. Your orthopedic physician's office will make arrangements through the American red Cross if you meet the requirement.
How long am I incapacitated?
You will probably stay in bed the day of your surgery. However, the next morning you will get up, sit in a chair or recliner and will be walking with a walker or crutches.
How long will I be in the hospital?
Most knee patients will be hospitalized for three days after their surgery. There are several goals that you must achieve before you can be discharged.
What if I live alone?
Two options are usually available to you. You may either stay at a sub-acute (skilled nursing) facility following your hospital stay, or a home health nurse and a home physical or occupational therapist may assist you at home.
How do I make arrangements for surgery?
Your surgeon's office has scheduled you for your surgery and your pre-admission testing (PAT). They have also given you a schedule of dates available to attend a preoperative education class. You may choose whichever date is most convenient for you to attend this class; however, we do recommend you attend a class at least three to four weeks prior to your surgery. The classes are held at The Wellness Center. If you have questions, you may call Misty Spano, the Joint Program Coordinator, at (423) 431-6937.
How long does the surgery take?
We reserve approximately one to two hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery.
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," or a regional anesthetic. The choice is between you and the anesthesiologist. You will discuss this with your anesthesiologist prior to your surgery. For more information, read "Basics of Anesthesia" in your notebook appendix.
Will the surgery be painful?
You will have discomfort following the surgery, but we will keep you comfortable with appropriate medication. Generally most patients are able to stop very strong medication within one day. You may receive pain medication by a special pump (PCA) that delivers the drug directly into your IV and may have a nerve block.
Who will be performing the surgery?
Your orthopedic surgeon will do the surgery. An assistant often helps during the surgery.
How long, and where, will by scar be?
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 prior scar. There may be some numbness around the scar. This will not cause any problems.
Will I need a private nurse?
No. You do not need a private nurse, but if you want one, we can provide a list of agencies for you.
Will I need a walker, crutches or a cane?
Yes. For about six weeks we do recommend that you use a walker, a cane or crutches. The case manager can arrange for them if necessary.
Where will I go after discharge from the hospital?
Most patients are able to go home directly after discharge. Some may transfer to a sub-acute facility. Stays there are from three to five days. Your case manager will help you with this decision and make the necessary arrangements. You should check with your insurance company to see if you have sub-acute rehab benefits.
Will I need help at home?
Yes. The first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, etc. Family or friends need to be available to help if possible. Preparing ahead of time, before your surgery, can minimize the amount of help needed. Having the laundry done, house cleaned, yard work completed, clean linens put on the bed and single-portion frozen meals will reduce the need for extra help. Home health nursing and therapy will be arranged if ordered by your physician.
Will I need physical therapy when I go home?
Yes. You will have either outpatient or in-home physical therapy. Patients are encouraged to utilize outpatient physical therapy. The case manager will help you arrange for an outpatient physical therapy appointment. If you need home physical therapy, we will arrange for a physical therapist to provide therapy at your home. Following this, you may go to an outpatient facility up to three times a week to assist in your rehabilitation. The length of time required for this type of therapy varies with each patient.
When will I be able to get back to work?
You will need to discuss this with your orthopedic surgeon. Getting "back to normal" will depend on your progress, and if your job is quite sedentary or not. An therapist can make recommendations for joint protection and energy conservation on the job when you do return to work.
How long until I can drive and get back to normal?
Do not drive until you return to your surgeon for your first post-op visit. Your surgeon will instruct you on when you are cleared to drive. 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 6 weeks. Getting "back to normal" will depend somehwat on your prgress. You will not be able to drive while you are taking narcotic pain medications.
When can I have sexual intercourse?
The time to resume sexual intercourse should be discussed with your orthopedic surgeon.
How often will I need to be seen by my doctor following the surgery?
Seven to 10 days after discharge, you will be seen for your first postoperative office visit. This appointment will be scheduled for you before you are discharged from the hospital. The frequency of follow-up visits will depend on your progress. Many patients are seen at six weeks, 12 weeks 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, golf, hiking, swimming, bowling and gardening.
Will I notice anything different about my hip?
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. Kneeling may be uncomfortable for a year or more. Some patients notice some clicking when they move their knee. This is the result of the artificial surfaces coming together and is not serious.