Total Knee Replacement
Total Knee replacement surgery was first performed in the 1960’s with hinged type of implants that did not work well. The problem was early loosening because a hinge did not permit the natural relation and bending of the knee. These early implants also had high infection rates. In the mid-1970’s better implants, called condylar total knee implants, were designed. They only came in two sizes and were solid pieces. Orthopedic surgeons were cautious about using them because of their experience with hinges, but as good results were recognized, more surgeons performed knee replacement. Implant companies then designed prostheses that were easier to place, as well as better instruments that made the surgery more reproducible. By the nineties, partial and total knee replacement surgery was widely accepted as good operations with excellent pain relief from arthritis.
Today, knee replacement is a procedure which is commonly performed around the world. The Anderson Clinic surgeons have pioneered advances in knee replacement surgery and will continue to research technologies to get our patients back to an active lifestyle.
Frequently Asked Questions
When do I decide to have it done?
The preliminary step in this decision is to meet with your surgeon to see if you are a candidate for total knee arthroplasty. This will commonly involve a history, physical examination, and X-rays of the involved knee. Even if the pain is significant and the X-rays show advanced arthritis of the joint, the first line of treatment is nearly always non-operative, to include weight loss if appropriate, an exercise regimen, medications, injections, or bracing. If the symptoms persist despite these measures, then a patient would consider total knee arthroplasty. The decision to move forward with surgery is not always straight forward, and usually involves a thoughtful conversation with yourself, your loved ones, and ultimately your surgeon. The final decision rests with the patient, and is based on the pain and disability from the arthritis influencing the patient’s quality of life and activities of daily living. Patients who decide to proceed forward with surgery commonly report that the symptoms from the knee keep them from participating in activities important to them (i.e. walking, stairs, work, sleep, etc.), AND have been non-responsive to the non-operative measures.
How long do they last?
It is often quoted that total joint replacements last “15-20 years”. This is not the ideal way to interpret the longevity of total joint replacements. The more accurate way to think about longevity is via the annual failure rates. Most current data suggests that both hip and knee replacements have an annual failure rate between 0.5-1.0%. This means that if you have your total joint today, you have a 90-95% chance that your joint will last 10 years, and 80-85% that it will last 20 yrs. With improvements in technology, these numbers may improve.
What is minimally invasive surgery, and how big is my scar?
Minimally invasive surgery is a term that today describes a combination of reducing incision length and lessening tissue disruption beneath the incision. This includes cutting less muscle and detaching less tendon from bone. Combined with these techniques are advancements of anesthesia and pain management that take place around the surgery. All of this combines to allow patients to feel better, have less pain, and regain function faster than in the recent past.
The size of the incision is variable, and depends on several factors that include the size of the patient, the complexity of the surgery, and surgeon preference. Most studies have shown that smaller incisions offer no improvement in pain or recovery and may actually worsen the surgeons’ ability to adequately perform the procedure.
When will my scar disappear?
The scar will heal within a few weeks, but then will remodel and change appearance over the course of 1-2 years. The color often fades and smoothes over time to blend into surrounding skin, but will likely never fully disappear.
Are there different types of implants?
Yes. In Orthopaedics, as well as most technologies, industry has developed a number of innovative technologies in an effort to improve the outcomes of total joint arthroplasty. In recent years, these technologies have been marketed directly to patients which has increased the awareness as well as confusion on what these different designs mean. The most important message is that while a certain manufacturer may claim that their design is “better”, almost all of the available registry data (large collections of data from countries that track total joints done in that country) show that there are no clear advantages to any of these designs when it comes to improving outcomes.
Is there a role for a computer, robot, or custom cutting guides in my surgery?
This question is the subject of many studies that are attempting to evaluate these emerging technologies and their influence of the success of surgeries. Each of these technologies has a specific goal that has fueled its development (i.e. more accuracy in implant placement, more efficient or faster surgery, etc.). To date, there appears to be both pros and cons to each of these technologies, but more research is required to determine what advantage, if any, these may offer. The best approach is to discuss this topic with your surgeon. You may want to know if they use one of these technologies, why they have chosen to do so, and what their experience has been in using it.
How long do I stay in the hospital?
Some patients go home the day of surgery. Others stay 1-2 days in the hospital. If you are having revision surgery or if you have other medical problems your length of stay could be longer.
When can I shower?
You can take a shower when your wound is dry. If you have a plastic dressing, it is waterproof. If you have a gauze dressing, remove it before you shower.
When can I walk after surgery?
We use very progressive rehab protocols which emphasize getting patients out of bed quickly. Often on postoperative day #1 patients are walking with the assistance of a walker and weaning to a cane or nothing at all by 3 weeks.
Is Total Knee Replacement very painful?
Pain following total knee replacement has come a long way over the last 10-15 years with increased use of regional nerve blocks, spinal blocks, and various other modalities used for pain control. Early range of motion and rapid rehab protocols are also designed to reduce early stiffness and pain, making the procedure in general much less painful than in years past. However, patients handle and perceive pain differently and as such; some patients may have relatively mild pain following the procedure while others have a more difficult time.
When can I drive?
Most surgeons allow patients to drive two to four weeks after surgery as long as your physical therapy feels that you have adequate muscle control of your leg AND you have discontinued the use of narcotic pain medication.
When can I return to work?
Returning to work is highly dependent on the patient’s general health, activity level and demands of the job. Patients with sedentary jobs such as computer work can expect to return by four to six weeks. More demanding jobs may need up to 3 months prior to returning.
How long does it take to recover?
Most patients are able to participate in a majority of daily activities by four to six weeks. Overall, by three months, most patients have regained much of the endurance and strength lost around the time of surgery and are able to participate in daily activities without restriction.
Do I need Physical Therapy and, if so, for how long?
Most patients do require outpatient physical therapy following knee replacement. A skilled therapist can accelerate the rehabilitation as well as make the process more efficient with the use of dedicated machines and therapeutic modalities. Depending on a patient’s preoperative condition, physical therapy is beneficial for up to 3 months and rarely longer. The amount of therapy needed depends upon a patient’s pre-op conditioning, motivation, and general health.
What are the major complications?
Total knee replacement is primarily a pain relieving procedure however it may not relieve all pain with possible residual stiffness and swelling. Although complications are relatively rare (1-2% of patients), patients may experience a complication in the postoperative period. These include very serious and possibly life threatening complications such as heart attack, stroke, pulmonary embolism and kidney failure. Stiffness or loss of motion can also occur. Infection (1%) is one of the most debilitating complications and often requires prolonged antibiotics with several additional surgeries to rid the infection. Blood clot in the leg is another possible complication requiring some type of blood thinner following surgery to reduce the incidence. The implants can also fail over time due to wear or loosening of the components. But this generally occurs many years after surgery.
What can I do/not do after surgery?
Restrictions following knee replacement are generally few and should be discussed with your surgeon. Many patients following knee replacement will have some difficulty kneeling on the operative knee. Most patients become less aware of this with time but will always have a general perception that the knee is artificial and doesn’t really feel like a normal knee. Most patients are able to return to preoperative activities and work but may have some difficulty performing heavy labor such as construction or farming. Most sporting activities are fine with the exception of running or jumping. Traveling should be not be affected by a joint replacement after the first 4-6 weeks when most surgeons advise against prolonged seated travel or flying due to increased risk of blood clot.