When a surgeon recommends a total knee replacement you will likely have a lot of questions. Here, we address the most common 12 concerns.
There is no precise formula for deciding when you should have a knee replacement. The main reason to have it done is pain, but if you have tried all other forms of non-operative treatment including lifestyle remedies, anti-inflammatory medication, physical therapy, and injections it may be time to think about surgery.
An orthopedic surgeon will carry out a thorough examination and make a recommendation. It might also be beneficial to get a second opinion.
Before you consider surgery, your doctor will usually encourage you to try various non-surgical treatments. These may include:
- physical therapy
- weight loss (if appropriate)
- anti-inflammatory medication
- steroid injections
- hyaluronic (gel) injections
- alternative treatments such as acupuncture
In some cases, these solutions may help manage knee problems. However, if the symptoms become worse and start to affect your quality of life, surgery may be the best option.
If a total knee replacement (TKR) is necessary, delaying or declining surgery for a long period of time could result in the need for a more complex operation and a less favorable outcome.
Questions to ask yourself include:
- Have I tried everything?
- Is my knee preventing me from doing the things I enjoy?
Get more information to help you determine if you should consider knee surgery.
The surgeon will make an incision over the front of your knee to expose the damaged area of your joint.
The standard incision size varies from approximately 6–10 inches in length.
During the operation, the surgeon moves your kneecap to the side and cuts away the damaged cartilage and a small amount of bone.
They then replace the damaged tissue with new metal and plastic components.
The components combine to form an artificial joint that is biologically compatible and mimics the movement of your natural knee.
Most knee replacement procedures take 60 to 90 minutes to complete.
Artificial knee implants consist of metal and medical-grade plastic called polyethylene.
There are two ways of attaching the components to the bone. One is to use bone cement, which usually takes about 10 minutes to set. The other is a cement-free approach, in which the components have a porous coating that allows the bone to grow onto it.
In some cases, a surgeon may use both techniques during the same operation.
Any operation done with anesthesia has risks, although it is rare that severe complications result from any type of anesthesia.
The options for TKR include:
- general anesthesia
- spinal or epidural
- a regional nerve block anesthesia
An anesthesia team will decide on the most suitable options for you but most knee replacement surgery is done using a combination of the above.
There will definitely be some pain after your operation but your surgery team will do everything possible to keep it manageable and minimal.
You may receive a nerve block prior to your operation and your surgeon may also use a long-acting local anesthetic during the procedure to help with pain relief after the procedure.
Your doctor will prescribe medication to help you manage the pain. You may receive this intravenously (IV) immediately after surgery.
When you leave the hospital, the doctor will give you pain relief medication as pills or tablets.
After you recover from surgery, your knee should be significantly less painful than it was before. However, there is no way to predict the exact results and some people continue to have knee pain for many months after their operation.
Following your doctor’s instructions after surgery is the best way to manage pain, comply with physical therapy and achieve the best result possible.
Find out more about the medications you may need after surgery.
If you have had a general anesthetic, you may wake up feeling a bit confused and drowsy.
You will probably wake up with your knee raised (elevated) to help with swelling.
Your knee may also be cradled in a continuous passive motion (CPM) machine that gently extends and flexes your leg while you are lying down.
There will be a bandage over your knee, and you may have a drain to remove fluid from the joint.
If a urinary catheter was placed, a healthcare professional will usually remove it later on the day of your operation or the next day.
You may need to wear a compression bandage or sock around your leg to improve blood circulation.
To reduce the risk of a blood clot, you may need anticoagulant medication (blood thinners), foot/calf pumps, or both.
Many people have an upset stomach after surgery. This is usually normal, and your healthcare team may provide medication to ease discomfort.
Your doctor will also prescribe intravenous antibiotics to reduce the risk of infection.
Antibiotics can help prevent infections, but it’s important to be able to recognize the signs of an infection, if one occurs after knee surgery.
Most people are up and walking within 24 hours with the aid of a walker or crutches.
Following your operation, a physical therapist will help you bend and straighten your knee, get out of bed, and ultimately learn to walk with your new knee. This is often done on the same day of your operation.
Most people are discharged from the hospital 2–3 days after surgery.
After you return home, therapy will continue regularly for several weeks. Specific exercises will aim to improve the functionality of the knee.
If your condition necessitates it, or if you don’t have the support you need at home, your doctor may recommend spending time at a rehabilitation or nursing facility first.
Most people recover within 3 months, although it may take 6 months or longer for some people to recover fully.
If you live in a multiple-story house, prepare a bed and space on the ground floor so that you can avoid the stairs when you first return.
Make sure the house is free of obstructions and hazards, including power cords, area rugs, clutter, and furniture. Focus on pathways, hallways, and other places you are likely to walk through.
Make sure that:
- handrails are secure
- a grab bar is available in the tub or shower
You may also require a bath or shower seat.
Some surgeons recommend using a CPM (continuous passive motion) machine in the hospital as well as at home while lying in bed.
A CPM machine helps increase knee motion during the first few weeks after surgery.
- slow the development of scar tissue
- help you maximize your early range of motion following your operation
If you are sent home with a CPM machine you should use it exactly as prescribed.
Your doctor will prescribe any mobility equipment that you will need, such as a walker, crutches, or a cane.
Most patients require an assistive device (walker, crutches, or cane) for approximately 3 weeks after knee replacement surgery although this varies significantly from patient to patient.
You will also be able to do low-impact exercise such as riding a stationary bike, walking, and swimming after 6–8 weeks. Your physical therapist can advise you on introducing new activities during this time.
You should avoid running, jumping, as well as other high-impact activities.
Discuss with your orthopedic surgeon any questions concerning your activities.
According to research, more than
Younger people are more likely to need a revision at some point during their lifetime, mainly due to a more active lifestyle. Consult with a doctor about your particular situation.