Orthopaedic Services

FREQUENTLY ASKED QUESTIONS ABOUT TOTAL KNEE SURGERY

People facing joint replacement surgery typically ask the same questions.  However, if you have questions that are not covered in this section, please ask your surgeon or the joint care team.  We are here to help.

*What is arthritis and how does it affect my knee?
Arthritis is a disease of the articular cartilage, the smooth cushion that pads and protects joints.  In a healthy knee, this cushion or cartilage located between the end of the thigh bone (femur) and the shin bone (tibia) that prevents the two bones from rubbing against each other.  Over time, or following injury, the cartilage begins to wear away leading to bone-on-bone contact.  The nerve endings surrounding the bones become irritated resulting in the pain, swelling and stiffness associated with arthritis. 

*What is a total knee replacement?
The term total knee replacement is misleading since the knee itself is not replaced.  The ends of the femur and tibia are shaped and capped with an implant device referred to as a prosthesis.  The process is similar to having a crown put on your tooth. A plastic spacer is attached to the prosthesis that creates a smooth cushioning effect much like the original cartilage.  By replacing the diseased and painful surface, the bone-on-bone articular pain is eliminated and allows you to return to an active, healthy lifestyle.  

*Is it possible to have both knees done at the same time?
It is possible to have both knees done at the same time.  This is called a bilateral total joint replacement.  Unilateral joint replacement (one knee at a time) is done more often. The decision to replace one or both knees depends on several factors and the risks and benefits of this procedure should be discussed with your surgeon.

*What is the difference between a cemented or uncemented prosthesis?
When using the cemented technique, a prosthesis with a smooth finish is cemented or glued into place.  In the uncemented technique, a prosthesis with a porous coating is placed directly into the bone.  It is held in place by bone in growth into a rough or textured surface over time.

*Which is better-cemented or uncemented prosthesis? 
Each person’s condition is unique, which is why your surgeon and you must weigh advantages and disadvantages specific to your needs.

Cemented replacements are more generally used for less active people and people with weaker bones or osteoporosis .  Uncemented replacements are more generally used for younger, more active people.  Studies show that cemented and uncemented prostheses have comparable rates of success. 

*What is the success rate for total knee replacements?
Approximately 90-95% of patients report good to excellent results in terms of pain relief.  Most are able to significantly increase activity and mobility and return to the low impact activities they participated in prior to the onset of arthritis pain. 

*Am I too old for this surgery?
Your overall health is more of a determining factor than your age.  Prior to the surgery, you will be asked to see your family doctor to access any health risks.  All measures will be taken to prepare you for a successful surgical outcome. 

*How long will my new knee last?
There are no guarantees on how long your new knee will last.  Various factors such as weight, activity and bone quality can affect the usable life of your new knee prosthesis.  Current studies indicate that the average knee prosthesis lasts longer than 20 years.  With new materials and procedures, these expectations may continue to improve. 

*Will I need to have my knee replaced again in the future?
Some people have a knee replacement that lasts their entire lives; other people need to have the procedure repeated.  The total joints implant’s longevity will vary in every patient.  If the bone does not bond properly to the first replacement, the prosthesis becomes unstable and needs to be replaced.  If the plastic spacer that cushions the joint becomes extremely worn, this may also require replacing. 

*What are the major risks of this surgery?
All surgeries carry a certain amount of risk; infection and blood clots are two major complications.  However, because of our proactive approach in preventing possible complications, most of our joint patients are just fine and are ready to leave the hospital in a few days. 

We take special care to safeguard you from infection following surgery.  You will be given antibiotics both before and after the surgery.  To further minimize the risk of infection, we have streamlined the surgical procedure to take less time.  The less time your wound is open, the less chance of infection. 

Following surgery, blood clots can be a problem.  You will usually be given medication to reduce the risk of blood clots forming.  Examples of such blood thinners or anticoagulants are Asprin, Coumadin, and Lovenox.  Getting out of bed and walking soon after surgery is another way to reduce the risk of blood clots. 

*How much time will the surgery take?
The surgery itself takes one or two hours.  There is much preparation in the operating room with anesthesia, positioning, and equipment.  Afterward in the recovery area you will be monitored closely in a special unit called the Post Anesthesia Care Unit (PACU) until the anesthesia wears off.  Once you are awake and stable, you will return to your room on the orthopaedic floor and your family will be able to visit with you.

*Who will be doing the surgery?
Your orthopaedic surgeon will be performing the surgery.  Physician Assistants, Registered Nurses, or orthopaedic residents often assist during the surgery. 

*Will I be awake during the surgery? 
During surgery, an anesthesiologist will administer an anesthetic that will provide total pain relief.  There are different types of anesthetics:  a general anesthetic will put you into a deep sleep, while a regional anesthetic will numb specific areas only.  Normally regional anesthetics are given with another medication that will make you very relaxed and put you into a light, dreamlike state. (Refer to the Pain Management section in the manual.)

*Will I be in a lot of pain after surgery?
You will have discomfort following the surgery. However, we have considerable experience in caring for patients after surgery and know how to keep our patients comfortable.  (Refer to the Pain Management section in the manual.)

*What will my scar look like?
There are several different techniques used for knee replacement.  The type of technique will determine the number, location, and length of the scar(s).  Your surgeon will discuss which technique is right for you. 

There may be some numbness around the scar after it is healed.  This is perfectly normal and should not cause any concern.  The numbness usually disappears over time. 

*Will my joint be any different?
Some people may notice a minor clicking sound when the bend their joints.  This is the result of the prosthesis, or artificial parts, coming in contact with each other.  It is normal and is no cause for concern.  Kneeling may be a bit uncomfortable during the first year.  This normally becomes less noticeable over time, but not everyone can kneel of the total knee without discomfort.    

*Will I need a blood transfusion after surgery?
You may need blood after surgery although this is becoming less frequent.  If your surgeon requests it, prior to surgery you may donate your own blood (autologous), have relatives donate blood for you (donor directed), or use the community blood supply (blood bank).  Many surgeons also use a re-infusion drain system after surgery. This system allows your own blood that is collected into the drain to be returned back to you through your IV within a certain period of time after surgery.

*How long will I be confined to bed after surgery?
On the day of surgery, you will stay in bed most of the day.  Depending on the time of day that you get to your room after surgery, you might get out of bed with help to briefly stand essentially beginning your recovery the same day!  Your care team will advise you when it is safe to get up.  Early the next morning, you will be up and dressed to start the day’s activity.  Usually, most patients are walking with a walker or crutches by the afternoon. 

*How long will I be in the hospital?
Joint replacement patients usually stay in the hospital an average of 2 to 3 days, assuming they achieve the goals necessary to meet discharge criteria.

*Will I need a walker, crutches, or cane?
Patients use an assistive device such as walker, crutches, or cane until balance and strength are near normal.  People progress at their own pace and will normally use the assistive device for at least 2 weeks.  Your surgeon will tell you when it is time to retire them.  The discharge coordinator will arrange for you to get the assistive devices.  The physical therapist will teach you how and when to use them.

*Will I need any other equipment at home?
After total joint surgery, you may benefit from a high toilet seat.  You may also benefit from a bath seat or grab bars in the bathroom.  Physical therapy, occupational therapy, and the Discharge coordinator will discuss the options with you.   

*Can I go directly home or do I have to go to a rehab center?
Occassionally,  some patients require a short stay in a subacute/rehab facility especially if you live alone.  However, most of our patients (approximately 80%) go directly home.  We believe that the recovery in the familiar environment of home is most effective with visiting nurses and physical therapists.  The Discharge Coordinator will talk with you and make these arrangements.

*Will I need help at home?
Although you will be well on your way to recovery when you leave the hospital or the subacute/rehab facility, you will need someone to assist you with meal preparation, dressing, etc., at least for the first week or two.  If you go directly home from the hospital, your surgeon and the Discharge Coordinator will arrange for a home healthcare agency to visit your home.   

Prior to coming to the hospital for surgery, plan ahead to make the coming home easier.  Take care of such things as getting prescriptions filled, changing the bed linens, doing the laundry, washing the floors, arranging for someone to cut the grass, walk the dog, stocking up on groceries, etc.  Your job after surgery is to focus on your recovery. 

*Will I need physical therapy when I go home?
Physical therapy immediately after surgery is a key factor recovery.  Patients are encouraged to utilize the outpatient physical therapy as soon as possible and we recommend that you call to set up your post-op PT appointments BEFORE your surgery.  The number of physical therapy sessions is based on your individual progress. Commonwealth Orthopaedics has several outpatient physical therapy facilities, or you can also go to one of your choice. 
Physical therapy can also be arranged in your home through the Home Heathcare agency if needed. 

*Why should I exercise before surgery?
The better the condition your muscles are in prior to the surgery, the easier and faster your recuperation is expected to be.  It is important to learn the exercises and be comfortable with them prior to the surgery so that you can continue them once you return home.  Starting the exercise before surgery will build muscle tone and pave the way to quick recovery. 

*After leaving the hospital, when do I see my surgeon again?
Your surgeon will tell you when to make your follow-up appointment in the office; it is usually 10 days to 3 weeks after surgery.  You will be given specific instructions at the time of discharge from the hospital. 

*When can I drive?
Your return to driving largely depends on which knee was effected and how committed you are to your exercises and physical therapy.  If you had surgery on your left knee, you may be able to drive a car with an automatic transmission sooner than if the surgery was on your right knee with a manual transmission.  Regardless of your progress, you should not consider driving if you are still taking prescription pain medication.  Your surgeon will let you know when it is advisable to drive again. 

*When can I return to work?
Typically, people plan on taking a one month leave of absence from work.  The physical demands required for your job, as well as your own progress, will determine when you can return to work. Your surgeon will tell you when you can return to work and if there are limitations. 

*When can I resume having sexual intercourse?
After surgery, it will take time to regain your strength, as well as confidence in your new knee.  Most people feel able, physically and mentally, to engage in sexual activity about four to six weeks after surgery.  Depending on the individuals healing rate, at four to six week the incision, muscles, and ligaments are usually sufficiently healed to consider resuming sexual activity.  Talk to your surgeon if you have any questions.

*Will my medications affect my ability to engage in sexual intercourse?
Some medications can affect performance and/or enjoyment during intercourse.  Many narcotic pain relievers and cortisone medications can decrease sexual performance.  Other common medication-related side effects are a decreased interest in sex, vaginal dryness, abnormal erections and delayed orgasms. 

If you sense that your medication is causing these side effects, try having sex in the morning before taking your first dose or in the evening before your last dose. 

Do not adjust or stop taking your prescribed medicine without consulting your surgeon.  Often, a simple adjustment or change of medication can eliminate unwanted side effects. 

*Are there any positions that should be avoided during sexual intercourse?
It is best to use a side-lying position in the early recovery stages to avoid kneeling on your new knee joint.  Pillows can also be used to pad the knees and provide support. 

As your recovery progresses, lying on your back using a pillow under the knee to create a comfortable bend is often an alternative position. 

Later in the recovery process as the swelling decreases and range of motion improves, the male joint replacement patient can assume a top position.  Do not use this position until your knee is comfortable and the incision is totally healed.

Remember, you are still healing.  Just like other activities, it may take some time to regain your former stamina but the changes are temporary and needed to protect your new knee. 

*Are there any activities that I should avoid initially?
It is important to keep your new joint moving.  However, you should return to your normal activities gradually.  Start out slow, and work your way up.  For example, taking a five mile hike on your first time out is not realistic.  Rather, walk until you begin to get tired adding distance to each subsequent walk until you have reached your goal. 

You will be instructed by your joint care team to avoid specific positions of the joint that could put stress on your new joint.  You should avoid high impact activities such as long distance running, singles tennis, basketball, downhill skiing, football, and the like.  Consult your surgeon prior to participating in any high impact or injury-prone sports.

*Are any activities better than others?
Exercise is important to the entire body to maintain health and it is especially beneficial for your new joint.  Your surgeon will advise you when it is safe for you to incorporate low impact activities such as dancing, golf, hiking, swimming, bowling, gardening, and the like back into your normal routine.