Frequently Asked Questions Total Knee Replacement Click to download the Patient Guide for Total Knee Replacement. Patients have many questions about total knee replacements. Below is a list of the most frequently asked questions along with the answers. 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 thigh bone (femur), the upper end of the shin bone (tibia), and the under-surface 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 knee replacement? A total knee replacement is really a bone and cartilage replacement with an artificial surface. The knee itself is not replaced, as is commonly thought, but rather an artificial substitute for the cartilage, or an implant, is inserted on the end of the bones. This is done with a metal alloy on the thigh bone and a plastic spacer on the shin bone and kneecap. This creates a new smooth cushion and a functioning joint that does not hurt. What are the results of total knee replacement? Results will vary depending on the quality of the surrounding tissue, the severity of the arthritis at the time of surgery, the patient’s activity level, and the patient following the doctor’s orders after the surgery. Ninety to 95% of patients achieve good to excellent results with relief of discomfort and significantly increased activity and mobility. When should I have total joint replacement surgery? Your orthopaedic 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? All implants have a limited life expectancy depending on an individual’s age, weight, activity level, and medical condition. A total joint implant’s longevity will vary in every patient. It is important to remember that an implant is a medical device subject to wear that may lead to mechanical failure. While it is important to follow all of your surgeon’s recommendations after surgery, there is no guarantee that your particular implant will last for any specific length of time. 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 possible complications associated with joint replacement? While uncommon, complications can occur during and after surgery. Some complications include infection, blood clots, implant breakage, dislocation, and premature wear – any of which may necessitate implant removal/replacement surgery. Other complications include unequal leg length, nerve injury, foot drop, adverse reactions to anesthesia, stroke, heart attack, and death. While these devices are generally successful in attaining reduced pain and restored function, they cannot be expected to withstand the activity levels and loads of normal, healthy bone and joint tissue. Although implant surgery is extremely successful in most cases, some patients still experience pain and stiffness. No implant will last forever; factors such as a patient’s post-surgical activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon. Should I exercise before the surgery? Yes. You should either consult your physician, an outpatient physical therapist, or follow the exercises listed in your patient guide. Exercises should begin as soon as possible. How long will I be incapacitated? The night after surgery you will dangle your legs at the side of the bed. However, the next morning, you will get up, sit in a chair or recliner, and you should be walking with a walker later that day. How long will I be in the hospital? Most knee replacement patients will be hospitalized for three to five days after their surgery. You must achieve several goals before you can be discharged. What if I live alone? You may return home and receive help from a relative or a friend. You may also have a home health nurse and physical therapist assist you at home for two or three weeks, if needed. There is a possibility that you will require additional care, such as the services provided on our Skilled Nursing Unit or at Health South Rehabilitation. This will be discussed during your discharge planning. How do I make arrangements for surgery? After your surgeon has scheduled your surgery, the Joint Center secretary will contact you. The Orthopaedic Nurse Clinician and Joint Center secretary will guide you through the program and make arrangements for both pre-op and post-op care. Both roles are described in the patient guide along with phone numbers for both. How long does the surgery take? We reserve approximately two to two-and-a-half hours for surgery. Some of this time is used by the operating room staff to prepare for the surgery. You will be away from your family for approximately four hours. Do I need to be put to sleep for this surgery? You will have regional anesthesia. There are different types of regional anesthesia including spinal block, epidural block, and continuous peripheral nerve catheter. The goal of regional anesthesia is to provide a numb leg during surgery along with IV sedation, as needed; you will breathe on your own. Another option is general anesthesia. General anesthesia is what most consider “being put to sleep.” You will discuss specific options for anesthesia at your pre-op screening visit with a nurse and anesthesiologist. Will the surgery be painful? There will be pain or discomfort after surgery, but we will keep you as comfortable as possible with appropriate medication. The type of medication depends on the type of anesthesia used. Patients who have regional anesthesia, specifically a continuous peripheral nerve catheter, will have a continuous infusion of numbing medicine given through the catheter to bathe most of the nerves that go to the knee. In addition, you will initially need some intravenous (IV) pain medication and later, oral pain medication to help ease your pain. You may have a PCA pump, which is a special pump connected to the IV fluids. The pump delivers pain medication through the IV only when the patient pushes the dose button. The dose is regulated so that you will not get more than the prescribed maximum dose for that hour. If you are hurting, press the button. Who will be performing the surgery? Your orthopaedic surgeon will do the surgery. An assistant often helps during the surgery. This is a teaching hospital; residents may assist in your surgery. How long and where will my 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 walker or crutches or cane? Yes. For about six weeks we do recommend that you use a rolling walker, a cane, or crutches. The Joint Center staff can arrange for them, if necessary. Will I need any other equipment? Yes. You will need a raised toilet seat or a three-in-one bedside commode. A tub bench and grab bars in the tub or shower may also be necessary. If you have stairs, you may need to install hand rails. This will be decided prior to discharge. Where will I go after discharge from the hospital? Most patients are able to go home directly after discharge. Some may transfer to a rehab facility where the average stay is seven days. The Joint Center staff will help you with this decision and make the necessary arrangements. Your insurance will explain your options, coverage, and payment regarding discharge plans. Some of your options will be home health and physical therapy, outpatient physical therapy, and inpatient rehab. 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, getting around, and other normal daily activities. If you go directly home from the hospital, the Joint Center staff will arrange for a home health care nurse to come to your house, as needed. Family or friends need to be available to help, if possible. Preparing ahead of time can minimize the amount of help needed. Will I need physical therapy when I go home? Yes. You will either have outpatient or in-home physical therapy. Patients are encouraged to use outpatient physical therapy. The Orthopaedic Nurse Clinician will help you arrange for an outpatient physical therapy appointment. If you need in-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 three times a week to assist in your rehabilitation. How long until I can drive and get back to normal activities? 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 four weeks. If the surgery was on your right leg, your driving could be restricted as long as six weeks. Getting back to normal will depend somewhat on your progress and may result in your being able to resume driving when you feel that you can safely control your vehicle. Consult with your surgeon or therapist for advice on your activity. When will I be able to go back to work? This will be decided between you and your physician. How often will I be seen by my doctor following the surgery? You will be seen daily during your hospital stay either by a resident or your staff physician. After discharge, your first post-operative visit will be in two to three weeks. The frequency of follow-up visits will depend on your progress. Many patients are seen at six weeks, 12 weeks, six months and 12 months. 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? You are encouraged to participate in low-impact activities, such as walking, dancing, golfing, hiking, swimming, bowling, and gardening. Will I notice anything different about my knee? Yes. You may have a small area of numbness to the outside of the scar and 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.