Total Knee Replacement FAQ

In the knee joint there is a layer of smooth cartilage on the lower end of the thighbone (femur), the upper end of the shinbone (tibia) and the undersurface of the kneecap (patella). This cartilage serves as a cushion and allows for smooth motion of the knee. Arthritis describes the wearing away of this smooth cartilage. Eventually it wears down to bone. Rubbing of bone against bone causes discomfort, pain, swelling and stiffness.

A total knee replacement is 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. The substitute is made of metal and plastic. The piece which covers the lower end of the thigh bone is made of a corrosion-resistant alloy of stainless steel, usually cobalt chromium or titanium. The opposing surface of the shin bone is made of plastic and designed to mate with that of the thigh bone. The undersurface of the kneecap is replaced with plastic, which moves against the metal of the thigh bone component. This combination of metal-on-plastic creates a joint of minimal friction and wear, thus ensuring long life.

90-95 percent of patients achieve good to excellent results with pain relief and significantly increased mobility and activity.

We expect most knees to last more than 10-20 years. If you are overweight, or extremely active, this time may be shortened. A second replacement may be necessary.

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.

Although chronic illnesses increase the risk for any surgical patient, knee replacement surgery has a low rate of complications. On a national average, fewer than two percent of patients experience knee joint infection or other major difficulties. Blood clots in the leg veins are the most common complication and can be prevented by medications, special support hose, inflatable leg coverings, and gentle exercises which begin soon after surgery.

Yes. You should discuss preoperative physical therapy/exercise options with your Southern Joint Replacement Institute orthopaedic surgeon. Exercises should begin as soon as possible.

You may need blood after the surgery. You may:

• Donate your own blood, if you are able
• Use the community blood bank supply

Your Southern Joint Replacement Institute orthopaedic surgeon may request that you get out of bed the day of your surgery. The next morning you will get up, sit in a chair or recliner and walk with a walker helped by staff.

Most knee patients will be hospitalized for three to four days after their surgery. If you need more time for rehabilitation, Southern Joint Replacement Institute staff will discuss available options with you.

Southern Joint Replacement Institute reserves approximately two to two-and-a-half hours for surgery. Some of this time is taken by the operating room staff to prepare for surgery.

You may have either general anesthetic or a spinal anesthetic. The anesthesiologist will gladly explain the differences and help you decide which is best.

As with all surgery, knee replacement is painful, but manageable. For the first 1-3 days after surgery, pain is well controlled with an epidural catheter. Thereafter, oral medication, such as tablets of Percocet or Vicodin, usually suffice. After leaving the hospital, patients may require further pain medication, but less frequently. Within six weeks following surgery, only aspirin or ibuprofen are needed.

The scar will be approximately six to eight 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 will be some numbness around the scar which is normal due to nerves being nicked or cut during surgery.

Yes. Until your muscle strength returns after surgery, you will need a walker, a cane or crutches. Your equipment needs will be determined by the physical therapist and ordered for you before you leave the hospital.

Possibly. A three-in-one bedside commode, a tub bench and grab bars in the tub or shower may also be necessary. Your home equipment needs will be evaluated and arranged while you are in the hospital. If needed, you will also be taught by an occupational therapist to use adaptive equipment to help you with lower body dressing and bathing.

Many patients go directly home when discharged. You should check with your insurance company to see if you are eligible for rehabilitation benefits. In certain cases, patients may qualify for inpatient rehabilitation or home health care.

Many individuals lack the appropriate support of a healthy spouse or close family member to allow them to go home immediately from the hospital. For those unable to depend upon family or close friends, an excellent alternative is to use a skilled nursing facility for one to three weeks. The aim is to regain adequate independence in order to reduce home-care needs to a level which friends or family can easily manage.

Yes. The first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, housekeeping, etc. If you go directly home from the hospital, family or friends need to be available to help. Preparing ahead of time, before your surgery, can minimize the amount of help required. 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.

Yes. A physical therapist can visit your home or you will receive the therapy at an outpatient physical therapy facility. The length of time required for therapy varies with each patient. Southern Joint Replacement Institute staff will help you with these arrangements before you go home.

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 right leg, your driving could be restricted as long as six weeks. Getting "back to normal" will depend on your progress. Consult with your Southern Joint Replacement Institute surgeon for their advice regarding your activity. Also, you should not drive if you are taking narcotic pain medication.

We recommend that most people take at least one month off from work, even if your job allows you to sit frequently. More strenuous jobs will require a longer absence from work.

Six weeks after discharge, you will be seen for your first post-operative office visit. The frequency of follow-up visits will depend on your progress. Patients usually return for a three month, six month, and yearly checkup. However, if the patient is experiencing discomfort or has concerns, they may contact the Southern Joint Replacement Institute at any time and schedule an appointment.

Yes. High-impact activities such as contact sports, running, singles tennis and basketball are not recommended. Injury-prone sports such as downhill skiing are also dangerous for a new joint.

Individuals undergoing total knee replacement are ready to return to extensive travel and activities, including golf, within six to eight weeks of surgery. More vigorous sports, such as tennis and skiing are possible within three to four months. You are encouraged to participate in low impact activities such as walking, dancing, golfing, hiking, swimming, bowling and gardening.

Yes. You may have a small area of numbness to the outside of the scar, which is normal and may last a year or more. Kneeling may be uncomfortable for a year or more. Some patients notice a clicking noise when they move their knee—this is the result of the artificial surfaces coming together and is not cause for concern. Depending on the amount of stiffness you have before surgery, you may not regain full bending and/or straightening of the knee.