Total Knee Replacement Information

What is the basic anatomy of the knee?
As the largest joint in the body, the knee is comprised of the lower end of the thighbone (femur), the upper end of the shin bone (tibia) and the kneecap (patella). Large ligaments attached to the femur and tibia provide stability, while the thigh muscles give the knee strength. The knee is held together by cartilage which enables the bones to move easily.
What causes knee pain?
The knee is held together by cartilage that enables the bones to move easily. The cartilage acts as something of a shock absorber, but if the cartilage wears away, the bones can rub against each other and cause significant pain and swelling. The most common cause of knee pain is a condition known as osteoarthritis, which is caused by trauma or direct injury to the knee.
What causes knee joint degeneration?
Factors that cause knee joint degeneration include heredity, abnormal development of the knee, repetitive injures and normal “wear and tear.” While being overweight does not necessarily cause arthritis, it can contribute to early and more rapid progression of knee problems.
What is total knee replacement?
Total knee replacement is a surgical procedure in which certain parts of an arthritic or damaged knee joint are removed and replaced with an artificial implant called a prosthesis. When joint replacement surgery is performed correctly, the prosthesis enables the artificial joint to move as a normal, healthy knee. It is a good idea to watch a joint replacement video to complete understand the procedure.
What are the most common reasons for knee replacement?
The most common reason for knee replacement surgery is pain that cannot be relieved by traditional medications or physical therapy. Other reasons include restricted flexibility, advanced arthritis or other degenerative conditions. Degeneration can make daily activities such as sitting, climbing stairs or even putting on socks a challenge.
How “bad” does my joint pain have to get before I consider having joint replacement?
Pain affects individuals differently. Having a total joint replacement is a very personal decision that should be made with the help of a total joint doctor’s evaluation. When more conservative treatment options such as medication, injections and physical therapy no longer provide pain relief, total joint replacement may be recommended.
What pre-surgery preparations are necessary?
Your doctor may require a complete physical examination to assess your health and pinpoint any conditions that could interfere with your surgery or recovery. This evaluation could include blood and urine tests, chest X-rays, dental evaluations, medication assessments and weight evaluations.
How long is the actual knee replacement surgery?
You will most likely be admitted to the hospital the day of surgery. Once the procedure has begun, it generally takes a few hours to remove the damaged cartilage and bone and install the knee prosthesis.
How long is the recovery time in the hospital post-surgery?
A typical hospital stay for knee replacement surgery is one to three days. Each patient must reach their discharge goals before leaving. Discharge goals will be explained in the pre-operative total joint education class before the total joint surgery takes place.
What physical therapy activity is expected post-surgery?
Depending on your condition, you may begin with slow movement of the knee while lying in bed to improve circulation by moving the leg muscles. Foot and ankle movement is also encouraged immediately following surgery to increase blood flow. Most patients begin knee exercises the day after surgery. However, a physical therapist will teach specific exercises to strengthen the knee and restore movement for walking and other normal daily activities.
If you are a patient traveling from out-of-town, we request that you stay two weeks to begin your physical therapy using our specific total joint protocols.
What complications can occur from a knee replacement surgery?
The most common complication of knee replacement surgery is blood clots in the leg veins or pelvis. To prevent blood clots, elevate your legs, conduct lower leg exercises to increase circulation and wear support stockings. Your physician may also prescribe medication to thin your blood.
What are the warning signs of oncoming blood clots?
Notify your doctor immediately if you experience calf/leg pain unrelated to your incision, tenderness or redness above or below your knee, increased swelling in your calf, ankle or foot, shortness of breath, or chest pain, particularly with breathing or coughing.
How can post-surgery infection be prevented?
The most common causes of infection are from bacteria that enter the bloodstream during dental procedures, urinary tract infections or skin infections. The American Academy of Orthopaedic Surgeons (AAOS) recommends antibiotic prophylaxis before all dental work.
What are the warning signs of infection?
Notify your doctor immediately if you experience persistent fever greater than 100°F orally, shaking chills, redness, tenderness or swelling of the knee wound, drainage from the knee wound, or increasing knee pain with both activity and rest.
How will my “new” knee feel different?
There may be some numbness and stiffness following the procedure, especially with excessive bending activities. The effectiveness of the knee replacement depends on the motion of the knee prior to surgery. Most patients can expect to nearly fully straighten the replaced knee and to be able to climb stairs and get in and out of a car. Although it may be uncomfortable, kneeling is not harmful. Some patients may feel a soft clicking of the metal and plastic while bending or walking, but this feeling usually diminishes with time.
Will the materials in the “new” knee activate metal detectors?
The new knee may activate metal detectors in airports and some buildings. Tell the security agent about your knee replacement if an alarm is activated.
Are knee replacements a common procedure?
According to the Centers for Disease Control and Prevention, about 719,000 total knee replacements are performed in the United States each year.
How should a knee joint replacement physician be selected?
It’s important to choose a physician that  specializes in and performs only hip and knee joint replacement surgeries. Doctors that perform many different orthopaedic procedures do not usually have the level of experience needed to ensure success. If a doctor performs 350 hip and knee replacement surgeries per year, and another performs 35, success is far more likely with the surgeon who has more experience.
Patients that have joint replacement surgery will experience bone loss, which makes a second surgery even more difficult and increases chances of further complications. Dr. Brett R. Smith and Dr. G. Daxton Steele, specialize in and perform only hip and knee joint replacement surgery and have a success rate of greater than 99 percent. Outcomes are more predictable and the complications are far less if performed correctly the first time by a specialist.
What is minimally invasive knee replacement?
Minimally invasive total knee replacement involves inserting the implants through smaller incisions rather than a slightly longer incision. This gained traction a few years ago as it was believed by some clinicians to provide quicker, less painful recovery and more rapid return to normal activity. However, experts at the Andrews Institute Total Joint Center believe the benefits of an open total joint surgery far out-weigh minimally invasive joint surgery. Risks with minimally invasive joint surgery include the skin being stretched so much that it does not always return to normal and can increase the risk of infection, and the surgeon may not always be able to angle surgical instrumentation or the joint replacement at optimal levels. Imagine a mechanic lifting the hood of your car only eight inches, rather than opening completely to fix your motor.
What is an unicompartmental knee replacement?
An unicompartmental knee replacement is not as common as a total knee replacement. It is used when the damage to the knee is limited to a single compartment of the knee (either the inner medial, outer lateral or kneecap). If two or more compartments are damaged, unicompartmental knee replacement might not be the best option. Because of its limited scope, the procedure has a smaller, less invasive incision typically making rehabilitation faster.
Who is eligible for a unicompartmental knee replacement?
Unicompartmental knee replacement is less desirable for a young, active person because it may not withstand high levels of activity that can cause extreme stress. It is best suited for an older, healthy person with a relatively sedentary lifestyle.
How long does a knee replacement last?
As successful as most replacement surgeries have become, the artificial joint can become loose or wear out, requiring a revision (repeat) surgery. The rate at which this happens depends on a person’s age, weight, quality of bone health, activity level and compliance with physician orders. Your physician can provide you a better estimate of what to expect after evaluating your specific condition.