Total Knee Replacement

If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down. If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider a total knee replacement.

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Total Hip Replacement

The decision to have total knee replacement surgery should be a cooperative one between you, your family, your family physician, and your orthopedic surgeon. Your physician may refer you to an orthopedic surgeon for a thorough evaluation to determine if you might benefit from this surgery. A knee replacement (also called knee arthroplasty) might be more accurately termed a knee “resurfacing” because only the surface of the bones is actually replaced.

  • Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
  • Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or “press-fit” into the bone.
  • Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.
  • Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

When Surgery Is Recommended

There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from total knee replacement often have:

A knee that has become bowed as a result of severe arthritis.

  • Severe knee pain or stiffness that limits your everyday activities, including walking, climbing stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker.
  • Moderate or severe knee pain while resting, either day or night
  • Chronic knee inflammation and swelling that does not improve with rest or medications
  • Knee deformity — a bowing in or out of your knee
  • Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries

Candidates For Surgery

There are no absolute age or weight restrictions for total knee replacement surgery.

Recommendations for surgery are based on a patient’s pain and disability, not age. Most patients who undergo total knee replacement are age 50 to 80, but orthopedic surgeons evaluate patients individually. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

Common Causes of Knee Pain

The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

Osteoarthritis

This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.

Rheumatoid Arthritis

This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”

Post-Traumatic Arthritis

This can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

Knee Replacement FAQs

How do I know when I am ready to have a knee replacement?

The primary reason to have a joint replaced is pain. Patients that have pain that limits their daily activities and X-ray findings of arthritis generally are candidates for replacement surgery. Other indications for surgery include deformity and stiffness.

When will I start PT?

Typically we will try to start PT the day of surgery. That may involve moving from your bed to the chair with assistance, performing exercises while seated, or possibly walking with a physical therapist using a walker. You will continue to work with PT in the morning and afternoon the day after surgery. In those sessions, you will complete exercises, walk with a walker, and practice going up and down steps.

How long will a knee replacement last?

Artificial knees are mechanical parts that have a limited lifetime. The lifetime of an artificial knee is dependent on the amount of force placed across the joint as well as the activity level. Highly active patients tend to have higher wear rates. It is recommended that patients avoid engaging in high-impact activities. These activities include running and jumping. Studies show some implants have lasted beyond 15 years.

Will my implant set off metal detectors?

The majority of implants do set off metal detectors. Unfortunately, there is no identifying document or card that the TSA recognizes.

Will I get a card or letter to allow me through the airport?

Cards are available if requested but they are not recognized by the TSA or any other government agency.

Does a partial knee replacement last longer than a total knee replacement?

Not necessarily. All implants have a limited life expectancy depending on an individual’s age, weight, and activity level.

Can I have a total knee replacement after a partial knee?

Yes. The conversion of a partial knee replacement to a total knee replacement is very similar to a first-time knee replacement.

Why would I have a partial knee replacement?

A partial knee is typically used for patients who have osteoarthritis in limited parts of their knee. Studies suggest partial knee replacements may give the individual a more natural feel to their knee.

Will I need a walker of cane at home?

Yes, if you do not have them already, we will supply you with a walker and cane in your pre-op visit.

How much motion should I have after a knee replacement?

The biggest predictor of motion after the replacement is the amount of motion a patient has prior to surgery. If you have limited motion, your doctor may prescribe outpatient PT or home exercises prior to surgery to try to improve your range of motion. We strive to have every knee bend at least 90 degrees. In knees that are stiff and lack significant bend prior to surgery, achieving full motion can be a challenge. Most often this is due to the stiffness of the ligaments and tendons which can be improved to some degree with surgical releases. Participation in a comprehensive PT plan following surgery is essential in order to maximize motion.

What if I live alone or do not have help at home?

The majority of patients go home after their hospital stay. You will require someone to be available to assist you with your daily needs for at least one week. It is important to make these arrangements with your family or friends prior to surgery. Patients who do not have assistance at home may qualify for an inpatient rehabilitation center. It is best to arrange this prior to your surgery.

How do I arrange for inpatient therapy?

A counselor from the hospital will contact you prior to your surgery and review your situation to determine if you would qualify.

How long will I be at the hospital?

The typical stay is 1-2 nights. For example, Patients having surgery on Monday would go home either Tuesday afternoon or Wednesday morning.

When can I shower?

Once the incision is dry, patients can shower. You will be given specific instructions upon discharge from the hospital.

Is it normal for my knee to feel warm after surgery?

Isolated warmth of the skin after knee replacement is not unusual and can persist for up to six months. This is thought to be due to increased blood flow during the healing process.

How do I know if I have an infection?

If you are concerned about an infection, you should see your surgeon. Signs of infection include drainage from the incision, redness, pain, and swelling.

Will I need a blood thinner after surgery?

Yes, a medication to protect against blood clots is necessary for up to 35 days after a Total Hip Replacement. We will give you this prescription at your pre-op visit. You will not need to fill this prescription if you are going to an inpatient rehab facility.

How do I avoid a blood clot?

While blood clots are a risk factor after surgery, there are things you can do to help prevent them. It is important to complete your full prescription of blood-thinning medication and to perform exercises that are shown to you in your class prior to surgery and taught to you in PT.

Do I need to attend the class before surgery?

Attending the joint replacement class allows patients to familiarize themselves with the hospital, nursing staff, and physical therapist. The class includes: reviewing the operation, scheduling therapy, and pain management. Studies have shown that patients who attend class have shorter more productive hospital stays.

How do I know if I have a blood clot?

If you are concerned that you may have a blood clot, you should see your surgeon. Signs of blood clots include pain and swelling in one or both of your lower legs.

How will my pain be controlled?

Pain is typically well controlled with oral and IV medications while in the hospital. Once a patient goes home after surgery, their pain will be controlled with oral medication. You will receive a prescription for pain medication after surgery at your pre-op visit.

When will I be able to drive?

Most patients can return to driving in one month, however, we ask that you do not drive until we see you at your first follow-up appointment after surgery.

When will I be able to return to work?

This varies on the type of work you are returning to. Most patients can return to non-strenuous work activity in 4-6 weeks. It will take longer to return to work that requires climbing, squatting, and heavy lifting.

When will I see my doctor after I leave the hospital?

You will have a follow-up appointment scheduled 2 ½ – 3 weeks after surgery. If you have any questions during that time, please contact your doctor’s office.

Lowcountry Orthopaedics’ Hip & Knee Team

Richard Zimlich, MD

Eric Stem, MD

Sarah Burden, FNP-BC

Tony McCurry, Jr, PA-C

Morgan Conde, PA-C

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North Charleston, SC 29406

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