We are glad you have chosen the Total Joint Center to care for your knee problem. Patients ask many questions about total knee replacements. Below is a list of the most frequently asked questions along with their answers. If there are any other questions that you need answered, please ask your surgeon or the Total Joint Center Nurse Manager. We want you to be completely informed about this procedure.
FAQs: Knee Problems
For Total Knee Surgery:
- What is arthritis and why does my knee hurt?
- What is a total knee replacement?
- What are the results of total knee replacement?
- What is Uni-compartment knee replacement?
- What is computer navigation?
- When should I have surgery?
- Am I too old for this surgery?
- Am I too young for this surgery?
- Why do they fail?
- What are the major risks?
- Should I exercise before the surgery?
- Will I need blood?
- How do I donate my own Blood?
- How long am I incapacitated?
- How long will be in the hospital?
- What if I live alone?
- Will I need a second opinion prior to the surgery?
- How do I make arrangements for surgery?
- How long does the surgery take?
- Do I need to be put to sleep for this surgery?
- Will the surgery be painful?
- Who will be performing the surgery?
- How long, and where, will my scar be?
- Will I need a private nurse?
- Will I need a walker or crutches or cane?
- Will I need any other equipment?
- Where will I go after discharge from the hospital?
- Will I need help at home?
- Will I need physical therapy when I go home?
- How long until I can drive and get back to normal?
- When will I be able to get back to work?
- When can I resume sexual intercourse?
- How often will I need to be seen by my doctor following the surgery?
- Do you recommend any restrictions following this surgery?
- What physical/recreational activities may I participate in after my recovery?
- Will I notice anything different about my knee?
For the Kneecap:
- What is patella femoral pain syndrome?
- What are the symptoms?
- Who gets it?
- How is it diagnosed?
- How long does patella femoral pain syndrome last?
- What is the treatment?
- Now for the good news...
Answers for Total Knee Surgery:
What is arthritis and why does my knee hurt?
There is a layer of smooth cartilage on the lower end of the femur (thighbone), the upper end of the tibia (shinbone) and the undersurface 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 cartilage replacement, replacing the damaged cartilage with an artificial surface. The knee itself is not replaced, as is commonly thought, but rather metal is inserted on the end of the bones, the femur and the tibia. A plastic spacer goes between the tibia and femur. A plastic lining is placed on the back of the kneecap. This creates a new smooth cushion and a functioning joint that does not hurt. A more accurate name for a total knee replacement is total knee resurfacing.
Before: Raw bone rubbing on raw bone.
After: The prosthesis creates a smooth, pain-free surface.
What are the results of total knee replacement?
94-96 percent of patients achieve good to excellent results with relief of discomfort and significantly increased activity and mobility.
What is Uni-compartment knee replacement?
A uni-compartment knee replacement is a third of a knee replacement. Less surgery means less pain and a quicker recovery. You are a good candidate for this procedure if you have arthritis only one compartment of your knee.
What is computer navigation?
Computer navigation uses a GPS system that helps the surgeon align and orient knee implants with the patient’s anatomy. This enables the surgeon to place the prosthesis in a position to give the new knee the best strength, stability and range of movement. Another benefit is fewer of post-op pain from tendonitis, bursitis, etc. and by placing the components in the right position, wear is decreased.
When should I have surgery?
Your orthopedic surgeon will help you 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, based on pain and decreased quality of life.
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 will be asked to see a physician for his/her opinion about your general health and readiness for surgery.
Am I too young for this surgery?
Thanks to recent developments in design and materials, total knee replacements are projected to last 20 to 40 years.
Why do they fail?
The most common reason for failure is loosening of the artificial surface from the bone or wearing of the plastic spacer. This will result in the need for revision.
What are the major risks?
Most surgeries go well, without any complications. Infection and blood clots are two serious complications that concern us the most. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce the risk of infections. Our infection rate is 0.1%.
Should I exercise before the surgery?
Yes. You should either consult a physical therapist or follow the exercises listed in the Joint Center’s NoteBook. Exercises should begin as soon as possible.
Will I need blood?
You may need blood after the surgery. You may donate your own blood, if you are able, use the community blood supply or have your relatives donate for you. Banked blood is considered safe, but we understand if you want to use your own.
How do I donate my own Blood?
Call the Total Joint Center Nurse Manager, who will work out the details of your blood donation.
How long am I incapacitated?
You may get out of bed the day of your surgery. However, the next morning you will get up and start walking using a walker or crutches. You will be able to put your weight on your operated leg, so feel free to walk as far as you can.
How long will be in the hospital?
Most patients will be hospitalized for three to four days after their surgery. There are several goals that you must achieve before you can be discharged. You must be able to walk 200-400 feet, climb up and down as many stairs here as you have at home, get in and out of bed by yourself and be able to dress yourself.
What if I live alone?
Three options are available to you. If you have co-morbidities or bilateral knee replacements, you may be able stay at the Acute Rehab unit on the 7th floor, otherwise, if you haven’t met your discharge goals we will send you to a Skilled Nursing Facility until you are safe to go home. The final and usually best option is to go directly home. A physical or occupational therapist will come to your house two times a week to provide therapy. Many people who live alone go home directly from the hospital without any problems.
Will I need a second opinion prior to the surgery?
The medical assistant will contact your insurance company to pre-authorize your surgery. If a second opinion is required, you will be notified.
How do I make arrangements for surgery?
The Total Joint Center Nurse Manager will schedule your surgery. She will guide you through the program and make arrangements for both pre-op and post-op care. Her role is described in the NoteBook along with her phone number.
How long does the surgery take?
We reserve approximately two to two-and- a-half hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery.
Do I need to be put to sleep for this surgery?
You may have a general anesthetic, which most people call “being put to sleep.” Some patients prefer to have a spinal or epidural anesthetic that numbs your legs only and does not require you to be asleep. The choice is between you and the anesthesiologist. For more information read “Anesthesia and You” in your NoteBook appendix.
Will the surgery be painful?
You will have discomfort following the surgery, but we will keep you comfortable with appropriate medication. We use a 0 to 10 scale to monitor pain. 0 is no pain, while 10 is unbearable pain. Generally, most patients are able to stop very strong medication within one to two days. Some patients control their own medicine with a special pump called a PCA, this pump delivers the drug directly into their IV. For more information read about PCA in “Day of Surgery - What to Expect” in your NoteBook. You may have an indwelling pain pump in your knee. This will have a continuous flow of marcaine, a numbing medicine, going into you knee. This allows you to participate in your therapy without having to take as much pain medication. You may have a femoral nerve block. This will block your feeling of pain.
Who will be performing the surgery?
Your orthopedic surgeon will do the surgery. An assistant helps during the surgery and you will be billed separately by that assistant.
How long, and where, will my scar be?
All the surgeons at the TJC utilize MIS (Minimally Invasive Surgery) for the knee. The scar will be approximately 3 to 4 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. The less cutting, the less pain and the quicker the healing.
Will I need a private nurse?
No. You do not need a private nurse, but if you want one, we can give you a list so you may make these arrangements.
Will I need a walker or crutches or cane?
Yes, for about two to six weeks you will need a walker, a cane, or crutches. Most people go home with crutches. The discharge planner will arrange for them if needed. Within a few weeks you should progress to one crutch or a cane and then nothing at all.
Will I need any other equipment?
Yes. You may need a raised toiled seat or a three-in-one bedside commode. A tub bench and grab bar in the tub or shower may also be necessary. An occupational therapist can help you decide. Some patients will use a motion machine at home called a CPM. This will be decided at the time of discharge and we will make all necessary arrangements for delivery of all equipment.
Where will I go after discharge from the hospital?
Most patients are able to go home directly after discharge. Some may transfer to Acute Rehab. It is very difficult to qualify for a stay in Acute Rehab. Stays there are from four to eight days long. Others may need to go to a Skilled Nursing Unit. The Discharge Planner will help you with this decision and will make the necessary arrangements. We will check with your insurance company to see if you have benefits.
Will I need help at home?
For the first several days or weeks, depending on your progress, you may need someone to assist you with meal preparation, grocery shopping, laundry, etc. Family or friends may need to be available to help.
Preparing ahead of time, before your surgery, can minimize the amount of help needed. Having the laundry done, house cleaned, yard work completed, clean linens put on the bed, and frozen meals will reduce the need for extra help.
Many people who live alone are able to return home and take care of themselves without any assistance.
Will I need physical therapy when I go home?
Yes. We will arrange for a physical therapist to provide therapy at your home. Following this, you may go to an outpatient facility two-three times a week to assist in your rehabilitation. The length of time required for this type of therapy varies with each patient. When you are ready to move from home health therapy to out-patient therapy, please call the Total Joint Center with the fax number of your therapy clinic and we will fax them the prescription.
How long until I can drive and get back to normal?
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 two weeks if you are not taking narcotics. If the surgery was on your right leg, your driving could be restricted for as short as two weeks or as long as six weeks. Getting “back to normal” will depend on your progress. Consult your surgeon or therapist for their advice on your activity. Our expectation is that you will be able to bend your knee 95 to 130 degrees.
When will I be able to get back to work?
We recommend that most people take at least one month off from work, unless their jobs are quite sedentary and they can return to work with crutches on the job.
When can I resume sexual intercourse?
The time to resume sexual intercourse should be discussed with your orthopedic physician. The Total Joint Center has a guide on sexual intercourse and will give you a copy on request.
How often will I need to be seen by my doctor following the surgery?
You will be seen for your first post-operative office visit two weeks after surgery. The frequency of follow-up visits will depend on your progress. Many patients are seen at two weeks, six weeks, twelve weeks, three months and then yearly intervals.
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 after my recovery?
You are encouraged to participate in low impact activities such as walking, dancing, golfing, hiking, biking, 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 that may last a year or more and is not serious. Kneeling may be uncomfortable for a year or more, but you can kneel if you want to. Some patients notice some clicking when they move their knee. This is the result of the artificial surfaces coming together and is not serious. You may notice that your knee is warm for up to one year, again, this is not unusual. It is your knee healing from the surgery.
Answers for Kneecap Problems:
What is patella femoral pain syndrome?
Patella Femoral Pain Syndrome (PFPS) is a condition of the kneecap characterized by a rough or soft spot on its cartilage surface. In the past, it has been called chondromalacia patella, runner’s knee, or dashboard knee.
What are the symptoms?
It causes pain, giving way, stiffness and a feeling of catching or grinding. Going up and down stairs is painful, and sitting with your knees bent or squatting is very uncomfortable. It makes the knee “give out,” grind, or pop loudly.
Who gets it?
Many people may have PFPS, but only about 10 percent have a long-lasting pain or disability because of it — a fact not clearly understood by the medical profession. Over-activity, excess weight and injury sometimes initiate the symptoms. This condition is often seen in adolescents, manual laborers and athletes.
How is it diagnosed?
Cartilage contains no calcium and, as a result, cannot be seen by ordinary x-rays. A patient’s history and a physical examination suggest the diagnosis. If there is any doubt, we suggest an MRI or an arthroscopy to look behind the kneecap and check to see that there is no other injury or abnormality.
How long does patella femoral pain syndrome last?
It may last several months, but fortunately, is usually a self-limiting problem. If you are born with an abnormal kneecap, it may last indefinitely. You may even need an operation to correct it, though this is unusual.
What is the treatment?
Small doses of anti-inflammatory medicines can often decrease swelling, stiffness and pain. Other treatments may include injections, ice, rest, and physical therapy. Taping and a brace to stabilize the kneecap also can be helpful.
Now for the good news...
The good news is that although PFPS can be uncomfortable, usually it is only a short-term nuisance and inconvenience. It also generally does not lead to arthritis or any other joint problems.
