15 things you need to know about knee replacement

Knee replacement means you’ve opted to replace your joint with an artificial one. It’s only an option when all other treatments – pain meds, injections, etc – can no longer relieve your pain.

Why do joints fail? The pain results from lost or damaged cartilage that cushions the bones of the knee, says orthopaedic surgeon, Dr John V. Tiberi.

The surgery itself involves replacing some of the damaged bone and cartilage in the joint with a smooth gliding surface made of metal and plastic, says Nashville orthopaedic surgeon, Dr Jeffrey Hodrick.

Typically, people get knee replacements because of arthritis: especially osteoarthritis, but also post-traumatic arthritis, rheumatoid arthritis, and other inflammatory arthritis such as gout, explains chief of orthopaedic surgery, Dr Jeffrey I. Peretz.

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Knee replacements can be either partial or total. The knee is divided into three compartments, explains orthopaedic surgeon, Dr Barbara Bergin.

medial (inside)

lateral (outside)

anterior (kneecap)

Patients can get opt for partial replacement when only one part of the knee’s cartilage is damaged (usually the medial), according to orthopaedic surgeon, Dr Bradford Waddell, who makes an evaluation based on listening to and examining the person and reviewing their imaging. That said, most replacements are total because arthritis tends to affect the entire knee, says orthopaedic surgeon, Dr Miho J. Tanaka.

When it comes to picking a surgeon, “research shows that the more of these surgeries the surgeon performs, the better the outcomes,” says joint replacement surgeon, Dr Nakul Karkare. Once you’ve chosen your doctor, the best way to prepare is to follow the doctor’s orders to optimise your health, advises Dr Peretz.

Since diabetes and obesity can negatively influence the outcome, according to Dr Bergin, if you have these conditions, it’s best to get them under control. Another way of improving your odds of a good outcome, according to Dr Hodrick, is to engage in ‘prehab,’ a pre-surgery protocol involving exercises to strengthen the muscles around the knee.

While the surgery itself can be accomplished between 30 to 60 minutes, with prep time and anaesthesia the patient’s time comes out closer to two hours, according to Dr Peretz.

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Orthopaedic surgeon, Dr Timothy Gibson, says that, for a total knee replacement, surgical anaesthesia will include:

a spinal anaesthetic (this numbs the legs during the surgery and for several hours after)

a local anaesthetic (at the knee)

A significant new advance, according to Dr Gibson, is the use of a ‘nerve block’, which can extend pain relief into the days that follow. Pain after a partial knee replacement is much less severe than a full knee replacement, and a nerve block may not be given.

The severity of post-surgical pain depends upon the individual. The best way to manage it, according to orthopaedic surgeon, Dr James Van Horne, is to prevent it from starting. Typically, opioid pain medication is used to ease the immediate, and more severe, post-operative pain. But patients are encouraged to switch to non-narcotic medication as soon as possible. “During my surgeries, I inject a non-opioid option, which provides relief with decreased opioid consumption for 48 to 72 hours after surgery, in combination with other anti-inflammatories,” Dr Horne says.

Find out which pains you should never, ever ignore here.

Most total replacements require one to two nights in the hospital, says orthopaedic surgeon Dr Russell G. Cohen. However, other surgeons may choose to do it as an outpatient procedure, depending on their training and the hospital protocols. Partial replacements are more likely to be an outpatient operation.

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Dr Cohen describes the recovery as a year-long process that occurs in three phases:

First six weeks: heal, reduce swelling and regain movement.

Next three to five months: build endurance and muscle strength through regular-life activity and exercise.

Final six months: continue to gain strength and mobility.

Starting the day of surgery, you should begin moving the joint and see a physiotherapist (plan to go three times per week). In the first few weeks, you may need a walker or walking stick, says Dr Peretz; some surgeons recommend patients not flex their knee beyond 90 degrees. People who like shopping can be walking in the mall in three weeks, says Dr Eugene S. Krauss. “Golfers should be hitting golf balls by six weeks.”