Patients that are experiencing chronic knee pain that affects quality of life and daily function may be suffering from knee arthritis. Generally speaking, arthritis is a condition in which the cartilage surface that protects and cushions the ends of the bone in the knee joint is damaged and worn thin. This can be from wear and tear (osteoarthritis), trauma, or diseases that cause severe inflammation in the joint (e.g. rheumatoid and psoriatic arthritis). If your pain has not decreased with medication, injections, weight loss, and/or acceptable activity changes, you may be a candidate for partial or total knee replacement.
What is knee replacement surgery?
Total knee replacement
A total knee replacement entails resurfacing the damaged parts of the joint with metal and polyethylene (a hard plastic) generally removing only a few millimeters of bone. The primary ligamentous structures and soft tissues remain intact.
Partial knee replacement
A partial knee replacement involves the removal of only the damaged part of your knee joint and replacing it with an artificial device. The healthy parts of the knee are maintained. This can be considered if only one compartment of the knee is involved.
What happens during knee replacement surgery?
Your treatment begins with a pre-surgical evaluation to plan for the best size and position of your artificial joint utilizing computer templated digital x-rays and occasionally CT scans.
During your knee replacement surgery, Dr. Morrison uses instruments that help measure the knee and prepare the surfaces. The guides allow for precise removal of damaged bone and resurfacing with implants. Only the minimal amount of bone is removed to allow for a well-balanced and mobile knee. Dr. Morrison utilizes computer navigation and robotic assisted technologies to assist in the procedure.
What is the recovery time?
Everyone heals from his or her surgery at a different pace. In most cases, however, you will be restricted to using a walker and/or cane for two to six weeks after your operation. Your physical therapist will guide you through this progression. You will gradually return to normal function without any assistive devices. Most patients begin aerobic exercise around week six. Although your knee will be improving quickly at this point, it is still common to have pain and be more tired than normal earlier in the day. By three months you should have normal energy and only mild knee discomfort at times. Your new joint and surrounding tissues will continue to heal even up to a year after your procedure.
Can I sleep on my side?
You may sleep on your non-operative side whenever you feel comfortable. Avoid sleeping on your stomach for two weeks
How long do I need to keep a bandage on my incision?
Waterproof bandage should be worn for 7 days after your surgical procedure. Remove the waterproof bandage after 7 days post-op. Do not remove steri-strips at this time. Continue to shower as normal with steri-strips in place. Within a week these steri-strips will begin to roll up along the edges. You may then remove the steri-strips. If desired, you may continue to wear a bandage to protect the incision from irritation.
When can I shower (get the incision wet)?
You may shower as soon as returning home as long as the waterproof bandage is in place for the first 7 days. After waterproof bandage is removed, continue to shower as normal.
When can I immerse my knee in water (e.g., bath, swimming pool, ocean, hot tub)?
Typically, you should not swim or get in a hot tub or bath tub for six weeks. However, in some circumstances we will allow patients to do so after four weeks if there is no drainage. Check with your therapist and surgeon.
How long will I be on pain medication?
You will likely require some form of pain medication including Tylenol and an anti-inflammatory medication (e.g. Meloxicam or Celebres) for 6 weeks. Some patients also require a stronger pain medication (narcotic or opioid) for a shorter time period after surgery. Ice, rest, and elevation also play an important part in managing pain and swelling.
Do I need a physical therapist?
Yes! The physical therapist plays a very important role in recovery. You will see a physical therapist the day of your surgery. If you are unable to go home the day of surgery, the physical therapist will see you during your hospital stay. Over 95% of patients start outpatient physical therapy within 2-3 days of going home. Therapy is typically 2-3 times weekly for 6 weeks. The therapist should follow the protocol that has been issued to you on your pre-op visit and/or discharge from the hospital. Your therapist will keep your surgeon informed of your progress.
How long will I be on a blood thinner?
Typically, you will be on Aspirin as a blood thinner. This medication is used to help prevent blood clots. Some surgeons may order a stronger blood thinner after your surgery depending on your medical history and risk of blood clots. You will normally need to be on a blood thinner for six weeks. This will be decided prior to your discharge from the hospital. This will all be discussed with you at your pre-op appointment.
When can I drive?
Once you are strong enough to walk without a walker and are completely off narcotic medication you can drive. This is typically 2-3 weeks after surgery.
When can I return to work?
This depends on your profession. Typically, if your work is primarily sedentary, you may return after approximately two to four weeks. If your work requires prolonged standing, walking, or travel you may need 6 weeks off. If your work is more rigorous and requires heavy lifting, squatting, or climbing you may require up to two to three months before you can return to full duty.
When can I travel?
You may travel as soon as you feel comfortable. It is recommended that you get up to stretch or walk at least once every two hours when taking long trips. This is important to help prevent blood clots.
I am constipated. What should I do?
It is very common to have constipation postoperatively. This may be due to a variety of factors, but is especially common when taking narcotic pain medication. A simple over-the-counter stool softener (such as Colace) is the best prevention for this problem. In rare instances, you may require a suppository or enema.
Can I have sex?
You may resume sexual activity as soon as you feel comfortable to do so.
Can I drink alcohol?
If you are on any blood thinner avoid alcohol intake. Otherwise, use in moderation at your own discretion. You should always avoid taking narcotics or other medications if consuming alcohol.
Can I go up and down stairs?
Yes, however for the first two weeks after your surgery we want you to avoid any extra stairs. Initially, you will lead with your nonoperated leg when going down stairs. You can use the phrase, "Up with the good, down with the bad" to help you remember. As your legs get stronger, you will be able to perform stairs in a more regular pattern (about six weeks).
What should I expect for my range of motion at six weeks? At one year?
Everyone's range of motion varies and depends on individual factors (especially your range of motion before surgery). Your potential will be discussed with your surgeon prior to surgery. In most cases, you will have at least 90 degrees of flexion and full extension by two weeks. At one year, you may have up to 125-130 degrees of flexion, but 115 to 120 degrees is usually satisfactory.
ROM Needed for the Following Activities:
Walking on level ground
Climbing stairs
Descending stairs
Sitting down
Tying shoes
Lifting grandchild
Squating
67 degrees
83 degrees
100 degrees
93 degrees
106 degrees
117 degrees
125 degrees
Do I need antibiotics before dental work or an invasive procedure?
Yes. You will be given instructions explaining this in detail at your surgical discussion and first follow-up visit. This is also located your joint replacement booklet. Avoid any dental cleaning or non-urgent procedures for six weeks postoperatively.
I feel depressed and/or have a loss of appetite. Is this normal?
It is not uncommon to have feelings of depression and/or have a loss of appetite after your hip replacement. This may be due to a variety of factors, such as limited mobility, discomfort, increased dependency on others and medication side effects. Feelings of depression and/or loss of appetite will typically fade as you begin to return to your regular activities. If your feelings of depression and/or loss of appetite persist, consult your primary care physician.
I have insomnia. Is this normal? What can I do about it?
This is a very common complaint following hip replacement surgery. Nonprescription remedies such as Benadryl or melatonin may be effective. If this continues to be a problem, medication may be prescribed to you.
How long will my total knee replacement last?
This varies from patient to patient. For each year following your knee replacement, you have a 1 percent chance of requiring additional surgery. For example, at 10 years postoperatively, there is a 90 percent success rate. Newer implants and technologies may have even better success rates.
When do I need to follow up with the office for x-rays?
Follow-up appointments should be made postoperatively at six weeks, six months, year one, year two, year five, and every five years after that. More frequent follow up may be requested if needed.
Normal things about your new knee:
- Clicking noise with knee motion
- Skin numbness on the outer (lateral) part of your knee
- Swelling around knee or lower leg
- Bruising all the way from your upper thigh down to your ankle/foot
- Warmth around knee
- "Pins and needles" feeling at or near your incision
- Dark or red incision line
- Bumps under the skin along the incision. Occasionally, the sutures used to close the wound can be felt.
Abnormal things about your new knee (call the surgeon if you experience any of these):
- Increasing bright redness, particularly spreading from incision
- Increasing pain and swelling that is not controlled by pain medicine
- Fevers (above 101 degrees)
- Persistent drainage from your wound
- Calf swelling or pain, particularly associated with ankle motion
- Ankle swelling that does not resolve or decrease overnight
- Bleeding gums or blood in urine/stool
