Your Guide to Knee Replacements

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1 Your Guide to Knee Replacements By Lori Newman, Lifescript Staff Writer Published August 24, 2012 Is your knee so painful that it affects everyday life? Then your doctor may recommend joint replacement surgery. Here s everything you need to know about knee replacements and recovery... Considering knee replacement surgery? So have thousands of other Americans more than 600,000 total knee replacements are performed in the U.S. each year, according to the American Academy of Orthopaedic Surgeons. It s a complicated procedure, with months of recovery time. What else should you know? We asked two top orthopedic surgeons to answer your most common questions about knee replacements. What could be causing my knee pain? It could be knee osteoarthritis, injuries and cartilage degeneration for other reasons, such as improper alignment of the bones. Swelling, stiffness and limited knee movement are often due to rheumatic diseases, including rheumatoid arthritis, a chronic inflammatory condition, says David Geier, M.D., assistant professor of orthopedic surgery at Medical University of South Carolina, in Charleston, and director of its sports medicine program. Cartilage damage from arthritis is probably the most common cause of your pain, and the most common reason for knee replacement surgery, he says. Structural damage can also cause knee pain severe enough for surgery to be a consideration. Such damage includes a tear in the meniscus, the cartilage that separates your upper and lower leg bones, or ligament, the fibrous tissues that control the knee s range of motion, Dr. Geier says. What happens to a knee with osteoarthritis? Over time, osteoarthritis breaks down the cartilage, which is tissue that acts as shock absorbers in healthy joints, he explains. The disease can result from an injury or may be hereditary. How do I know if I m a candidate for knee replacement surgery? If it s painfully difficult to walk or do other daily activities, such as driving a car, cooking or getting dressed, surgery might be an option, Dr. Geier says. No doctor can tell you that you have to have a knee replaced, he adds. [The decision] comes down to how much pain you re in and whether or not you can manage it with medication, ice, heat or other therapies.

2 Should I postpone knee replacement surgery as long as possible? Yes, surgeons usually don t recommend surgery at the first sign of knee pain, says William B. Kurtz, M.D., a hip and knee replacement specialist at Tennessee Orthopaedic Alliance and chief of orthopedics at Baptist Hospital in Nashville. That s because knee implants don t last forever, and outcomes aren t as good with second replacements, Dr. Kurtz says. It s certainly best to have it done only once, he says.but don t wait so long that you can t function, Dr. Kurtz cautions. If you re in constant pain and are giving up activities important to you, it s probably time to consider surgery, he says. How long do knee replacements last? Implants don t expire, but they can wear down, depending on activity levels, Dr. Kurtz says. Still, the technology used to create them is improving all the time; as a result, no one really knows exactly how long a knee implant performed this year will last, he adds. You can expect them to be good for at least 20 years, he says. The materials used in knee replacements are a great improvement over what was used in the 1990s but even then, they were pretty good, he says. So far, 80% are still working after 20 years. Will the pain disappear after surgery? Yes, pretty much 100%, after you ve healed from your surgery, Dr. Kurtz says. Patients usually feel some pain and discomfort right after surgery, he says. But within a couple of weeks, when you ve regained a good range of movement, your knee should feel much better, he says. What are partial knee replacements? Knees have three compartments: the medial (inside the knee), lateral (outside of the knee) and patellofemoral (in front of the knee). A partial replacement replaces one or two parts of the knee, which means we re leaving some of the joint behind, Dr. Kurtz explains. What are the benefits and risks? This surgery offers a faster recovery because it s less invasive, Dr. Kurtz says. You still have some of the ligament left, he explains. So after a partial knee replacement, you have more of the feeling of a normal knee, instead of an implant. But with a partial knee replacement, you risk having to re-do the surgery some years into the future [because] there s always the chance that you might develop arthritis on the part of your knee that wasn t replaced, he warns. What are total knee replacements? What are its benefits and risks? With total knee replacement surgery, all three parts of the knee are replaced with artificial implants. It s definitely the more traditional surgery and probably makes more sense [than a partial knee replacement], Dr. Geier says.

3 That s because patients with partial knee replacements often have to undergo a second surgery, this time to replace the entire knee joint.in a total knee replacement, surgeons cut off the ends of the femur and tibia [thigh and shin bones] and replace the knee s cartilage and bone with metal and plastic, he explains. This will reduce pain, so you can increase activities and improve everyday functioning within a couple of weeks after your hospital stay, Dr. Geier says. The risks include blood clots, a bad reaction to anesthesia, or a hard-to-fight infection following surgery, he warns. Adverse risks are higher if you re 60 or older, have medical problems besides knee pain including heart and respiratory conditions or take a lot of medications, Dr. Geier says. Younger patients usually don t have those heart- and lung-related issues, so their risk tends to be lower, he says. Most knee surgery patients are older, but [lately] we re seeing a lot more people in their 50s and even 40s maybe because of injuries [from] sports or other activities, Dr. Geier says. When is minimally invasive knee replacement surgery an option? What are the benefits and risks? Minimally invasive surgery, which involves a much smaller incision, causes less trauma to the soft tissue, Dr. Kurtz says. It means you ll heal faster, he says. But it s not the right choice for people who have knee bone deformities or advanced arthritis, Dr. Geier adds. They may need traditional surgery. The surgeon has to properly align the [knee] components, and for some knees, that could be difficult through a small incision, he explains. Dr. Kurtz adds: The most important factor is the outcome of the surgery, not the size of the incision. For the best results, choose a surgeon who specializes in minimally invasive knee replacements, he advises. It s important that the surgeon is comfortable with that procedure, Dr. Kurtz says. I have pain in my left and right knees; should I consider a double knee replacement and have both replaced at the same time? That s a decision to make with your doctor. Everybody has to weigh the pros and cons [of a double knee replacement], Dr. Geier says. It s a tough decision. One advantage: You get both surgeries over at one time, which helps if you prefer to take one medical leave from work instead of two, he notes. The downside is that it s a bigger hit to your system, he says. The older and more medically challenged a person is, the less likely they are to be able to handle doing both sides at once. Even younger, healthier patients will need to have long conversations with their knee surgeon to make

4 sure they ve considered all the issues involved. You ll be a little more incapacitated after a double surgery, so you ll need plenty of help, almost around the clock, Dr. Geier says. You certainly won t be able to do your own shopping or drive to physical therapy appointments for a couple of weeks. How do I choose a knee replacement surgeon? Start with recommendations from your primary care physician, family and friends who ve had the surgery, Dr. Geier says. I strongly recommend that people pick a joint replacement specialist, not a general orthopedic surgeon, he says. You need a doctor who does this all the time preferably every day. Dr. Kurtz agrees: Definitely go to a surgeon who does a lot of knee replacements and knows all the latest research and technology. How long will I be hospitalized? The average stay is 3-4 days. Some patients are released within two days of having a total knee replacement, Dr. Kurtz says. Some go home sooner, some later if the patient has medical issues, like a respiratory problem where they were on oxygen at home before their surgery, he says. Or if they re elderly and weak, they [may] need a few extra days in the hospital with people looking after them until they can get their strength back. What happens after the procedure? As soon as you re wheeled out of recovery and into your hospital room, hospital staff will get your pain under control, get you eating and get your knee bending as soon as possible, Dr. Geier says. Within 24 hours, he explains, a physical therapist will come by and get you walking a bit with crutches, and bending your knee a bit with a motion machine. Before you re discharged, you should be able to fully extend your knee, bend it to a 90-degree angle, walk using crutches or a walker, and maneuver up and down a couple of stairs, Dr. Geier says. You also get blood tests to make sure everything s all right before they let you go home, he says. At home, you ll need to have someone help out for at least the first week or two after you re released from the hospital, he adds. How long does complete recovery take? It depends on how quickly you get motion back and how many other medical issues you have, Dr. Geier says. You ll work with a physical therapist for at least the first week or so and then told to do whatever your new knee will tolerate. Depending on your fitness level before your knee replacement surgery, it will take anywhere from 2-6 weeks to start moving normally, he says. Most people are fully recovered and mobile within six months, but with some people it could take up to a year, he says. It s a process. You continue to improve for quite a long time. For more information, visit Lifescript's Osteoarthritis Health Center.

5 How Much Do You Know About the Types of Arthritis? About 46 million American adults nearly one in five suffer from some type of arthritis. It s estimated that number will rise to 67 million by Do you or someone close to you have arthritis? Take this quiz to see how much you know about this disease.