|FAQ for Total Knee arthroplasty:
What are your qualifications for performing total knee arthroplasty, and how many have you done?
Dr. Belcher trained at Mayo Clinic, Dr. Branson trained at Northwestern, and Dr. Morgan completed joint fellowship training at the Cleveland Clinic. The OCV surgeons have performed more than 6,000 joint replacement surgeries over the years.
How long is the operation?
For one knee, surgery time is typically 40-60 minutes. Surgery is performed using a team approach. When both right and left knees are done, two teams work at the same time. Operating time for two knees is about 60 minutes.
Total knee arthroplasty is a complex operation. Many specialized instruments are required to align the prostheses. The nurses, assistants and anesthesiologists are all part of the joint replacement team. Every aspect of the surgery is regularly reviewed to be sure we follow best possible practices to make the surgery go as smoothly and safely as possible.
How long is hospitalization?
Typical time in the hospital is 3 days for one knee, 5 days when both knees are replaced. Time in the hospital is determined by several factors including complexity of pre-operative deformities, patient health, endurance, home conditions and insurance company regulations.
Typically surgery is performed on day of admission. Patients get up the same day and stand or take a few steps. The next day, physical therapy will walk with you, and start work on range of motion exercises. Patients may be discharged when pain is controlled, temperature is less than 100.5, and they are walking well enough to be safe at home.
For some patients, inpatient rehabilitation may be an option. HealthSouth is a rehabilitation hospital adjacent to Princeton Hospital. Patients lacking strength and endurance, or having problems with other joints may benefit from a 10-14 day stay in rehab. Typically PT is done twice a day. Occupational therapy and other treatments are available based on individual needs.
What brand / type of knee do you use?
We have a broad range of prosthesis available for special uses. For most patients, we use the Stryker Triathalon system. The Triathalon system has an extensive track record of good results. The size and shape of the knee is a result of extensive research. There is a broad range of sizes to fit both men’s and women’s knees. The polyethylene bearing surface of the knee is available in the latest cross linked polymer plastics. These plastics have superior wear characteristics. The knee can be implanted using minimally invasive techniques.
How long do knee replacements last?
For over 90% of patients, knee replacements will last more than 15 years.
Do you recommend a CPM (constant passive motion exerciser) after surgery?
Yes. For most cases, we apply the CPM immediately following surgery to help keep the knee moving. Movement decreases the formation of scar tissue which can result in a stiff knee replacement.
While we use the CPM, the mainstay of rehabilitation rests with the patient. There is no substitute for hard work in getting muscles back into shape. Deformity and arthritis has altered the alignment of your leg and changed how you walk. Total knee surgery corrects the deformities. The muscles must be retrained, and the strength lost due to arthritis must be recovered for a good result. Even when less invasive approaches are used, regaining function is hard work.
How long will I be in physical therapy (PT)?
Patients are discharged from PT when they achieve good function and motion with following surgery. Typically, patients attend outpatient PT for 6-8 weeks following total knee. Some patients may not require therapy. On the other hand, patients with particular problems, such as stiffness of the knees before surgery may require therapy for an extended period of time.
What facility do you recommend for outpatient PT?
We work with many outpatient physical therapists. We recommend selecting a facility that is convenient to your home, and familiar with rehabilitation of joint replacement patients.
How about in home, or home health physical therapy?
Early rehabilitation is important to the ultimate outcome of the procedure. In home PT will be more challenging for both the patient and therapist. We typically recommend therapy in a clinic. If in home PT is the best option, we want to be sure that the therapist has experience with rehabilitation of joint replacement. In some cases, early post operative office visits will be more frequent to be sure rehab stays on schedule.
Does someone perform a home assessment to determine what equipment I’ll need at home?
Home Health can perform in home evaluations for safety and medical equipment. Such assessments are performed only when necessary. Discussion of what’s needed at home is usually sufficient to plan for home medical equipment.
How much pain can I expect, and for how long?
The amount of pain following knee replacement surgery varies from patient to patient. We have had patients that have taken nothing more than Tylenol with codeine following the surgery. At the other end of the spectrum, some patients rate pain following the procedure as the worst they have ever experienced.
Typically, patients experience severe pain requiring strong narcotics for the first 1-2 days after surgery. Most patients take narcotic pain medications before therapy for about a month after surgery. Patients that take narcotic containing pain medications prior to surgery generally report more pain following the procedure.
In our program, post operative pain is managed with a three tier approach developed under the supervision of the anesthesiologists. After surgery, most patients will use a patient controlled analgesia machine. When the patient presses a button, the machine will administer morphine into the IV. Pain pills and injections are also used to address the initial post operative pain.
What restrictions will I have when I go home?
There are no specific restrictions following surgery. The knee implants are designed to be used immediately after surgery. We recommend arranging the house for comfort and safety during recuperation.
When can I drive my car?
Driving is allowed when you have sufficient control of your legs to operate your car safely. For left knees, most people can drive as soon as they are able to sit comfortably in the car. For right knees, you must have enough strength and motion to operate the gas and brake safely. Most patients with right knee surgery can drive at 3-4 weeks after surgery. We do not recommend driving “left footed.”
When can I do light housework and cocoking?
Most patients can do light housework and cooking 2-3 weeks after surgery. We recommend having help for shopping, housework and cooking for at least 2 weeks after surgery.
How long does it take for complete healing?
Complete healing of knee replacement takes about a year. Most patients will have some swelling and stiffness in the knee, or swelling in the leg on occasion for up to a year after surgery. That being said, most patients feel they are quite functional and improved at 3-4 weeks after surgery.
My knee replacement clicks, is that bad?
The metal / plastic articulation of the components may make some clicking noises with certain motions of the joints. This is normal.
Will the anesthesiologist see me before surgery?
The anesthesiologist will see patients with typical medical histories immediately prior to surgery. If you have unusual medical problems or a personal or family history of problems with anesthesia, a pre-operative consultation with the anesthesiologist may be scheduled prior to surgery.
What about the knee designed for women?
This year I questioned a manufacturer’s representative for the women’s knee. The only difference he could point out was additional sizes of the components. It appears that the initial system had large gaps between sizes, particularly in the smaller sizes. Such jumps in size could make it difficult to achieve a good fit, particularly in smaller female patients. When the manufacturer corrected this deficiency by adding additional sizes, they marketed the change as a “women’s knee.
We use the Triathalon knee. Sizing for women was built into the system from the start. The design was a modification of clinically proven designs. The modifications in the new design were based on one of the most extensive studies of bone size and anatomy we know of. In surgery, component size matching and fit is one of the best characteristics of the system, for both men and women.
So what’s all the women’s knee hype all about? Women’s bones tend to be smaller than men’s bones. The female knee is also aligned differently due to the width of the pelvis that allows for childbearing. The sex related difference in alignment is taken into account during surgery when preparing the bone to accept the prosthesis. The difference in bone size is taken into account by proper size increments of the implants. The only other major difference is it seems that the Triathalon knee system got it right the first time.
Do you do minimally invasive surgery?
We have been constantly improving our surgical techniques. We incorporate changes that have been proven to be beneficial each year. Consequently, much of the surgery we do today is different than what we did 10 years ago. And yes, we are trained to do minimally invasive surgery.
The reason for the long preamble is that we feel the promises made by minimally invasive surgery are misleading to patients considering joint replacement. The procedure is not painless, and there are real risks that must be understood and accepted. We have experience with a broad range of approaches, and will select the approach that will yield the best result possible for each patient.
Rest assured that we at OCV monitor advances in technology. We implement new technology when it is proven to be better. If you are considering joint replacement surgery, we think it important that you have realistic expectations regarding the risks and benefits of the surgery. We are seldom impressed with things that sound too good to be true. In fact, minimally invasive techniques have yet to be proven comparable to, let alone superior to traditional joint replacement.