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Knee Replacement Q&A

 
  Watch the video to understand the consequence of delaying surgery

I have heard that people should postpone knee replacement surgery as long as possible. Is that right?
Early diagnosis and treatment of osteoarthritis are important for your long-term mobility.1 In fact, having knee replacement surgery earlier in the course of the disease may be linked with better outcomes.2 So if your doctor has recommended that you undergo a knee replacement, don’t delay. Delaying surgery can lower your quality of life, both before and after surgery.2 Remember, there is no cure for osteoarthritis. It is a degenerative disease, which means that your condition will get worse over time if left untreated.3

What can I expect during recovery and rehabilitation from knee replacement?
Each patient recovers differently. After surgery, you will work with a physical therapist to gradually increase your knee strength and mobility. You may experience some pain during physical therapy. The good news is that medications can help you manage this pain, and it should be temporary. The hard work you do in the early weeks of rehab will pay off with improved strength and motion, which will help reduce stiffness in your knee.

Am I going to have much pain after surgery?
Many patients find that the pain after surgery is tolerable, treatable, and subsides gradually over a few months. Surgeons and hospital staff have a variety of options to manage pain and keep patients comfortable after surgery, such as numbing injections, IV pain medication, patient-controlled anesthesia, injections, pain pills and anti-inflammatory medications.

How long will I be in the hospital?
The typical hospital stay is 2 to 6 days.

Should I be concerned about anesthesia during surgery?
There are two common types of anesthesia used during knee replacement surgery: general anesthesia where the patient is put to sleep, and regional anesthesia, where the patient is numbed below the waist, typically with an epidural or femoral/sciatic nerve block. Which type of anesthesia you will receive depends on your situation as the patient, as well as your surgeon's and anesthesiologist's recommendations. Speak with your surgeon or anethesiologist if you have any concerns regarding the anesthesia that will be used during surgery.

Will I recover at home or at a rehabilitation facility?
Many people are able to go home soon after surgery. Others choose to recover at a rehabilitation center. This decision depends on the availability of family or friends to help you with daily activities; home environment and safety considerations; and your overall evaluation after surgery. Your surgeon and you will decide together which course of treatment is best for you.

When can I resume normal activities, such as working or driving?
Talk with your surgeon to determine what’s best for you. Many patients are able to drive again in about 4 to 6 weeks, so long as you can tolerate it and are not taking narcotic medications. If your job is not physically demanding, you may be able to return to work after about a month.

I’ve heard there are knee replacements made just for women. Do I need one of these?
There is no clinical evidence to support the need for a gender-specific knee implant, nor is there any clinical data on the long-term success of a gender-specific knee. It won’t be known for many more years if these implants can last as long as the knee replacements currently available.

More than 60% of all current knee replacements are implanted in women, with a 90% to 95% rate of satisfaction.4,5

Why is knee rotation important? Does it impact men and women equally?
Many patients believe that the knee joint acts as a hinge, which can only bend and straighten like a door. In reality, the knee is much more complex because the surfaces roll and glide against each other as the knee bends. For women, rotation is a particularly important consideration, as women’s knees rotate more than men’s during deep knee bending.6 So rotation is a key factor in the way your knee functions.

What about minimally invasive knee replacement surgery?
There are some early studies of minimally invasive surgery (MIS) that have shown benefits such as less blood loss, shorter hospital stays, and better motion.7 Other studies, however, have shown more complications, poor implant positioning, and no difference in the length of recovery.7 Because MIS is still relatively new, it won't be known for 10 to 15 years if these new techniques affect the long-term function and durability of the implant.7 You should discuss with your surgeon whether MIS is an appropriate surgical course of treatment for you.

How long will the implant last?
The success of your knee replacement is measured by whether or not you're satisfied with the decrease in pain and the increase in mobility you should have, as well as the durability of your implant over time. Knee replacement in general is a very successful operation. In fact, according to an Arthritis Foundation study, outcomes for total knee replacement generally have 90% to 95% patient satisfaction and an implant lifespan greater than 95% at 10 and 15 years with some designs.4

What is the cost of a knee replacement?
The cost of a total knee implant depends on your individual needs, but typically costs from a few thousand to several thousand dollars, plus orthopaedic surgeon fees and the cost of your hospital stay. However, most insurance companies as well as Medicare and Medicaid cover knee replacement surgery. You should contact your insurance provider to see whether knee replacement is covered under your plan.

How can I pay for my knee replacement?
Knee replacement surgery is considered medically necessary and is typically covered by both private insurance and Medicare. Your out-of-pocket expenses may be impacted by either your co-pay or deductible, so you should check with your insurance company for complete information.

If you do not have private insurance or Medicare, you may want to visit the website www.covertheuninsured.org to research resources in your area.

How can I prepare my family and myself before surgery?
Several weeks before you undergo knee replacement surgery, discuss your recovery with your surgeon and caregiver(s). Speak with your family members and/or friends about the role they will play in your recovery. Explain the recovery process to them and the care you will need after surgery.

What else should I be aware of?
The way a knee replacement will perform depends on your age, weight, activity level and other factors. There are potential risks and recovery takes time. If you have conditions that limit rehabilitation you should not have this surgery. Only an orthopaedic surgeon can tell you if knee replacement is right for you.

Next: Choosing a Surgeon

References:
1. Fortin PR, Clarke AE, Joseph L, et al. Outcomes of total hip and knee replacement. Arthritis & Rheum. 1999;42(8):1722-1728.
2. Fortin PR, Penrod JR, Clarke AE, et al. Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis & Rheum. 2002;46(12):3327-3330.
3. American Academy of Orthopaedic Surgeons. Osteoarthritis. Available at:
http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=365&topcategory=Arthritis. Accessed January 14, 2008.
4. The Arthritis Foundation. Update on Hip and Knee Arthroplasty. Available at:
http://ww2.arthritis.org/research/Bulletin/vol51no11/Introduction.asp. Accessed January 14, 2009.
5. American Academy of Orthopaedic Surgeons (http://www.aaos.org/Research/Stats/Knee_Facts.pdf)(2006).
6. Hsu WH, Fisk JA, Yamamoto Y, Debski RE, Woo SL. Difference in Torsional Joint Stiffness of the Knee Between Genders. The American Journal of Sports Medicine. 2006;34(5):765-770.
7. American Academy of Orthopaedic Surgeons. Total Knee Replacement. Available at:
http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=513&topcategory=Knee. Accessed January 14, 2009.

 

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