FAQ- Knee Replacement Surgery

What surgery is available for a torn knee meniscus?

Several options are available for treating a torn knee meniscus. Broadly speaking torn menisci can either be repaired or they can be trimmed back (debrided) so they are not unstable or painful. The decision to repair or debride depends on the size shape and location of the tear as well as the age and expected demands of the patient. Most of the time either procedure can be performed using an arthroscope which is a small fiber-optic camera system used with small instruments so the incisions are very small and the recovery is relatively quick. The success rate is very high in most cases.

The best way to decide what procedure (if any) is best for you is by seeing a surgeon with considerable experience in the surgical and non-surgical approaches that are available to treat knee problems of this type.

What is the chance for success of Knee replacement?

Total Knee replacement is one of the most successful surgical procedures in Orthopaedics now. In our hands, as in most of the good surgical centres around the world, the success rate is about 97%. The persons who can have problems with a knee replacement are –

a. Uncontrolled diabetics who have high blood sugars even with insulin.

b. Age above 85 or 90 years with poor general health where the healing capacity of the body is already compromised.

Success of the surgery can be answered by asking a patient the following three questions: Are you glad you had the operation? Did it fulfill your expectations? Would you do it again?

Approximately 98% of patients at one year will say “yes” to all three questions.

What is the recovery time?

Each patient heals from surgery at a different pace just like there is a difference for small skin wounds to heal in different people. But in 3 to 4 days time, 70% of the discomfort will be gone. It is for the first two days that most patients could have some amount of sharp pain. We use a femoral or epidural medicine pump with a small catheter attached to your leg or back which will help you not to feel most of it.But you will be able to move your leg and stand up, on the very next day after surgery.

You will be discharged from the hospital in 4-6 days time. In most cases, you will be restricted to the use of a walker or crutches for approximately 3 to 7 days.  There will be some physical therapy to improve movements and strenghening of the leg muscles for a period of 1 month. By that time most people can start moving out of the house and attend light social gatherings like temples, mosques and churches. You can start climbing stairs in You will gradually return to normal function without any assistive devices by 3 months.

When can I drive?

If you had surgery on your right knee, you should not drive
for at least 4 weeks. After 4 weeks you may return to driving as soon as you
feel comfortable. If you had surgery on your left knee, you may return to driving
as soon as you feel comfortable if you have an automatic transmission. If you
are driving a straight shift automobile, it will be 4 weeks regardless of which
knee you have surgery on. Do not drive if you are taking narcotics.

When can I travel?

You may travel as soon as you feel comfortable doing so.
You should get up to stretch or walk at least once an hour and stay well
hydrated when taking long trips. This is important to help prevent blood clots.

When can I return to work?

It depends on the nature of your job. If your work
is mostly sedentary, you can probably return within 1 month. If your work is
more active, you may require up to 3 months before you can return to full duty.
In some cases, more or less time off will be necessary.

What activities are permitted following surgery?

You may return to most
activities as tolerated, including walking, gardening, dancing, and golf. Good
activities to help with motion and strengthening are swimming and use of a
stationary bicycle. You should avoid high impact activities like running and
jumping and vigorous sports such as singles tennis.

How long will my total knee last?

Ninety to ninety-five percent of total knee
replacements should last 15 years or longer. The most important factors in
maintaining your knee replacement would be your activity level and keeping
your weight under control.

When can I shower?

You may shower 4 days after your operation. You will
have steri-strips (brownish pieces of tape) over your incision line. These will
gradually begin to curl around the edges at 2 weeks after surgery. When this
happens, you may gently pull the curled tape off. Underneath will be a healed
incision line. Also, you may notice a clear piece of thread coming from he top
and bottom of your incision line. Do not pull or trim this suture. These are absorbable sutures, and they will fall off on their own somewhere around the fourth week. Be sure to dry the incision line well after showering.

When can I immerse my knee totally, such as for bathing or swimming in a
pool?

Your knee can be totally immersed once your incision is completely
healed.

How long will I need a bandage on my incision?

After the first initial dressing
change in the hospital, you will not be required to use a bandage on your
incision. If there is any drainage, use a dry sterile gauze or band-aid to protect
the area.

How long will I be on pain medication?

It is not unusual to require some form
of pain medication for approximately 6-12 weeks. Initially, the medication will be
strong (such as a narcotic). Taking it as prescribed usually provides the most
effective pain relief. Most people are able to wean off their strong pain
medication after 1 month and switch to an over-the-counter medication such as
acetaminophen or ibuprofen.

Can I go up and down stairs?

Yes. Initially, you will lead with your operated
leg when coming down. As your muscles get stronger and your motion
improves, you will be able to perform stairs in a more normal fashion (usually in
about a month).

When can I resume sexual intercourse?

As soon as you are comfortable. Usually in 2-3 weeks time most of the patients are comfortable to do most of the activities they liked to do 10-15 years back and were now restricted due to the knee arthritis.

Will I set off the security monitors at the airport?

You will probably set off
the alarm. Be proactive and inform the security personnel that you have had a
total knee replacement and will most likely set off the alarm. Wear clothing that
will allow you to show them your knee incision if necessary. A letter from your
physician or a wallet card is no longer of any help when passing through
security checkpoints.

When can I kneel?

After several months you can try to kneel. It may be painful
at first but will not be harmful or damaging to your knee. Much of the discomfort
comes from kneeling on your recent incision.

Replacing both knees at the same time.

This is an excellent question and like many good questions the answer is somewhat complicated. It is almost always technically possible to replace both knees at once. However one has to ask: what would be gained or given up by doing this? As of now there have been a handful of scientific studies that have asked that very question. One of those studies concluded that it is no problem to go ahead and replace both knees at the same time but most of them came up with a slightly different response: the overall time to full recovery is shortened by doing knees at the same time but you take some increased risk to gain this advantage. Here’s the summary as I interpret it:

The benefit of same-day both-knee surgery: The time to full recovery is shorter. If that does not seem intuitive think about it this way: If you figure it will take between 2-3 months to really start to feel right after a knee replacement and you do that twice that’s 4-6 months of total recovery time. If you do them both the same day you go through the experience once and the whole thing is behind you in 2-3 months.

The disadvantage of same-day both-knee surgery: The surgical risk appears to be increased if the . The types of complications that were more common in patients having the knees done together included:

• the need for blood transfusions and
• cardiac complications 

There are some people whose medical conditions (like a history of prior heart attacks) or very advanced age would make it simply a bad idea to do both at once.

In my experience after having this conversation with patients who have severe arthritis in both knees about 3/4th my eligible patients choose same-day both-knee surgery and 1/4th choose to do them one at a time. So it’s obviously a very personal choice but one that is best made with all the facts at hand and in consultation with a surgeon whom you trust.

I personally suggest single sitting both knee replacements to healthy patients younger than 75 years, with good cardiac function for obvious reasons of faster recovery, reduced cost and reduced disturbance of life for other family members.