What is arthritis?
Arthritis is where the smooth gliding cartilage (articular cartilage) wears away. As the arthritis becomes more advanced, portions can wear completely away until the underlying bone is exposed. Based on what part of your knee wears out first, some patients can have an obvious deformity where they are very “bowlegged” or ”knock kneed”.
Will surgery correct this?
Yes. By carefully removing specific amounts of bone, your surgeon will be able to realign your knee to reestablish a more normal alignment.
What happens during surgery?
Your surgeon will use specially designed instruments to carefully remove the arthritic cartilage and damaged bone from your femur (thigh bone), tibia (shin bone), and patella (knee cap). The end of the femur and tibia are replaced with metal and the gliding surface of the patella is replaced with plastic. Then after confirming the proper fit, the implants may be cemented in place, or you may have a special prosthesis where your bones grow into it. Then a plastic spacer is placed between the metal implants. Then you wake up in the recovery room.
How long does surgery take?
Typically, the surgery takes 2 – 2 ½ hours.
What type of anesthesia is used?
A combination of general anesthesia as well as a regional anesthetic (nerve blocks) are used. The nerve blocks typically help with pain relief for up to 24 hours after surgery. Your surgeon will also inject long-acting numbing medicine in your knee that can last up to 48 hours. Your anesthesiologist will discuss all the different options with you on the day of your surgery.
How long will I be in the surgery center?
With the advances made in pain control, the expectation is to have surgery in the morning and go home early that afternoon.
What should I expect at the surgery center?
This will be addressed in detail at the preoperative total joint teaching classes offered by your surgery center. (During the pandemic, the surgery center may send this information to you rather than have an in-person class)
How quickly will I walk after surgery?
A physical therapist or nurse will get you up and walking the day of your surgery.
Will I have to have a catheter in my bladder?
No. These are only used if you cannot urinate on your own.
When can I take a shower?
Most people shower one or 2 days after surgery. You will have a special waterproof dressing on your knee after surgery.
Do I need to change the dressing after surgery?
You will receive detailed discharge instructions when you leave the surgery center. Typically these instructions are to remove the bulky gauze and Ace wrap dressing the day after surgery. You will have a waterproof surgical dressing over your incision that will stay on your knee for two weeks after your surgery. We will remove it at your first postoperative visit.
What type of pain medicine will I be on after surgery?
We use several different medications to help control pain after surgery. This way we are controlling pain through several different pathways. Each medicine works on a different part of your brain/spinal cord to prevent pain. As your pain is improving over the days/weeks after surgery, you will decrease the amount and frequency of your pain medicines. The following is a list of several different medications you may be on:
- Narcotics-you are typically on a short acting narcotic such as oxycodone (Percocet), or hydrocodone (Vicodin or Norco). The doses vary based on factors such as your age, weight, etc.
- Acetaminophen (Tylenol)- this is also used as a pain reliever after surgery, unless it is already mixed in as part of your narcotic in medicines such as Vicodin or Norco.
- Over-the-counter anti-inflammatory medicines
What other medicines will be sent home on?
- Antinausea medicine-typically a prescription for promethazine (Phenergan) or ondansetron (Zofran) is given for convenience. We recommend you fill it, but you only need to take it if you are having nausea. Taking your pain medicine with food will help prevent nausea.
When can I stop my pain medicine? How do I taper off of it?
You can stop your pain medicine as soon as to feel comfortable doing so. Your narcotic pain medicine will likely say to “take 1 or 2 pills every 4 hours as needed for pain”. If you are taking 2 pills, as your pain is decreasing you can switch to 1 pill, or increase the amount of time between doses to 5 hours or 6 hours, etc. based on your comfort level. Eventually, you will wean completely off of the medicine. As for gabapentin which is every 12 hours, people typically stop the daytime dose first, then take it only at night for a couple of days. You may also wean off of your anti-inflammatory medicine and/or Tylenol as needed.
What type of blood thinner will I be on after surgery?
Depending on your health, we may use aspirin 81mg twice a day for one month. Or if you are at higher risk of having a clot, we can use an oral blood thinner such as Xarelto for 12 days. If you are on Xarelto, we typically have you use an aspirin (81mg) twice a day for 2 weeks after finishing your prescription, or possibly resume your regular aspirin dose if you normally take aspirin.
What other methods are used to prevent blood clots after surgery?
- Early ambulation-we want you up and walking at least 3 times a day. Some people wonder how much walking is too much walking… Your body will tell you this. If you’re knee is extra painful or swollen, then you are walking too much.
- TED hose-these are tight compression socks, typically knee-high, that we have you wear 23 hours a day to prevent blood clots. These are used for 2 weeks after surgery.
- Sequential compression devices (SCDs)-these are used at home as well as in the surgery center to help prevent blood clots. They wrap around your lower leg and will intermittently gently squeeze your calf muscle to help prevent blood clots. You will use these whenever you are sitting or lying down, including sleep. You may remove them when you are walking or exercising. These are used for 2 weeks after surgery.
When will I start physical therapy?
You will normally start outpatient physical therapy about 2-3 days after your surgery. Please do not wait until after your surgery to try and schedule physical therapy. Some clinics may have a 1-2 week wait before a new patient appointment is available. You will receive a prescription for physical therapy at your history and physical examination.
What special equipment will I need after surgery?
Our surgery scheduler will arrange for a walker if you don’t have one. Also if you are interested in a cooling unit, rather than using ice bags or frozen gel pads, contact our office and we sell these. Finally some people like to use a shower chair, elevated toilet seat, or bedside commode. These can be purchased at a local medical supply store.
When can I drive after surgery?
It takes most people about 2-3 weeks before they are able to drive after surgery. You need to be off of the narcotic pain medicine during the time you would be driving and be able to safely move your operative leg quickly enough to operate your vehicle. It may take longer to return to driving if you had your right knee replaced.
When can I return to work?
This depends on your profession. If you have a sedentary desk job, you should be able to return in 4 weeks. If you have a more physical job or one that requires you to stand all day long, it could be as long as 6-12 weeks before you could return.
How often will I have follow up visits with the surgeon or physician assistant?
We typically see you at 2 weeks after surgery, 6 weeks after surgery and at 12 weeks after surgery. If everything is going well at that point, then we typically don’t see you back until your one year anniversary from surgery. Obviously if there are any concerns, we will see you more frequently.
What type of exercise can I expect return to after surgery?
Generally speaking, people are able to return to low impact activities such as walking, dancing, golf, hiking, swimming, bowling, gardening, and doubles tennis. Some people are also able to return to more aggressive activities such as skiing, but on groomed surfaces only.
Do I need to let my dentist know I had a knee replacement?
Yes! Typically after a joint replacement surgery, patients need to be on antibiotics before they have any dental procedure, including a routine cleaning for the first two years after surgery. Call our office or your dentist several days before your dental appointment and we can call in a prescription for antibiotics that you will take 1 hour prior to your appointment.
What about when I go through the security checkpoint at the airport? Will I set off the metal detector?
Yes. You will likely set off the metal detector. Some of the joint replacement manufacturers will provide you with a card that shows you have metal implanted in your body but it will not get you through security any faster. I typically tell patients to get there 5 min. earlier than you would normally arrive and wear baggy pants so you can show the TSA agents the scar on your knee.
My new knee makes a clicking sound when I walk. This is normal?
Yes. Some people experience a clicking sensation when they walk because they now have metal that glides on plastic as their new joint surface. If you do notice clicking, it should not be painful.
How long will my knee be swollen after surgery?
Swelling can take 6-12 months to resolve after surgery.
At times my knee is achy after surgery, this is normal?
Yes, occasional achy pain and swelling can be experienced for up to 12 months after surgery.
I have a lot of bruising after surgery, is this normal?
Yes, bruising is very common after surgery and the amount varies from patient to patient depending on what blood thinner you are on, and how long your procedure was. Some people only have minimal bruising, others can have extensive bruising from mid-thigh to their ankle. Bruising can occur a few days after surgery, other times it can take a week or longer to appear.
I have clear or blood blisters near my incision or on my knee, is this normal?
This is not particularly common, but depending on how much swelling people have after surgery, the skin can stretch so fast blisters can occur along the edges of your waterproof dressing or Steri-Strips. (We see this more often following an ankle fracture when people have a lot of swelling very quickly, so we often call them “fracture blisters”) Rarely they could occur on parts of your knee that are not near the incision. We will typically have you send us a picture of your knee (or you could come in to clinic) so we can evaluate them. If they occur, the vast majority of the time they are very small and we let them decompress on their own. If they are larger than a quarter, then we may have you come in so we could sterilely drain them.