Do You Think You Need A Knee Replacement?
Here is what to expect!
I recently had a friend who got a knee replacement and was completely surprised at the changes that have occurred over the last 20 years with this surgery. Thankfully, he was delighted at the progress that has been made.
If you are considering a knee replacement, knowing what to expect is critical. Knee replacement is a surgery that’s done to treat osteoarthritis of the knee. This type of knee arthritis is a condition that occurs as people get older, when the cartilage that provides cushioning in the bones of the knee joint begins to degenerate and wear away. This causes the bones to rub together, resulting in significant pain. It also can lead to inflammation and swelling, which may affect your ability to bend and straighten your leg.
The term “knee replacement” may sound scary to some people. It makes the surgery sound very different from what it actually is. What occurs in a modern knee replacement is surfaces of the knee joint are replaced, not the joint itself. Sometimes it is compared to a dentist capping a tooth: the surgeon is adding new caps to the bones. While historically knee replacements have been done in older patients, as our society has changed and people have become more active, we are seeing younger patients, especially former athletes, needing knee replacements at earlier ages.
How do you know you need knee replacement surgery?
It is really up to the patient to determine the following:
- Non-surgical treatment options are no longer working
When your knee pain first started, lasting relief may have been as simple as reaching for a couple ibuprofen, using an ice pack or taking a hot bath. But as time has gone on, these home remedies may have started to lose their effectiveness.
But at some point, these non-surgical options may no longer provide the relief or healing power they once did. For example, a cortisone injection used to give you relief for six months or more, but now you’re lucky to get weeks of relief. Or maybe your mobility has continued to decline, making regular physical therapy and exercise increasingly painful. If any of this sounds familiar, it may be time to start the conversation around a knee replacement.
- Your knee pain is getting more intense and frequent
We all feel an occasional twinge in our knees after a long car ride or a long day on our feet. While annoying, this is totally normal – and these aches are usually gone almost as quickly as they appeared. But feeling regular knee pain or intense knee pain isn’t normal.
Pain feels a little different for everyone, but there are some common types of pain we tell our patients to pay attention to, including:
- Knee pain that lasts for more than a couple weeks
- Knee pain that keeps you awake at night
- Knee aches during and after exercise
- Knee pain that doesn’t respond to over-the-counter medications, like acetaminophen and ibuprofen
- Knee pain that gets worse in humid or cold weather
- Your mobility has become increasingly limited
It’s normal to lose some joint flexibility as you get older. But persistent knee stiffness that effects your mobility can be a sign of a more complicated knee concern.
What do you need to be on the lookout for? These are the most common mobility issues we see in our patients when we begin discussing knee replacement surgery:
- Knee stiffness that becomes worse after sitting for a long period of time, like on a long car ride or during a movie
- Knee stiffness that requires the use of a cane or other mobility device
- Difficulty walking or climbing stairs, standing up from chairs or climbing out of the bathtub
- Morning knee stiffness that lasts for up to 30 minutes
- You notice swelling in your knee
Cartilage helps protect your knee from pressure and friction caused by walking and moving. Knee conditions, including knee osteoarthritis, can cause the cartilage around your knee to wear out. Arthritis is painful and leads to inflammation. And when knees become inflamed, they can swell.
- It’s becoming more difficult to do everyday activities
Putting off a trip to the store until tomorrow because you’re still achy from your workout is normal. But it’s not normal to struggle with daily activities because of persistent knee pain.
What is meant by daily activities? For starters, if you’re finding it increasingly difficult to sit down, stand up or climb stairs without pain, stiffness or assistance, take note.
If you’re also having difficulty with activities like going grocery shopping or getting dressed – or you’re starting to completely avoid them – because your pain and lack of mobility has increased significantly, don’t delay getting the care you need.
- You’ve had to stop doing the things you love
We all slow down a little as we age. Running your yearly marathon might become nightly walks around your neighborhood after dinner. Or you may stop playing competitive soccer in favor of casual games with friends. Making small adjustments because you’re just not as spry as you used to be is part of life. But knee pain shouldn’t keep you from doing activities you love.
What has changed over the years with knee replacement surgery?
I spoke with Dr. Chip Comadoll, a Salisbury orthopedic surgeon who has practiced for over 30 years and specialized in joint replacement surgery. He is a graduate of the University of Minnesota Medical School where he also did his orthopedic residency. He is currently teaching Wake Forest/Baptist residents at the Bill Hefner VA Medical Center. He came to Salisbury in 1993 and started practicing at Rowan Medical Center.
Dr. Comadoll says that when he first finished residency, the typical knee replacement surgery was done as an inpatient and the patient stayed in the hospital for 7-10 days. After that, they often went to a rehab center for a stay of a week or more before going home.
When he came to Salisbury, he started working on improving the care of patients undergoing joint surgery, both for hips and knees. In partnership with Rowan Medical Center, Dr. Comadoll developed the Joynt Camp, which was one of the first such programs in the area. Joynt Camp housed all patients undergoing joint surgery on one patient care unit in the hospital, with the same nurses and physical therapists who developed expertise in the care of this type of patient. Additionally, patients were required to come to “orientation” prior to surgery and were taught about the surgery, the exercises needed after surgery, and basically what to expect.
Dr. Comadoll and his colleagues began performing joint surgeries on Mondays or Tuesdays and tried to get the patients ready to be discharged by Thursday or Friday. Cutting down the length of stay in the hospital was targeted as a means of reducing complications. Research was telling us that the sooner the patient got out of bed and began physical therapy, the less complications were happening such as infections or blood clots. Improvements in techniques with the actual surgeries, the implants used in surgery, and pain management were significant in improving care of the patient. By 2018 we were seeing knee replacements being performed with as little as a one day stay in the hospital, and sometimes patients being discharged the same day if they were otherwise healthy. Getting patients out of bed the day of surgery became critical to the success of the patient.
What about Robotic surgery?
Rowan Regional Medical Center was the first hospital in our region to acquire the MAKO robot in 2013. The MAKO robot, which the staff named R2Knee2 in a contest, was a unique tool to assist the surgeon in individualizing the exact surgical procedure to the precise anatomy of the patient using technology that married a CT scan of the patient’s knee with the computer in the robot. The surgeon still performs the actual surgery using the information provided by the robot. There has not been evidence to support better outcomes with robots, which are now part of the arsenal of all the major orthopedic parts companies, but many surgeons like to use them, and patients like the personalization they afford.
What can I expect in today’s world with knee replacement surgery?
I spoke with Dr. Chris Caldwell, Chief Orthopedic Surgery resident at LSU/Ochsner Medical Center in Shreveport, Louisiana. Completing his many years of training at Brody School of Medicine (ECU) and LSU/Ochsner residency program, Dr. Caldwell is getting experience in the latest trends and technologies in joint surgery.
One of the biggest changes Dr. Caldwell noted is the trend toward “optimization” of the patient prior to surgery. Patients have better outcomes if they have chronic issues under control before surgery. This includes weight management, diabetes management and tobacco use, including vaping, among others. Prior to scheduling a patient for surgery, a pre-op visit includes review of the patient’s total health picture. Most surgeons do not like to operate on a patient who has a BMI (basic metabolic index) of greater than 40, or a Hemoglobin A1c (used to measure blood sugars) of greater than 7.0. Additionally, they like patients to stop smoking at least six weeks prior to surgery. WHY? Because each of these factors impacts wound healing and the ability to fight off infection. Other chronic conditions such as cardiac problems, or lung disease also need to be under control, since they can increase the risk of complications of any surgery.
Dr. Caldwell also noted the current trend to send patients home the day of surgery in otherwise healthy patients or at least one to two days after surgery. Going to a skilled nursing facility or rehab center after knee replacement surgery is rarely indicated. Much work goes into assessing the patients living environment before surgery and making any modifications to the home. Some modifications may include placing needed items on the lowest cabinet shelf for easy reach, making arrangements for meals to be provided, and placing a walker and potty chair in the home for the immediate use after returning home. Of course a major ingredient to recovery is having help from family and friends, so social support is also assessed in determining course of treatment after surgery. Outpatient physical therapy and exercises the patient can do on their own to strengthen muscles will also speed recovery. With no complications, the patient can expect to return to normal life – now without the knee pain – in about six weeks after surgery.
Will I be on blood thinners to prevent blood clots?
While prescription blood thinners were once used with joint surgery, now patients are instructed to take 2 baby aspirin per day (81 mg), as this has been found to be most effective.
Will I be on antibiotics after surgery?
Not unless there is a problem. Antibiotics are given IV in the operating room, but there is no indication to continue after surgery. However, it is critical that you follow the instructions given to you by your surgeon about care of the surgical incision.
Where can I have my knee replaced?
A search of the internet can provide a wealth of information about facilities that provide joint replacement surgery and the associated orthopedic surgeons who do the surgery, including their quality ratings. It is also advised that you check with your health insurance to make sure your surgeon and facility where the surgery will occur are covered by your plan. For Rowan County, Novant Health Rowan Medical Center has been named a Blue Cross Center of Distinction for Joint Replacement surgery, and continues to utilize Joynt Camp as part of their program.
While knee replacement is something we all hope we won’t need, it is great to know how far the procedure has advanced and that it is available in our own community.