Deciding to undergo surgery is never an easy decision, even when the latest surgical techniques can reduce your risks and shorten your recovery time. But joint replacement procedures can be life-changing, especially when they involve your knees.
If you find it hard to perform simple tasks around the house, such as walking up stairs or picking up laundry, you may be dealing with the effects of arthritis in the knee – the largest joint in your body – or other conditions that are causing havoc in that area, making you a candidate for surgery.
Joint pain is the result of damaged cartilage that lines the end of the bones. When cartilage wears away, bone can rest against bone without any cushion of protection, making it very painful to get around.
Patients opting for joint replacement have usually tried medications, such as the pain reliever acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen (Aleve) and ibuprofen (Advil). Physical therapy and cortisone shots, as well as arthroscopy, a minimally invasive procedure, may also have been tried without success.
When you have a total knee replacement, the surgeon removes damaged cartilage and bone from the surface of your knee joint and replaces them with a manufactured surface of metal and plastic. In a partial knee replacement, the surgeon only replaces one part of your knee joint. After a knee replacement, you will no longer be able to do certain activities, such as jogging and high-impact sports. For this reason, you should consider all options before deciding on total knee replacement surgery.
Anatomy of the Knee
Knee anatomy involves more than just muscles and bones. Ligaments, tendons, and cartilage work together to connect the thigh bone, shin bone, and knee cap and allow the leg to bend back and forth like a hinge.
Three important bones come together at the knee joint:
- The tibia (shin bone)
- The femur (thigh bone)
- The patella (kneecap)
There are two types of cartilage in the knee joint:
- Articular cartilage is the smooth lining that covers the end of the bone.
- Meniscus is a shock absorber that sits between the end of the thigh bone and the top of the shin bone.
There are four major ligaments that surround the knee joint.
- Cruciate ligaments are in the center of the joint, and they cross each other. They consist of the anterior cruciate ligament and the posterior cruciate ligament.
- Collateral ligaments are on each side of the knee joint—the medial collateral ligament on the inner side and the lateral collateral ligament on the outer side.
The knee joint is most significantly affected by two major muscle groups:
- The quadriceps muscles provide strength and power with knee extension (straightening).
- The hamstring muscles allow for strength and power in flexion (bending).
Types of Knee Replacement
Millions of Americans suffer from chronic joint pain and a loss of mobility that brings challenges to the simplest daily routines. Knee replacements are a fairly common solution and one of the most reliable treatments in any area of medicine. For the right patient, they can be a game-changer.
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Total Knee Replacement
If the cartilage damage in your knee has occurred on both sides of the joint, or in all three joint components, a total knee replacement procedure may be performed. During the surgery, the damaged part of the knee joint is removed from the surface of the bones, and the surfaces are then shaped to hold a metal and plastic artificial joint. The artificial joint may be attached to the thigh bone, shin, and knee cap either with cement or special bonding material. When fit together, the attached artificial parts for the joint, relying on the surrounding muscles and ligaments for support and function.
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Partial Knee Replacement
If you have an injury or arthritic condition that disproportionately affects only one or two surfaces on one side of your knee, you may be a candidate for partial, or “unicompartmental,” knee replacement. During this procedure, the surgeon resurfaces the diseased part of the knee and implants a smaller prosthetic. This option offers many advantages, including preserving more natural tissue plus a shorter procedure with a smaller incision (approximately 3 inches) which can lead to a quicker recovery.
8 Signs You May Need a Knee Replacement
How do you know if you need a knee replacement in the first place? Deciding when it is time is a personal decision between you and your doctor, but there are some factors that make you a more likely candidate for surgery.
1. You Have Bad Arthritis
Most people who undergo a knee replacement have either osteoarthritis, the wear-and-tear type of arthritis; an autoimmune condition that causes joint pain and damage such as rheumatoid arthritis; or postinjury arthritis.
Osteoarthritis, rheumatoid arthritis and posttraumatic arthritis affect the knee through different mechanisms; however, these different conditions are similar in that they all result in loss of cartilage, which causes pain and loss of motion. When these symptoms become severe, knee replacement surgery may provide considerable symptom relief by replacing the worn-out surfaces of the knee.
2. Non-Surgical Treatments Are No Longer Effective
Knee replacement is major surgery, so you should try less invasive strategies first to manage their pain. Your primary care physician can recommend pharmacologic options, including non-steroidal anti-inflammatory medications and joint injections—such as corticosteroids and hyaluronic acid—as well as physical therapy.
If you have already gone this route and still have not found relief, a knee replacement may be a good option, and you will want to consult a specialist to talk about the procedure in detail.
3. Your Pain Prevents You From Doing Normal Activities
Your knee pain may be manageable when you’re resting or doing low-impact activities, but as soon as you try to do something more strenuous, the pain becomes unbearable. If your knee pain is interfering with your ability to perform daily tasks or enjoy your favorite activities, it’s time to talk to an orthopaedic specialist.
4. You Have Severe Pain Even When Resting
Knee pain can be difficult to live with, especially if it occurs more often than not. For some people, the most common reaction is to “baby” their knees or avoid using them as often. They may even spend more time sitting than usual. While this may help reduce pain for some individuals, it can make the condition worse and cause the joints to freeze or lock up.
There are many pain medications that can help alleviate knee pain. However, they may not provide enough or long-term relief for some. If you experience knee pain that seems to be getting worse or persists when you are at rest or not using your legs, it is time to consult an orthopedist that can help you determine if it’s time for knee replacement surgery.
5. Your Knee Is Always Swollen
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.
So, if you are experiencing consistent or recurring knee swelling – do not ignore it. For starters, you are likely experiencing increasing pain or mobility issues, too. Plus, consistent or recurring knee swelling can be a sign of cartilage damage, which can lead to more wear and tear.
6. Your Knee Has Become Deformed
Your knee has become deformed from injury or arthritis. It bows in or out. However, in some cases, severe deformity can make surgery more difficult. If you start to feel severe deformity, talk with your doctor sooner than later.
7. You Understand That Some Activities Will Be Unavailable Afterward
Patients should know what to expect after knee replacement surgery and understand that regular high-impact activities may not be advisable.
Total knee replacement is quite successful in enabling patients to return to an active lifestyle — patients can perform all types of recreational activities, including hiking, bicycling, skiing, surfing, tennis and golf. In general, we do not limit activities but suggest that patients avoid impact activities on a consistent basis to reduce wear of the prosthesis.
8. You Are Over 60
As we age, our risk of developing knee osteoarthritis, rheumatoid arthritis, and other conditions that can lead to knee pain increases. If you’re over the age of 60 and have chronic knee pain, knee replacement surgery may be the best option to relieve your pain.
What You Can Expect
When other methods don’t work, a new knee offers a safe, effective route back to an active life.
First, your surgeon removes damaged cartilage and bone. Your doctor will then place the artificial joint and cement it within the bone. A drain will allow extra fluid to flow out.
The procedure involves:
- Removing the damaged bone and cartilage on the ends of the bones
- Capping the bones with metal
Replacement can take:
- 2 hours for the operation
- Same day discharge to 3 days in the hospital
- 6-12 weeks before you go back to work
Depending on your health, you can be up and walking in days to a couple of weeks.
Risks and Complications
While knee replacement surgery can help improve your pain and mobility, you can experience problems as well. Complications may include stiffness, clicking, wearing out of the implant, possible infection, as well as blood clots.
Some of the more serious risks include:
- Infection
- Side effects of anesthesia
- Bleeding
- Blood clots
- Nerve and artery damage
- Persistent pain
Ask Your Doctor
Everyone’s journey to recovery from surgery or orthopedic injury is unique. The general guidelines above will help you estimate how long it can take to return to driving after different types of surgeries. But in the end, you need to make a decision based on your personal needs and abilities.
You must follow specific restrictions if you have been given anesthesia or other medications. If you have limited movement of a body part or pain, you may need to avoid driving for an extended period of time. That is because slower response times and limited range of motion put you at risk for an accident.
To learn more about driving after surgery or to schedule an appointment with one of our specialists, call us at 800-698-1280.
