Whether you're considering surgery yourself or supporting a loved one through the process, understanding the ins and outs of knee replacements is essential. Seeking advice that will equip you with the knowledge you need for informed decision-making and optimal recovery will help throughout your knee replacement journey.
- How long will the surgery take?
- While the key portions of the surgery typically take under an hour, you are typically in the operating room for about 2 hours as this time includes anesthesia, positioning, draping, the actual surgery, and closure.
- What type of anesthesia will be used?
- The actual anesthesia is ultimately determined by the anesthesiologist, and they make their decision on many factors, such as: age, cardiac history, BMI, hx of reflux, etc.
- I use a multi-modal pain regimen which works great because it attacks the pain pathway in multiple ways. This approach includes the following:
- Pre-op days before surgery:
- an anti-inflammatory medication called Celebrex 5 days before surgery
- Pre-op on the day of surgery:
- more anti-inflammatory with celecoxib (Celebrex)
- a nerve pain medication called pregabalin (Lyrica)
- an analgesic with high dose acetaminophen (Tylenol)
- a strong anti-inflammatory that also helps with nausea- steroids IV
- a regional nerve block that numbs up most of the knee front and side of the knee for about 3 days
- Pre-op days before surgery:
- When will I start walking after surgery?
- You will typically start walking a few hours after surgery.
- After surgery, if your vitals are stable and your leg is strong enough, a physical therapist will help you walk with the aid of a walker.
- Can I do stairs after surgery?
- Yes. You will be able to do stairs on the day of surgery. So, if you have stairs to get into your house, then will you be able to as you learn how to do stairs before you get discharged.
- Do I need to buy any equipment after surgery?
- Not immediately. Everything that you initially need will be provided to you, such as a walker. At some point, you will need to purchase a cane.
- How long is the recovery period after knee replacement surgery?
- Most of the recovery occurs in the first few months but you can continue to improve for up to 1 year.
- Will I need physical therapy after the surgery?
- Yes. On average, you will get 6 weeks of physical therapy. You typically have the option of going to outpatient physical therapy for 6 weeks or getting the first 2 weeks of home therapy and then 4 weeks of outpatient there. A small percentage of patients develop scar tissue and will need more than 6 weeks of physical therapy.
- Will I get a nerve block?
- Most patients get a nerve block in the preop holding area right before surgery. The block contains an anesthetic that numbs up the saphenous nerve which then numbs up the anterior (front) and medial (inside) part of the knee for about 72 hours. This nerve block is called an adductor canal block and one of its benefits is that is a sensory only (sensation) block and not a motor block (shouldn’t affect the muscle strength of the leg).
- When can I start driving after surgery?
- Based on studies that have tested braking response, you typically can’t drive for 4 weeks after a “right” knee replacement and 2 weeks after a “left” knee replacement. In addition to these time frames, you also should be off narcotics and “feel” safe.
- When can I return to work?
- On average, you can return to work in 6 weeks if you have a sit-down job or 8 weeks if you have a stand up job. If you have a more labor-intensive job or if you are a slow healer, then you may need up to 3 months before you can return to work.
- What medications will I receive for pain after surgery?
- You will typically receive a combination of medications after surgery, assuming you have no contra-indications to these meds. These will consist of the following:
- A narcotic: oxycodone
- An analgesic: high dose acetaminophen (Tylenol) 975mg every 8 hours
- An anti-inflammatory: celecoxib (Celebrex) daily for about a month
- We recommend that you use the narcotic only if the acetaminophen and celecoxib are not working.
- The acetaminophen and celecoxib work better when taken together
- Narcotics can be addicting so we recommend that you take the least amount to be comfortable and try to wean off as soon as the pain subsides
- You will typically receive a combination of medications after surgery, assuming you have no contra-indications to these meds. These will consist of the following:
- What restrictions will I have after the surgery?
- There are no real restrictions other than avoiding soaking the incision in water (bath, pool, etc) for 1 month. However, we do recommend that you avoid high-impact activities such as running, jumping, or kneeling to decrease the chance of the implant wearing out or loosening.
- How long will the knee replacement last?
- The newer knee replacements don’t have long-term in-vivo (in a living organism) studies but in-vitro (in a lab) studies show that they can last around 30 years. Ultimately, the longevity is based on the amount of wear and tear you place on it which is affected by your activity and weight.
- What are the implants made up of?
- Standard knee replacements are made up of 3 major materials:
- The Femur is made of cobalt-chromium alloy (which has a small amount of nickel)
- The tibia is made up of titanium alloy
- The tibia and patella line (plastic) is made of a cross-linked polyethylene
- Standard knee replacements are made up of 3 major materials:
- What is the success rate of knee replacement surgery?
- The worldwide success rate is variable but most studies show about 85% great success, 10% okay, and 5% not very satisfied.
- Even with these numbers, knee replacement surgery is considered one of the most successful procedures in all of orthopedics.
- How long will I need to use crutches or a walker after surgery?
- On average, you will use a walker for a few weeks and then a therapist will transition you to a can for a couple weeks.
- Will I need anyone to stay with me after surgery and for how long?
- It is recommended that someone stays with you for at least a few nights after surgery.
- Will I get staples or “glue” for my incision?
- Our goal is to use glue because it creates a tight seal and then there are no staples that need to be removed. However, if your skin is too thin and glue won’t hold, we use staples which actually work great and don’t really hurt when they are removed.
- When can I shower after surgery?
- You can start showering the day after surgery but we don’t recommend any soaking (like baths or pools) for one month.
- What will I be placed on to prevent blood clots?
- We generally use aspirin for DVT prophylaxis unless there is a contraindication such as an allergy to aspirin, a history of gastric bypass, low platelets, or a history of DVT (deep vein thrombosis, i.e. blood clot).
Dr. Eddie El-Yussif is a Board-Certified Fellowship-Trained Orthopedic Surgeon and Fellow of the American Academy of Orthopaedic Surgeons specializing in Knee Surgery at Henry Ford Health, serving the greater Detroit area.