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As a board-certified orthopedic surgeon, I’m well-versed in helping other patients understand if and when they should consider knee replacement surgery. But when I became a patient undergoing the same procedure I perform, I gained a unique perspective in understanding the benefits and risks of surgery.
Joint replacement surgery may offer relief for knee pain when conservative treatments fail.
Knee arthritis and traumatic injuries can cause pain and stiffness over time, making it hard to do simple daily activities. Conservative treatment options are typically the first approach in treating chronic knee pain. When I began having pain in my right knee, I tried anti-inflammatory medications and several steroid injections. Unfortunately, nothing helped. I put up with the pain as long as I could, but then it started to get in the way of my life and interfere with my ability to do my job. I knew a knee replacement would be a safe, effective way to restore my range of motion and eliminate my pain so I could resume the things I enjoy.
During a knee replacement, a knee specialist removes the damaged surface of the knee joint and replaces it with an artificial part. Sometimes, the affected knee is only damaged in one or two compartments of the knee. In this case, patients may be candidates for a unicompartmental (partial) knee replacement, allowing the surgeon to preserve more natural tissue. In other cases, patients benefit from a total knee replacement, which involves replacing the entire joint with artificial surfaces. Most replacements are open surgery, although a partial replacement may be performed using less invasive techniques that can lead to a much quicker recovery. Other surgeons may use robotic-assisted platforms to perform these procedures, which can speed recovery for some patients.
Preparing for surgery.
Lowering the risk of surgical complications.
When I’m counseling a patient who is a candidate for knee replacement surgery, I work closely with other specialists to ensure they are in optimal health before undergoing the procedure. It’s important to collaborate with primary care providers, cardiologists, nephrologists, and even dentists to help each patient medically prepare for surgery. Every surgery has risks, from infection to blood clots and other complications. For example, if you have gum disease, it can increase the odds that infection spreads to the bloodstream. If you have diabetes, your blood sugar levels need to be stable pre-surgery to minimize the risk of infection. By working with a team of experts, we can help to address any health conditions and lower the chance of complications during or after surgery.
Following medication and dietary instructions.
Before surgery, it’s important to review your medications with your care team, as you shouldn’t take aspirin or blood thinners before surgery. If you currently take any medications, your doctors will determine what is safe to continue taking and when you should stop a medication that isn’t. Additionally, you’ll be given guidelines for when to stop eating and drinking before surgery. However, this period of time is shorter than in the past because we know that hydration can enhance recovery.
On the day of surgery.
Once you arrive for surgery, your surgeon and anesthesiology team will work together to manage your pain during and after surgery. Commonly, patients receive general anesthesia, spinal anesthesia, or a regional nerve block, which can help manage pain. The type of pain medication used will vary for each patient based on your condition, health, and preferences. I don’t remember anything after sedation, which means I was completely comfortable during the surgery.
Recovery.
Early mobilization is key.
The procedure typically takes less than two hours, and when you wake up in the postoperative room, you’ll be encouraged to get up and move. A physical therapist helped me to walk with the aid of a walker and safely get in and out of bed. They also taught me home exercises to help regain strength and range of motion in my knee progressively over time. I had an outpatient knee replacement, which meant that I went home the same day as my surgery, once I met certain criteria for discharge.
Postoperative pain control.
You will feel some pain and discomfort after surgery, but your care team will help you to manage it in a way that supports your recovery. At MedStar Health, we take a multimodal approach to managing pain during and after surgery. That means our pain specialists use several techniques to keep pain under control, including anti-inflammatory medications, nerve blocks, and ice while limiting narcotics, when possible. Each patient’s pain relief plan will be personalized to their needs and pain levels. The goal is to keep pain manageable so that you can participate in your activities of daily living (ADL) and physical therapy.
Returning to activities.
As your pain and swelling decreases, you can slowly increase your activity level. As you return to activity, it’s important to avoid high impact sports that require pivoting and other motions that are hard on the joints and can affect the longevity of your knee replacement.
Many patients with sedentary jobs can return to work within four to six weeks, while others who perform manual labor or spend more time on their feet may need three to four months for recovery. Most patients are fully recuperated in less than six months. And many people are much more mobile in the month after surgery than they were with knee pain before surgery.
Is knee pain affecting your quality of life?
I lived with knee pain for a while before deciding that I didn’t want to let it limit me anymore. Not everyone needs knee replacement surgery, and many patients respond well to conservative treatment options. But if knee arthritis and pain keeps you from your job, hobbies, or even simple everyday tasks, a knee replacement can safely and effectively restore you to a life without pain. That’s what it did for me.
