What should I bring with me when I come for an appointment?

When you come for your appointment remember to bring the following:

  • Driver's License or a valid ID
  • Insurance information
  • Referral Letter (if required)
  • Reports, X-rays, MRI's, CT scans and any other relevant information
  • List of medications (if any)

What is arthritis and how does it affect my knee?

Osteoarthritis, also called degenerative joint disease, is the most common form of arthritis. This disease affects the tissue covering the ends of bones in a joint (cartilage). In a person with osteoarthritis, the cartilage becomes damaged and worn out causing pain, swelling, stiffness and restricted movement in the affected knee. Over time, the cartilage wears out to the point of bone-on-bone contact.

How can I prevent arthritis from getting worse?

Unfortunately, we know that osteoarthritis will continue to progress with time as it is a degenerative process. There are no medications or supplements that have been proven to prevent arthritis. However, there are several things you can do to try to prevent symptoms from getting worse. This includes:

  • Maintain a healthy weight/lose weight if you are overweight
  • Light to moderate exercise. Stay active to improve muscle strength and reduce joint pain and stiffness.
  • Avoid injury and falls. Use a cane or walker if needed for support.

What is knee arthroscopy?

This is an outpatient minimally invasive surgery where a small digital camera is inserted into your knee joint through a small 3-4mm incision. Two additional small incisions are made so small tools can be used to remove or repair tears of the cartilage rings in your knee called a meniscus or to remove loose pieces of cartilage. It is used to relieve the symptoms of instability and pain associated with meniscus tears but it will not relieve pain associated with arthritis. If you already have severe arthritis in the knee, this procedure is typically not a good option.

What is a total knee replacement?

A Total Knee Replacement (TKR) is a surgery that replaces an arthritic knee joint with artificial metal or plastic replacement parts called the ‘prostheses’. The procedure is usually recommended for older patients who suffer from pain and loss of function from arthritis and have failed results from other conservative methods of therapy. The typical knee replacement replaces the ends of the femur (thigh bone) and tibia (shin bone) with plastic inserted between them, and also under the patella (knee cap), to create a smooth cushioning effect much like your original healthy cartilage.

Total Knee Replacement FAQs

How long will my new knee last?

Although there are no guarantees regarding how long your knee will last, current studies indicate that the average knee prosthesis lasts for 15 to 20 years. A more accurate way to think about longevity is via the annual failure rates. Most current data suggests that knee replacements have an annual failure rate between 0.5-1.0%. This means that if you have your total joint replaced today, you have a 90-95% chance that your joint will last 10 years, and a 80-85% that it will last 20 years. With improvements in technology, these numbers may improve. Various factors such as weight, activity level, and bone quality can affect the usable life. However, it is also possible that the knee could fail very early on for reasons such as infection, injury, fracture, or dislocation. You may require a knee revision surgery in the future if your knee replacement fails.

Am I a candidate for outpatient knee replacement?

If you are in good health overall, we prefer to perform knee replacement as an outpatient in our surgery center where you go home the same day. Unfortunately, Medicare patients are not a candidate for outpatient surgery at this time, but most other insurance companies will approve it. If you have any significant heart or lung problems, uncontrolled diabetes, sleep apnea, or other significant underlying medical problems, you may need to stay one night in the hospital.

How long will I be in the hospital?

If you are not a candidate for outpatient surgery, most patients stay only 1 night in the hospital then choose to go home with home health care. If there are any significant medical complications during your operation or admission, you may have to stay longer until discharge criteria are met.

Who will perform the surgery?

Dr. Daley will perform the surgery with the assistance of his physician assistant, Jessica Rodriguez, PA-C, and an additional surgical assistant. He does not use any residents during surgery.

How long is the recovery after total knee replacement?

Remember, every patient is different and recovery times can greatly vary. As a general guideline, by 6 weeks most patients are doing fairly well. It can take three months for you to return to most activities, and likely six months to one year to fully recover to maximal strength and endurance following total knee replacement surgery. This depends on your condition before surgery, additional medical problems, and your expectations.

Is knee surgery and recovery very painful?

Pain following total knee replacement has come a long way over the last 10-15 years with increased use of regional nerve blocks, spinal blocks, and various other modalities used for pain control. Early range of motion and rapid rehabilitation protocols are also designed to reduce early stiffness and pain, making the procedure in general slightly less painful than in years past. However, you should expect a fair amount of pain during initial recovery even with the use of narcotic pain medications. Everyone is unique and handles and perceives pain differently.

What is minimally invasive surgery?

Minimally invasive surgery is a term that describes a combination of reducing the incision length and lessening tissue disruption beneath the incision. This includes cutting less muscle and detaching less tendon from bone. There have also been advancements in anesthesia and pain management during and after total knee replacement surgery. All of these practices allow you to feel better, have less pain, and regain function faster than in the recent past.

How big will my scar be?

The size of the incision can vary and depends on several factors that include the size of the patient, the complexity of the surgery, and surgeon preference. Most studies have shown that smaller incisions offer no improvement in pain or recovery and may actually worsen the surgeon’s ability to adequately perform the procedure.

Will I need general anesthesia?

While general anesthesia is a safe option, knee replacements can be performed under spinal anesthesia. Some surgeons and anesthesiologists even prefer spinal anesthesia because data shows it can reduce complications and improve your recovery experience with less pain, less nausea and less narcotic medicine required. Recently, peripheral nerve blocks have become more popular as an adjunct for pain control. For total knee replacement this can include an adductor canal block, which allows pain control without causing weakness of your muscles. You should have a discussion regarding anesthesia and post-operative pain management with your surgeon and anesthesia team prior to your surgery.

When can I return to work after knee replacement?

This depends on the type of work you do, as well as your company’s policies on allowing you to return to work with restrictions. For the first few weeks, you should see recovering from your operation as your full-time job. Patients with seated jobs who can return part-time to start with, may go back in as little as 2-3 weeks although this may be very difficult. Most people will need to take more time off. Patients with more strenuous jobs may be off 2-3 months. Remember, this varies based on each individual patient and their progress. Also, keep in mind that you will be taking narcotic pain medications which can distort your thinking, and you will be unable to drive for possibly 6 weeks.

When can I shower?

You cannot get your incision wet for 3 weeks after surgery. However, you may shower if you use a waterproof dressing or plastic wrap over the incision. You should take extra caution getting in and out of the shower. You cannot soak the incision in a bath, pool, etc. until your incision is completely healed which can take 6 weeks or longer.

When can I drive?

Most surgeons allow patients to drive at six weeks after surgery, and sometimes sooner if the operative leg is the left leg. There is some literature that states that your reaction time will not be back to normal prior to six weeks. You should not drive while on narcotics, and should discuss returning to driving with your surgeon.

When can I walk after surgery?

Most surgeons and hospitals today emphasize getting you out of bed quickly. Most people are walking with the assistance of a walker on the day of surgery, and using a cane or nothing at all by two to three weeks.

Will I need physical therapy, and if so, for how long?

Most people who have had a total knee replacement will have home health physical therapy for 1-3 weeks then transition to outpatient physical therapy. A skilled therapist can accelerate the rehabilitation as well as make the process more efficient with the use of dedicated machines and therapeutic modalities. Depending on your condition before surgery, physical therapy is beneficial for up to three months and rarely longer. The amount of therapy needed depends upon your condition before surgery, motivation, and general health.

What limitations do I have regarding my total knee replacement going forward?

In general, you should let your symptoms be your guide in returning to activity. After surgery, you will have some difficulty kneeling on the operative knee, which you will become less aware of with time, but will always have a general perception that the knee is artificial and doesn’t really feel like a normal knee. You should kneel only on a limited basis and only on a soft or cushioned surface. You should avoid any crawling.

Most people are able to return to usual activities and work but may have some difficulty performing heavy labor such as construction or farming.

Most surgeons advise against prolonged seated travel or flying for the first four to six weeks after knee replacement, due to increased risk of blood clot.

Any high-impact activity, including running, pivoting/cutting type activities, jumping, and downhill skiing should be avoided forever to elongate the life of your implant. You should also avoid deep squatting and lifting more than 50 pounds. If you have any specific questions, please ask your surgeon.

Are there complications to total knee replacement surgery?

  • Total knee replacement surgery is primarily a pain relieving procedure; however, it may not relieve all pain, and there is a possibility of residual stiffness and swelling.
  • Although complications are relatively rare (1-2% of patients), patients may experience a complication in the postoperative period. These include very serious and possibly life threatening complications such as heart attack, stroke, pulmonary embolism and kidney failure.
  • Stiffness or loss of motion can also occur.
  • Infection (1%) is one of the most debilitating complications and often requires prolonged antibiotics with several additional surgeries to rid the infection.
  • A blood clot in the leg is also a relatively common complication requiring some type of blood thinner following surgery to reduce the incidence.
  • The implants can also fail over time due to wear or loosening of the components, but this generally occurs many years after surgery.

Will my implant set off metal detectors at airports and courthouses?

Usually patients with joint replacements will set off metal detectors. It is reasonable for you to inform the TSA screening agent at the airport that you have had a joint replacement; however, you will still require screening and will need to follow the directions of the screening agent. There are millions of individuals with joint replacements, and screening protocols recognize that people who have had joint replacements may set off detectors. You do not need to carry specific documentation to prove that you have a joint replacement.

Metal detector screenings follow universal protocols that allow for people with joint replacements to proceed after confirmation that no threat exists.