Is this a minimally invasive surgery?
This is a great question. I use less-invasive techniques with my knee replacements to accelerate your recovery such as entering through a “mid-vastus” approach where I avoid cutting into your quadriceps tendon as is traditionally performed. I believe this can make it easier to regain some of your motion after surgery. However, “minimally invasive” has no true definition. For example, some people think “minimally invasive” corresponds to the size of the skin incision, but the size of the incision varies patient to patient, and is typically related to how large the leg is. Bigger legs will get bigger incisions. In addition, if we use robotics or computer navigation, this also requires the incision to be bigger. The worst thing you can do is have an incision that is too small, because the stress on the incision from the surgeon “forcing” things into a smaller space can put your incision at risk for wound complications and infection. At the end of the day, I think what most people want (and what I would want for myself or my own family members) is a procedure that is safe, precise, and associated with less postoperative pain and a quicker recovery.
What is the recovery time?
After surgery, you will be using a walker for about the first week after surgery. When ready, you will transition to using a cane for about 1-3 weeks. By 4 weeks after surgery, many patients might not need to use any external supports. We ask that you use a walker and/or cane to help with balance, and it will also help you weight-bear as comfort allows. “Recovery” is different for every patient, and even different from one knee to the next. No two patients are the same, and no two joints are the same. As a rule of thumb, it can take approximately 3 months to return to 80% “recovered” and you can continue to improve up to about 1 year after surgery. Just keep in mind that everyone heals and recovers at a different pace.
What type of anesthesia is used?
Most patients receive a spinal anesthesia. This has some similarities to an epidural that many women in labor receive. A spinal anesthesia gives us the ability to decrease the amount of general anesthesia you get so you wake up with less pain, nausea, and other issues that some patients can get with general anesthesia. However, some patients are not good candidates for spinal anesthesia and instead receive general anesthesia. The final recommendation rests with the excellent anesthesiologists we work with and trust with our patients’ care.
How long will my replacement last?
This is a common question and particularly important for younger patients. A general rule of thumb is that there is a risk of needing a repeat operation due to any cause of about 1% per year. That means you have a 99% chance it will last at least one year, and an 80% chance it will last at least 20 years. We can’t say modern implants will last 30 years because they’re modern! They haven’t been around 30 years yet for us to know. But I tell all my patients that there is approximately an 80% chance that in 20 years, they’ll still have the same parts we put in there.
How long will I be in the operating room?
You’ll be in the operating room for approximately 3 hours total, but the procedure itself takes much less time than that. I always compare it to traveling. You may be traveling for 6 hours even if your flight is only 2hrs because of time you spend getting to the airport, checking in your bags, going through security, etc.
When will I be able to walk?
Our goal is to get you up and walking as soon as it is safe to do so! Your knee will structurally be able to withstand your entire weight while walking immediately after surgery. Because of normal pain after surgery, most people need some type of assistive device (cane, walker, crutches) usually for a few weeks.
Will I have pain after surgery?
Yes, yes, yes. This is a BIG surgery and pain is NORMAL. With our medication regimen, your pain should always be at a TOLERABLE level. But having some pain is normal. In general, the first 48 hours are the worst, but it should be consistently improving day by day after that. Most people require narcotic pain medications for about 3 weeks or so, then are able to manage with simple Tylenol and/or ibuprofen. Again, your pain level should always be TOLERABLE. Your attitude towards pain control can also affect how well you manage your pain after surgery. If you believe that the pain will be uncontrollable or unmanageable, your pain and distress will worsen. I guarantee that. If you believe that your pain can be managed and controlled, then it will be. Research studies have shown a positive attitude can actually improve the effectiveness of pain medication.
When can I drive?
Patients can usually drive around 3 to 4 weeks after surgery. It is very important that you are off all narcotics and are not using an assistive device before you start to drive. It is also important that if you are having a right sided joint replacement that you are able to press the brake down quickly in case of an emergency. You want to make sure that you are comfortable and confident that you are able to operate your car safely. We suggest practicing in a parking lot prior to driving on the road.
When can I travel?
You may travel after your first in clinic post-operative appointment. It is recommended that you get up and either walk or stretch at least once each hour during long trips. This is to help prevent blood clots. If you are thinking of going on a long trip within the first 3 months after surgery, we suggest you take one 81 mg of Aspirin twice daily beginning 2 days prior to your trip and complete this regimen 2 days following your trip.
When can I return to work?
That answer depends on your occupation. If you have a more sedentary job and are not on your feet all day, you could return after 4 to 6 weeks. I would personally recommend no sooner than 3 weeks. If you have a more labor-intensive job where you don’t have the opportunity to sit at work and rest, it could be 2-3 months before you can return to your job. We suggest that all patients plan to be off work a minimum of 4 weeks, and we can adjust as needed depending on your recovery and progression. However, the maximum time off that our office is allowed to write for is 3 months.
Why does the skin around my incision feel numb?
When you undergo a joint replacement, the sensory nerves are interrupted which results in the numbness around the knee. This will improve over the course of 1 year, but it could always feel somewhat different.
What kind of activities are not allowed or are allowed after a joint replacement? I’ve heard you “can’t run” after a knee replacement.
I do not restrict my patients’ activities at all – as far as I’m concerned, we’re doing this surgery for your quality-of-life so I want you to get back to the activities that give you joy! But as I said, this isn’t your 18 year old knee again. So while your knee is structurally sound, strenuous activities might cause you more discomfort. Higher impact activity like running or jumping can also potentially wear out the plastic liner sooner, but it is impossible to say how much activity will do this. I do ask that all my patients avoid trying any impact activities for a minimum of 4 months after surgery due to the need for your body to fully heal. Please discuss with Dr. Bremjit if you have any questions regarding specific activities.
Will I be able to kneel on my operative extremity?
For knee replacements, after a few months you may try kneeling on your operative extremity. It can be painful at first, but it will not harm your knee. The discomfort is coming from your incision and the healing tissues. Kneeling will become more comfortable as time passes. Often beginning with kneeling on a pillow or something soft can help to desensitize the incision. If you have any trouble after the first 3-4 months, we have a desensitization protocol we can give you.
My knee replacement makes a clicking or bumping noise. Is this normal?
Yes, this is NORMAL as this is an artificial knee, and you may “hear” or feel the metal and plastic articulating. This is not harmful to you.
I think my leg feels longer now. Is this possible?
For the majority of people, this will not happen. In the case of a knee replacement, this is usually simply the result of straightening out a knee that pre-operatively had a significant bow to it. Your actual leg will be the same length, and should not differ within 1-2mm. In hip replacement surgery, there can be a slight leg length discrepancy post operatively, which is accepted in order to achieve a stable hip replacement that does not dislocate. Most people are born with a leg length discrepancy that averages from ¼ inch to 1 inch. Over time your body will adapt and your gait will normalize. Occasionally, we can consider a shoe lift if needed.
What Results Should I Expect?
You should plan for and expect a successful outcome from your joint replacement surgery. Generally, patients experience less pain and more mobility in their joint, and can resume most of the activities they enjoyed before the onset of arthritis. Long-term studies show that over 90% of artificial joints are intact and fully functional after 10-years, and 80-85% at 20 years. Your artificial joint will last longer if you maintain your ideal weight, low impact exercise, and undergo routine follow-up examinations.
For more information please visit:
Total Hip Replacement: https://hipknee.aahks.org/total-hip-replacement
Total Knee Replacement: https://hipknee.aahks.org/total-knee-replacement
