What causes arthritis?
Arthritis is a breakdown of the articular cartilage covering the ends of bones – a degenerative process over time, similar to the thinning of your tire treads with use. There are many causes of arthritis. There are an estimated 30-40 million Americans with arthritis; most of these tears are due to degenerative arthritis (osteoarthritis). There are 2-3 million Americans with inflammatory rheumatoid arthritis. Trauma to the knee is one of the major reasons for arthritis in the younger individual. Arthritis most often increases as we age.
What kind of symptoms would I have if I have arthritis?
Symptoms of arthritis are stiffness, pain, and swelling of the joint. Morning stiffness is very common.
What kind of treatment options are there?
Treatment options include weight reduction and good (cushioned) shoe wear. Further conservative measures include taking over the counter Tylenol or anti-inflammatory drugs (NSAIDs). Occasional steroid injections or hyaluronic acid injections can be given into the knee. Surgical options can include arthroscopic procedures to wash out the knee or debride the roughened areas about the tibia and femur of the knee. Arthroscopic debridement of the cartilage surfaces during arthroscopy does not guarantee long term pain relief. There are many surgical procedures to replace small areas of localized arthritis including transplanting cartilage tissue to this area. Ongoing arthritic problems in the knee lead to increasing pain, eventually possibly requiring a total knee arthroplasty.
How do I know if I need to have surgery for my arthritis?
You need to have surgery when the pain gets so bad that medicine can’t control it, if you have difficulty sleeping or cannot walk a few blocks. Surgery attempts to improve the quality of your life by decreasing pain and increasing motion.
How do I treat arthritis in the knee?
Arthritis can come from trauma, but generally arthritis increases with age. There is a 50% hereditary component with arthritis. Arthritis is treated first conservatively with weight reduction, activity restriction, NSAIDs (nonsteroidal anti-inflammatory drugs) like Motrin, Aleve, Celebrex. Tylenol can help relieve the pain as well. Stretching and exercise is important to keep the joint loose. Physical therapy is used to work on strengthening the muscles around the knee, to limit stresses on the arthritic portions. Once conservative measures fail to provide pain relief surgical options can be discussed.
Arthroscopic debridement of torn meniscus or loose cartilage can provide pain relief for some patients but will not treat the arthritis pain.
Debridement is a measure to help delay more invasive surgery.
Microfracture is a procedure in which small holes are drilled into the areas where cartilage is damaged. These small holes provide blood and nutrients which can produce fibrocartilage, a material similar but less durable than normal hyaline cartilage.
Mosaicplasty/OATS are procedures in which pieces of cartilage from low stress locations of your knee are surgically removed and implanted in the areas of arthritis. The donor areas are harvested by using special drills which core out the healthy cartilage and bone. These bone plugs are then implanted into the region with arthritis.
Allograft transplantation is similar to mosaicplasty/OATS but uses cadaver tissue / bone plugs. The areas of arthritis in your knee are sized, and a matching area of the allograft (cadaver) cartilage and bone are harvested. The allograft tissue is then precisely fit into the area of your arthritis as a plug.
Autologous Chondrocyte Implantation (ACI) is a 2 stage procedure in which a cartilage biopsy is taken from your knee during an initial arthroscopy and then is sent to a lab to be grown. The cartilage cells are grown in a medium and are later injected back into your area of arthritis. The cartilage cells are covered with a graft which protects the cartilage cells while they attach to the bone.
What is arthritis and why does it make my knee hurt?
There is a layer of smooth cartilage on the lower end of the femur (thighbone), the upper end of the tibia (shinbone) and the undersurface of the kneecap (patella). This cartilage serves as a cushion and allows for smooth motion of the knee. Arthritis is a wearing away of this smooth cartilage. Eventually it wears down to bone. Rubbing of bone against bone causes discomfort, swelling and stiffness.
What is total Knee replacement?
A total knee replacement is really a cartilage replacement, replacing the damaged cartilage with an artificial surface. The knee itself is not replaced, as is commonly thought, but rather metal is inserted on the end of the bones, the femur and the tibia. A plastic spacer goes between the tibia and femur. A plastic lining is placed on the back of the kneecap. This creates a new smooth cushion and a functioning joint that does not hurt. A more accurate name for a total knee replacement is total knee resurfacing.
What are the results of total Knee replacement?
94-96% of patients achieve good to excellent results with relief of discomfort and significantly increased activity and mobility.
What is computer navigation?
Computer navigation uses a GPS system that helps the surgeon align and orient knee implants with the patient’s anatomy. This enables the surgeon to place the prosthesis in a position to give the new knee the best strength, stability and range of movement. Another benefit is fewer of post-op pain from tendonitis, bursitis, etc. and by placing the components in the right position, wear is decreased.
When should i have surgery?
Your orthopedic surgeon will help you decide if you are a candidate for the surgery. This will be based on your history, exam, X-rays and response to conservative treatment. The decision is yours, based on pain and decreased quality of life.
Am I too old for this surgery?
Age is not a problem if you are in reasonable health and have the desire to continue living a productive, active life. You will be asked to see a physician for his/her opinion about your general health and readiness for surgery.
Am I too young for this surgery?
Thanks to recent developments in design and materials, total knee replacements are projected to last 20 to 40 years
Why do they fail?
The most common reason for failure is loosening of the artificial surface from the bone or wearing of the plastic spacer. This will result in the need for revision.
What are the major risks?
Most surgeries go well, without any complications. Infection and blood clots are two serious complications that concern us the most. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce the risk of infections. Our infection rate is 0.1%.
Should I exercise before the surgery?
Yes. You should consider consulting with a physical therapist. Exercises should begin as soon as possible.
Will I need blood?
You may need blood after the surgery. You may donate your own blood, if you are able, use the community blood supply or have your relatives donate for you. Banked blood is considered safe, but we understand if you want to use your own.
How do I donate my own blood?
The Total Joint Center Nurse Manager can help you work out the details of your blood donation.
How long am I incapacitated?
You may get out of bed the day of your surgery. However, the next morning you will get up and start walking using a walker or crutches. You will be able to put your weight on your operated leg.
How long will be in the hospital?
Most patients will be hospitalized for three to four days after their surgery. There are several goals that you must achieve before you can be discharged. You must be able to walk 200-400 feet, climb up and down as many stairs here as you have at home, get in and out of bed by yourself, and be able to dress yourself.
What if I live alone?
Three options are available to you. If you have co-morbidities or bilateral knee replacements, you may be able stay at the Acute Rehabilitation unit at Saint Francis. If you haven’t met your discharge goals, we will send you to a skilled nursing facility until you are safe to go home. The final and usually best option is to go directly home. A physical or occupational therapist will come to your house two times a week to provide therapy. Many people who live alone go home directly from the hospital without any problems.
Will I need a second opinion prior to the surgery?
The medical assistant will contact your insurance company to pre-authorize your surgery. If a second opinion is required, you will be notified.
How do I make arrangements for surgery?
The Total Joint Center nurse manager will schedule your surgery. She will guide you through the program and make arrangements for both pre- and post-op care.
How long does the surgery take?
We reserve approximately two hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery.
Do I need to be put to sleep for this surgery?
You may have a general anesthetic, which most people call “being put to sleep.” Some patients prefer to have a spinal or epidural anesthetic that numbs your legs only and does not require you to be asleep. The choice is between you and the anesthesiologist.
Will the surgery be painful?
You will have discomfort following the surgery, but we will keep you comfortable with appropriate medication. We use a 0 to 10 scale to monitor pain. 0 is no pain, while 10 is unbearable pain. Generally, most patients are able to stop very strong medication within one to two days. Some patients control their own medicine with a special pump called a PCA, this pump delivers the drug directly into their IV. You may have an indwelling pain pump in your knee. This will have a continuous flow of marcaine, a numbing medicine, going into you knee. This allows you to participate in your therapy without having to take as much pain medication. You may have a femoral nerve block. This will block your feeling of pain.
Who will be performing the surgery?
Your orthopedic surgeon will do the surgery. An assistant helps during the surgery and you will be billed separately by that assistant.
How long, and where, will my scar be?
All the surgeons minimally invasive surgical techniques. The scar will be approximately 3 to 4 inches long. It will be straight down the center of your knee unless you have previous scars, in which case we may use the prior scar. The less cutting, the less pain and the quicker the healing.
Will I need a private nurse?
No. You do not need a private nurse, but if you want one, we can provide a list so you may make arrangements.
Will I need a walker or crutches or cane?
Yes, for about two to six weeks you will need a walker, a cane, or crutches. Most people go home with crutches. The discharge planner will make arrangements. Within a few weeks you should progress to one crutch or a cane and then nothing at all.
Will I need any other equipment?
Yes. You may need a raised toiled seat or a three-in-one bedside commode. A tub bench and grab bar in the tub or shower may also be necessary. An occupational therapist can help you decide. Some patients will use a motion machine at home called a CPM. This will be decided at the time of discharge and we will make all necessary arrangements for delivery of all equipment.
Where will I go after discharge from the hospital?
Most patients are able to go home directly after discharge. Some may transfer to our acute rehabilitation center. Stays there are from four to eight days long. Others may need to go to a skilled nursing facility. The discharge planner will help you with this decision and will make the necessary arrangements. We will check with your insurance company to see if you have benefits
Will I need help at home?
For the first several days or weeks, depending on your progress, you may need someone to assist you with meal preparation, grocery shopping, laundry, etc. Family or friends may need to be available to help. Preparing ahead of time, before your surgery, can minimize the amount of help needed. Having the laundry done, house cleaned, yard work completed, clean linens put on the bed, and frozen meals will reduce the need for extra help. Many people who live alone are able to return home and take care of themselves without any assistance.
Will I need physical therapy when I go home?
Yes. We will arrange for a physical therapist to provide therapy at your home. Following this, you may go to an outpatient facility two-three times a week to assist in your rehabilitation. The length of time required for this type of therapy varies with each patient. When you are ready to move from home therapy to out-patient therapy, please call the Total Joint Center.
How long until I can drive and get back to normal?
The ability to drive depends on whether surgery was on your right leg or your left leg, and the type of car you have. If the surgery was on your left leg and you have an automatic transmission, you could be driving at two weeks if you are not taking narcotics. If the surgery was on your right leg, your driving could be restricted for as short as two weeks or as long as six weeks. Getting “back to normal” will depend on your progress. Consult your surgeon or therapist for their advice on your activity. Our expectation is that you will be able to bend your knee 95 to 130 degrees.
When will I be able to get back to work?
We recommend that most people take at least 30 days off work, unless their jobs are quite sedentary and they can return to work with crutches on the job.
When can I resume sexual intercourse?
The time to resume sexual intercourse should be discussed with your orthopedic physician. The Total Joint Center has a guide on sexual intercourse and will give you a copy on request.
How often will I need to be seen by my doctor following the surgery?
You will be seen for your first post-operative office visit two weeks after surgery. The frequency of follow-up visits will depend on your progress. Many patients are seen at two weeks, six weeks, twelve weeks, three months and then yearly intervals.
Do you recommend any restrictions following this surgery?
Yes. High-impact activities, such as running, singles tennis and basketball are not recommended. Injury-prone sports such as downhill skiing are also dangerous for the new joint.
What physical/recreational activities may I participate in after my recovery?
You are encouraged to participate in low impact activities such as walking, dancing, golfing, hiking, biking, swimming, bowling and gardening.
Will I notice anything different about my knee?
Yes. You may have a small area of numbness to the outside of the scar that may last a year or more and is not serious. Kneeling may be uncomfortable for a year or more, but you can kneel if you want to. Some patients notice some clicking when they move their knee. This is the result of the artificial surfaces coming together and is not serious. You may notice that your knee is warm for up to one year, again, this is not unusual. It is your knee healing from the surgery.
How do I know if I am a candidate for minimally invasive partial knee replacement?
For up to 20% of the patient population suffering from knee arthritis, minimally invasive partial knee replacement is a viable option. When only one compartment of your knee is damaged and your orthopaedic surgeon has determined that you have adequate ligament stability, the surgeon may choose to replace only the diseased portion of your knee. The healthy compartments remain untouched, and because the procedure is done through a much smaller incision than a total knee replacement, rehabilitation is less painful and more rapid.
Can I resume my normal activities after minimally invasive partial knee replacement?
Most patients can resume normal activities following partial knee replacement once they have regained adequate strength and flexibility and their orthopaedic surgeon has released them to begin normal activities. However, any activity that results in repetitive joint trauma, such as running, jumping or twisting, should be avoided. After recovering from partial knee replacement surgery, many patients have returned to activities such as swimming, golf, doubles tennis and gardening.
Why is an OXINIUM◊ partial knee replacement something I should ask my surgeon about?
OXINIUM Oxidized Zirconium is nothing short of revolutionary. This new material is used to produce components of knee implants that offer superior performance characteristics over traditional cobalt chrome surfaces due to their increased hardness, smoothness and resistance to scratching and abrasion. OXINIUM material incorporates the best features of cobalt chrome without the risks often associated with it. This makes for potentially longer-lasting, superior performance.
How long will my partial knee implant last?
It’s difficult to predict the lifespan of any individual knee implant. However, when good surgical technique and accurate instrumentation are combined with proper patient selection, the vast majority of patients remain trouble-free for up to and even beyond 10 years.
How do scratching and friction affect a knee implant?
Traditionally, cobalt chrome has been the material of choice for knee implants because of its strength and relative hardness. However, studies have shown that cobalt chrome implants have a tendency to roughen over time when implanted in the body. Thus, when a roughened replacement joint rubs against a plastic bearing surface, the plastic wears out. In fact, laboratory tests show that even a single scratch on a cobalt chrome surface can increase the rate of plastic wear 10 times. Over time, the plastic surface simply wears out and additional surgery is then needed to replace the worn implants. Studies conducted recently have proven through controlled wear testing that a scratched or roughened cobalt chrome implant will dramatically increase production of plastic wear debris and reduce the life span of the knee implant substantially.
So how long will an OXINIUM knee replacement last?
According to laboratory wear testing, OXINIUM implants demonstrate the scratch and wear resistance necessary to be potentially longer lasting as compared to traditional artificial knee joints. The smooth, hard surface of an OXINIUM ◊ implant is not a coating, but the result of a process which allows oxygen to absorb into the zirconium metal, which changes only the surface from metal to ceramic. The ceramic surface makes OXINIUM implants 4,900 times more abrasion resistant than cobalt chrome. It also reduces friction between the implant and the plastic surface for superior durability over time.
I am in pain, but my orthopaedic surgeon has advised me to wait for my knee replacement because I am too young. Why will an OXINIUM knee replacement be different?
Oftentimes in the past, orthopaedic surgeons have advised patients under 65 years of age to wait to have knee replacement surgery because the life span of traditional cobalt chrome implants is limited. With the new potentially longer-lasting OXINIUM ◊ knee implant, surgeons have a viable option for a younger patient who may not have been a knee replacement candidate in the past. Therefore, a younger patient with advanced arthritis no longer has to suffer for years until he or she reaches an appropriate age for joint replacement surgery.
In addition, patients who want to return to an active lifestyle which can include low impact activities like dancing, gardening and stationary cycling, may also benefit from OXINIUM ◊ knee replacements due to the fact that they are better able to tolerate activity and may last longer than traditional joint replacements.