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Knee Replacement FAQ

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General

Osteoarthritis is the most common form of arthritis. It is caused by the breakdown of cartilage. Cartilage is the tough elastic material that covers and protects the ends of bones. Bits of cartilage may break off and cause pain and swelling in the joint between bones. This pain and swelling is called inflammation. Over time the cartilage may wear away entirely, and the bones will rub together. Osteoarthritis can affect any joint but usually affects hips, knees, hands and spine.
When arthritis or other conditions cause chronic pain that inhibits activity and can’t be addressed through medications, physical therapy or other treatments, replacing the affected joint can help. Joint replacement is a surgical procedure in which a worn out or injured joint, most often the knee or hip, is replaced with a metal, ceramic or plastic joint. For many people, a new minimally invasive joint replacement technique requires a much smaller incision, shorter hospital stay, less time for recovery and less trauma on surrounding muscles and tissues. This surgery has been widely used for many years with excellent results, especially with knees and hips. Other joints, such as shoulders, elbows and knuckles, may also be replaced.
Arthritic Knee If you have severe Knee pain that is limiting your mobility and affecting your daily functions, you may benefit from Knee replacement. The following three are the most common causes of joint damage due to arthritis:

Osteoarthritis: A disease which involves the wearing away of the normal smooth joint surfaces. This results in bone-on-bone contact, producing pain and stiffness.
Rheumatoid Arthritis: The body’s immune system attacks and destroys the synovial lining covering the joint capsule, the protective cartilage and the joint surface. This causes pain, swelling, joint damage and loss of mobility.
Trauma related arthritis: Resulting from damage to the joint from a previous injury. It also results in joint damage, pain and loss of mobility.

Total knee replacements are usually performed on people suffering from severe arthritic conditions. Most patients who have artificial knees are over age 55, but the procedure is performed in younger people.

The circumstances vary somewhat, but generally you would be considered for a total knee replacement if:

  • You have daily pain.
  • Your pain is severe enough to restrict not only work and recreation but also the ordinary activities of daily living.
  • You have significant stiffness of your knee.
  • You have significant instability (constant giving way) of your knee.
  • You have significant deformity (knock-knees or bowlegs)
Knee replacement is removing the edges of the joint that have been diseased by degeneration or trauma. Knee resurfacing is like a retread. The only part of the joint that is resurfaced is the side of the joint that is diseased.

Most of the patients with severe crippling arthritis have severe affection of both knee joints and deformities.

The advantages of replacing both knees simultaneously in one stage are :

  • Single anaesthesia and hospitalisation
  • One time medication and rehabilitation
  • More economical

The patients who undergo simultaneous bilateral TKR definitely have more cardio-respiratory fluctuations than staged joint replacement but choosing the right patient, having good intensive care and cardiac back up, our experience has been good with no significant increase in complication rate and equally good results when compared to staged procedure (one knee at a time).

I try to take an individualized approach to my patients. For patients who haven’t had any other treatments, I want to see them try some of the simpler things first – anti-inflammatory injections, physical therapy, maybe even arthroscopic surgery. At the same time I will follow them closely, checking them every couple of months, maybe with X-rays, to see if they are losing bone, because I can’t in general make the bone come back. If a patient comes to me who has tried other options and still has problems – they can’t walk where they need to go and have a lot of trouble getting around and doing the things they want to do – then that’s when we start looking at a joint replacement.
I try some of the simpler things first because even though joint replacements work very well for most people, they don’t work well for everybody.
While the new, minimally invasive procedures available through our Joint Replacement Centre require a smaller incision and less recovery time, some pain will accompany it as it does with any surgical procedure. Anesthesiologists and pain management specialists, also part of the Joint Replacement Centre team, work with each patient to control pain. Many factors, including your tolerance for pain, physical condition and level of activity prior to your surgery will impact the level of pain you may experience.
Major surgery on a joint may take two or three hours in the operating room. Getting full range of motion, strength and flexibility back in that joint after surgery usually takes months. That’s where pre-operative exercise and education and post-operative physiotherapy programs come in – to ensure you’re physically and emotionally prepared for surgery, and to maximize your recovery after surgery. Together, such programs are among the most important determinants in the success of your surgery. We also do offer home physiotherapy facilities for better rehabilitation.
It’s impossible to predict how long a new joint will last, since factors such as age, weight, activity level and bone strength determine the final outcome. If your new joint loosens over time, it may be necessary to repeat the surgery. It’s likely that your new joint will bring you years of pain-free activity. With the new materials and components, most people have a 90 percent or greater success rate at 20 years after surgery.
If you look in the literature, generally around 95 percent of people do very well with hip or knee replacements. These are some of the more reliable procedures we do. Still, I like to try the conservative things first because there can be significant complications.
If a knee is infected the patient is first given antibiotics. If the infection does not clear up, the implant will have to be taken out and the patient is scheduled for revision surgery. The original components are removed and a block of polyethylene cement treated with antibiotics (known as a spacer block) is inserted into the knee joint for six weeks. During this time the patient is also treated with intravenous (I.V.) antibiotics. After a minimum of six weeks, new knee components are implanted.
You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities. Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery is predicted by the motion of your knee prior to surgery. Most patients can expect to nearly fully straighten the replaced knee and to bend the knee sufficiently to go up and down stairs and get in and out of a car. Kneeling is usually uncomfortable, but it is not harmful. Occasionally, you may feel some soft clicking of the metal and plastic with knee bending or walking. These differences often diminish with time and most patients find these are minor, compared to the pain and limited function they experienced prior to surgery.
Getting full range of motion, strength and flexibility back in that joint after surgery usually takes months. That’s where pre-operative exercise and education and post-operative physiotherapy programs come in – to ensure you’re physically and emotionally prepared for surgery, and to maximize your recovery after surgery. Together, such programs are among the most important determinants in the success of your surgery.
Even though you may increase your activity level after a knee replacement, you should avoid high-demand or high-impact activities. You should definitely avoid running or jogging, contact sports, jumping sports, and high impact aerobics.
You should also try to avoid vigorous walking or hiking, skiing, tennis, repetitive lifting exceeding 50 pounds, and repetitive aerobic stair climbing. The safest aerobic exercise is biking (stationary or traditional) because it places very little stress on the knee joint.
With newer minimally invasive technologies using FIFO (fast in Fast out), post surgery you need to be in hospital for 1-2 days in single knee and 2-3 days for both knees.
It depends on your profession. If a patient has a sedentary or desk job, they may return to work in approximately 3-6 weeks. If your work is more labor intensive, patients may require up to 3 months before they can return to full duty. In some cases, more or less time is necessary.
Yes. For the first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, housekeeping, etc. If you go directly home from the hospital, family or friends must be available to help. Preparing ahead of time, before your surgery, can minimize the amount of help required.
You can manage stairs around a month after surgery if it’s both knees and much earlier if its single. A good rule of thumb to remember when deciding which leg to lead with is “up with the good, down with the bad.”
This varies from patient to patient depending upon one’s comfort and confidence. Typically, patients may drive when they are using a cane comfortably and not taking narcotics. Some surgeons do not allow the patient to drive until after they have been seen in the office at 4-6 weeks after surgery.
After several months you may try to kneel, squat or sit cross legged. It may be painful at first, but will not harm or damage your knee replacement. Much of the discomfort comes from healing on your recent incision and the healing local tissues. These activities generally become more comfortable as time passes. Avoid sitting cross legged on floor.
People can travel on an airplane six weeks after their surgery. During flying, exercise your calf muscles and ankles frequently. Also, get up and walk the aisle of the airplane to avoid the possibility of blood clots. Check with your surgeon about taking a blood-thinner medication before flying. Wear your white anti-embolism stockings to reduce the risk of blood clots.
For a replacement operation on the right leg, it is wise to wait a four to six weeks and after you have stopped taking medications that impede your driving ability. By that time, you have control of your reflexes, making driving safe.
If your waterproof dressing has been unstained for a 24-hour period and there is no drainage, then you can shower. You should avoid immersing your incision under water. When drying the incision, pat the incision dry, do not rub it.
Even though you may increase your activity level after a knee replacement, you should avoid high-demand or high-impact activities. You should definitely avoid running or jogging, contact sports, jumping sports, and high impact aerobics.
You should also try to avoid vigorous walking or hiking, tennis, repetitive lifting exceeding 50 pounds, and repetitive aerobic stair climbing. The safest aerobic exercise is biking (stationary or traditional) because it places very little stress on the knee joint.
You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities. Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery is predicted by the motion of your knee prior to surgery. Most patients can expect to nearly fully straighten the replaced knee and to bend the knee sufficiently to go up and down stairs and get in and out of a car. Kneeling is usually uncomfortable, but it is not harmful. Occasionally, you may feel some soft clicking of the metal and plastic with knee bending or walking.
These differences often diminish with time and most patients find these are minor, compared to the pain and limited function they experienced prior to surgery.
Implants are made of metal alloys (chrome cobalt or Titanium alloy), ceramic or ceramicised material, and strong plastic parts. Up to three bone surfaces may be replaced in a total knee replacement and two surfaces in partial. The chosen materials must be durable, allow for some flexibility with movement and be biocompatible.
Joint replacement surgery for arthritis is considered a treatment of last resort. But even though replaced joints may not last forever, the weight, activity, and implant type have the most significant impact on how long a knee replacement will last. Some strenuous activities, including impact sports, and any activity requiring running and jumping can create stress on the implants that may lead to early failure of the implanted joint.

Hip Replacement FAQ

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General

Total hip replacement (THR) is the replacement of the ball and socket of the hip joint with implants. There are two main components used in total hip replacement. The acetabular shell replaces the hip socket. The femoral stem replaces the worn-out top of the femur. During surgery, the head of the femur (thigh bone) is removed and replaced with both a stem and socket, mimicking your existing anatomy.
Arthritic Hip

If you have severe hip pain that is limiting your mobility and affecting your daily functions, you may benefit from hip replacement surgery.

The following three are the most common causes of joint damage due to arthritis:
Osteoarthritis: A disease which involves the wearing away of the normal smooth joint surfaces. This results in bone-on-bone contact, producing pain and stiffness.
Rheumatoid Arthritis: The body’s immune system attacks and destroys the synovial lining covering the joint capsule, the protective cartilage and the joint surface. This causes pain, swelling, joint damage and loss of mobility.
Trauma related arthritis: Resulting from damage to the joint from a previous injury. It also results in joint damage, pain and loss of mobility.
Treatment Options: When medication, physical therapy and other conservative methods of treatment no longer relieve pain, total hip replacement may be recommended by your surgeon.

A hip replacement may become necessary to prevent pain and increase mobility if your hip joint is damaged as a result of disease or injury. The most common cause of hip replacements is osteoarthritis, but the procedure may also be necessary for people with rheumatoid arthritis, osteoporosis, bone tumours or a fractured femur (thigh bone). Hip replacements may not be recommended for people who have a high likelihood of injury, such as people with Parkinson’s disease or a significant weakness of the muscles.
Excessive delay in intervention can cause further worsening of joint, at times fracture too. Damage to other joints and lower back because of over loading. Weight gain, stiffness, leg shortening and muscle wasting are other downsides in delay for surgery.
There exist a number of non-surgical alternatives, such measures as lifestyle modification, weight reduction, exercise and physical therapy, and medication should be implemented before deciding on surgery.
If all of these measures have been exhausted, then and your surgeon may recommend surgical intervention.

Here is a list of potential post-surgery complications:

  • Blood clots
  • Infection
  • Fracture
  • Dislocation
  • Loosening
  • Need for second hip replacement

At ELITE Orthopaedics, surgical team will evaluate your risk for complications and provide specific treatments to avoid these risks.

The scar will be approximately 6–8 inches long. It will be along the side or front of your hip. Usually staples are applied but in a couple of cases stitchless surgery is done.
It is true that today’s incisions for total hip replacement are typically shorter than in the past. Patients are recovering faster than previously due to a variety of factors including patient motivation, physical therapy advances and improvements in peri-operative pain control. Minimally invasive preserves cutting muscles and tendons and so less pain and more gain.
The success rate for this surgery is high, with greater than 95% of patients experiencing relief from hip pain. The success rate of hip replacements 10 years after surgery is 90- 95% and at 20 years 80-85%. Should an implant wear or loosen, revision to a new hip replacement is possible.
The newer articulating surfaces are more durable, wear less and so more longevity can be expected with better range of motion. The newer articulating materials are metal on metal, ceramic on ceramic and metal with highly cross linked polyethylene.
You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time and most patients find these are minor compared to the pain and limited function they experienced prior to surgery.
Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your hip replacement if the alarm is activated.

About Recovery

With new innovative technologies in pain control concepts and minimally invasive surgeries done with FIFO, patients now recover way faster. They mostly walk on their feet around 3 hours after surgery, go to toilet seat next morning and outside their room in afternoon. Within 12 weeks following surgery, many patients will resume their recreational activities, such as talking long walk, cycling, or playing golf. It may take some patients up to 6 months to completely recover following a hip replacement.
Returning to work is highly dependent on the type of work you do, as well as your own recovery progress. If you have an office or desk job, you can expect to return after four to six weeks. With more physical jobs that require lifting, extensive walking or travel, you might need up to two months to fully recover. Your surgeon will tell you when you can return to work and if there are limitations.
With new innovative platforms like FIFO and Minimally Invasive Surgery hospital stay with new technique is mostly 2 to 3 days.
Yes. Physiotherapy is an essential part of your total hip replacement recovery process. Physical therapy begins the day of your surgery and will take place over the course of few weeks. At first, you will do some simple exercises like contracting and relaxing your muscles in order to strengthen your hip. You will also learn new techniques for movements such as sitting, standing, and bending, in order to prevent any possible damage to your hip replacement.
For the first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, housekeeping, etc. If you go directly home from the hospital, family or friends must be available to help. Preparing ahead of time, before your surgery, can minimize the amount of help required.

About returning to activity

Using FIFO coupled with modified anaesthesia techniques and improvised pain control techniques, you will be made to walk around 3 hours after surgery in majority of cases. Normal walking will take 2 to 4 to weeks as guided by your physiotherapist.
Yes. You will start with a walker until your muscle strength returns after surgery. Your outpatient physical therapist will advance you to a cane when appropriate.
Stair climbing can start in first few weeks after surgery as per comfort of patient, but it’s important to have support when you climb and descend stairs, especially immediately after surgery. … That means you should lead with your stronger leg that still has your original hip to walk up the stairway and your weaker leg to walk down it.

Some patients may drive as soon as 2 weeks after surgery, while others may need as long as 6 weeks. During this period, simply getting in and out of a car can be challenging, especially if the car’s seats are low to the ground. Patients must meet the following requirements:

  • The patient must be off of narcotic pain medication while driving.
  • The patient must be able to hit the brake quickly.
  • The patient must be able to get in and out of the car comfortably and safely.
In addition, reflexes and muscle strength should have returned to their pre-surgical levels.
As a general rule of thumb, sleeping on your back is the best position. In opposition, sleeping on your stomach is never recommended after surgery. Generally, if your surgeon approves, it is usually safe to sleep on your surgical side when it feels comfortable. This will not be until about the 6 week mark but if hip is operated from front, then much earlier. Always remember to keep a pillow between legs while changing sides.
If your waterproof dressing has been unstained for a 24-hour period and there is no drainage, then you can shower. You should avoid immersing your incision under water. When drying the incision, pat the incision dry, do not rub it.
Normally stitch less surgeries are done that do not require any removal, sutures dissolve on their own and do not have to be removed. If Sutures/staples are there, then removal approximately 2 weeks after surgery. This can be done by a visiting nurse if you are at home, or in hospital facility.
People can travel on an airplane six weeks after their surgery. During flying, exercise your calf muscles and ankles frequently. Also, get up and walk the aisle of the airplane to avoid the possibility of blood clots. Check with your surgeon about taking a blood-thinner medication before flying. Wear your white anti-embolism stockings to reduce the risk of blood clots.
Yes, the precautions are for life and should be strictly adhered to for the duration of the healing and muscle strengthening. However, hip precautions can be relaxed once the hip is strong and healed.
For a replacement operation on the right leg, it is wise to wait a four to six weeks and after you have stopped taking medications that impede your driving ability. By that time, you have control of your reflexes, making driving safe.
It depends on your profession. If a patient has a sedentary or desk job, they may return to work in approximately 3-6 weeks. If your work is more labour intensive, patients may require up to 3 months before they can return to full duty. In some cases, more or less time is necessary.
After several months you may try to squat or sit cross legged. It may be painful at first, but will not harm or damage your hip replacement. Much of the discomfort comes from healing on your recent incision and the healing local tissues. These activities generally become more comfortable as time passes. Avoid sitting cross legged on floor.
As soon as your are comfortable taking care to avoid hip flexion of more than 90 degrees and rotation of the leg more than 35-40 degrees in either direction.
You will probably set off the alarm as you progress through the security checkpoint. Be proactive and inform the security personnel that you have had a hip replacement and will most likely set off the alarm. Wear clothing that will allow you to show them your hip incision without difficulty. We do provide patients with a special card that certifies you as having hip replacement; however, patients will usually be screened by security as well.
The latest advanced technology ANTERIOR HIP, involves sparing the surrounding muscles and tendons when performing total hip replacement surgery. This technique builds a traditional hip implant in-place without cutting any muscles or tendons. It has far lesser chances of leg length discrepancy, hip coming out (dislocation) after surgery and faster recovery.
Most patients have a sense that the operated leg feels longer early in their recovery and this may initially feel awkward. This is due to the fact that the affected leg is usually shorter than the unaffected leg prior to surgery. Arthritis is the process of the protective cartilage covering wearing away from the bone. As the cartilage in the hip joint is destroyed, this results in the leg becoming shorter. Eventually, patients become accustomed to their “new anatomy” following surgery, and do not have any long lasting sense of a leg length discrepancy. Occasionally, some patients choose to wear a small shim in a shoe. At times, the leg is intentionally lengthened at the time of surgery in order to tighten the surrounding soft tissues of the hip and prevent/limit the risk of dislocation. In the majority of cases your leg length will essentially be unchanged.
While not an exhaustive list, you can use this as a starting point to open a conversation with your doctor.