Alexander Sah, MD
Specialty: Orthopaedic Surgery
With more than 600,000 surgeries performed in the U.S. each year and an
estimated 4.7 million Americans living with implants,
knee replacements are incredibly common. That number is only expected to grow. In fact, the
Agency for Healthcare Research and Quality estimates that by 2030 the number of knee replacements each year will
grow to over 3 million – due in large part to the aging Baby Boomer
population. At Washington Hospital’s
Institute for Joint Restoration and Research, between Dr. Dearborn and myself, we perform more than 900 total knee
replacements each year, or a little over half our total annual joint surgery volume.
People are living longer and expecting to maintain their quality of life
as they age, which includes maintaining mobility, independence and employment.
Hip and knee replacement can help them achieve that.
Before you decide to undergo surgery, here are some frequently asked questions
about knee replacement surgery.
What Is Involved in Total Knee Replacement?
At the IJRR, we specialize in both traditional and minimally invasive knee
In traditional knee replacement, an 8 to 10-inch incision is made on the
front of the knee to expose the damaged area of your joint. During this
process the quadricepts tendon is cut and the kneecap is dislocated, allowing
the surgeon to cut away damaged bone and cartilage and replace them with
a prosthetic joint. Due to incision length, muscle dissection and other
tissue trauma occurring during this procedure, the recovery process can
be months long.
However, some patients may be candidates for minimally invasive knee replacement.
As the name implies, a smaller incision (only about 4” long) is
made, and, more importantly, the muscle isn’t cut and the kneecap
is shifted to the side rather than dislocated. For the patient undergoing
the procedure, there’s less trauma, less pain, shorter hospital
stays, and a faster recovery.
Do I Really Need This Surgery?
As an elective surgery, the decision to undergo knee replacement is entirely
up to you. If knee pain is affecting your ability to go about daily activities
like working or walking the dog, it may be the best option for maintaining
your quality of life.
Of course, there are other routes you can explore before deciding. Physical
therapy and exercise can help strengthen the muscles around the knee,
stabilizing the joint. Your orthopedic surgeon may recommend other procedures
or treatments to try, like steroid injections or less invasive surgical
approaches, before resorting to total knee replacement.
But, ultimately, it all depends on what you want to be able to physically
accomplish in your life now and into the future.
What About the Pain?
During this procedure, you will be under regional anesthesia. While it’s
not without its risks, complications from anesthesia are extremely rare.
Epidural and spinal anesthesia effectively and safely numb the waist down,
so that general anesthesia can be avoided.
After surgery, you may experience some pain, but that generally lasts less
than a week. At the IJRR, we practice multi-modal pain management. What
that means is we use a variety of different medications in smaller doses
to optimize pain based on an individual’s tolerance. This helps
us avoid using narcotics and opioids and helps patients recover more quickly
and with fewer side-effects.
So how long can you expect to experience post-surgical pain or discomfort?
While there’s no way to predict results, it can be affected by your
willingness to perform the physical therapy and lifestyle modifications
necessary to optimize recovery from surgery.
What Can I Expect After Surgery?
Immediately after the operation is complete, patients spend 2-3 hours in
a recovery room. At the IJRR, patients are then transferred to the Center
for Joint Replacement building, where they’re placed in the care
of nurses and therapists who specialize in joint replacement patients.
After 2-3 hours, you’ll regularly meet with physical therapists
to work on stretching exercises and techniques for performing routine
tasks independently. Single knee patients are usually up and walking (with
a walker or crutches) the day of surgery and discharged that same day
or the next.
After discharge, regular occupational or physical therapy will continue
for the following weeks. The exact length depends on your healing progress,
operation approach, and joint function. You should be able to perform
basic activities like assisted walking and bathing within a week, but
you should always consult your physical therapist before introducing exercise
or other physical activities during this rehabilitation period.
How Long Will This Replacement Joint Last?
In general, the need to perform a revision surgery occurs at a rate of
less than one percent per year. In fact, studies show that total knee
replacements will last for 20 years or longer
in 80 to 90 percent of cases. Some common causes of implant failure include:
- Patient-Related Factors (age, activity level, surgical history, and weight)
- Wear and Loosening
Additionally, the plastic joint liners, while durable, can wear over time,
but can be removed and changed without disturbing metal components or
While a worn knee joint may not affect how long you live, it can affect
your ability to live life to its fullest. Chronic pain and loss of mobility
can affect your ability to work, play, and even perform simple daily tasks
like bathing or walking to your car. If osteoarthritis or injury is adversely
affecting your quality of life, knee replacement may be an option for you.
Posted August, 2018