Below are some frequently asked questions, which you will find contains general information, which would apply to most surgical procedures at any surgical center or hospital.
Will I Need a Blood Transfusion?
Some patients who have a total joint replacement could require a blood transfusion.
If you are donating blood for your surgery, you will be asked to donate one or two units of your own blood within 35 days prior to your surgery date. This will involve scheduling an appointment with the blood bank of the hospital, or if necessary, a blood donation facility recommended by your insurance carrier or one closer to where you live (for out of state patients). Only one unit of blood can be donated at a time, so you may need to go in for two visits. The blood is then stored until your operation.
If you are unable to donate blood for whatever reason, donor blood will be used. Donor blood is carefully screened for communicable diseases, so you need not be concerned about the transmission of disease through donor blood. The risk of hepatitis and HIV infection is extremely low. To our knowledge, disease transmission through use of donated blood has never occurred in any of our patients.However, there is no question that your own blood is the safest, so if you are able, we recommend that you donate blood for your surgery.
If distance is a problem, arrangements can be made to have you give blood locally and transported here for your surgery.
Please be assured that any unused blood that you give will be returned to you.
Will There Be any Pre-Admission Testing?
Within two weeks before your surgery, you will be asked to undergo several laboratory tests and possibly an electrocardiogram and chest xray. Pre-admission testing will indicate whether you have any conditions which might increase the risk of surgery. A regular physical examination, performed by your own medical doctor or hospital staff here, is also required.
What Can I Eat or Drink the Day Before My Surgery?
Just Before Surgery. You must not drink or eat anything after midnight and on the morning of the surgery. In some cases, you may be allowed to take a medication you normally take in the morning with a minimal amount of water. Your admitting nurse will question you and note your food, water and medication intake.
What Will Happen the Day of Surgery?
Your doctor may order xrays just prior to surgery. If not done previously, a physical examination will be done. If you have not already done so, you will be asked to sign an operative consent form to state that you understand what is being proposed and that you are in agreement that we may proceed with the operation. Just prior to surgery, an intravenous line will be started and you will be taken into the operating suite.
Anesthesia. You will be seen by an anesthesiologist prior to surgery. The anesthesiologist can answer specific questions you might have. Most of our surgeries are performed under spinal anesthesia which is safer than general anesthesia and is much less disturbing to major body functions. The anesthesiologist will give you some medication to make you sleepy so that you are not really aware, but not totally asleep either. The surgical site will be totally numb throughout the operation and for several hours after the surgery.
How Long Will the Surgery Last?
The actual surgical procedure takes between two and three hours. Prior surgeries, level of damage and deformation and other factors determine the time required.
How is the Total Joint Replacement Done?
The damaged bone and cartilage is first removed. Next, the area is prepared for the prosthesis. Surgical tools are used to shape the bone so that the prosthesis fits properly. The artificial joint is then placed into the bone with or without bone cement (methylmetacrylate). Adhesion with bone cement is immediate.
Another method of adhesion is called “biologic fixation”. This method requires that the surface of the prosthesis next to the bone is porous. With time, bone grows into the pores and the prosthesis becomes an integrated part of the joint. There are advantages and disadvantages to each type of “fixation.”
Furthermore, the type of fixation recommended to you will depend on your age, weight, and activity level.
What Happens Immediately After Surgery?
When your surgery is completed, you will go to the recovery room where you will be closely monitored until the effects of the anesthesia and intraoperative medicines are decreased and you are relatively awake and comfortable.
When you have completed your stay in the recovery room, you will be transferred to your hospital room in the orthopaedic nursing unit. You will be lying on your back in a comfortable position. If you have surgery early in the morning, you may sit up on the edge of the bed that evening. In general, all patients are out of bed within twentyfour hours and attending physical and occupational therapy. The therapists will instruct you in learning how to use crutches or a walker and show you some of the precautions that are necessary in the immediate postoperative period. The physical therapist will answer any of your questions and will go over all of the details.
Will I Need Physical Therapy?
Both in the immediate postoperative period and after you go home, physical therapy is very important. You will have to extend some effort to get the best possible result.
Physical Therapy (Total Knee Replacement) and Passive Manipulation.
We will be asking you to move your knee in the immediate postoperative period and you will need to work on strengthening your muscles. If, in about 10 days, you are unable to move your knee to 90° (a right angle) we may recommend a manipulation, meaning that, under anesthetic, your knee would be passively, physically bent for you. This manipulation is intended to break down adhesions (scar tissue) that might have formed around your knee after the surgery and which prevent movement.
Risks. It is important that you understand that there are risks associated with any major surgical procedure and total knee replacement is no exception. If you have undergone a previous surgery, you are already aware of some of these risks. There is a risk of death, which is true of any major surgical procedure requiring anesthesia and blood transfusion. The risk of death in our hospital for total knee replacement is very small, in the order of 1 per 1,000 cases. The specific risk for you would depend upon your general medical condition, your age, and the difficulty of the surgical procedure.
Are There Other Risks I Should Be Aware Of?
Other potential risks are infection, limitations in knee motion, and loosening of the prosthesis. Our hospital has in place extremely stringent measures to prevent infection and your risk here is very low, actually about 1 case in 400.
You will be receiving an antibiotic on the morning of surgery and this will be continued for 24-36 hours after surgery.
A risk involved with total knee replacement is that the motion of the knee may be more limited than before the surgery. To a certain extent, how well your prosthesis moves will depend upon how much your knee moved before the surgery. If your knee was extremely stiff before surgery, you may not get as much motion as patients without stiff knees. Some whose knees moved easily before surgery may actually lose some motion following surgery. Pain free motion, even if motion is somewhat limited, is the goal. Navigating stairs or rising or sitting from your chair without pain should be possible after surgery.
There are a host of other extremely rare but possible complications. Instances of muscle ruptures, pulling off of the tendon, injuries to nerves and blood vessels, superficial infection and opening of the wound and other complications of this nature may occur.
Will my Prosthesis Loosen and What Are The Odds?
A gradual loosening is characterized by discomfort over a period of time. In most instances this can be corrected surgically. What is the risk potential? We think in general, it’s probably a cumulative risk of about 1% per year, so that if you have your prosthesis for 20 years, the possibility of loosening over that 20 years could be as high as 1 in 5. If you have your prosthesis for 10 years, it could be 10%. Improvements in surgical instruments, prostheses, and surgical techniques utilized by our doctors and in our hospitals have resulted in a reduced risk of loosening.
What can you expect to be able to do with a successful total knee replacement? You can do anything that requires normal walking. You should be able to go up and down stairs easily. You should be able to get in and out of a chair, should have enough movement to be able to put on your shoes and socks and should be able to walk distances that were previously limited by your painful knee.
Sports (Total Knee Replacement). Your initial visits with your doctor made you aware that knee replacement is not meant for sports. The main thing that we would like to achieve and the main purpose for doing a total knee replacement is to reduce your discomfort and most who have a total knee replacement have either no pain whatsoever, or very minimal occasional pain which would not require any medication. Tendons, ligaments and muscles remain intact, so if these were a source of pain before total knee replacement, they will continue to be a source of discomfort. Often this discomfort can be controlled with antiinflammatory medication which you will very likely need to continue following total knee replacement surgery.
About the knee: The knee is a complex joint which is made up of muscle, tendons, ligaments, and bones. These components permit it to move in a number of directions enabling us to sit, stand, walk, climb stairs, and change direction (pivot). There are three bones involved: the femur (thigh bone), the tibia (shin bone), and the patella (knee cap). The surface of the ends of these bones is covered in cartilage. A cartilage pad, called the meniscus, sits between the femur and the tibia. The entire joint is bathed in a slippery fluid (synovial fluid) which lubricates the joint and also supplies the cartilage with nutrients. The knee can be damaged by trauma (for example, falls, sports injuries, car accidents) or through disease such as with arthritis. Following trauma or disease, the articular cartilage wears away and raw bone begins to rub against raw bone. When such damage has occurred, the knee becomes painful and any or all of these conditions may follow: limping, instability, giving way, swelling, a decrease in the motion and function of the knee joint.