Knee Replacement FAQs
How long will the knee replacement last?
There is no easy answer to this question. Most studies to date show excellent implant survival rates at long-term follow up (10-15 years). However, the longevity of the knee replacement can be influenced by factors other than implant material, design, and surgical technique. For example, the younger the age of a patient at the time of knee replacement, the higher the risk of needing to revise the implants. This is because the risk of failure increases by 0.5 – 1% for every year of life. Other factors such as infection, bone fracture, and dislocations may also necessitate revising the implants.
What is the difference between partial and total knee replacement?
The knee consists of three compartments. A partial knee replacement replaces one of those three compartments. In contrast, a total knee replacement replaces all three compartments. Both procedures are successful options for severe knee arthritis depending the extent of disease. If you are a candidate for both procedures, Dr. Halawi will discuss each option with you.
Can I have both of my knees replaced at the same time?
The recovery from one knee replacement requires considerable rehabilitation to ensure favorable functional outcomes. Patients often rely on the opposite leg as they get used to the replaced knee. When both knees are replaced at the same time, the amount of pain, stiffness, and swelling is doubled, amplifying the rehabilitation demands and prolonging recovery. Studies have also reported higher rates of blood transfusion, complications including blood clots, and non-home discharge when both knees are replaced at the same time. For those reasons, we recommend replacing one knee at a time, usually 6 – 12 weeks apart depending on how soon a patient recovers from the first knee replacement.
What kind of anesthesia will I have?
For primary knee replacement, Dr. Halawi’s preferred anesthetic technique is spinal anesthesia with light sedation. Compared to traditional general anesthesia, the advantages of spinal anesthesia include lower blood loss, less pain, less systemic effects, and less complications. However, not all patients are candidates for spinal anesthesia and the choice of anesthesia will be determined by your anesthesiologist.
Will I have a computer, robot, or custom-made cutting guides in my surgery?
Both computer navigation and robotic-assisted surgery are great technologies that aim to improve surgical accuracy, but their clinical advantages over conventional instrumentation remain to be demonstrated. Most knee replacements can be performed reliably with conventional instrumentation. Dr. Halawi uses computer, robot, or custom-made cutting guides for special cases where conventional instrumentation is of limited use.
How big will my scar be?
On average, the surgical incision is 6 – 8 inches long depending on the size of the leg and case complexity.
How is recovery process?
Dr. Halawi utilizes minimally invasive surgery and rapid recovery pathways. In the absence of intraoperative complications, patients will ambulate as soon as they recover from anesthesia and are expected to walk at least 100 feet the day of surgery. You will have a therapist teach you how to get in and out of bed or chair, navigate stairs, use the walker, and manage your activities of daily living.
A total knee replacement requires considerable rehabilitation after surgery. This is because the replaced knee has a tendency to be stiff and swollen with resulting pain. Daily exercises are required for several weeks to maximize the knee range of motion.
The skin incision usually heals in 2 – 3 weeks. Most patients are walking without assistive devices by 6 weeks. Complete recovery (bone and soft tissue healing) may take up to a year, but most patients experience significant improvement and return to baseline activities or work by 3 months.
How long will I stay in the hospital?
Depending on the time of the day when the surgery is finished and meeting discharge criteria, patients leave to home either the same day of surgery or the following day. In certain circumstances (e.g., a patient with poor health and lack of family support), discharge to a rehabilitation or skilled nursing facility may be necessary and this may require longer hospitalization depending on your insurance carrier. Most patients recover better at the comfort of their homes.
Will I be in pain?
Pain is expected after surgery but will normally improve. Every person reacts to pain differently. In general, the higher the pain level and disability one has before surgery, the higher the chance of experiencing more pain after surgery. Patients on chronic prescription opioids before surgery are especially likely to experience higher pain levels after surgery. If you are on prescription opioids, you will be advised to reduce the medication(s) amount or wean off completely before surgery. This has not only been shown to improve pain control after surgery, but there also is emerging evidence that it reduces the risk of postoperative complications. Dr. Halawi uses multimodal pain relief pathways (before, during, and after surgery) that has been shown to significantly improve pain control and minimize the need for opioid medications. This also permits faster discharge and increased ability to work through the recovery process.
When can I walk?
In the absence of intraoperative complications, patients will ambulate with the help of a walker as soon as they recover from anesthesia. Patients are expected to walk at least 100 feet the day of surgery and daily to tolerance thereafter.
When can I drive?
You can drive when you have good control of your right leg, you are able to get in and out of the car on your own, and are not taking any opioid medications. This can range from 2 – 6 weeks.
When can I return to work?
The decision to return to work primarily rests with you depending on your recovery and the demands of your job. Depending on your occupation, this can range from 6 weeks – 3 months. Most patients return to light duty first and then advance as tolerated. It is important that you plan accordingly to avoid any issues with your employer.
Will I have any restrictions after surgery?
Your prosthetic knee will never be like the native, self-remodeling, and shock-absorbing knee that you were born with. After surgery, you will be encouraged to gradually resume the activities you enjoy as you progress with recovery. However, you are cautioned to avoid high-impact activities such as jumping and long-distance running as it is not clear how these activities may impact your knee replacement in the long-term. Return to sports is not recommended until after 3 months from surgery.
What are the potential complications of knee replacement?
Although infrequent, there are several potential complications associated with knee replacement. These include:
- Infection (most common cause of early failure).
- Implant wear and/or loosening (most common cause of late failure).
- Fractures around the prosthesis.
- Tendon and/or ligament rupture.
- Maltracking of the knee cap.
- Wound healing issues.
- Nerve and/or blood vessel injury.
- Blood clots (in legs and/or lungs).
- Persistent pain.
- Metal hypersensitivity.
Will my knee replacement set off metal detectors?
Yes. If you are at an airport, simply notify the TSA agent of your knee replacement prior to screening. You will still have to be screened like everyone else and may need to show the agent your surgical scar.
How long will I continue to see my surgeon after surgery?
Routine follow-up is 2 weeks, 6 weeks, 1 year, and then every other year.
Do I need antibiotics when I see my dentist?
The use of antibiotics before dental work is a topic of debate due to inconclusive evidence regarding the efficacy of this practice. In general, patients undergoing dental procedures other than simple cleanings, those with immunocompromised health, poor diabetes control, and/or history of prior joint infection are advised to take a single dose of an oral antibiotic one hour prior to the planned dental procedure. Notify your dentist prior to your dental appointment so an antibiotic can be prescribed in a timely manner.