Evaluation and expectations

Is Total Knee Replacement for You?

The decision whether to have total knee replacement surgery should be a cooperative one between you, your family, your family physician, and your orthopaedic surgeon. Your physician may refer you to an orthopaedic surgeon for a thorough evaluation to determine if you could benefit from this surgery.

Reasons that you may benefit from total knee replacement commonly include:

• Severe knee pain that limits your everyday activities, including walking, going up and down stairs and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cain or walker.

• Moderate or severe knee pain while resting, either day or night.

• Chronic knee inflammation and swelling that doesn't improve with rest or medications.

• Knee deformity - a bowing in or out of your knees.

• Knee stiffness - inability to bend and straighten your knee.

• Failure to obtain pain relief from non-steroidal anti-inflammatory drugs. These medications, including aspirin and ibuprofen, often are more effective in the early stages of arthritis. Their effectiveness in controlling knee pain varies greatly from person to person. These drugs may become less effective for patients with severe arthritis.

• Inability to tolerate or complications from pain medications.

• Failure to substantially improve with other treatments such as cortisone injections, physical therapy or other surgeries.

Most patients who undergo total knee replacement are age 60 to 80, but orthopaedic surgeons evaluate patients individually. Recommendations for surgery are based on a patient’s pain and disability, not age. Patients as young as age 16 and older than 90 have undergone successful total knee replacement.

The Orthopaedic Evaluation

The orthopaedic evaluation consists of several components:

• A medical history, in which your orthopaedic surgeon gathers information about your general health and asks you about the extent of your knee pain and your ability to function.

• A physical examination to assess your knee motion, stability and strength and overall leg alignment.

• X-rays to determine the extent of damage and deformity in your knee.

• Occasionally, blood tests, an MRI (magnetic resonance imaging) or a bone scan may be needed to determine the condition of the bone and soft tissues of your knee.  

Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether total knee replacement would be the best method to relieve your pain and improve your function. Other treatment options including medications, injections, physical therapy, or other types of surgery also will be discussed and considered.

Your orthopaedic surgeon also will explain the potential risks and complications of total knee replacement, including those related to the surgery itself and those that can occur over time after your surgery.

Realistic Expectations About Knee Replacement Surgery

An important factor in deciding whether to have total knee replacement surgery is understanding what the procedure can and can’t do.

More than 90 percent of individuals who undergo total knee replacement experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement won’t make you a super-athlete or allow you to do more than you could before you developed arthritis.

Following surgery, you will be advised to avoid some types of activity for the rest of your life, including jogging and high impact sports.

With normal use and activity, every knee replacement develops some wear in its plastic cushion. Excessive activity or weight may accelerate this normal wear and cause the knee replacement to loosen and become painful. With appropriate activity modification, knee replacements can last for many years.

Preparing for Surgery

Medical Evaluation If you decide to have total knee replacement surgery, you may be asked to have a complete physical by your family physician several weeks before surgery to assess your health and to rule out any conditions that could interfere with your surgery.

Tests Several tests, such as blood samples, a cardiogram, and a urine sample may be needed to help your orthopaedic surgeon plan your surgery.

Preparing Your Skin and Leg Your knee and leg should not have any skin infections or irritation.Your lower leg should not have any chronic swelling. Contact your orthopaedic surgeon prior to surgery if either is present for a program to best prepare your skin for surgery.

Blood Donation You may be advised to donate your own blood prior to the surgery. It will be stored in the event you need blood after your surgery.

Medications Tell your orthopaedic surgeon about the medications you are taking. He or she will tell you which medications you should stop taking and which you should continue to take before surgery.

Dental Evaluation Although the incidence of infection after knee replacement is very low, an infection can occur if bacteria enter your bloodstream. Treatment of significant dental diseases (including tooth extractions and periodontal work) should be considered before your total knee replacement surgery.

Urinary Evaluations A preoperative urological evaluation should be considered for individuals with a history of recent or frequent urinary infections. For older men with prostate disease, required treatment should be considered prior to knee replacement surgery.

Social Planning Though you will be able to walk on crutches or a walker soon after surgery, you will need help for several weeks with such tasks as cooking, shopping, bathing, and doing laundry. If you live alone, your surgeon’s office and a social worker or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at home. They also can help you arrange for a short stay in an extended care facility during your recovery, if this option works best for you.

Home Planning Several suggestions can make your home easier to navigate during your recovery. Consider:

• Safety bars or a secure handrain in your shower or bath.

• Secure handrails along your stairways.

• A stable chair for your early recovery with a firm seat cushion (height of 18-20 inches), a firm back, two arms and a footstool for intermittent leg elevation.

• A toilet seat riser with arms, in you have a low toilet.

• A stable shower bench or chair for bathing.

• Removing all loose carpets and cords.

• A temporary living space on the same floor, because walking up or down stairs will be more difficult during your early recovery.

October 2003