KNEE REPLACEMENTS ALL ABOUT KNEE REPLACEMENTS WITH DR. GIRLING
WHAT IS A TOTAL KNEE REPLACEMENT?
The knee is the largest joint in the body made up of the lower end of the thigh bone (femur), the upper end of the shinbone (tibia), and the kneecap (patella). The ends of these three bones are covered with cartilage to protect the bones and enable them to move smoothly within the joint. In a knee replacement surgery we remove the damaged cartilage and a small amount of bone. We go through the front of the knee to put in a combination of metal and plastic to make up for the damaged cartilage. Once we get those components in place, the knee moves smoothly similar to how a regular knee would.
WHAT PATIENT SHOULD CONSIDER A KNEE REPLACEMENT?
We recommend a total knee replacement once we confirm the ‘easy things’ have failed. Once a patient has tried activity modification, pain medications, injections, therapy options, home exercise, chiropractic, and if the pain is still not tolerable, if their quality of life, mood, or sleep is affected or if they are not able to do the things that they want to do, then we consider a total knee replacement. There's different types of knee replacements, however. In some cases we don't have to do a total replacement. Instead, we can perform a partial knee replacement.
WHAT ARE THE RISKS OF UNDERGOING A TOTAL KNEE REPLACEMENT?
The reason we don't offer a total knee replacement surgery to everybody is because there's certainly risks. Certain patients will be at higher risk for knee replacements than others, so there’s many factors to consider when offering this option.
The biggest risk is going to be infection. While our infection rates are incredibly low—we're way below the national average—it would be unfair for anybody to claim they have zero infections because that’s always a risk.
We worry about fractures around the implants—especially if you have trauma. We worry about falls and instability, which can develop over time, or injury caused by an incident like a car accident.
Most of all, our biggest worry is patients who get a replacement with unrealistic expectations. For that reason, we always recommend talking to your surgeon to make sure you're comfortable with details of the upcoming procedure: what to expect before surgery, how bad the knee is before surgery and what you will experience after the replacement.
Lastly, we worry about all the details surrounding an anesthesia procedure—which is a concern for any type of surgery. We worry about blood clots, the heart, the lungs, and making sure we're safe and healthy for surgery. While there's certainly many factors we consider, anesthesia induction is one of the major categories.
Our prime strategy going into surgery is to always talk to our patients about all the risks involved prior to surgery and the expectation post surgery.
WHAT IS INVOLVED IN THE RECOVERY FROM SURGERY?
Typically, when we perform total knee replacement, you will be up and walking the same day. Our goal is to have the patient moving right away.
A lot of patients are actually now candidates for an ‘outpatient’ surgery, a medical treatment that does not require being admitted to a hospital. I'll do the surgery then we can get you home the same day so you can be with your family and in your own home. You'll have the medications you need with a lot of instructions and guidance to set you up for success. Alternatively, we can take the traditional route of having the patient stay in the hospital. Our average hospital stay now is really only one night for most patients. Certainly, if you need longer we will not rush out.
With both ‘outpatient’ and traditional surgery, the patient can be up and walking the same day while using walking aids. At first, you're leaning on the walking aids, but after some time the aid becomes just training aids. Most patients are off the walking aids in about two and four weeks. It really comes down to your strength and your stability.
Safety's key. By six weeks, you're moving around and feeling really good. Night pain seems to be the last thing that goes away because you're working really hard in therapy to keep the muscles strong. Finally, we consider a knee replacement fully healed between two and three months. At that time, you're back to most of your activities, you're moving around like you were before surgery, and you are probably doing activities you hadn’t done in a while.
Knee replacements keep on getting better because your body keeps adapting to it. You keep adding new activities for about a full year after the surgery, so it's a gradual process. With the newer techniques of today, we're getting patients a lot better, a lot quicker.
The biggest differences, recently, are our approach to surgery, how we manage the surgery itself, and the post operative recovery. The implants are great, they last a lot longer than they used to. Overall, I believe that’s where we shine the most—our process during and after surgery.
IS THERE A COMMON MISCONCEPTION ABOUT A TOTAL KNEE REPLACEMENT?
I believe most patients who are apprehensive or hesitant about knee replacement surgery develop those feelings from talking to a patient who had a bad experience. I believe that's true with anything—whether it's medicine or other areas in life. The patients who don't have a good outcome are the ones that are gonna be the most vocal—and, I think that's fair. When you've had a complication or a problem during a medical procedure or in any facet of life, you certainly want to vocalize it to share your experience.
However, if you are somebody who's looking at a knee replacement keep in mind that behind every patient that's unhappy with their outcome, there's hundreds that are doing fantastic that don't talk about their knee replacement. Frankly, I believe those happy patients forget that they had a replacement sometimes. Due to that, I believe trusting your surgeon, understanding the upcoming process, have realistic expectations about your specific situation, and knowing what to expect are the most important parts of this procedure. That's how we know we're going to get you to where you want to be and where we can get you with good expectations.