A Patient’s Complete Guide to Knee Replacement Surgery

July 13, 2023 By Stefan D. Tarlow MD

Knee replacement surgery is a life-changing procedure that can provide immense relief and improved mobility for individuals suffering from severe knee pain and dysfunction. If you or a loved one are considering knee replacement surgery or seeking information about the procedure, this comprehensive guide will address your concerns, provide a detailed understanding of the surgery, and help you make an informed decision.

Understanding Knee Problems

an elderly man holding his knee because of knee pain

Before delving into knee replacement surgery, it’s important to understand the common causes of knee pain and mobility issues. Osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, and other conditions can lead to the deterioration of the knee joint, causing pain, stiffness, and limitations in daily activities. Non-surgical treatments such as medication, physical therapy, and lifestyle modifications may offer temporary relief, but when these options are no longer effective, knee replacement surgery becomes a viable solution.

Knee Replacement Procedure

The knee replacement procedure involves removing the damaged surfaces of the knee joint and replacing them with artificial components. This surgical intervention is customized to meet the unique needs of each patient, with options including total knee replacement or partial knee replacement. During the surgery, the patient is placed under anesthesia. The surgeon makes an incision to access the knee joint. Using robotic technology, the damaged bone and cartilage are precisely removed using the Mako robot, and the artificial components are securely placed to correct angular deformity to restore stability which alleviates arthritic knee pain. Many people have returned to near-normal functions by returning to activities such as walking, hiking, most sports, and travel.

Preparing for Knee Replacement Surgery

a patient and a knee surgeon doing a pre operative consultation

Before undergoing knee replacement surgery, a thorough evaluation and consultation process is conducted to ensure the patient’s suitability for the procedure. This includes reviewing medical history, physical examinations, and pre-operative tests to assess overall health. Lifestyle modifications, such as weight management and strengthening exercises, may be recommended to optimize the surgical outcome. Correctable risk factors (obesity, diabetes, and smoking) should be modified prior to surgery to minimize the risk of an adverse event. During this preparatory phase, we address patient expectations and address any concerns that are specific to our individual patients.

The Day of Surgery

Knee replacement is a day surgery procedure for nearly all people. On the day of the surgery, patients are admitted to the Ambulatory Surgery Center and undergo pre-surgical preparations with the surgical team that includes nursing and anesthesia and your surgeon. The patient is then taken to the operating room, where the surgical procedure is performed under the care of experienced orthopedic surgeons and a dedicated medical team. Post-surgical recovery room care and monitoring is usually 90 minutes, ensuring the patient’s comfort and stability. People are discharged to home with a walker, pain medications, and post-op instructions.

Knee Replacement Recovery

The recovery phase after knee replacement surgery is crucial for a successful outcome. Physical therapy plays a significant role in the recovery process, helping patients regain knee strength, flexibility, mobility, and decreased pain. Strong pain medicine is required for 3-5 days. A walker is used for 7-14 days. A healthy diet, rich in nutrients, is also important for optimal healing and recovery. Patients can expect to achieve various milestones throughout the recovery timeline, gradually returning to their driving (1-2 weeks), normal daily activities (2-4 weeks), and work and exercise routines (1-3 months).

Managing Risks and Complications

a knee doctor talking to a patient in a wheelchair

Like any surgical procedure, knee replacement surgery carries certain risks and potential complications. These may include infection, blood clots, implant-related issues, and nerve or blood vessel damage. However, advancements in surgical techniques, infection prevention protocols, and appropriate post-operative care have significantly minimized these risks. It’s crucial for patients to follow their surgeon’s instructions, take prescribed medications, and seek medical help if they notice any signs of complications.

Life After Knee Replacement

After successful knee replacement surgery, patients experience remarkable improvements in mobility, pain relief, and overall quality of life. Activities that were once limited or challenging become more manageable. While the artificial knee joint may last for many years, proper care and maintenance are essential. Lifestyle factors such as maintaining a healthy weight, engaging in low-impact exercises, and avoiding excessive strain on the knee joint can promote long-term joint health.

Frequently Asked Questions (FAQs)

To address common concerns, here are answers to some frequently asked questions about knee replacement surgery:

How long does the recovery process take after knee replacement surgery?

The recovery timeline varies for each individual, but most patients can expect significant
improvement within a few weeks. Full recovery and return to normal activities may take 3-12 months.

What precautions should I take during the recovery period?

It is important to follow the surgeon’s post-operative instructions, including medication
schedules, physical therapy exercises, and wound care. Avoid high-impact activities and excessive bending or twisting of the knee during the initial recovery phase.

Will I be able to resume activities such as sports and exercise after a knee replacement?

Most patients may resume most activities such as walking, swimming, cycling, hiking, racquet sports, skiing, golfing, and jogging. Always consult with your surgeon regarding specific activities and timelines.

What are the potential risks and complications associated with knee replacement surgery?

Potential risks include infection, blood clots, implant-related issues, nerve or blood vessel damage, and allergic reactions. However, these risks are relatively low, and the surgical team takes necessary precautions to minimize them.

How long does a knee replacement implant last?

Modern knee replacement implants are designed to be long-lasting, with an average lifespan of 20 – 30 years. However, the actual durability can vary depending on various factors, including patient activity level and overall joint health.

What are signs that indicate the need for a knee replacement?

Signs that you may need a knee replacement include persistent knee pain, limited mobility, difficulty performing daily activities, and the failure of non-surgical treatments to provide relief. Consult with an orthopedic specialist for an accurate diagnosis and treatment recommendation.

How Successful Are Total Knee Replacements in the First Three Years?

Knee Replacement surgery is very successful. 90% of patients are pleased with their knee function with the artificial joint. Twenty-year implant survival rates are 90%.

Does Outpatient Physical Therapy Improve Functional Outcome After Total Knee Replacement?

Quality of life and functional outcomes after total knee replacement are of great importance to both patients and surgeons. All studies show that a post-operative rehabilitation program is essential for a successful functional outcome. However, that program can either be directed by a physical therapist or the patient. Be sure to exercise your replaced knee in the first few months after surgery – failure to participate in some type of rehabilitation program will be a detriment to your outcome.

Knee replacement surgery offers hope and restoration for individuals suffering from debilitating knee pain and limited mobility. By understanding the procedure, its benefits, risks, and recovery process, patients can make an informed decision and approach their surgery with confidence. Remember, always consult with an experienced orthopedic surgeon to assess your individual situation and determine the best course of action.

If you are interested in learning more about knee replacement surgery, its benefits, and the recovery process, visit https://tarlowknee.com/ to explore additional information and resources.

Kneecap Replacement Surgery Recovery Time

September 20, 2017 By Stefan D. Tarlow MD

The recovery time of kneecap replacement surgery depends on what type of procedure was performed, the quality of the knee surgeon and on the health and age of the individual having the surgery. However, to speed up your recovery, it is important that you follow the advice of your surgeon after the surgery. Much depends on how you take care of yourself with regards to how soon you will be able to be up and running.

How Soon Will You Be Able to Be Up and About?

If you have undergone a minimally invasive kneecap replacement surgery, you will be able to stand up and walk on the very same day of your operation. The staff or nurse will help you stand and assist you in walking within the first 12 to 24 hours after the operation. During this time, it is highly encouraged that you use crutches or a frame when walking. In most cases, people will be able to walk independently, supported by a stick or cane, after just about a week.

While you are still staying in the hospital, you will be taught certain exercises that help strengthen your knee. You can begin doing these minimal and safe exercises the day after the operation. It is important that you only follow the advice of the medical professional.

It is normal to feel and experience discomfort when walking and exercising during the first few days. Other people also experience swelling in their feet and legs. If there is swelling, it is advised that you raise your legs to improve circulation. You may also be put on a motion machine while you are in bend to restore movement in your knee and legs.

Recovery At Home

You will only stay in the hospital, generally, for three to five days. This depends on how you progress and the type of kneecap replacement you underwent, whether it was traditional surgery or minimally invasive. Half-knee replacement and minimally invasive procedures usually require shorter hospital stay. Others even get discharged within the first three days after the operation, of course, upon the advice of your doctor.

When you are at home, take time to rest. It is normal to experience discomfort and tiredness. That is a normal aftermath of a surgery. Just follow the advice of your surgical team and other medical professionals that had a hand in your surgery. To speed up your recovery at home, avoid the things that the professionals asked you to avoid and continue exercising. It is better if you have someone who will assist you in your recovery at home for your safety. Just eat healthy and take care of yourself and you’ll recover quickly.

How Long Till You Feel Normal

You can do away with the crutches, frame or stick after six weeks. By this time, you can now resume your normal leisure activities. However, in some instances, the swelling continues up to three months. But this will generally not affect your movement and daily activities. Just avoid extreme sports and strenuous movements until you have fully recovered.

If you wish to know more about kneecap replacement surgery or if you are planning to undergo such procedure, make sure that you only contact a knees-only orthopedic surgeon like Dr. Tarlow. Contact us today to schedule your appointment.

Warning Signs That You May Need Knee Replacement Surgery

August 29, 2017 By Stefan D. Tarlow MD

This past year, there have been more than 600,000 total knee replacements performed by surgeons in the United States alone. And this number is expected to continually rise for the years to come. This says that despite the long rehabilitation and recovery process of the procedure, more and more people trust the effectiveness and benefit of the knee replacement surgery. But when do you know that you may already need to undergo knee replacement surgery? The answer is both personal and practical.

Sometimes, people wait for things to become unbearable and too much before they decide to get knee replacement surgery. Well, this is more or less a normal response because surgery is a big deal to most people. People prefer minimally invasive and other non-surgical options to treat their knee problem. But there are cases where the only and best option left is to undergo total or partial knee replacement. And there are warning signs for this.

Signs You Need Knee Surgery

Severe pain in the knee and the surrounding area, which already affects your daily activities.
Knee pain is still present even when you are resting, feeling moderate to severe pain day or night.
Knee swelling and inflammation that no longer respond to medications.
Knee stiffness.
Bowing out of the leg.
Taking NSAIDs no longer provide relief for the pain.

If you feel and experience these warning signs, immediately go to the surgeon and ask for an advice. Chances are, it is high time that you undergo knee replacement surgery before things get from bad to worse.

These are serious signs. These signify that you must not delay because things are surely starting to get worse. The best warning that you must really heed is when the surgeon himself has advised you to undergo surgery as soon as possible. If you don’t heed such warning signs, you may suffer from any of these repercussions.

Weakened muscles and ligaments in the knee.
Deformities of the area outside the knee joints.
Limited mobility due to loss of functionality and chronic pain.
Continued degeneration of the knee joints which leads to various complications.
Reduced success rate of surgery in the future.

There is no hard and fast rule as t when you should need knee replacement surgery. The best advice is that coming from a reliable, experienced surgeon. Factors like medical conditions, age, weight and lifestyle also play a vital role on whether you should undergo knee replacement or not, or when.

Contact a Surgeon

But if you already suffer from any of the mentioned warning signs, the best thing to do is not to delay. Immediately seek help from a qualified professional. If you decide to get a Makoplasty knee replacement surgery, don’t hesitate to come straight to TarlowKnee. We provide advanced knee care in Arizona.

TKR Surgery Fact: Do Both Knees End Up Being Replaced?

July 26, 2017 By Stefan D. Tarlow MD

Not all who have knee problems need to undergo knee replacement. Most of the time, only patients with severe destruction of the knee joint or osteoarthritis end up having their knee replaced. The procedure is medically known as Total Knee Replacement surgery. In this procedure, the defective knee will be replaced with an artificial one. The diseased or injured joint will be replaced with plastic and metal parts which function normally and last long enough for the patient to enjoy doing normal activities again.

Total Knee Replacement is a popular procedure not only for osteoarthritis patients, but also to those who have devastatingly injured their knee. Despite the success and innovativeness of this procedure, some people are still wary of its effects. Some patients are still concerned about the pros and cons of Total Knee Replacement.

But it is not only this that they are worried about. There are reports that say once you have undergone TKR on your one knee, you will likely undergo another procedure on your other knee. Patients raise concern that once you have had one knee replaced, there is a high chance that your other knee will need replacement too. So the question that needs to be answered is this: do both knees end up being replaced? Is this a fact or just a myth? Let us find out if there is any truth to this.

To answer the question, let us take a look into a particular study conducted on the subject. A population study spanning 40 years was conducted. This question was addressed to the TKR candidates: if you had one knee replaced, what are the chances that the other knee will also be replaced through Total Knee Replacement surgery? Based on the data studied, the general finding is this: there is 45% chance that the other knee will be replaced within 11 years after the first knee replacement. In the study, the data of 2,000 total knee patients, spanning from 1969 to 2008, were analyzed. The results show that out of the 2,000 patients who underwent one knee replacement, 809 had their other knee replaced within 11 years after the initial knee replacement procedure. In fact, most of the patients underwent the second knee replacement surgery within 10 years.

Now going back to the question, the answer is yes, it is a TKR surgery fact that both knees could end up being replaced. But this does not mean that TKR as a procedure is not working. It just goes to show that once one knee has encountered an injury or another problem that needs surgery; there is higher chance that the other knee will also encounter the same fate. Still, this does not take away the fact that TKR is an innovative and important procedure. And if you indeed end up having your other knee replaced too with an artificial one, you can still count on the procedure just as you had during the first surgery. As long as it is done right and by the right professional, there is really nothing to worry about.

If you wish to know more facts about Total Knee Surgery or if you need to consult anything about your knee problems or injury, contact Dr. Tarlow at Advanced Knee Care. Make an appointment with us and we will help you with your knee issues.

Sex Life after Knee Replacement

July 19, 2017 By Stefan D. Tarlow MD

Knee problems such as osteoarthritis affect millions of Americans every year. Aside from this fact, many people are not that aware that there is a correlation between knee problem and sexual function. Based on a research presented at the annual meeting of American Academy of Orthopaedic Surgeons (AAOS), osteoarthritis of the knee limits sexual activity.

In a survey of Knee Replacement patients, several patients were observed. These patients have undergone knee replacement surgery two years prior. The results and findings of such survey were published in the Journal of Arthroplasty. Before knee replacement, 45% of the patients with knee arthritis said that before knee replacement, their sexual frequency and/or quality was limited. They cited knee pain and limited knee flexions as the major factors that make having sexual activity challenging. After they have undergone knee surgery, 72% of the patients said that they were no longer limited by the aforementioned factors. Postoperatively, patients were able to resume sexual activity at an average of 2 ½ months (ranging from 0-18 months) after the knee replacement operation.

In another study, patients under the age of 70 with a mean age of 57.7 years agreed to participate. The study required them to answer and fill out questionnaires prior their scheduled for primary total knee replacement. They were also asked again six months and then one year after surgery. Out of the 147 patients, 78 of which are women and 68 are men, 65% participated in and completed the three surveys. The result of said study contains the following findings and generalizations:

67% of the patients reported physical problems and limitations regarding sexual activity prior to the surgery. The common problems include stiffness, pain, reduced libido and inability to attain proper sexual position.
91% of the patients answered that they experienced psychological issues related to their knee problem or osteoarthritis. The issues include low sexual self image and diminished sense of general well-being.
90% of the TKR patients reported that they experienced improved overall sexual function after the surgery. More women reported improvement more than men. 42% reported improvement in libido; 41% said that their intercourse frequency has increased; 41% also said that they have increased intercourse duration; 84% of the patients reported that their general well-being improvement; and 55% attested that their sexual self image developed. Only 16% of the patients said that the surgery did not significantly affected their sexual function, particularly due to fear that the replacement joint might get damaged.

Sexual function is also a vital part of one’s life. It is only justifiable to include sexuality and sexual activity in the evaluation of the outcome of total knee replacement and other knee surgery. Sexual experience is part of one’s overall health and lifestyle, which is why it is great to note that knee surgery has something to offer as regards one’s overall sexual function.

But there must be a balance between sexual function and taking care of the knee replacement. This is better discussed personally with your surgeon or knee professional. If you need to learn more about knee surgery or if you want to undergo the same, contact Tarlow Knee. Make an appointment with us today.

Improving Total Knee Replacement Surgery Results: Optimize Risk Factors PreOp

March 20, 2017 By Stefan D. Tarlow MD Leave a Comment

One way of improving the results of Total Knee Replacement Surgery is to optimize the risk factors. The common patient risk factors include the following: uncontrolled diabetes (Blood Sugar >150, HbA1C>8), Smoking, Obesity (BMI > 40), Opioid use, and Kidney disease. All these risk factors should be corrected prior to having the surgery.

There are treatments available to reverse these risk factors. Uncorrected, the above listed factors increase the chance a patient will suffer an prosthetic joint infection, a return to the operating room for another knee procedure, wound healing problems, revision knee surgery or an unsatisfactory surgical result.

Knee Replacement Surgery Risks

Like any other surgery, total knee replacement carries some risks. However, the occurrence of these risks is quite low: infection, nerve damage, stroke or blood clot. The aforementioned risks are those that might occur during or after the surgery. What we are going to focus on are the factors that might affect the outcome of the surgery. Such factors or risks must be corrected before the surgery is conducted. They include the following: uncontrolled diabetes, smoking, obesity, opioid use and kidney disease.

Uncontrolled Diabetes

The Risks

According to a number of studies, people with diabetes face a higher risk of postsurgical complications. The possible complications that a patient may experience if he/she undergoes a surgery such as total knee replacement with uncontrolled diabetes are the following: joint loosening, fracture around the implant, blood clot, stroke and wound infection.

The Treatment

Diabetes is an important consideration before a patient undergoes a surgical procedure. The research suggests that patients need to control their diabetes before undergoing a major surgery such as total knee replacement. While your blood sugar will be tightly monitored right before and after surgery, it’s up to you to make the long-term lifestyle changes necessary to ensure you get the best outcome. This is an important conversation to have with both your surgeon and the physician or provider who helps you manage your diabetes. Eating well and exercising (if appropriate and with approval from your providers) can help you get your body ready for surgery.

Smoking

The Risks

Research shows that there is a correlation between smoking and the success of knee surgery. Some studies put the chance of redoing the surgery at a rate ten times higher in smokers than in non-smokers. Smokers also show higher rate of surgical complications which include blood clots, kidney problems, urinary tract infections, and abnormal or irregular heartbeats. This is because nicotine constricts the blood vessels, which interfere with and affect the healing process.

The Treatment

The best way to get rid of the risks is to quit smoking. You may have tried to do so in the past and not found success, but if you’re going to have total knee replacement surgery, let this be the big push you need to finally quit. In addition to the possibility of increased post-surgical complications, just imagine trying to find a place to smoke while you’re recuperating. Talk with your primary care provider about available techniques and support.

Obesity

The Risks

Obesity is the root of various health conditions and diseases like type 2 diabetes, obstructive sleep apnea, cardiovascular diseases, hypertension and metabolic syndrome. All these conditions increase the risk of knee replacement surgery. Aside from these, patients with obesity are also more at risk to experience the following postsurgical risks: blood clots, difficulty breathing, poor and slow wound healing, infection and pulmonary embolism.

The Treatment

To lower the risks and to promote a better result, patients with obesity are advised to lose some weight. It is important that the patient is in good health and weight prior the surgery. Try hard to lose some weight and eat healthy before the scheduled surgery. Your immediate post-surgical health will improve—and along with your new knee, being in better shape will give you a new lease on life.

Opioid Use

The Risks

One of the total knee replacement precautions a patient must know concerns opioid use. One study showed chronic opioid use before a total knee arthroplasty led to worse outcomes for patients, including “longer hospital stays, more postoperative pain, and higher complication rates… [patients] were also more likely to need additional procedures, require referrals for pain management, suffer from unexplained pain or stiffness, and have lower function and less motion in the replaced knee.”

The Treatment

The FDA suggests that patients undergoing knee replacement surgery should decrease the duration and amount of opioid use. There are many other pain management treatments available besides opioids, and you should explore them with your pain management physician—not just because of your surgery, but because chronic opioid use itself brings a whole host of problems you don’t want.

Kidney Disease

The Risks

Patients with kidney disease, particularly chronic renal disease, have increased risk for readmission after the surgery. The success of knee replacement surgery is also low and the occurrence of common complications is high among patients with kidney problems.

The Treatment

If you have kidney disease and need to have surgery—any kind of surgery—you and the doctor managing your disease, as well as the surgeon, need to work closely together to assess your risk and make sure surgery is the right course for you. If you and your providers move ahead, techniques like post-operative dialysis, substituting or changing the normal dose of medications like antibiotics given before and during surgery and avoiding pain medications that are known to cause problems are all good strategies to keep you healthy.

Reducing Total Knee Replacement Complications

We, the patient and the doctor, both want something in common. That is, the best outcome possible of the surgery. Knowing how to reduce the complications is powerful information. It is very important that you follow the tips mentioned in this article and control the risks mentioned to improve the results of your total knee replacement surgery.

If you’re contemplating knee replacement, schedule an appointment to see me and the rest of the team here at Advanced Knee Care. Assessing your needs and the appropriate treatment for you is our top priority.

Knee Surgery for Obese Patients: Problems and Solutions

March 5, 2017 By Stefan D. Tarlow MD Leave a Comment

Why Obesity Poses Greater Risks for Surgical Complications

A literature review published in the May issue of the Journal of Arthroplasty attempts to define and identify areas of concern for obese patients undergoing total joint arthroplasty (TJA). “Obesity risk assessment is compounded by the fact that obesity is rarely an isolated diagnosis,” the authors write, “and tends to cluster with other co-morbidities that may independently lead to increased risk such as diabetes mellitus, coronary artery disease, hyperlipidemia, hypertension, and sleep apnea.” Among the authors’ findings:

- Despite improvements in patient-related outcome measures, all obese patients undergoing total joint arthroplasty are at increased risk for perioperative complications.
- Patients with a body mass index greater than or equal to 40 who undergo total knee arthroplasty are at risk for the majority of perioperative complications.

Published data on perioperative complications among obese patients undergoing total hip arthroplasty appear to be less clear.

New Procedure Offers Treatment Option for Obese Patients With Knee Pain

Subchondrplasty Joint Preservation Treatment Less Invasive Than Joint Replacement Surgery.

MRI of BME-Xray normal
From Zimmer Institute

Subchondroplasty® Procedure is the innovative new joint preservation procedure developed by Zimmer Knee Creations to treat the microfractures that develop just under the joint surface in painful knees. These lesions are similar to stress fractures and develop due to overload of the bones that make up the knee joint.

Rather than replacing the entire knee, this treatment aims to stimulate nature to heal the bone lesion which can lead to reduced knee pain and better knee function. Subchondroplasty is an arthroscopic knee surgical procedure done as an outpatient. This is a safer and less invasive procedure than Total or Partial knee replacement and as such may be carried out in higher risk surgical patients, such as the obese patient, with less fear of an adverse outcome such as infection or blood clot.

BML-MRI image
From Zimmer Institute

Bone Marrow Edema (BME), or Bone Marrow Lesions (BML) are thought to cause pain in knees with early or late osteoarthritis. These lesions can only be diagnosed with high resolution 3 T MRI scans. In 2001 Felson identified BME/BML as the strongest predictor of the presence of pain associated with knee OA. They also determined that arthroscopy alone will not predictably relieve knee pain associated with arthritis.

This observation has been confirmed by other investigators. However, the novel Subchondroplasty® Procedure is a percutaneous outpatient intervention that addresses the painful defects associated with subchondral bone marrow lesions (BME/BML). BMLs are related to stress fractures or micro-fractures, that can only be visualized using MRI scans. Left untreated, these defects have been shown to lead to cartilage degeneration, limited function, pain and greater risk for joint deterioration.

Theoretically, mechanical enhancement and/or biologic stimulation of chronically damaged and structurally compromised SubChondral bone, juxtaposed to a region of the joint with deficient cartilage, will relieve Knee pain emanating from the SubChondral bone and slow progression both bone and cartilage deterioration.

From Zimmer Institute

In this minimally invasive, arthroscopically-assisted procedure, navigation instruments are used to inject specialized Ceramic Calcium Phosphate bone filler (Etex), without violating the joint. As the bone filler is resorbed, the pain due to BML subsides as the lesion is replaced with new, healthy bone. The substitution of abnormal bone with healthy bone is the reason patients experience pain relief. The Subchondroplasty Procedure is the first procedure to treat bone-based changes within a painful joint, and addresses an unmet clinical need between early interventions, such as NSAIDs and joint arthroscopy, and total joint replacement. Subchondroplasty was introduced in November 2010. This procedure is now available in the Greater Phoenix area from Makoplasty Surgeon Stefan D. Tarlow, M.D. of Advanced Knee Care, PC.

How to Get Back on Your Feet Quickly After Knee Surgery

February 24, 2017 By Stefan D. Tarlow MD Leave a Comment

Predictors for Returning to Work After Total Knee Replacement

A study from Cleveland identified factors that are important in estimating a patients return to work following Total Knee Replacement surgery. Average time to return for all patients is 9 weeks.

An accelerated group returning to work in 4-5 weeks had some of these qualities: had a sense of urgency to return, were female, were self employed, had high mental health scores, had higher physical function scores, and had good overall health.

Patients with some of these qualities were likely to return to work 9 or more weeks after Knee Replacement surgery: a physically demanding job, were receiving Workman’s Compensation or had less pre operative pain.

In my practice – Advanced Knee Care – most patients return to work 4-12 weeks after Knee Replacement (a few return sooner, a few return later).

The report concluded that although the physical demands of a patients job has a moderate influence on the ability to return to work, individual characteristics including physical and mental well being and motivation are the most predictive factors for estimating return to work after Total Knee Replacement surgery.

Lifestyle Modification Key to Great Outcomes Following Knee Replacement Surgery

After recovering from knee replacement surgery, patients’ physical activity levels with their new joint were varied.

Total knee replacement is primarily for pain relief, it’s not a lifestyle intervention. After surgery patients need to change their lifestyle in order to attain expected improvement in Function and Mobility and Exercise Tolerance.

Most people who have the surgery are pleased with the results in terms of having less pain and gaining more day-to-day function. These people are not always pleased with their ability to participate in recreational activities, such as participating in sports, yoga or gardening.

At the time of surgery, study participants reported spending about two hours a week being active, mostly doing moderate-intensity activities such as yard work, strength training and walking.

After surgery patients spent about 11 hours a week being physically active, according to findings published in The Journal of Arthroplasty.

Commitment to a lifestyle change including eating healthy, exercising regularly and avoiding harmful behaviors will go a long way towards improving a patients outcome from Total Knee Replacement surgery.

Internet Based Outpatient Physical Therapy

After recovering from knee replacement surgery, patients’ physical activity levels with their new joint were varied.

At the time of surgery, study participants reported spending about two hours a week being active, mostly doing moderate-intensity activities such as yard work, strength training and walking.

After surgery patients spent about 11 hours a week being physically active, according to findings published in The Journal of Arthroplasty.

Everything You Need to Know About Minimally Invasive Surgery

February 13, 2017 By Stefan D. Tarlow MD Leave a Comment

Who is a Candidate for Minimally Invasive Surgery?

Here in the Phoenix – Scottsdale, Arizona area I am frequently asked by patients “Can you perform Minimally Invasive (MIS) Total Knee Replacement (TKR) on my knee?”

My answer is I can perform Minimally Invasive Total Knee Replacement on most any patient but I choose to use the technique on the large subset of patients that benefit most from the technique. It is a surgical procedure that is more technically demanding and more time consuming than traditional Total Knee Replacement so I am somewhat selective on choosing patients for this method. By analogy, I would not buy a new Basketball for my 90 year old mother in law but I would for my teenage son who is on the high school basketball team. She would never use the basketball and he would use it frequently.

I always perform Minimally Invasive Surgery on the healthy, motivated, energetic patients who will recover fast because of their good health and motivation to get well fast. I rarely perform Minimally Invasive Surgery on unhealthy patients with multiple co morbidities (Diabetes combined with cardiac or respiratory disease combined with high Body Mass Index is a typical patient profile that comes to mind). The first example patient would take full advantage of having had this technique by discharging from the hospital in 1-2 days, be walking freely without a walker in 5-10 days, be driving in 10 days -3 weeks, be back to work in 2-4 weeks and be golfing or hiking in the beautiful Arizona desert in 4-8 weeks. The second example patient would recover but take 1-3 months to reach similar milestones.

Body mass index is sometimes a factor since some patients with high BMI have low energy. BMI alone is not a reason not to perform MIS Total Knee surgery.

A normal BMI is under 30 and defined as a six foot tall man weighing 215 pounds or less or a five foot six inch woman weighing 182 pounds or less.
Obesity (BMI 30-40) is the six foot man between 215 and 285 pounds or the five foot six woman between 182 and 240 pounds. Morbid obesity (BMI above 40) is above 285 pounds for the six foot man and above 240 pounds for the five foot six inch woman. (BMI tables are available online to calculate your own BMI). Minimally Invasive Surgery can be performed on the higher BMI patients. It always requires a skin incision 2-4 times longer than the incision in under 30 BMI patients. The longer skin incision allows the surgeon to “convert” the high BMI patient into a low BMI patient by retracting away the “extra” skin and subcutaneous tissue. However, the definition of Minimally Invasive Surgery Knee Replacement and the key factor allowing for faster recovery is not the size of the skin incision but the size of the deep or Capsular incision that allows the surgeon into the knee joint proper. Therefore high BMI patient can have Minimally Invasive Total Knee Replacement Surgery and enjoy the benefits of a faster recovery.

Returning to the question posed at the beginning of this post: Who is a candidate for Minimally Invasive Total Knee Replacement Surgery? The answer is that most people are good candidates for MIS TKR as long as they are healthy, have a good energy level and are motivated to recover quickly.

Minimally Invasive Knee Replacement is Safe/Better: Refuting the Wall Street Journal

The October 14, 2008 edition of the Wall Street Journal published an article entitled “New Doubts About Popular Joint Surgery”. The following excerpt from the WSJ raises issues concerning Minimally Invasive Joint Replacement surgery (MIS).

“But patients aren’t always told that minimally invasive surgery is more difficult to perform than a traditional operation. Because of the smaller incision, surgeons have a harder time seeing what they are doing. And because minimally invasive surgery has grown so fast, many doctors don’t have extensive experience performing the complicated procedure.”

As an experienced MIS Knee Replacement Surgeon I completely agree with the above quoted comments. However, the other side to the story is that experienced surgeons using computer surgical navigation have patients with consistently excellent outcomes and complication rates as low or lower than traditional joint replacement surgeons.

I would like to address the three issue raised. First, “minimally invasive surgery is more difficult that a tradition joint replacement”. There is a known “learning curve” of approximately 25 cases, after which most surgeons will have mastered the MIS technique. I have been performing MIS Total Knee Replacement since 2004 and to date have over 500 cases experience. The transition to MIS replacement will occur with time and can be compared to the transition in sports medicine from open “traditional” knee and shoulder surgery in the past to current arthroscopic treatment for most knee and shoulder injuries.

Secondly, “because of the smaller incision, surgeons have a harder time seeing what they are doing”. Using Computer surgical navigation intraoperatively or computer generated surgical cutting blocks preoperatively provides the Minimally Invasive Joint surgeon with the information needed to accurately place the new hip or knee joint using the smaller incision. Computer technology more than overcomes the exposure issue raised in this second point. I personally do not perform MIS Total Knee Replacement unless I have computer navigation or computer generated cutting blocks.

Third, “because minimally invasive surgery has grown so fast, many doctors don’t have extensive experience performing the complicated procedure”. Every major city and some smaller towns have compentent, experienced minimally invasive joint replacement surgeons. As a patient, do your research and find the well trained, experienced minimally invasive joint replacement surgeon and you will often times be rewarded by a faster recovery and a less painful experience while getting all the long term benefits of traditional total joint replacement.

Minimally Invasive Total Knee Replacement Facilitates Recovery

An article appeared in the July, 2007 Journal of Bone and Joint Surgery entitled “Minimally Invasive Total Knee Arthroplasty Compared With Traditional Total Knee Arthroplasty“. The main author is Seth S. Leupold, M.D. from the Department of Orthopedic Surgery at the University of Washington in Seattle.

The conclusion of the article is that minimally invasive Total Knee Replacement seems to facilitate recovery after this operative procedure. The patients who had the minimally invasive approach demonstrated significantly better clinical outcomes with respect to shorter length of hospital stay, higher percentage of patients discharged to home instead of inpatient rehabilitation facility, less narcotic use at 2 and 6 weeks post-operatively and less need for assistive devices to walk at two weeks after surgery.

The Journal of Bone and Joint Surgery is one of the most respected and credible orthopedic surgery publications. The journal was founded in 1903 and is the official journal of the American Association of Orthopedic Surgery. The guiding principle of the JBJS is excellence through peer review. There are high standards, professional review and rigid criteria that have to be met before an article is accepted for publication. This is one of the first unbiased articles to appear in a prestigious orthopedic journal confirming the benefits of minimally invasive Total Knee Replacement. Therefore I believe the appearance of this article in the JBJS is highly significant.

Like the author of this article, I began performing MIS Total Knee Replacement in 2004. And just as the author discusses in the quoted article there is a learning curve of at least 25 cases to become more familiar with the technique. Like the author I perform a number of these operations on a monthly basis so that I got the over the learning process in a 3 month period. Over the last 3 years I have performed Minimally Invasive Knee Replacement on most of the patients I treat surgically for knee arthritis.

The components that are implanted are the same for MIS and Traditional Knee Replacement. I always use Surgical Computer Navigation as I believe this improves the accuracy in component position.

In my experience 1 in 4 patients are discharged home after one night in the hospital and most of the remaining patients go home after 2 nights. It is less common for a patient to be hospitalized 3 nights or to be discharged to an inpatient rehab facility. Similarly 25 % of patients are walking without assist in a week and the 70 % are walking without assist at 2 weeks. Most patients are driving in 2-3 weeks.

The results with respect to mobility, knee motion, pain relief and function for activities of daily life after MIS and Traditional Knee Replacement seem to merge around 3-12 months after surgery, however the return of quadriceps strength seems to occur sooner in MIS patients.

In conclusion I found the publication of the article highly significant and supportive of the beliefs of my colleagues who are currently performing minimally invasive Knee Replacement. Surgeons using minimally invasive techniques for Joint Replacement do so because of the greater patient benefits with this procedure.