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What to Know About Knee Replacements

While knee replacements have become increasingly common, safe, and effective over the years, there are still misconceptions about what the procedure entails, when it’s necessary, and what to expect afterwards. To help bring everything into focus is Southeastern Med’s Dr. Bill Kumler, a board-certified orthopedic surgeon with more than 20 years of experience.

Why get a knee replacement?

According to Dr. Kumler, “A knee replacement is the final option for patients with pain, deformity, or loss of function of a knee due to arthritis; when non-operative treatment options are no longer helping.”

What can you try before knee replacement?

As noted, a knee replacement operation is usually only recommended when other healing techniques have failed to improve a patient’s condition. It’s still worth exploring these other options before discussing surgical options with your physician. “If your medical conditions allow,” Dr. Kumler explains, “you can take anti-inflammatories such as ibuprofen, naproxen, and other ‘non-steroidal’ anti-inflammatories, or steroids by mouth or injection. You can also use a cane, crutches or walker to help with pain and stability.  Braces on the knee can help with pain, swelling and stability, and low impact exercises (water exercises, walking, bicycles, elliptical machines etc.) have been shown in studies to help limit pain and maintain function in arthritic joints.  Inactivity and immobility will make arthritic joints more stiff and painful.  In other words, your joint will ‘rust-out’ faster than it will “wear-out”.  So, pushing through pain as best as you can will help your arthritis.”

What about those injections that can cushion your joint or restore it without surgery?

In recent years, expensive knee injection treatments (i.e., “rooster-comb,” hyaluronic acid / glycosaminoglycans, and “joint cushion”) have been promoted as alternatives to knee replacements. But Dr. Kumler warns about putting too much stock in these trends. “If it sounds too good to be true, it probably is,” he says, noting that most of these injections have been shown to deliver lasting results for only a smaller percentage of patients. “Despite the implications of their advertising, they have not been shown to regenerate cartilage or prevent knee replacements, nor prolong the life of the arthritic knee.  Likewise, there is no evidence that various stem cell treatments regenerate the joint.”

What is a knee replacement?

While the word “replacement” can sound intimidating and extreme in a surgical context, modern knee replacements can actually be minimally invasive, high-precision procedures. “A knee replacement is basically a resurfacing procedure,” according to Dr. Kumler. “It can now be done as an outpatient surgery, limited incision, with the patient going home the day of surgery or the day after. The joint is measured, and instruments are used to shave the bad bone and cartilage off of the joint; then multiple sizes are available to replace the shaved-off bone and cartilage with metal and plastic pieces.  The majority of the bone, tendons, ligaments, nerves and blood vessels are left alone and in place to do their normal jobs. It is not a “bionic” knee that moves on its own; your body moves it just as before. Once healed, you only see a scar (sometimes barely) on the front of a knee. You have probably had multiple people walk by you with a knee replacement and not known it.”

How is the surgery done?

Dr. Kumler describes knee replacements here at Southeastern Med as “a team approach” and  “a systematic, integrated process.”

“Primary care providers, surgeons, anesthesia, nurses, techs, physical therapists, and many others are all important parts of the process. The actual surgery is generally 127 steps with 51 decisions done in 30-90 minutes. You can be awake or asleep, have a spinal or other ‘block’ to numb the knee/leg for pain control during and after surgery. Most people go home the same day or next day with home nursing and therapy visits and/or outpatient Physical Therapy.”

How’s the recovery process?

Recovering from a knee replacement can involve plenty of hard work on the patient’s part, and some will power to get through the pain. As always, though, patience and consistency will pay off. “You can get up and walk with a walker or crutches once you are awake enough from anesthesia on the day of surgery,” Dr. Kumler says. “You will have to work very hard to get the knee moving and prevent stiffness. The incision is mostly healed by two weeks after surgery.  Everyone is different, but generally between 1-6 weeks after surgery you will have less pain than before surgery. You are about 90% recovered by 12 weeks after surgery, but we will suggest continuing to work on motion and improvement for up to 6-12 months after surgery.  You will get antibiotics to help decrease the risk of infection (less than 0.5% of knees get infected).  You may also get stockings and/or leg pumps and blood thinners to decrease the risk of blood clots in your legs.”

How long will the replacement last?

“A knee replacement can last 15-30+ years,” Dr. Kumler says. “More than 90% of knees are still working after 15 years. It is the plastic portion that can eventually wear out or become loose on the bone. Other reasons it might not last would be as a result of a fall, accident, injury, etc. Infections can also require removal of parts in rare cases, as can allergic reactions to the metal, cement, or plastic in the replacement. Again, these are quite uncommon events.

Should I have mine done by a robot, computer guided, or custom implants?

“Studies done up to this point generally demonstrate that robots, computer guides, and custom implants will increase the cost, but do not improve the longevity of the knee or patient satisfaction with the results,” says Dr. Kumler.

Do I need to go to a special hospital to get the best knee replacement possible?

“Neither the building, nor the name on the building treats you medically,” Dr. Kumler says. “It is all about the individuals and how well they work as a team and how well you as a patient work with them; that’s what determines the quality of your outcome. Here at Southeastern Med we have sound core values and an outstanding Musculoskeletal/Orthopaedic team ready to help care for your surgical and non-surgical needs. We are confident that we can provide care as good as anywhere in the country while understanding the limits of our resources, knowledge and experience.”

 

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