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Total Knee Replacement

When the cartilage has worn away, an artificial knee (called a prosthesis) can take its place. The surgery to implant the prosthesis is termed a total knee replacement. Only the surface of the joint is removed - the arthritic ends of the bones are shaved off and replaced with new metal and plastic surfaces. The knee replacement recreates the normal function of the knee. While the idea of getting an artificial knee joint may be frightening to some, it is one of the safest and most effective medical procedures.

Benefits

The goal of a total knee replacement is to relieve pain. It may also help to restore motion and straighten the limb. If you are looking for the best knee replacement surgery in Philadelphia and its surrounding regions that surgeons can provide, then you'll want to receive care from doctors at Rothman Institute.

Potential Complications

While inflammation of the leg veins (phlebitis) is not rare, the occurrence of death from this has been greatly reduced with the use of support stockings, knee motion machines and blood thinning medications (such as Coumadin.)

Infection in a total knee replacement can be a disaster. Like other complications, it is better avoided than treated. At the Rothman Institute all joint replacement surgery is done in special laminar flow operating rooms designed to keep out dust, germs and unclean air. The surgeons also wear "space suits". These full body suits, worn over normal scrubs, let the surgeons move and breathe without spreading germs, since an exhaust tube carries dirty air out of the room. Thanks to these measures, the infection rate at The Rothman Institute is among the lowest in the world - less than half of 1%.

Long term complications such as wear, stiffness or loosening of the parts relate as much to patient behavior as to surgical success. However, these problem knees can usually be improved through revision surgery.

FAQ

 Who should have a Total Knee Replacement?

The most common reason for a total knee replacement is severe arthritic pain. Pain cannot be measured, and the degree of pain sufficient to warrant surgery should be decided by the patient and doctor together. Painful and arthritic knees often become unstable and untrustworthy, causing falls and other injuries. The patient’s independence is compromised and the quality of their life will decrease. If you are considerng having knee replacement surgery in Philadelphia or the surrounding region, it's time to call Rothman to make an appointment for a consultation.

Patients at our Thomas Jefferson University Hospital affiliate are encouraged to participate in a joint replacement seminar. For more information, visit www.jeffersonhospital.org/jointreplacement.

Recovery

 Follow up after surgery

1st post-op visit is 4-6 weeks from date of surgery if you have staples

1st post-op visit is 2 weeks from date of surgery if you have sutures

When will my staples or sutures be removed?

At approximately two weeks from your surgical date. They will be removed and Steri-Strips are applied and will eventually wash off. Staples will be removed at the rehab center or at home and if you have sutures they will be removed in the office.

How long will I remain on anticoagulation (blood thinners)?

This is prescribed for up to 6 weeks post-operatively. If you are on Coumadin a home health nurse will take blood 1-2 times a week and your medical consultant will adjust your medication dosage. If you are placed on aspirin you will not require blood testing.

Is swelling of my knee, leg, foot, and ankle normal?

Yes, for three to six months. To decrease swelling, elevate your leg and apply ice for 20 minutes at a time (3-4 times a day).

Is it normal to feel numbness around the knee?

Yes, it is normal to feel numbness around the incision and side of the knee.

What exercise should I perform at home?

Please do exercises as instructed by your surgeon. Please refer to the knee replacement booklet that was provided to you. Remember that if you are using your knee to do things, you are actually doing physical therapy for your knee.

How long will I need to use a cane?

This varies with each patient. Usually between 2-6 weeks.

May I go outdoors prior to my first postoperative visit?

Yes, we encourage you to do so.

May I drive or ride in a car before my first postoperative visit?

Yes, you may ride in a car, however, you must be off all pain medications prior to driving. It is a patient's responsibility to determine their own safety. If your right knee is replaced, you should wait for a month before driving.

May I ride in an airplane before my first postoperative visit?

Yes, you may ride in an airplane. Be sure to get up and move around at frequent intervals. You may find it more comfortable in an aisle seat.

Why is my leg bruised?

It is common to have bruising on the skin. It is from the normal accumulation of blood after your surgery.

What is the maximum range an artificial knee can achieve?

This depends on your preoperative range-of-motion. Your final range-of-motion will be close to the range-of-motion that you had before the surgery.

May I have a pain medication stronger than Darvocet if I need it?

We do not recommend taking any medications stronger than Darvocet. Elevation of your leg and the application of ice will also help to decrease the degree of pain.

What is the short-term outlook?

The short-term outlook of total knee replacement is excellent. Most patients can stand the morning after surgery and begin exercise that day. With the support of walkers or crutches, patients can walk with confidence, climb stairs and ride in a car by the time they leave the hospital. Physical therapy and motion exercises are the key to a good result and these should continue for months. Some swelling, aching and numbing are normal during this time. Most patients are up and about within six weeks after surgery.

What is the long-term outlook?

The patient with a well performed knee replacement should expect a 98% chance of success at 10 years and a 94% change that their joint will be in place and functioning well in 20 years. The patient can influence these odds by staying at an ideal weight, exercising, protecting against infection and avoiding impact sports.

Can I still play golf after a knee replacement?

The doctors at the Rothman Institute are avid golfers and truly appreciate the value of the game of golf in the lives of our patients. Many patients that are seen at the Rothman Institute are dedicated golfers. Fortunately, knee replacement surgery, in Philadelphia and its surrounding areas, not only restores our patients' quality of life but of equal importance allows them to return to this game. Recognizing that golfing is a primary recreational and social activity for many of our patients, we have offered the following advice about when and how to resume golfing after total knee replacement.

*Start slowly with chipping and putting before progressing to playing 9 or 18 holes.

*While walking exercise is important for your heart, resume your golfing career by using a cart. Eventually you can walk the course. At that time use a caddy or a roller for your bag. Carrying your bag increases forces across your knee joint and may excessively stress your new knee.

*Use spikeless shoes. Spiked shoes fix your stance during the golf swing and will increase rotational stress on your artificial knee. As most courses now require spikeless shoes, this advice may be superfluous.

*Avoid playing in wet weather where the chance of slipping or falling during a golf swing is increased.

*Learn to play more "on the toes". Swinging flat-footed increases stresses on the joint replacement. On the backswing, the left heel should come off the ground and on the downswing, the right heel should come off the ground. (Note- This recommendation is for right-handed golfers and the terms "right/left" need to be reversed for left-handed golfers. This advisory was added by Dr. Hozack who plays as a lefty.)

*Right-handed golfers with a right total knee replacement may benefit from "stepping through" their swing with their right leg. The right leg comes off the ground during the downswing and follow-through, and actually steps toward the target. This will effectively unload a right total knee replacement; however, no golfer with a left total knee replacement should attempt this, as it may result in excessive loading of the left knee.

*Right-handed golfers with a left total knee replacement may benefit from an open stance. This may make the backswing a little more difficult, but if the player allows his left heel to come up, he should still be able to accomplish a full turn. The open stance has the golfer facing the target, and the hips do not need to turn as drastically to the left in the impact zone, thereby reducing the stress and torque within the left knee.

 

Please note:

All questions will be answered at your follow-up exam. For non-emergency questions please call the Assistant for your physician.

 

 

When the cartilage has worn away, an artificial knee (called a prosthesis) can take its place. The surgery to implant the prosthesis is termed a total knee replacement. Only the surface of the joint is removed - the arthritic ends of the bones are shaved off and replaced with new metal and plastic surfaces. The knee replacement recreates the normal function of the knee. While the idea of getting an artificial knee joint may be frightening to some, it is one of the safest and most effective medical procedures.

Benefits

The goal of a total knee replacement is to relieve pain. It may also help to restore motion and straighten the limb. If you are looking for the best knee replacement surgery in Philadelphia and its surrounding regions that surgeons can provide, then you'll want to receive care from doctors at Rothman Institute.

Potential Complications

While inflammation of the leg veins (phlebitis) is not rare, the occurrence of death from this has been greatly reduced with the use of support stockings, knee motion machines and blood thinning medications (such as Coumadin.)

Infection in a total knee replacement can be a disaster. Like other complications, it is better avoided than treated. At the Rothman Institute all joint replacement surgery is done in special laminar flow operating rooms designed to keep out dust, germs and unclean air. The surgeons also wear "space suits". These full body suits, worn over normal scrubs, let the surgeons move and breathe without spreading germs, since an exhaust tube carries dirty air out of the room. Thanks to these measures, the infection rate at The Rothman Institute is among the lowest in the world - less than half of 1%.

Long term complications such as wear, stiffness or loosening of the parts relate as much to patient behavior as to surgical success. However, these problem knees can usually be improved through revision surgery.

FAQ

 Who should have a Total Knee Replacement?

The most common reason for a total knee replacement is severe arthritic pain. Pain cannot be measured, and the degree of pain sufficient to warrant surgery should be decided by the patient and doctor together. Painful and arthritic knees often become unstable and untrustworthy, causing falls and other injuries. The patient’s independence is compromised and the quality of their life will decrease. If you are considerng having knee replacement surgery in Philadelphia or the surrounding region, it's time to call Rothman to make an appointment for a consultation.

Patients at our Thomas Jefferson University Hospital affiliate are encouraged to participate in a joint replacement seminar. For more information, visit www.jeffersonhospital.org/jointreplacement.

Recovery

 Follow up after surgery

1st post-op visit is 4-6 weeks from date of surgery if you have staples

1st post-op visit is 2 weeks from date of surgery if you have sutures

When will my staples or sutures be removed?

At approximately two weeks from your surgical date. They will be removed and Steri-Strips are applied and will eventually wash off. Staples will be removed at the rehab center or at home and if you have sutures they will be removed in the office.

How long will I remain on anticoagulation (blood thinners)?

This is prescribed for up to 6 weeks post-operatively. If you are on Coumadin a home health nurse will take blood 1-2 times a week and your medical consultant will adjust your medication dosage. If you are placed on aspirin you will not require blood testing.

Is swelling of my knee, leg, foot, and ankle normal?

Yes, for three to six months. To decrease swelling, elevate your leg and apply ice for 20 minutes at a time (3-4 times a day).

Is it normal to feel numbness around the knee?

Yes, it is normal to feel numbness around the incision and side of the knee.

What exercise should I perform at home?

Please do exercises as instructed by your surgeon. Please refer to the knee replacement booklet that was provided to you. Remember that if you are using your knee to do things, you are actually doing physical therapy for your knee.

How long will I need to use a cane?

This varies with each patient. Usually between 2-6 weeks.

May I go outdoors prior to my first postoperative visit?

Yes, we encourage you to do so.

May I drive or ride in a car before my first postoperative visit?

Yes, you may ride in a car, however, you must be off all pain medications prior to driving. It is a patient's responsibility to determine their own safety. If your right knee is replaced, you should wait for a month before driving.

May I ride in an airplane before my first postoperative visit?

Yes, you may ride in an airplane. Be sure to get up and move around at frequent intervals. You may find it more comfortable in an aisle seat.

Why is my leg bruised?

It is common to have bruising on the skin. It is from the normal accumulation of blood after your surgery.

What is the maximum range an artificial knee can achieve?

This depends on your preoperative range-of-motion. Your final range-of-motion will be close to the range-of-motion that you had before the surgery.

May I have a pain medication stronger than Darvocet if I need it?

We do not recommend taking any medications stronger than Darvocet. Elevation of your leg and the application of ice will also help to decrease the degree of pain.

What is the short-term outlook?

The short-term outlook of total knee replacement is excellent. Most patients can stand the morning after surgery and begin exercise that day. With the support of walkers or crutches, patients can walk with confidence, climb stairs and ride in a car by the time they leave the hospital. Physical therapy and motion exercises are the key to a good result and these should continue for months. Some swelling, aching and numbing are normal during this time. Most patients are up and about within six weeks after surgery.

What is the long-term outlook?

The patient with a well performed knee replacement should expect a 98% chance of success at 10 years and a 94% change that their joint will be in place and functioning well in 20 years. The patient can influence these odds by staying at an ideal weight, exercising, protecting against infection and avoiding impact sports.

Can I still play golf after a knee replacement?

The doctors at the Rothman Institute are avid golfers and truly appreciate the value of the game of golf in the lives of our patients. Many patients that are seen at the Rothman Institute are dedicated golfers. Fortunately, knee replacement surgery, in Philadelphia and its surrounding areas, not only restores our patients' quality of life but of equal importance allows them to return to this game. Recognizing that golfing is a primary recreational and social activity for many of our patients, we have offered the following advice about when and how to resume golfing after total knee replacement.

*Start slowly with chipping and putting before progressing to playing 9 or 18 holes.

*While walking exercise is important for your heart, resume your golfing career by using a cart. Eventually you can walk the course. At that time use a caddy or a roller for your bag. Carrying your bag increases forces across your knee joint and may excessively stress your new knee.

*Use spikeless shoes. Spiked shoes fix your stance during the golf swing and will increase rotational stress on your artificial knee. As most courses now require spikeless shoes, this advice may be superfluous.

*Avoid playing in wet weather where the chance of slipping or falling during a golf swing is increased.

*Learn to play more "on the toes". Swinging flat-footed increases stresses on the joint replacement. On the backswing, the left heel should come off the ground and on the downswing, the right heel should come off the ground. (Note- This recommendation is for right-handed golfers and the terms "right/left" need to be reversed for left-handed golfers. This advisory was added by Dr. Hozack who plays as a lefty.)

*Right-handed golfers with a right total knee replacement may benefit from "stepping through" their swing with their right leg. The right leg comes off the ground during the downswing and follow-through, and actually steps toward the target. This will effectively unload a right total knee replacement; however, no golfer with a left total knee replacement should attempt this, as it may result in excessive loading of the left knee.

*Right-handed golfers with a left total knee replacement may benefit from an open stance. This may make the backswing a little more difficult, but if the player allows his left heel to come up, he should still be able to accomplish a full turn. The open stance has the golfer facing the target, and the hips do not need to turn as drastically to the left in the impact zone, thereby reducing the stress and torque within the left knee.

 

Please note:

All questions will be answered at your follow-up exam. For non-emergency questions please call the Assistant for your physician.