Total Knee Replacement Surgery
A normal knee acts like a hinge joint between the femur (thigh bone) and tibia and fibula (lower leg bones). The joint surfaces where the bones come together are covered with articular cartilage which wears out over time like the tread of a tire. This progressive loss of articular cartilage is called arthritis and is related to age, gender, genetics, race, trauma, occupation, and body mass. When nonoperative treatment is not effective is where a total knee replacement surgery at Coastal Orthopedics can help.
What is a Total Knee Replacement Surgery?
Also referred to as knee arthroplasty, total knee replacement is a common orthopedic surgery used for replacing worn or damaged knee surfaces. When a surgeon replaces these surfaces with a "prosthesis" or implant, the intention is to relieve pain and increase mobility, which allows you to get back to living your active life.
During any type of knee replacement, the surgeon removes the remaining damaged cartilage and a small portion of bone and soft tissues. Ultimately, the objective of this procedure is to provide you with a pain-free, long-lasting knee so you can return to your everyday activities.
Improvements in surgical technology, techniques and materials have made the total knee replacement procedure a hugely successful orthopedic procedure with more than 700,000 surgeries performed in the U.S. successfully each year. Most individuals experience less pain, increased movement, and improved quality of life following their surgery. But, the implants don't last forever.
What Are the Types of Total Knee Replacement?
There are two types of total knee replacement: traditional total knee replacement and minimally invasive total knee replacement.
1) Minimally Invasive Total Knee Replacement: Minimally invasive total knee replacement is similar to the traditional total knee replacement, but with some variations. For instance, the surgeon cuts less of the surrounding tissue of the knee. They use the same artificial implants as they do with the traditional approach, but they use instruments that are specially designed for preparing the tibia and femur, so they can place the implants accurately.
The minimally invasive total knee replacement surgery also uses smaller incision that disturbs less tissue. Along with the shorter incision, the minimally invasive approach to opening the knee is less invasive. Generally, in minimally invasive knee replacements, the surgeon uses methods that are "quadriceps-sparing."
This means they avoid trauma to the quadriceps and VMO muscles and tendons in the front of your thigh. Because the methods used for exposing the joint provide less muscle disruption, it could result in less postoperative pain and faster recovery time than having a traditional total knee replacement.
2) Traditional Total Knee Replacement: Minimally invasive total knee replacement surgery isn't suitable for everyone. In some cases, a patient is better suited for a traditional total knee replacement surgery. To perform a traditional knee replacement, your surgeon makes an eight to 10-inch vertical incision over the front of the knee to expose the joint. The larger incision enables the surgeon a view to properly align the bone and implant.
In this procedure, the surgeon cuts into the quadriceps tendon connecting the quadriceps muscles on the front of the thigh to the kneecap. The surgeon moves the kneecap to access the arthritic joint.
Your orthopedic surgeon will go over both surgical options with you.
Who Performs a Total Knee Replacement Surgery?
An orthopedic surgeon will perform this procedure. Orthopedic surgeons go through many years of special training to become board-certified. However, they don't require any special licensing or certification specific to total knee replacement procedures.
You can increase your chances of a successful total knee replacement procedure and reduce your risk of complications by wisely choosing your orthopedic surgeon near you and ensuring they have already performed a high volume of knee replacements.
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What is An Orthopedic Surgeon?
Orthopedic surgeons are doctors who treat musculoskeletal system problems which involves:
- Diagnosing your disorder or injury.
- Treating your condition with medication, surgery, exercise, casting or other options.
- Rehabilitation through physical therapy or exercises to restore strength, movement and function.
- Prevention through treatment plans and information to slow disease progression or prevent injury.
Although orthopedic surgeons work with every aspect of the musculoskeletal system, many specialize in specific body areas like the spine, foot and ankle, knee, hip, shoulder or hand. They might also focus on specific fields such as trauma, pediatrics or sports medicine. Some specialize in a few areas.
Orthopedic surgeons go through extensive training in the accurate diagnosis and treatment of musculoskeletal system diseases and injuries. They have up to 14 years of formal education under their belt, including:
- Four years of university or college study.
- Four years of medical school study.
- Five years of orthopedic residency training at a major medical center.
- A couple of optional fellowship years in a specialized field or area.
After an orthopedic surgeon establishes a licensed practice, they've demonstrated complete comprehension of orthopedic knowledge when they pass the American Board of Orthopedic Surgery certifying exams. They'll continue in a Maintenance of Certification process throughout their career.
They will spend countless hours studying, attend continuing courses in medical education and take self-assessment exams to ensure they stay up-to-date.
What Occurs During Total Knee Replacement?
The surgeon will discuss the details of your surgery so you know what to expect. They'll have a team of specialized healthcare providers to assist them in performing the surgery. The entire surgery can take a couple of hours. Some things you can usually expect are as follows.
- You'll be provided with spinal or general anesthesia with regional block supplementation so you'll sleep through the procedure and won't feel any discomfort or pain. In some cases, patients have received a local anesthesia and medication to keep them awake, but relaxed.
- A healthcare provider will monitor your vital signs, such as your blood pressure and heart rate, during your procedure.
- You will be given antiseptics and antibiotics before the surgery to prevent infection.
- The orthopedic surgeon makes an incision over the middle of your knee, cutting down to your underlying tissue.
- They'll remove the damaged articular cartilage with a little of the supporting shin and thigh bone as well.
- They'll then place metal or ceramicized metal implants into your joint space, typically cementing them into the bone.
- The surgeon will, in most cases, remove a portion of your kneecap's underside
- They'll insert a plastic spacer into the area between the implants and the kneecap to make movement easier.
- They'll then surgically close the layers of your muscle and skin.
Is Total Knee Replacement a Good Option for you?
Deciding on having total knee replacement surgery should be one made between you, your orthopedic surgeon, your primary doctor and your family. Your doctor might refer you to an orthopedic surgeon to give you a thorough evaluation to see if you may benefit from this procedure.
When Is Total Knee Replacement Recommended?
You may be a candidate for total knee replacement surgery if you have:
- Moderate to severe pain in your knee while you rest, either day or night.
- Stiffness or severe pain in your knee that limits your daily activities like walking, climbing stairs, and getting out of a chair.
- Chronic knee pain, swelling and inflammation that doesn't improve with medications or rest.
- Failure to significantly improve with other treatments like weight loss, physical therapy, anti-inflammatory medicines, cortisone injections, lubricating injections, or other surgeries.
There are some weight and few age restrictions for this procedure.
Recommendation for this procedure is based more on your disability and pain, than your age. Most individuals who undergo this surgery are age 50 through 80, however, surgeons evaluate their patients individually. Orthopedic surgeons have performed this surgery successfully at all ages, from young teens with juvenile arthritis to senior citizens with degenerative arthritis.
When Is Total Knee Replacement Indicated?
The most common reason for this procedure is for relieving the severe pain osteoarthritis causes. Individuals who require this surgery typically have problems climbing stairs, walking and getting out of their chairs. Some people experience knee pain while resting.
Other health conditions that also cause knee joint damage include:
- Osteonecrosis: A condition caused by reduced flow of blood to the bones and cartilage in the joints.
- Rheumatoid arthritis: A common form of autoimmune arthritis caused by the immune system not properly working.
- Bone tumor in the knee joint. These can develop when cells within the bone divide uncontrollably.
- Fracture or injury of the knee joint. The most common fracture of the knee joint is the knee cap or patella.
The damage can be extremely painful and limit your regular activities. Total knee replacement can reduce your pain, improve your joint mobility, improve your deformity, and improve your quality of life. Generally, healthcare providers will only recommend this procedure when you continue having substantial problems after you've tried conservative nonoperative treatments such as corticosteroid injections or pain medications.
Are There Risks With the Total Knee Replacement Procedure?
Complications can occur, as with any surgery. Some possible complications could include:
- Neurovascular injury (Blood vessel and/or nerve injury)
- Blood clots in the lungs or legs
- Continued stiffness or pain
- Wearing or loosening out of the prosthesis
Your replacement knee joint could be dislodged, become loose or might not work like it should. You may require another replacement in the future. Blood vessels or nerves in the surgery site might be injured which can result in numbness or weakness. Surgery may not relieve the joint pain.
There could be other complications depending on your individual health condition. You should sit down and discuss any concerns you have with the surgeon before your surgery.
What is Total Knee Replacement Recovery Time?
Following a total knee replacement, you may go home the same day or next day, or stay up to two or three days. Longer stays are much less likely. While each patient will recover a little differently after this surgery, it typically takes 6 weeks to complete rehabilitation and six months to a year to gain your full strength back.
You'll probably be anxious to get behind the wheel again. Fortunately for you, if you had your left knee replaced and you're driving a vehicle with an automatic transmission, you could behind that wheel again in just a couple weeks.
If your right knee was replaced, it could be around four weeks. Driving vehicles with manual transmission may take longer. In either of these cases, you need to not be under the influence of narcotic pain medications and have the ability to bend your knee enough where you can safely operate the pedals.
What's Involved in Total Knee Replacement Recovery?
In the Hospital
In most cases, prior to leaving the operating room, the medical staff will cradle your knee in a passive motion machine, and they'll monitor the bending in (flexion) and straightening out (extension) limits of your knee.
During your stay at the hospital, the medical staff will encourage you to move your ankle and foot, increasing the flow of blood to your leg muscles, helping prevent blood clots and swelling. You'll likely wear compression boots or support hose and receive blood thinners to further protect against clotting and swelling.
They'll have you perform breathing exercises frequently and increase your activity level gradually. You may start weight-bearing therapy right away after your surgery. Additionally, you'll have some combination of occupational and physical therapy at the hospital. You should be able to walk and stand in most cases before you leave the hospital or at least do so with the assistance of a walker or cane.
Most of your rehabilitation and recovery will be at your home once you leave the hospital, but your doctor will probably prescribe physical therapy for continued rehabilitation at a local clinic. They'll suggest exercises you can perform at home. Some individuals require home health care. Talk with your doctor about what you can expect after your procedure. You might experience substantial pain around the incision site after your surgery, but pain medications might help ease your pain.
You may experience draining of fluid at the incision site. This is normal. Let the doctor know immediately if you experience an increase in swelling, redness or draining at the site of the incision. You should also let your doctor know if you experience chills, high fever or severe pain that doesn't improve.
You should be able to resume a regular diet fairly quickly.
Ensure you go to all your follow-up appointments. You might need to have your staples or stitches removed a week following your surgery.
After you recover, you can begin low-impact activities like swimming, walking, biking or golfing. However, you should not engage in higher impact activities, like skiing, jogging, sports and tennis that involve jumping or contact. Discuss your limitations with your doctor. You should always follow tips to avoid workout injuries too.
Implants should function for a minimum of 15 to 20 years in around 90 percent of patients. However, over time wear and tear can loosen them and this could cause loose particles, pain, instability and infection. You'll probably need knee revision surgery if this occurs.
What is the Cost of Knee Replacement Surgery and Does Insurance Cover it?
The cost of total knee replacement surgery can vary significantly, even when performed in the same geographical area. There are many factors that determine the final hospital charge, including:
- Type of surgical approach and implant: This includes the implant's material and if any specialized computer technology or customized surgical instruments are used.
- The number of days you spend in the hospital: Again, depends on what type of knee replacement you have (partial, total or bilateral).
- The length of time you spend in the operating room. The longer you need to stay in the hospital, the higher the costs.
- Preexisting conditions: You may need additional precautions during the surgery or extra care in the hospital.
- Equipment or unanticipated care required: These may be required if you experience complications during your hospital stay.
A total knee replacement surgery in the U.S., on average, costs around $49,500.
You can expect several other bills following your procedure, including bills for all treatments the surgeon gave you while you were in the hospital, hospital bills and other procedures and tasks performed by the staff in the operating room (i.e. work done by surgical assistants, anesthesiologist, physical therapists, etc.)
You may have inpatient charges which are those that occur during your stay in the hospital. These charges from the surgeon and other health staff might add up to around $7,500 on top of the basic charge for the surgery, bringing the total cost of total knee replacement in the U.S. to around $57,000.
Private insurance and Medicare generally cover most knee replacement surgery costs.
Where to Go in Corpus Christi for a Total Knee Replacement Procedure?
If you're looking for total knee replacement surgery in Corpus Christi, Coastal Orthopedics can help.
While injuries happen, they don't have to sabotage the quality of your life. If you enjoy an active lifestyle and become injured or if you have a condition like osteoarthritis that's affecting your knee joints, let us help you get back to living a pain-free life again. We're committed to your quality care and pride ourselves on the dedication and quality-care we provide our patients.
You no longer need to suffer from the pain. We can help you. Contact us to schedule your appointment today.
By Rob S Williams, MD
Other information on knee injuries and treatment options can be found here:
WHEN DO I NEED A TOTAL KNEE REPLACEMENT? (SIGNS AND SYMPTOMS)
WHAT IS OSTEOARTHRITIS? SIGNS, SYMPTOMS, AND CAUSES
TORN CARTILAGE IN MY KNEE? (SYMPTOMS, TREATMENT, AND SURGERY)
ARTHRALGIA (JOINT PAIN): CAUSES AND SOLUTIONS
MOST COMMON ORTHOPEDIC SURGERIES FOR WOMEN OVER 40 | CORPUS CHRISTI, TEXAS
MOST COMMON ORTHOPEDIC SURGERIES FOR MEN OVER 40
TREATMENT OPTIONS FOR OSTEOARTHRITIS: EXERCISE, MEDICATIONS, SURGERY
OUR ORTHOPEDIC PROCEDURES