What outcome(s) can I expect from the surgery?
The primary purpose of the procedure is relief of pain. Enhanced walking ability is a secondary consideration and finally, restoration of the anatomy as close to normal as possible.
What level of activity will the procedure restore?
The prosthesis is designed for walking (even brisk walking) but not designed for running etc.
What risks are associated with the procedure?
There are a number of risks that are generally applicable to many surgical procedures. Among those that apply to a total knee replacement are, in no particular order:
Should I use a general or local anaesthetic?
A general anaesthetic means you will be unconscious during the surgery and should have no recollection aside from going to sleep and waking up. A local anaesthetic allow you to remain conscious without feeling pain. One commonly used "local" anaesthetic is a spinal anaesthetic which blocks all pain in the area while leaving the patient conscious. This is a personal choice and can be discussed with the anaesthesiologist.
What can I do to minimize the risks of a blood clot?
To minimize the risks you will be asked to start walking as soon as possible after the surgery and you will receive a blood thinner, low molecular weight heparin, for approximately a week. It is my preference to prescribe another five weeks of aspirin use, 325mg per day. As well, if tolerated, the compression stockings provided to you at the hospital should be worn for a total of six weeks. Under these circumstances the risk of death from pulmonary embolism appears to be well below one in on thousand.
Do I need to donate blood prior to surgery?
Rarely complications during surgery can lead to rapid blood loss and require a blood transfusion. If this concerns you then you should discuss this possibility with your doctor.
How long before I can walk again?
Mobilization after surgery is important to prevent complications and to resume independent self-care as soon as possible. That said, the degree of weight bearing that is allowed immediately after surgery is decided upon by the surgeon during the surgery, depending on the achieved firmness of the fixation. With a non-cemented prostheseis, protected weight bearing may be necessary for approximately six weeks.
How long is the hospital stay?
How soon you leave the hospital depends on when the pain can be brought under control using medication by mouth and upon how soon you achieve safe, independent mobilization. Depending on circumstances this is usually anywhere between 1-5 days of hospital stay.
Will I need physiotherapy? How soon?
Physiotherapy starts immediately after the operation while still in hospital and is continued in the outpatient department after discharge.
How long before my knee feels "normal"?
Initially, residual discomfort and swelling are common. Numbness may be present around the knee. "Normal" is of course different for everyone but these initial issues usually settle in approximately six months, occasionally a year.
Do I need to come and see you again after surgery?
Standard follow-ups are done at 8 weeks, 6 months and 1 year. After this, yearly follow-up with X-rays is recommended, to allow early detection of possible problems with the prosthesis.
My 84 y old father had Total Knee Replacement surgery in 1990. He is now experiencing severe pain and can no longer walk on the knee. Is there any way a TKR from this era can be repaired?
Typically, once a knee replacement fails, it needs to be replaced by a new one. The difficulty of this can vary tremendously, and will need to be assessed by his surgeon. It is of paramount importance to know if the knee is infected or not.