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Recent advances in robotic surgery and minimally invasive approaches have made Total knee replacement better and less painful. However, it is not for everyone. In this blog I will help you figure out if you have tried everything else first, show you how to take a survey to know if your condition is bad enough for TKR (Total Knee Replacement), go over the surgery and rehab to help you decide if surgery is worth it for you. Finally, if it is the right time. I will show you ONE thing you need to do to get the best new knee for you.
Are you ready? Or not!
Total knee replacement is a big step. For one thing, it is not reversible: once you have an artificial knee, you cannot get your old one back. So, before considering total knee replacement, you want to have tried everything else first. That means making sure you have already had the standard treatment for knee pain due to arthritis.
The standard treatment for knee pain due to arthritis has five steps: home care, x-ray confirmation of arthritis, and physical therapy. If you still hurt, then hyaluronic or growth factor injection may postpone the need for total knee replacement surgery. Here is a breakdown of each step.
- Home care includes three weeks of a pull-on neoprene or knit sleeve brace, non-steroidal anti-inflammatory drugs like Aleve and Ibuprofen (when safe for your body), Ice, and rest. Home care for those with no red flags is recommended for no more than 3 weeks before seeing a medical or chiropractic doctor.
- The doctor examines you by performing Lachman’s and Macmurray’s tests and orders an x-ray before prescribing therapy. Check the radiologist’s report for the stage of arthritis. If you have grades 0,1, or 2 and Macmurray’s or Lachman’s tests were positive, then you need an MRI (Magnetic Resonance Imaging) as your issue is an anterior cruciate ligament or meniscal tear. For everyone else, you have moderate to severe arthritis and should start with physical therapy.
- I recommend PT (Physical Therapy) three times a week for three weeks to correct your station and learn strengthening exercises. If you have a good chiropractic doctor, they can do this as well: 5 sessions of chiropractic care followed by re-evaluation. If you are not making good progress, then see a Best Practice Certified joint replacement orthopedic surgeon for a knee injection.
- Do not have a steroid injection in your knee. While steroid injection feels good, recent studies show it may accelerate arthritis. Your best options are hyaluronic acid or growth factor injections. Neither one changes the ultimate need for total knee replacement, but at least you can buy more time if needed. If you still have severe pain, then you are then a good candidate for total knee replacement.
- Total knee replacement. The rest of this blog will discuss this definitive treatment for severe knee pain for longer than 6 months due to x-ray confirmed moderate to severe arthritis that has failed home care and physical therapy.
Everyone is different; so, how do you know if your pain is bad enough for total knee replacement surgery? You are ready for surgery if your knee pain is causing problems that are similar to other people who had total knee replacement and were glad they did. Doctors have developed the Knee Osteoarthritis Outcome Score (KOOS) for this very purpose. Click the link below and we will score your answers on KOOS, then compare your results to people who did end up needing surgery. If your score is comparable to people who had total knee replacement and were delighted with the result, then KOOS predicts that you are ready. The survey takes just a few minutes.
What to expect on the day of surgery…
Having a total knee replacement these days is easier than most people think. You will already have picked an orthopedic surgeon who operates in an ambulatory surgery center to avoid hospital errors and infections. You will have anesthesia, so you will need a driver. When you arrive, your surgeon will mark your knee for replacement. Have encourage them to write “wrong” on your good knee as well. There is no need for general anesthesia, but you will be given a spinal injection after conscious sedation. You will not feel or remember the procedure.
The surgeon will use a robotic assistant to pick the perfect new knee. Surgery is typically just over an hour and a half. You will wake up from the sedation in the recovery room. Once you are fully alert the nurses will give you instructions and send you home. Most people walk out less than six hours after they come into the center.
…and during recovery
The first few days are the worst. If you picked the right surgeon (minimally invasive) then you will not need much more than anti-inflammatory pain medicine. Most patients ditch their walker within a a few days. You will be up and wondering how far you can walk outside the house within a week.
Rehabilitation during recovery is especially important to achieving a good outcome from total knee replacement surgery. Most surgeons encourage you to go through a short course of post-operative3 physical therapy. We have a series of rehab videos
The one thing you need to get right.
Ready for some good news? Total knee replacement has a lot of moving pieces and getting it, all right can seem daunting. But as it turns out, your part is super easy. All you need to do is pick the right total knee replacement surgeon.
The right total knee means having the best approach, facility, implant, and robot. But you don’t know how to do a total knee replacement. Your surgeon picks each of these elements. All you need to do is one thing: pick the right surgeon! Here is a checklist you can use to find the right surgeon:
Or there is an even easier way. We have a list of orthopedic surgeons who meet these criteria for some locations. Check and see if we have the right surgeon listed for you here: Best Total Knee Replacement Surgeons. Or, if you prefer, just call Phoenix Spine and Joint for direct assistance: 602.256.2525.
We know this can be confusing. Sometimes you just need to talk to a real person. I have a team of great case managers trained to confirm you need a total knee replacement and look up the right surgeon for you. If we do not have one on our list, they will find one nearby who meets your criteria. The best thing of all? Our case managers are paid by the doctors; talking with them is free.