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Minimally Invasive Knee Replacement

A total knee arthroplasty, or knee replacement surgery may be your best option for long-term relief of symptoms from osteoarthritis. Other conditions that may warrant a knee replacement include avascular necrosis of the knee and post-traumatic arthritis of the knee. A total knee replacement entails removing the diseased and worn portions of a joint including the cartilage and replacing the surfaces of the bones with metal. A plastic liner is inserted in between the artificial surfaces of the femur (thigh bone) and tibia (shin bone). At Joint Pain Orthopedics, knee replacement surgeries are performed in a minimally invasive manner that limits damage to tissue around the knee. The surgery can be performed under a spinal anesthetic in most patients. After surgery, we have an extensive protocol that has been developed to allow for rapid recovery and improved pain control. Benefits of having a procedure such as a total knee replacement done by a surgeon who performs a high volume of joint replacement surgeries, such as a joint replacement specialist, may include a lower complication rate. Dr. Christopher Jimenez has undergone extensive orthopedic training at the University of Utah under the direction of leaders in the field of joint replacement surgeries, including Dr. Chris Peters.  In addition to this, he undertook a 1-year joint replacement fellowship in California where he performed surgeries with Dr. Edward McPherson who is widely regarded as an expert when it comes to revision and primary joint replacement surgeries.  This has given Dr. Jimenez the education, experience and ability to manage even the most complex joint replacements and revision surgeries.  Joint Pain Orthopedics manages patients from Texas cities such as Austin, San Antonio and San Marcos to name a few.


How long will I be in the hospital?

            This varies depending on each patient’s health status and fitness level.  Select patients may be candidates for surgery in an outpatient setting or perhaps in a surgery center, meaning they may not even have to stay in the hospital after surgery.  Others can remain in the hospital for 1 night to allow for adequate mobilization and stabilization of long-term medical problems.  In rare cases, a longer hospitalization may be required.


When is a knee replacement surgery the best option for you?

            Pain and dysfunction associated with arthritis can limit your ability to walk long distances, sit for an extended time or even sleep.  It can even cause a decline in sexual function.  The time may be right for a knee replacement when you experience symptoms that don’t respond well to measures such as rest, medication or even injections.  It is time to stop taking time off of work or isolating yourself from others and avoiding the things you used to like to do.  A knee replacement surgery can help tremendously.

  1. Husain, A. & Lee, G.-C. Establishing Realistic Patient Expectations Following Total Knee Arthroplasty. J Am Acad Orthop Surg 23, 707–713 (2015).


How can you improve your chances of having a successful knee replacement surgery?

            You want to put yourself in the best position possible to be successful after a knee replacement surgery.  As a patient you want this experience to be a one-time deal that goes without complication.  There are certain risk factors that would increase the risk profile of a candidate for knee replacement surgery.  In some cases these risks may be mitigated, or modified, so that we decrease your risk for major complications after surgery.  Uncontrolled diabetes, severe obesity, smoking, malnutrition and anemia are a few of those factors.  If you have any of these risk factors, don’t delay in seeing us.  We can help you navigate how to improve this and help with your pain in the meantime.

  1. Alamanda, V. K. & Springer, B. D. Perioperative and Modifiable Risk Factors for Periprosthetic Joint Infections (PJI) and Recommended Guidelines. 1–7 (2018). doi:10.1007/s12178-018-9494-z


Do you need to see your primary care doctor before your knee replacement surgery?

            We want to ensure that you have the optimal experience with your knee replacement surgery.  Long-standing medical problems should be well controlled prior to your surgery.  We will routinely ask that your primary care physician and possibly other specialists involved in the long-term management of your health needs provide clearance for you to proceed with a knee replacement surgery.


Where do you go after knee replacement surgery?

            The thought of returning to your home after a knee replacement surgery and managing life yourself can be a daunting process and cause for un-needed anxiety and stress.  These concerns about bathing, cooking and getting around at home are all valid concerns; however, the majority of people that undergo this surgery will be safe for discharge home.  In many cases people have been in a debilitated state of life prior to undergoing the surgery that they have developed ways to cope with such bad joints.  Very soon after the surgery they likely will find they are in a better state of function and pain when compared to the pre-surgery state of living.

            You might have relatives or friends who had joint replacement surgery in the past that went directly to the skilled nursing facility or inpatient rehabilitation after discharge from a hospital.  Interestingly, there are no studies showing that this practice leads to better outcomes.  In fact there is evidence that you are more likely to have complications such as infections, wound problems and returns to the emergency room if you go to a facility rather than returning home after surgery.  People who go directly home rather than a rehab or skilled nursing facility often achieve a faster recovery.  It may be appropriate for a small percentage of patients to go to a rehab or skilled nursing facility after surgery for safety concerns.

            Is it safe to discharge home if you live by yourself?  This is a frequent question encountered in our clinic.  This topic has been researched and studies indicate that in many circumstances it is safe to discharge home if you live by yourself.  Home health services may be a great option as you can have a physical therapist come to your house for the first week or two to allow you to gain the strength and confidence needed to drive.  Ridesharing apps and food delivery services that are available from a phone also make this a reasonable option.  There are personal caregivers that are available if you feel this will be required.  Ask the staff at Joint Pain Orthopedics for more information.

  1. Fleischman, A. N., Austin, M. S., Purtill, J. J., Parvizi, J. & Hozack, W. J. Patients Living Alone Can Be Safely Discharged Directly Home After Total Joint Arthroplasty. J Bone Joint Surg Am 100, 99–106 (2018).
  2. MD, D. E. P. et al. Discharge to Inpatient Rehab Does Not Result in Improved Functional Outcomes Following Primary Total Knee Arthroplasty. Journal of Arthroplasty 33, 1663–1667 (2018).


What kind of help will you need after knee replacement surgery?

            The patient should arrange for a person or a team of people to assist them in the immediate post-operative period.  Patients that live alone may want to ask a family member, friend, neighbor or church members for time and help for the first week or two after the knee replacement surgery.  It is also possible to set up a personal assistant if help is not readily available.


How can you prepare your household for knee replacement surgery?            

            Be sure to let family, friends and neighbors know that you are having surgery.  You can cook extra meals and freeze them or use delivery services for food.  Arrange for someone to look after your pets while you are recovering.  If this isn’t feasible, then it may be a good idea to kennel your pet for a short period of time.  Remove any rugs, cords or obstacles that may cause you to trip and fall down at home.


Preoperative education and labs

            Joint Pain Orthopedics requires you to partake in class that is intended to teach you more about the hip replacement surgery and what to expect after.  These classes may be taught in the hospital where you will have a nurse and physical therapist instruct the class.  It is advised to have someone with you that will assist with your post-operative care.

You may be required to undergo lab studies prior to your surgery to ensure you don’t require optimization of any abnormal parameters.  This may be coordinated with your primary care provider and/or the facility you will have your surgery at.


What should you expect on the day of surgery?

            You will be expected to be at the surgery facility a few hours before the scheduled time of your procedure.  You likely will be allowed to have clear liquids up until 2 hours before the surgical procedure; however, check with your surgery coordinator to be certain.  You will receive several different medications before surgery to enhance your surgical recovery.  You will also meet members of the surgical team, including the anesthetist and the nurse from the operating room.


Why do you use a spinal anesthetic?

            A spinal anesthetic is the preferred anesthetic used in total joint replacement surgeries.  Several studies have been conducted on the safety and benefits of this sort of anesthetic as compared to a general anesthetic.  There is a documented decrease in risk for major adverse events after the procedure when a spinal anesthetic is used.  A few of these are lower rate of blood clots, lower pain scores after surgery, lower rates of nausea and lower rates of confusion after surgery.  Our goal is to ensure you have an optimal experience with your knee replacement surgery.

  1. Turnbull, Z., Sastow, D., Giambrone, G. & Tedore, T. Anesthesia for the patient undergoing total knee replacement: current status and future prospects. LRA Volume 10, 1–7 (2017).


What happens during my surgery and how long does it take?

            The knee replacement surgery will usually be performed through a minimally invasive approach that limits damage to the muscle and tissue around your knee.  The diseased portions of the joint will be resurfaced with a metal implant on the ends of the thighbone and shinbone.  A polyethylene, plastic, liner will be inserted between the two implants.  The implant will usually be bonded to the bone using bone cement.  In some cases you may be a candidate for un-cemented implants that would give your body the ability to grow onto the surface of the implant. The surgeon’s goal should be to correct any misalignment and improve the range of motion of your knee.  We use advanced technology called navigation for this procedure, which gives us the ability to position the implants in the optimal position.  The surgical procedure usually takes 45-90 minutes in an experienced surgeon’s hands.  The length of the procedure depends on the level of deformity and difficulty of the case.


Why you should choose a surgeon with high surgical volume and advanced training in knee replacement surgeries?

            Joint Pain Orthopedic surgeons all have advanced surgical training in addition to the standard residency training that is required performing orthopedic surgery.  Standard training would give a surgeon the ability and know how to operate on several musculoskeletal issues ranging from spine surgery to bunion surgery and joint replacements.  Having a surgeon undergo a year or more of extra training in a specific subspecialty, i.e. knee replacements and revision surgeries, gives a surgeon a deep understanding of the surgical anatomy and relevant techniques that will be required of a knee replacement specialist.  Having the combination of a surgeon that is fellowship trained in joint replacement surgeries who performs a high volume of joint replacement surgeries is a great benefit to you as the patient.  There are several studies that have demonstrated a positive correlation between having a surgeon who specializes in knee replacement surgeries and having a lower chance of having major complications after total knee replacement surgery.  Dr. Christopher Jimenez has the advanced training in minimally invasive knee replacement surgery after completing a fellowship with Dr. Edward McPherson.

  1. Wilson, S., Marx, R. G., Pan, T.-J. & Lyman, S. Meaningful Thresholds for the Volume-Outcome Relationship in Total Knee Arthroplasty. J Bone Joint Surg Am 98, 1683–1690 (2016).


What kind of medications will you be on after your surgery?

            The Joint Pain Ortho Rapid Recovery plan has been developed with you in mind.  There are several different medications used that are non-opioid (narcotic) that will target pain and swelling from multiple different points.  This cocktail of medications may include an anti-inflammatory, non-opioid painkillers and nerve medications to name a few.  Opioid medication may be required for some patients; however, our goal is to make you comfortable to the point that these are unnecessary.  During the procedure the surgeon will infiltrate the tissue with a combination of medications that should provide excellent pain control for up to several days after the procedure.  Additionally, mobilization soon after a knee replacement has been shown to improve the perception of pain.  Cold therapy units may also enhance your recovery from a pain control and swelling standpoint.

Additional medications such as stool softeners and nausea medications may also be provided to decrease the possibility of complications after your surgery.  Deep venous thrombosis (DVT), or blood clots, has traditionally been a major concern for patients undergoing this surgery.  Your surgeon and or your healthcare team will decide what is the optimal medication to take to decrease this risk for you.  Mechanical compression devices may also be provided to further decrease your risk for DVT.  Additionally, rapid mobilization and ambulation further decreases the risk of DVT.


What kind of durable medical equipment will I need for my surgery?

            We would like for you to have a front-wheeled walker and a cane.  I generally do not advise you to have a walker with 4 wheels, as these require the use of hand-operated brakes.  I would also advise you to get a cane.  The transition off of assistive devices can be accomplished once you have no residual gait abnormality after surgery.  Cold therapy units are also available for purchase.  Cold therapy has been shown to improve pain and swelling in the immediate post-operative period.  Sequential compression devices are also available for purchase.  These devices may reduce your risk for DVT, or blood clots, after surgery.  Some patients with really low toilet seats may want to purchase a riser to assist with rising from the seated position.  Additionally, some patients may benefit from the use of a shower chair.  A long-handled shoehorn has also proven useful for some patients that have difficulty putting on shoes.


When can you drive an automobile?

            A patient is generally safe to drive an automobile in about 2-4 weeks after undergoing a knee replacement procedure.  I generally advise that you should have stopped all opioid drugs that may delay your response time.  You should have the ability to slam on the brakes to avoid the car in front of you before you drive. 

  1. van der Velden, C. A., Tolk, J. J., Janssen, R. P. A. & Reijman, M. When is it safe to resume driving after total hip and total knee arthroplasty? Bone Joint J 99-B, 566–576 (2017).
  2. Dalury, D. F., Tucker, K. K. & Kelley, T. C. When Can I Drive?: Brake Response Times After Contemporary Total Knee Arthroplasty. Clin. Orthop. Relat. Res. 469, 82–86 (2010).


Can you go through airport security with a knee replacement?

            It is safe to say that with enhanced security measures at airports nowadays your joint prosthesis is likely to set off the metal detector.  TSA prefers that you inform the security officer about the presence of knee replacement prosthesis at the time of screening.  A card stating that you have a prosthetic joint may be presented to the officer if you prefer not to say this out loud.  Feel free to watch the video describing this process below.

  1. Johnson, A. J., Naziri, Q., Hooper, H. A. & Mont, M. A. Detection of Total Hip Prostheses at Airport Security Checkpoints: How Has Heightened Security Affected Patients? J Bone Joint Surg Am 94, e44–1–4 (2012).


What should you do about showers and the dressing after knee replacement?

            We will routinely have what is called an occlusive dressing placed on your leg at the time of surgery.  This dressing is intended to prevent any leakage or contamination of the incision.  The intent of this dressing is to avoid the need for frequent dressing changes that could contaminate the incision.  In fact, it is designed so that you keep this on until your follow up appointment.  Most people can shower with this dressing on; however, we encourage you to place a secondary barrier to decrease the risk of penetration of the dressing with water.  If the dressing happens to get saturated, call the clinic for further instructions.  The incision should ideally not be left to soak in water.  Submerging your incision under water, as in bathing, should be avoided for 4-6 weeks after the surgery.  Ask your surgeon or a member of their team for specific instructions about their protocol.


When can I go back to work?

            Most patient should be able to return to work between 2-12 weeks after surgery.  The timing of return to work largely depends on the type of work you perform where people with heavy workloads such as construction will be closer to the 12-week goal.  Those with sedentary jobs such as desk jobs may be able to return to work much sooner.

  1. McGonagle, L. et al. Factors influencing return to work after hip and knee arthroplasty. Journal of Orthopaedics and Traumatology 1–9 (2019). doi:10.1186/s10195-018-0515-x


How long will it take to recover from knee replacement surgery?

            This depends on your definition of recovery.  To some patients, this means, “When will I be able to walk?”  Patients should expect to be up and walking with a physical therapist within a couple of hours after the surgery.  In general, patients should expect to be up and walking the day of surgery.  Rehabilitation after a knee replacement can vary depending on each patient’s goals and expectations.