Total Knee Replacement in New York City
What is a total knee replacement?
Your knee joint is formed by three bones: the tibia, the patella, and the femur. The tibia, commonly known as the shinbone, is a large bone that extends from your ankle to your knee. The femur, also known as the thighbone, is the longest and strongest bone in your body and stretches from the lower end of your pelvis to your kneecap. The knee joint, also referred to as the tibiofemoral joint, forms where the tibia and femur meet. The patella, also known as your kneecap, sits atop the femur and protects the knee joint. Damage to the cartilage or bone of the femur, tibia, or patella may result in knee pain and impaired mobility.
If you are experiencing severe or persistent knee pain or loss of mobility and have tried various treatment options that offer little relief, a total knee replacement, also known as a total knee arthroplasty, may be an appropriate treatment option for you. A total knee replacement involves restoring and replacing the damaged surfaces of the femur and tibia, and, in some cases, the patella. A total knee replacement differs from a partial knee replacement because it involves replacing the entire surface of the femur and tibia, while a partial knee replacement involves replacing only the damaged surfaces in one or two compartments of the knee. At David Mayman MD, we perform total knee replacements utilizing cutting-edge technology, such as robotic and computer-assisted surgery, to help provide optimal outcomes and help you get back in the game.
When is a total knee replacement needed?
A total knee replacement is performed to help alleviate severe knee pain and restore joint mobility. While most patients will require a total knee replacement, certain cases may only require a partial knee replacement. Your doctor may recommend a total knee replacement if:
- You are experiencing debilitating knee pain or stiffness that interferes with daily activities
- You are experiencing inflammation, pain, or stiffness of the knee that does not go away with medication
- You are experiencing persistent knee pain, even when resting
- You have a knee deformity, such as a bowed knee
What does a total knee replacement involve?
The procedure for a total knee replacement involves your doctor implanting prosthetic components to replace the damaged surfaces of your femur and tibia. The procedure begins with your doctor gently making an incision at the site of surgery. Your doctor will then “prepare the bone” by removing any damaged cartilage and bone from femur and tibia. Once the damaged surfaces are removed, your doctor will place prosthetic implants where the initial cartilage and bone once were. In most cases, your doctor will also remove damaged cartilage and implant a prosthetic component behind the patella. To ensure optimal mobility of the prosthetic pieces, your doctor will position and place a spacer between the prosthetic materials. When the procedure is complete, your doctor will carefully place all surrounding structures of the knee back in place and gently close the incision. Recovery time after a total knee replacement surgery will vary from patient to patient, however, patients are able to walk out of the hospital 1 – 2 days after surgery and are walking without a cane four to six weeks after surgery. Patients are back to almost all activities by three months but continue to improve for at least one year.
What are the benefits of a total knee replacement?
A total knee replacement is beneficial because it can alleviate pain and restore the functionality of the affected knee, helping you to get back in the game and return to your normal daily activities.
How long does the procedure take?
Most knee replacement procedures take 90 minutes to 2 hours. Patients may also spend a short amount of time in the recovery area of the surgical center, where anesthesia can begin to wear off under the observation of the surgical team
How to do I prepare for the procedure?
It may be necessary to prepare the home space prior to total knee replacement. If the home is multi-story, it may be best to create a comfortable sleeping area on the ground floor to use for a few days. However, physical therapy that begins in the hospital does assist patients with walking up and down stairs. Preparing the home may revolve more around clearing obstructions that may limit movement using an assistive device like crutches. The shower or tub should also be safely accessible, meaning that a handrail may need to be installed.
What are the risks of getting knee replacement surgery?
The American Academy of Orthopaedic Surgeons reports that more than 600,000 knee replacements occur each year in the United States. Fewer than 2 percent of these surgeries result in serious complications.
Risks related to total knee replacement include:
- General or regional anesthesia risks.
- Bleeding or blood clots.
- Damage to underlying nerves or arteries, which may require repair.
- Allergic reaction to metal components of the joint implant.
- Implant failure or need for revision surgery.
What does the recovery process look like?
Rehabilitation begins right away after total knee replacement. On the day of surgery, a physical therapist assists with standing and walking using devices such as a walker, cane, or crutches. Movement and weight-bearing are critical first steps in healing from knee replacement. Patients should expect a physical therapist to provide exercises that strengthen the muscles that support the knee. The physical therapist or nursing staff also shows how to get in and out of bed. Further assistance is provided to teach how to change the dressing or bandage, how to bathe, and how to use the toilet.
By the time patients are discharged from the hospital, they should be able to:
- Bend the knee nearly to a 90-degree angle
- Get in and out of bed without assistance
- Rely only minimally on an assistive device
- Bathe and dress independently
- Walk approximately 25 feet and go up and down a few stairs
Once at home after total knee replacement, patients engage in physical therapy as prescribed. Adherence to the exercises demonstrated by the physical therapist significantly improves the recovery experience. By about 6 weeks after surgery, patients should be able to walk up to half a mile without an assistive device. Normal, light activities such as housework become easier by 4 to 6 weeks post-op.
The second and third month of recovery is crucial for long-term success after total knee replacement. During this time, physical therapy focuses on rebuilding strength and flexibility in the knee to support a normal lifestyle as quickly as possible. The progress made in physical therapy influences how soon patients may resume additional activities, such as riding a bike or walking longer distances.
How long until I can drive after the procedure?
Driving should not resume for at least 4 weeks when:
- The right knee has been replaced or
- The automobile is a straight shift that requires the use of a clutch
- If the left knee has been replaced and the automobile is an automatic transmission (no clutch), patients may begin driving before 4 weeks as long as they are not taking narcotic pain medication.
How long until I can start to exercise?
Normal activities such as walking will begin the day of surgery and should continue daily, gradually increasing in distance.
Six to twelve weeks after total knee replacement, patients may begin some low-impact forms of exercise as approved by their physical therapist. Swimming and riding a stationary bike are typically encouraged due to their positive effect on strengthening the knee.
Higher-impact activities that require running or jumping of any kind can resume once approved by the physical therapist.
What will the results look like?
The goal of total knee replacement is to relieve pain and restore the best possible function to the joint. More than 90 percent of patients experience significant or complete pain relief after their full surgical recovery. Most patients are able to walk normally, without a limp or the need for an assistive device like a cane, even if one was necessary before surgery.
What will the scars look like?
The incision for total knee replacement surgery extends from a few inches below the knee to a few inches above it. The texture, color, and overall size of the resulting scar can vary quite a bit from one person to another. Healing is influenced by several factors, including sun damage, genetics, and how well the incision is cared for in the weeks after surgery. The surgical team may be able to suggest strategies such as using special ointments or silicone strips once the incision has fully closed. Usually, the incision scar is reduced to a thin line by 10 to 12 weeks after surgery.
How long do the results last?
Studies indicate that approximately 85 percent of total knee replacement procedures result in 15 to 20 years of improved functionality and comfort. Wear and tear on the joint may eventually affect its performance. However, lifespan may be supported with healthy weight management and conservativeness in the intensity of exercise.
If you are experiencing knee pain that is interfering with your daily activities and are interested in a total knee replacement, a consultation with an experienced orthopaedic specialist may be the first step towards helping you regain mobility, return to your normal daily activities, and get back in the game. Here, at our practice, Dr. David Mayman provides personalized treatment solutions paired with cutting-edge technology to deliver total patient care and optimal results. Call 212.774.2024 to schedule an appointment.