Doctors diagnose arthritis with a medical history, physical exam and x-rays of the knee.
No surgery is painless, and knee replacement surgery is no exception. However, postoperative pain from knee replacement surgery is usually manageable and newer advanced methods of pain management have helped control surgical pain while reducing use of narcotic pain medicines. Despite the surgical pain, daily and weekly improvements are typically made.
Most patients getting knee replacement surgery undergo spinal anesthesia with sedation, so they are not awake during the surgery. This type of anesthesia has many benefits, not the least of which is the continuation of pain relief for several hours after surgery. Additionally, spinal anesthesia has been demonstrated in studies to have other benefits, such as decreased surgical blood loss and a decreased risk of developing lower extremity blood clots when compared with general anesthesia. The muscle relaxation provided by spinal anesthesia also makes performing the surgery easier and therefore less traumatic for the patient.
After surgery, patients are treated with other pain medicine, mostly taken by mouth. While it may seem surprising, often the postoperative pain from knee replacement can be managed simply with oral pain medicine. This spares patients from the side effects of stronger intravenous medicines. On occasion, injections of pain medicine may be needed, until the day after surgery. After this, most pain medicine is provided in pill form as needed. Patients are often discharged with a prescription of the pills that worked for them during their hospital stay.
Patients can also help relieve their pain with means other than pain medicine. For example, applying ice and elevating the knee after therapy can go a long way toward controlling the swelling that often causes discomfort after such activity. On the other hand, when patients have discomfort from stiffness, usually doing some exercises will help relieve this pain more than any medicine will.
Repeat (also called “revision”) surgery is different than first time (also called “primary”) total knee replacement. The technical aspects of the surgery are more complex than the original total knee replacement, and recovery may be slower than the original surgery. However, the preparation for surgery and the hospital experience tend to be very similar to the primary knee replacement. There may be different weight bearing restrictions after surgery, as well as different rehabilitation protocols.
You will arrive the morning of your surgery and get prepared for surgery. You will be taken to the preoperative holding area where your surgeon or member of the team will mark the correct operative location. You will meet the anesthesia team and nurses who will be involved in your operation.
After surgery, you will recover in the post-anesthesia care unit (PACU) as your anesthesia wears off. You will then be transferred to your room. Once your anesthesia wears off, physical therapy will assist in getting you out of bed and you will begin to walk. Once you can walk, eat normal food and have your pain controlled, you can leave the hospital.
On average, patients stay for 0-3 nights after total knee revision surgery. Your discharge may be as early as the day of surgery, or may be prolonged, depending on the complexity of your revision.