KNEES
KNEE ARTHRITIS
Knee arthritis can be a debilitating condition that makes every day activities like getting in and out of a chair and going up or down stairs painful and exhausting. I will get a thorough history, perform a physical exam, and review X-rays of your knees in specific positions to confirm the diagnosis of knee arthritis. I will stick with you through the entire range of treatment options, which may include a combination of physical therapy, activity modification, medications, bracing, injections or surgery.
If you choose to consider surgery, I am specially trained in a wide variety of total and partial knee replacements. I have trained in minimally invasive and novel techniques, including the subvastus (quadricep-sparing) approach, performing knee replacement without a tourniquet, MAKO and CORI robotic knee replacement, and cementless knee replacement. I will explain your options to you so that you can choose the type of knee replacement that is best for you.
If you choose to consider surgery, I am specially trained in a wide variety of total and partial knee replacements. I have trained in minimally invasive and novel techniques, including the subvastus (quadricep-sparing) approach, performing knee replacement without a tourniquet, MAKO and CORI robotic knee replacement, and cementless knee replacement. I will explain your options to you so that you can choose the type of knee replacement that is best for you.
KNEE REPLACEMENT
Although every case is different, a typical patient can expect:
- Preparation. After we agree on a surgery date, we will schedule appointments for you to meet the anesthesiologist and get pre-surgical clearance. There is also a personalized joint replacement class that will help you prepare.
- Anesthesia. You will come in to the hospital or surgery center on the day of surgery. Most patients will get spinal anesthesia, which means that you will be sleepy and numb from the waist down.
- Incision & approach.Your incision will be a straight line along the front of your knee. For most patients I use the minimally invasive subvastus approach. This allows me to scoop under your muscle instead of going through it. I will close your incision with a plastic surgery closure using dissolving sutures under your skin and glue. You will have a waterproof dressing that can stay in place for 1 week, after which you will remove it.
- Surgical procedure. I (Dr. Wasterlain) am the one who performs your surgery – I will have an assistant, but there will be no students or residents performing your surgery. The surgery will take about 1.5 hours, but it may seem longer than that to your family members because the anesthesia and positioning takes some time as well. I will inject a long-acting numbing medicine called bupivacaine into the soft tissues around your knee to reduce your pain after surgery.
- Post-op recovery. After surgery, you will go to the recovery room to wake up from the anesthesia. A few hours after surgery your legs will regain sensation and you will be able to move them again. The physical therapists will work with you to stand up, walk, climb stairs, and do basic self-care activities on the same day as your surgery. You will not have any restrictions or need to wear any braces. The most important thing after a knee replacement is to work on motion. My goal for patients in the first 2 weeks after surgery is to be able to straighten the knee fully and bend it at least 90 degrees. You will be able to bend it even further eventually, but be patient with yourself.
- Discharge home. Depending on how you are progressing with physical therapy you may go home the same day, or you may spend one night in the hospital. After you leave the hospital, almost all of my patients go home. Research has shown that nursing homes and rehab facilities are associated with more complications (such as infections, blood clots, and hospital readmissions). Therefore, we avoid sending our patients to nursing homes except in rare circumstances.
- Physical therapy & recovery. For the first few weeks after a knee replacement, you will use a cane or walker. The first 2 weeks can be challenging because your knee will feel tight and stiff. The most important thing is to practice bending and straightening many times each day. After 1-2 weeks, you will start doing outpatient physical therapy 2-3 times per week. By 6 weeks you should be feeling much better and be able to walk comfortably without a limp or assistive device. The full recovery period can take up to 3 months, and some patients with a total knee replacement continue to feel better and better for an entire year – but many of my patients recover faster than that.