Total Knee Replacement in Fort Worth

Is Total Knee Replacement Right for You?

The orthopedic surgeons at Medical City Fort Worth are medical doctors with extensive training in the diagnosis and treatment (both surgical and nonsurgical) of disorders of the musculoskeletal system.

One of them will be happy to discuss with you whether a total knee replacement is the treatment option that offers you the best chance for permanent pain relief and improved mobility.

Medical City Fort Worth's surgeon will explain the potential risks and complications of total knee replacement - including those related to the surgery itself and those that can occur over time.

Consideration may also be given to treating your problem with an anti-inflammatory medication, physical therapy, or some other type of surgery.

Realistic Expectations About Total Knee Replacement Surgery

Crucial to your decision about whether to have total knee replacement surgery is having a good grasp of what the procedure can and cannot do.

More than 90 percent of the people who undergo total knee replacement surgery experience pain relief and a significant improvement in their ability to perform everyday tasks.

However, total knee replacement will not transform you into an Olympic athlete or enable you to do more than you could before you developed arthritis in your knee.

Indeed, after your surgery you will be advised to abstain from certain activities - including jogging and high-impact sports - for the rest of your life.

Even with normal use and activity, the plastic cushion of your knee-replacement implant will undergo a certain amount of wear over time. If you participate in high-impact activities or are overweight, this wear may accelerate and cause your implant to loosen and become painful.

But if you make appropriate adjustments in the range of your activities and their intensity, your knee replacement should last for many years.

Preparing for Surgery

Medical Evaluation

If you decide to have knee replacement surgery, you may be asked to have a complete physical examination by your primary care doctor before your surgical procedure. This is needed to assess your health and identify conditions that could interfere with your surgery or recovery.

Preparing Your Skin

Prior to surgery, there should be no infection or irritation of the skin of your knee and leg, nor should there be any chronic swelling of your lower leg. If any of these conditions is present, your orthopedic surgeon will recommend appropriate corrective measures.

Blood Donations

You may be advised to donate your own blood prior to surgery. It will be stored in the event you need blood after surgery.

Medications

Tell your Medical City Fort Worth orthopedic surgeon about the medications you are taking, including any herbal or home remedies you use. Either he or your primary care doctor will advise you which ones you should stop or can continue taking before surgery.

Dental Evaluation

One of the ways bacteria can enter your bloodstream and cause an infection is through a dental procedure. It is, therefore, wise to get any needed dental work taken care of well in advance of your knee replacement surgery. After surgery, routine cleaning of your teeth should be delayed for several weeks.

Urinary Evaluation

If you have a history of urinary infections, or are an older man with prostate disease, you should be evaluated by a urologist before having knee replacement surgery.

Discharge Planning

Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with routine tasks such as cooking, shopping, bathing, and doing laundry. If you live alone, a Medical City Fort Worth case manager will help you make advance arrangements to have someone assist you at home. A short stay in an extended-care facility may also be arranged.

Your Surgery

Prior to your being admitted to the hospital the day of your surgery, a member of Medical City Fort Worth’s anesthesia team will evaluate you. Information about the most common types of anesthesia for total knee replacement surgery can be found here. The anesthesia team will discuss your options with you and help you decide which type of anesthesia is best for you.

The procedure itself takes approximately two hours. Your Medical City Fort Worth orthopedic surgeon will remove the damaged cartilage and bone and then position the new metal and plastic joint surfaces to restore the alignment and function of your knee.

Many different designs and materials are currently used in artificial knee-implant joints. Your Medical City Fort Worth surgeon will choose the one that best meets your needs.

Whatever the specifics of their design, almost all knee implants consist of three components: a femoral component (made of a highly polished strong metal), a tibial component (made of a durable plastic often held in a metal tray), and a patellar component (also plastic).

After surgery, you will be moved to the recovery room where you will remain for one to two hours while your recovery from anesthesia is monitored. After you awaken fully, you will be taken to your private room.

Minimally Invasive Total Knee Replacement

Over the past several years, the orthopedic surgeons at Medical City Fort Worth have been very active in the development of new, minimally invasive techniques for inserting total knee-replacement implants through incisions approximately half the size of those used in the standard approach.

Numerous clinical studies (some of them performed at Medical City Fort Worth) suggest that a minimally invasive approach may result in a shorter hospitalization, a quicker and less painful recovery from surgery, and a more rapid return to normal activities.

Such an approach may be appropriate for a patient who is not obese, does not have a significantly deformed knee joint, and still enjoys good range of motion. Your Medical City Fort Worth orthopedic surgeon will be happy to talk to you about whether you are an appropriate candidate for minimally invasive total knee replacement.

Your Stay at Medical City Fort Worth

You will usually stay at Medical City Fort Worth for a few days after your surgery. During this period, you will feel some pain, but will receive medication to enable you to feel as comfortable as possible. Because appropriate pain management is important to your recovery, be sure to talk to your surgeon if postoperative pain becomes a problem.

Movement of your repaired knee is also important to your recovery and will begin immediately after your surgery. To assist in this process, your surgeon may use a knee support that slowly flexes your knee while you are in bed. The device, called a “continuous passive motion” (CPM) exercise machine, reduces swelling of your leg by elevating it, and improves your venous circulation by mobilizing the muscles of the leg.

Foot and ankle movement is also encouraged as a way to increase blood flow and help prevent swelling and blood clots. Most patients begin exercising the repaired knee the day after surgery.

A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement, which will facilitate the resumption of walking and other normal daily activities.

Complications

Blood clots in the leg veins are the most common complication of knee-replacement surgery. Your surgeon will outline a clot-prevention program, which may include periodic elevation of your legs, support stockings, lower leg exercises to increase circulation, and the use of a blood-thinning medication such as cuminin.

Recovery

To maximize the likelihood of a successful outcome, closely follow your Medical City Fort Worth orthopedic surgeon’s instructions during the first few weeks after your surgery.

Wound Care

You will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed several weeks after surgery. A suture beneath your skin will not require removal. Avoid soaking the wound in water until it has thoroughly sealed and dried. A bandage may be placed over the wound to prevent irritation from clothing or support stockings.

Diet

Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength.

Activity

Critical to a successful recovery from surgery is exercise, particularly during the first few weeks after discharge. You should be able to resume most everyday tasks anywhere from three to six weeks following surgery.

Driving usually begins when you can bend the repaired knee enough to enter and sit comfortably in your car. There must also be sufficient improvement in your muscle control to allow adequate reaction time for braking and acceleration. Most patients are able to resume driving four to six weeks after surgery.

Avoiding Falls

A fall during the first few weeks after surgery can damage your new knee and may result in a need for more surgery. You should use a cane, crutches, a walker, or handrails and/or have someone help you until your balance, flexibility, and strength improve.
Don’t neglect to see your Medical City Fort Worth orthopedic surgeon periodically for routine follow-up examinations and x-rays, even if your knee replacement seems to be doing fine.

Frequently Asked Questions

What are the most common reasons for undergoing a total knee replacement?

The people most likely to benefit from total knee replacement are those for whom knee pain continues even while resting, constantly interfering with their ability to perform ordinary activities such as walking, climbing stairs and getting in and out of chairs. Other strong indications for surgery include chronic knee inflammation and swelling that does not improve with rest or medication, significant deformity of the joint itself, and persistent pain that is not relieved through the use of standard anti-inflammatory drugs.

What are the advantages of a minimally invasive approach to total knee replacement?

The orthopedic surgeons at Medical City Fort Worth have observed shorter hospital stays and more rapid rehabilitation in the majority of patients treated using minimally invasive techniques. Some have been discharged from the hospital after only 24 hours, setting the stage for a quicker return to work and normal activity.

Who is a good candidate for ‘mini-incision’ total knee replacement?

The ideal candidate is a person who suffers from osteoarthritis of the knee, but is otherwise in excellent health and not seriously overweight. It is also important that the candidate retain nearly full range-of-motion in the affected knee, and that the joint itself not be significantly deformed.