5 Things to Know About Knee Replacement Surgery

How do I know if I need a knee replacement?

Braverman’s experience is typical in that the first course of action when seeking treatment will most likely be non-surgical.

Rishi Balkissoon, M.D., an adult reconstruction orthopedic surgeon at the University of Rochester Medical Center (URMC) in Rochester, New York, says 80 percent of his practice is nonsurgical, meaning he’ll recommend wearing a brace, doing physical therapy or getting cortisone injections before considering surgery.

Cortisone is a well-known steroid that can be “safely given every three months, and can happen lifelong if desired,” Balkissoon says. There are other injectables available, too — including hyaluronic acid, sometimes referred to as rooster comb or gel shots, and platelet-rich plasma (PRP) — though Balkissoon says there’s not enough evidence to show they’re effective at treating chronic arthritis pain.  

Ultimately, your pain level and your need to continue living a life you enjoy will determine when you’re ready for a knee replacement. “When you’ve been managed with injections and your symptoms are persistent and you have documented evidence of arthritis on either an X-ray or MRI, that’s when you’re a candidate for a replacement procedure,” Summers says.

What should I expect from surgery?

The surgery, in which the surgeon makes a vertical cut down the front of your knee, takes 90 minutes to two hours. Based on your history, you and your doctor will discuss whether you’ll receive general or regional anesthesia.

With general anesthesia, you will be completely under, and a tube in your airway will help you breathe. Regional anesthesia numbs just the area where the surgery will occur. It can be administered as spinal (a single shot) or epidural (continuously administered via catheter) anesthesia. Studies have shown that with regional anesthesia you should have fewer complications and shorter hospital stay compared with general anesthesia. In fact, Summers says, many patients go home the same day of surgery.

Braverman says she had a general anesthetic and remained overnight. “But they had me up and walking right away,” she says, adding that before you are allowed to be discharged, “they show you how to sit, stand, go up the stairs — with the good foot first, followed by the bad foot — and get in the car.”

What is the recovery like?

Some pain is to be expected once you get home, but over-the-counter pain relievers, like acetaminophen or ibuprofen, may be all you need to combat it. And because of improved pain control efforts and new nerve blocks given during surgery, Summers says, “we can make the whole knee extremely comfortable for patients for the first three days or so after surgery.”

He adds that there had been a fear factor for patients around the pain, and many people put off surgery. But now, he says, when patients return for a check-in after two weeks “they tell me, ‘Hey that wasn’t nearly as bad as my friends told me it would be.’”

You will need to use assistive devices such as a walker and a cane for a few weeks, Summers says. Shortly after surgery, you’ll begin to do physical therapy to get back your full motion.

Many hospitals will send a physical therapist to your home — expect to keep it up for about six to eight weeks. Summers also sends patients a small stationary bicycle specifically used for knee replacement therapy. Often, insurance will cover this device. “It a good way for [patients] to do more exercise in the comfort of their home,” he says. 

What are the risks in knee replacement surgery?

Blood loss is a common risk in knee replacement surgeries. For the past 15 years, Balkissoon says, most knee and hip reconstruction specialists have been using tranexamic acid during surgery to help provide clot stabilization and reduce postoperative blood loss. This has “dramatically reduced the potential for blood transfusions,” he says. Despite its wide use, tranexamic acid has not become the standard for care, according to the American Academy of Orthopaedic Surgeons and other groups.

Other risks include a small possibility of nerve or surrounding ligament damage. And, of course, there is always the possibility that you may have ongoing issues with your knees. But, according to the Cleveland Clinic, more than 90 percent of people who have knee replacement surgery have improved knee function for 10 to 15 years.

Should I have both knees replaced at the same time?

It’s not uncommon, as Braverman discovered, to have osteoarthritis in both knees. While some people undergo simultaneous (or bilateral) knee replacement surgery, it may not be the best solution for you. Making this determination requires a serious discussion with your surgeon.

Summers says it’s rare for him to recommend having both knees replaced at the same time. “There are increased risks for things like needing a blood transfusion or having a blood clot because it is more surgery that you're undergoing in one stay,” he says. He usually advises his patients to “stage it out,” and have the second surgery around two months after the first one. “As I tell patients, you want to wait until you have a good leg to stand on before we do the other one,” he says.

Braverman had her two knee surgeries nine months apart in 2016. Now, eight years later, she is playing tennis, walking, hiking, riding her e-bike — doing all the physical activities and traveling she has always enjoyed. And despite having two six-inch scars, she says, “I love my knees.”