Chapter 18

Frequently Asked Questions Concerning Total Knee Arthroplasty

Patients are rightfully trying to become more educated about their surgery and recovery. They often obtain (mis)information on the Internet or from friends. They need to be informed about their surgeon’s individual postoperative protocol, and they need to have their anxieties relieved when “things happen” during their recovery.

For years, measures have been in place at our hospitals to try to address this. These measures included a preoperative dialogue with the surgeon, and a preoperative teaching class was available that could be attended at the time of the preadmission screening tests.

What was missing was a document that the patient could refer to regarding events that might arise before, during, and after their hospitalization. To address this need, G. Erens and I created a brochure to be given to each patient when surgery is scheduled. Initially, the answers given to each question were our own responses. The concept became attractive to all members of the arthroplasty staff, and the brochure was modified for use by everyone.¹ A disclaimer was attached to remind patients that they were being given general information and they should always contact their personal physician with any questions or concerns.

Categories of Questions

Questions from patients were collected in three categories: preoperative, perioperative, and postoperative. Perioperative questions were divided into those that might arise in the hospital and those more likely to be asked soon after discharge.

In addition, three very frequent concerns of patients—depression, insomnia, and constipation—were specifically addressed.

Some things that normally occur after total knee arthroplasty (TKA) might be alarming to patients unless they are aware that their symptoms are within normal limits. These events include an intermittent clicking sensation inside the knee, an area of skin numbness on the outside part of the knee, swelling after exercise and at the end of the day, warmth around the knee, and palpable sutures under the skin that are not apparent until the swelling begins to resolve.

Worrisome things also can occur during recovery that are definitely abnormal and require an immediate call to the physician. These include increasing redness around the wound, increasing pain and swelling, fever over 101° F, any drainage from the wound, calf swelling or pain, ankle swelling that does not decrease or resolve overnight, and bleeding gums or blood in the stool or urine.

The Answers

This section provides possible answers to frequently asked questions. These are not meant to be definitive answers but rather guidelines that different surgeons might modify to fit their own practice routines.

Preoperative Questions

Q: What is the chance for success?

A: “Success” should not be measured as a quantitative knee score but rather by the ability to answer “yes” to the following three questions:

Are you glad you had the operation?

Did it fulfill your expectations?

Would you do it again?

Over 90% of patients at 1 year will answer “yes” to all three questions.

Q: What is the recovery time?

A: Everyone heals from surgery at a different pace. In most cases, however, you will be restricted initially to the use of a walker or crutches for distances but advance to a cane outdoors and no support around the house within several weeks. You will gradually return to normal function without any assistive devices. This usually takes about 3 months but may take shorter or longer.

Q: Will I go to a rehabilitation facility or home?

A: It depends. Most people are able to go home after their operation. However, you may go to a rehabilitation facility to gain the skills you need to safely return home. Many factors will be considered in this decision. These factors include availability of family or friends to assist with daily activities, home environment and safety considerations, postoperative functional status as evaluated by a physical therapist in the hospital, and overall evaluation by your hospital team.

Q: When can I drive?

A: If you had surgery on your right knee, you should not drive for at least a month. After 1 month, you may return to driving as soon as you feel comfortable. If you had surgery on your left knee, you may return to driving as soon as you feel comfortable if you have an automatic transmission. Do not drive if you are taking opioids. Some surgeons do not allow their patients to drive until after they have been seen in the office at 4 to 6 weeks after surgery. Check with your surgeon.

Q: When can I travel?

A: You may travel if you must as soon as you feel comfortable. It is recommended that you get up to stretch or walk at least once per hour when taking long trips. This is important to help prevent blood clots. Defer air travel for 1 month, if possible.

Q: When can I return to work?

A: It depends on your profession. Typically if your work is primarily sedentary, you may return after approximately 1 month or even sooner. If your work is more rigorous, you may require up to 3 months before you can return to full duty.

Q: What activities are permitted after surgery?

A: You may return to most activities as tolerated, including walking, gardening, golf, doubles tennis, and snow skiing (if approved by your surgeon). Some of the best activities to help with motion and strengthening are swimming and using a stationary bicycle. You should avoid high-impact stresses, such as running and jumping, and vigorous sports, such as singles tennis or squash. When skiing, avoid poor conditions, crowded slopes, and difficult trails.

Q: How long will my knee surgery last?

A: This will vary from patient to patient. For each year after your knee replacement, you have a 0.5% to 1% chance of requiring additional surgery. For example, at 10 years postoperatively, there is a 90% to 95% success rate without further surgery. At 20 years, there is an 80% to 90% chance of avoiding more surgery for the typical patient who has undergone TKA.

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