The Patient Experience: A Practice Manager’s Perspective

1. Is knee replacement the right option for me?

According to the Australian Orthopaedic Association National Joint registry, over 63,000 knee replacement surgeries were performed in 2017. Replacement surgery is a very successful procedure in restoring mobility and function and relieving the pain from arthritis in the appropriately selected patient. In advising you about your treatment options, your orthopaedic surgeon will take a medical history, do a physical examination and likely order some tests such as X-rays and MRI scans. I tell my patients that when the pain from arthritis is intrusive, affecting your mobility and quality of life despite maximal non-surgical management then that is the time to consider joint replacement surgery.

Seeing an orthopaedic surgeon can be a daunting thought. Your surgeon can offer advice and guidance with the non-surgical treatment options for your arthritis. This might include advice on medications, lifestyle changes, land and water-based exercise programs, physiotherapy and injectables such as cortisone and plasma (PRP).

2. Pre-surgery Preparation

Preparing yourself physically and mentally weeks and months out from your surgery can make all the difference. Preparing well in advance will help the surgery and your recovery go smoothly. Ensure that you have adequate leave from work and that you are not expecting any extra-ordinary bills during that time. Having a network of family and friends ready to assist you with your return home from the hospital is essential.

Ask questions of your surgeon, GP and physiotherapist. Know what the path to recovery is going to be like. Information is power.

Be in the best physical condition you can be. If you are overweight losing weight will help minimise your risks and also have benefits for your recovery and rehabilitation. Stopping smoking 4-6 weeks out from surgery will significantly reduce your risks of infection, wound complications and anaesthetic risk.

Participating in a pre-operative joint rehabilitation exercise program will improve your general condition going into your surgery and make for a faster and more successful post-operative recovery.

Finally, make sure your home is ready. Remove trip hazards such as throw rugs and make sure it is easy to move around with crutches or a frame. You might need to consider installing rails in the bathroom and toilet.

3. Post-operative rehabilitation

Physiotherapy is very important in your post-operative recovery. You will start seeing the physiotherapist the afternoon of or at the latest the next day after your surgery. The physiotherapist will guide you through exercises to strengthen the muscles around your knee, restore knee range of movement and get you walking again. Once you are discharged from hospital you will participate in a 6-week joint rehabilitation program. This will incorporate hydrotherapy exercises once the wound has fully healed

4. Pain

You will experience some level of pain with knee replacement surgery and during your early recovery. Recent advances in the delivery of anaesthetics combining the benefits of local anaesthetic blocks have significantly reduced the levels of post-operative pain. Throughout your hospitalization you will receive regular pain relief medication. Regular icing in the early postoperative period should not be underestimated. Not only will icing help reduce swelling but it also helps reduce your pain.

5. It won’t feel like your normal knee (before arthritis)

Your new knee will have less pain and improve your mobility compared to your worn-out arthritic knee. It is not uncommon however that you may hear or feel your replaced knee click, pop or tap occasionally. This is just the sound of the components moving on each other and if it is not associated with pain, you don’t need to worry. Bending and kneeling won’t harm your new knee joint but some people do not like kneeling following knee replacement surgery because it is uncomfortable or irritates the scar.

6. Factor in an extra 5 minutes at the airport

It is probable that your knee replacement will set off the airport security systems. Carrying a Card stating you have a joint replacement or revealing your scar may, but not always avoid a pat-down screening.

7. You don’t need to worry about dental procedures causing infection in your replaced knee

For a long time, it was recommended that patients with knee and other joint replacements have antibiotics when having dental procedures. The concern was that mouth bacteria could access the bloodstream and cause infection at the site of the replaced joint. Following an extensive literature review, the American Academy of Orthopaedic Surgeons and the American Dental Association released a combined statement saying that there is a lack of evidence that the use of antibiotics to cover dental procedures prevents joint replacement infection. This recommendation has been adopted by the Australian Arthroplasty Society with the exception being those with compromised immune systems.

8. Use your knee replacement well, it will be with you for a long time

90% of knee replacements will last 15-20 years. You can look after your replacement by maintaining a healthy weight and exercising regularly. 20-30 minutes of low impact exercise a day will not only help your heart but will maintain good muscle condition and improve your mobility. Brisk walking, gym exercises, cycling and aqua-therapy programs are all excellent exercises you can do following your knee replacement.

9. Follow up and monitoring the life of the replacement

It is important you follow up at regular intervals with your surgeon. It is generally advised you see your surgeon with new x-rays of the knee replacement at 1-2 years postoperatively, 5 years, 10 years and every 3-5 years afterwards.