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How will I know if my knee replacement is beginning
to loosen? |
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There are several things a patient may notice as a total knee replacement begins to fail. The first and most important would be pain. If the patient has had a pain free or essentially pain free knee replacement and it becomes more uncomfortable for them, this is probably the single most important factor that may indicate early loosening. Other factors that may be consistent would be change in alignment of the leg or the increasingly noticeable deformity. If either of these were to occur, the patient should see their orthopaedic surgeon, have radiographs obtained. The best way to avoid significant problems with the knee replacement is to have routine follow up. Generally, it is recommended that these should be radiographed at least every other year.
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What will the incision look like after the knee replacement
surgery? |
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In general, the incision is over the front of the knee. Unfortunately, this incision crosses the normal natural skin lines at a 90° angle. In that setting, it is not uncommon for the incision to broaden quite a bit. In addition, this is made a bit worse by trying to have the patient work as diligently as possible with physical therapy to regain range of motion. Normally, the lower third of the incision will result in little broadening because there is not much mobility to the skin over this area. However, from the level of the lower portion of the kneecap to the upper end of the incision it is common to have some degree of broadening postoperatively. Usually, the incision will be somewhat reddened and swollen for approximately four to six months. Then, the incision will soften significantly and the incision will turn the more natural skin color after approximately six to twelve months.
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My knee is warm postoperatively. Is this normal? |
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It is normal for knee replacements to be warm in the first four to six moths postoperatively. There is an extensive dissection underneath of the skin there is usually little soft tissue covering the knee. In that setting, the knee can, particularly with activities, become somewhat warm and stiff. Normally, this will resolve by approximately four to 6 months postoperatively.
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After surgery, is it normal for my knee to look larger than my other knee which has not had knee replacement surgery? |
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It is common for a post-operative total knee to be larger than the natural, native knee. That is a very common feature and finding and is not necessarily related to the parts being a different size than the amount of bone that was resected.
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Is it normal to have numbness along the outer or lateral aspect of the incision? |
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It is common to develop some numbness or change in sensation over the lateral or outer aspect of the incision after surgery. The normal skin nerves run from the inner aspect of the knee, rotating to the outer aspect of the knee. Incisions that are made directly over the front of the knee oriented along the length of the leg will cut across these nerves. Generally, after four to 6 months, much of the skin sensation will return. However, in some patients, there is always a reduced degree of sensation over the outer aspect of the knee. Usually, this is of little clinical significance.
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I have had several other surgeries to the knee with several other incisions. Will this influence how the surgery is performed? |
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The skin over the front of the knee is very sensitive to previous incisions. If care is not taken in making the incision and trying to incorporate previous incisions in the knee and the approach required for knee replacement surgery, there may be a problem with blood supply to some of the skin over the front of the knee. If this were to occur, it is very important to recognize it quickly. This may require the assistance of a plastic surgeon to place a skin or muscle flap over the front of the knee to ensure that the knee wound will be closed effectively. This is a situation that is best avoided. The best way to do this is to utilize previous incisions and take care with the soft tissue during the procedure.
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After total knee arthroplasty, what activities can
I return to? |
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After knee or hip replacement arthroplasty patients are encouraged to
walk as much as possible. In general, it is good to walk for 30-40
minutes at least four days per week. In addition, patients can use
either a regular or stationary bicycle, treadmill, stair stepping
device, elliptical trainer, and they can participate in a low impact
aerobics program. Water aerobics or water exercises are also to be
encouraged. Weight lifting can also be done after hip and knee
replacement surgery. For lower extremity exercises, it is best to use
lower weight and higher repetitions exercises. Any amount of weight
can be used in the upper extremities as long as it is done from a
seated or lying position. If you have questions regarding specific
machines or activities, please ask your orthopaedic surgeon.
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I have occasional clicking or clunking in my knee after surgery. Is this normal? |
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It is common to have some sensations or actually audible clicks or clunks after knee replacement surgery. Generally, this is not painful and not associated with any discomfort or functional deficit. At the time of surgery, a small degree of laxity is put into the knee to allow the knee to move and function well. If the knee is made so tight no clicking is allowed, the knee will be quite painful postoperatively and will gain limited range of motion over the long term. |
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My knee is becoming progressively more deformed. When is the appropriate time to consider knee replacement surgery? |
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The opposite form of deformity is a knock-knee leg or valgus deformity. Due to the differences in the ligaments on the inside and outside part of the knee, a valgus deformity can be more difficult to correct at the time of surgery. In patients who have a significant valgus or knock-knee deformity to their leg in general it is somewhat better to have the surgery done a bit sooner rather than wait until a marked deformity is present; although large or marked deformities can be corrected with a valgus or knock-knee deformity. These will resolve generally and a bit more soreness and swelling and pain postoperatively and may result in an increased operative time. In addition, there is an increased risk for stretching of the peroneal nerve that runs along the outer aspect of the knee. If this is significantly stretched it can result in numbness and weakness in the foot. Therefore, with a knock-knee or valgus deformity, surgery is normally recommended a little earlier in the arthritic course. The surgery will be conducted with the minimal limb deformity and will decrease the risk of neurovascular injury, reduce potential for swelling, pain, and bleeding postoperatively, and also improvement in the overall rehabilitation postoperatively. |
