Osteoarthritis, or degenerative arthritis, is a wear and tear disease that affects knee articular cartilage. The cartilage is worn away, creating painful bone-on-bone contact. As osteoarthritis becomes more severe, the joint loses range of motion, becomes increasingly painful, and may stop responding to conservative non-surgical treatment. It is at this point that knee replacement surgery may become an option to restore joint movement and to reduce or eliminate pain.

The most common symptoms of osteoarthritis are:

• Severe knee pain that limits everyday activity
• Knee pain at night causing sleeplessness
• Progressive deformity of the leg (bowing of leg inward or outward)
• Chronic swelling of the knee with morning stiffness
• Catching or locking of knee
• Grinding pain during movement

• Health and activity history
• Complete physical examination
  
• X-ray(s) while standing
• Observation while walking or standing

Some of the most common treatments include pain medication, non-steroidal anti-inflammatory medications, cortisone injections, physical therapy to help reduce joint pain and increase range of motion and assistive devices such as walkers, canes, or support braces. If a patient with osteoarthritis is overweight, weight-loss maybe recommended to reduce the amount of stress placed on the joints. Unloader shoes or a shoe insert may decrease pain. When these treatments fail to alleviate the painful symptoms of osteoarthritis, joint replacement surgery may be recommended.

There are several indications for total knee replacement including rheumatoid arthritis, arthritis resulting from previous injury to the bones in the joint, corrections of various bone deformities, or arthritis resulting from direct trauma to the joint.

• Surgical incision approximately 4-6 inches long on the front of the knee. (See Minimally Invasive Total Knee Replacement)
• Length of surgery will be approximately one and a half to two hours. Preoperative preparation and time spent in the recovery room can add an additional 2 to 3 hours before you are back in your hospital room.
• Rehabilitation and walking may begin the day after surgery.
• Hospital stay is normally 3 to 5 days followed by:
• In or out patient rehabilitation

Exercise is necessary for proper healing. Depending on your particular knee problem, physical therapy may begin between 24 and 48 hours after surgery. Formal physical therapy begins in the hospital and continues as directed as an outpatient.

Diligent physical therapy, and a willingness to follow the post operative recommendations will promote a more complete recovery. Most patients should be able to walk unassisted and drive four to six weeks after surgery. After a thorough evaluation, activities such as golf, bicycling, and swimming may be resumed.

Dr. Delee will set a follow-up schedule for the first year after surgery to evaluate each patient's progress. Annual visits may be required thereafter. Complications can occur with knee implants, so follow-up examinations are essential in evaluating any changes that may occur with your new joint. It's important to recognize that some of these changes can occur without symptoms. That is the reason for routine follow-up visits.

There are risks assorted with total knee surgery, These vary based on your medical condition and will be discussed with you before surgery. This will also be mentioned in the patient handout you are given before surgery.

The purpose of a joint replacement is to help restore movement to a joint with reduced pain. Once a patient's pain is under control, he or she should be able to return to a more active lifestyle. Activities that could not be performed before surgery, such as climbing stairs, walking acceptable distances, or driving, may be resumed as directed after total joint replacement surgery. Our office has patients who would be willing to speak with you about their experiences before and after total joint replacement surgery.

• Assistive devices such as shoe inserts, a brace, a cane, or a walker may provide temporary relief.
• Exercise or physical therapy can strengthen the muscles around the affected joint(s), possibly providing relief from pain while improving mobility and function.
• Medical management including nonsteroidal anti-inflammatory medications or steroid injections may assist in reducing painful joint inflammation and restoring function.

The average age for joint replacement is 65-80 years; however, joint replacement is indicated at younger ages when other disease processes occur and over 80 years of age in a relatively healthy, and active patient.

Dr. Delee will set a follow-up schedule for the first year after surgery to evaluate your progress. You will be seen regularly thereafter.