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What is knee replacement?
It is a metal and plastic covering for raw, arthritic bone ends. It would more accurately be called a knee cartilage replacement. It replaces cartilage that has worn away over the years. Knee replacement can eliminate pain and allow you to move easily with less discomfort. For those who have become bow-legged or knock-kneed over the years, it can also straighten your legs to a more natural position.

Who should have a knee replacement?
When arthritis knee pain severely limits your ability to walk, work, or perform even simple activities, knee replacement should be considered.

Is there an alternative to knee replacement?
Knee replacement is only recommended after careful diagnosis of your joint problem and you have exhausted all conservative measures such as anti-inflammatories, physical therapy and injections. Synvisc is not helpful in a knee with advanced arthritis. Arthroscopic or microscopic surgery is not helpful once arthritis is advanced. Some other alternatives to a total knee replacement are the uni-spacer and the uni-compartmental knee replacement. Please ask your surgeon if you are a good candidate for one of these procedures.

Should my knee replacement be cemented?
Knee replacements are successfully performed with all cemented components as well as with a combination of uncemented and cemented components or completely non-cemented. Most of the knee replacements at our hospital are non-cemented or combination, cemented-non-cemented. Your surgeon will discuss which technique is best for you.

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How long is the hospital stay?
The average hospital stay for a knee replacement patient is around 3-4 days. The average stay for two knees is 5-7 days, although we do not recommend that you do both knees at the same time. In some cases, fixing one knee reduces the stress on the other knee, thus giving another it two or three years if the arthritis is not too advanced. Each individual case is different.

How long is recuperation?
Recovery varies with each person. You will use a walker for approximately 1-2 days after the operation. You can drive a car in 2-4 weeks. Most people gradually increase their activities and play golf, doubles tennis, go hiking, bike riding, swimming or dancing within 12 weeks. After discharge, there is usually no need for a nursing home. Some patients who live alone may require a short stay at our Acute Rehab Center for a few days to a few weeks before they leave the hospital. This will depend on how you progress in the hospital. Keep in mind that healing and recovery times vary with each person.

After discharge, there is usually no need for a nursing home. Some patients who live alone may require a short stay at a rehab center for a few days after they leave the hospital. This will depend on how you progress in the hospital, and keep in mind that healing and recovery times vary with each person.

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Will I need a blood transfusion?
The need for blood transfusions after knee replacement surgery depends greatly on very individualized factors. The majority of knee replacement patients require a transfusion a few days after surgery.,. Some patients may want to donate their own blood prior to surgery for use after surgery. Your surgeon will be happy to discuss these issues with you.

What is the success rate?
Knee replacement surgery is recognized as a miracle of modern surgery. Most orthopedic experts consider replacement to be the best method of handling arthritis in the knee. Knee replacements have literally put hundreds of thousands of Americans back on their feet and allowed them to enjoy their lives. Knee replacement surgery is 96-98% successful. Success means the patient has reduced pain and improved function of the knee.

Are there complications?
As with any surgery, there is a risk of complications after knee replacement surgery. However, they are quite rare … driving on an interstate highway is probably more dangerous. To reduce the risk of infection, we take special precautionary measures in the operating room, and use powerful antibiotics. Other complications include blood clots. We take every precaution to avoid this. Our personnel are limited to fully trained and experienced nurses and technicians.

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What about pain?
Thanks to advances in medication technology, we are able to keep you very comfortable after surgery. After surgery, any temporary discomfort does not compare to the pain of arthritis endured by most people in months and years before surgery.

And because knee replacement patients are not "sick," you will not be treated as such. You will wear casual clothing after surgery, not hospital gowns. You’ll also join other joint replacement patients for Group lunches, group physical therapy and movies.

What is the cost?
As Medicare participating physicians, our doctors accept the amount Medicare approves for hip replacement. We will file your Medicare claim and also bill your supplementary insurance for the 20% portion of the surgeon’s fee that is approved by Medicare but paid by your supplementary insurance. The hospital also accepts Medicare assignment. We also accept many other types of insurance.

Please call the Total Joint Center at (415) 353-6380 to learn about insurance and costs or click here. 

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Can I talk to someone who has had a knee replacement?
Yes! We’ll gladly give you the names and telephone numbers of some of our patients who have new knees. They have volunteered to talk on the phone with people who are considering surgery and are happy to share their experiences with you. Just call our office and ask to speak with one of our patients who has gone through our program.

How can I schedule an evaluation? 
To make an appointment, please call (415) 353-6380. Joint Center physicians are available on Tuesday and Wednesday mornings from 9 am to 12 noon and alternating Monday afternoons. The Center accepts Medicare assignment and bills Medicare and secondary insurance. The Center also participates in most managed care plans as well as other insurances. Appointments for Workers' Compensation patients are authorized and scheduled through adjusters for the compensation insurance companies.

KNEE-CAP PROBLEMS:

What is patella femoral pain syndrome?
Patella Femoral Pain Syndrome (PFPS) is a condition of the kneecap characterized by a rough or soft spot on its cartilage surface. In the past, it has been called chondromalacia patella, runner’s knee, or dashboard knee.

What are the symptoms?
It causes pain, giving way, stiffness and a feeling of catching or grinding. Going up and down stairs is painful, and sitting with your knees bent or squatting is very uncomfortable. It makes the knee "give out," grind, or pop loudly.

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Who gets it?
Many people may have PFPS, but only about 10 percent have a long-lasting pain or disability because of it - a fact not clearly understood by the medical profession. Over-activity, excess weight and injury sometimes initiate the symptoms. This condition is often seen in adolescents, manual laborers and athletes.

How is it diagnosed?
Cartilage contains no calcium and, as a result, cannot be seen by ordinary x-rays. A patient’s history and a physical examination suggest the diagnosis. If there is any doubt, we suggest an MRI or an arthroscopy to look behind the kneecap and check to see that there is no other injury or abnormality.

How long does patella femoral pain syndrome last?
It may last several months, but fortunately, is usually a self-limiting problem. If you are born with an abnormal kneecap, it may last indefinitely. You may even need an operation to correct it, though this is unusual.

What is the treatment?
Small doses of anti-inflammatory medicines can often decrease swelling, stiffness and pain. Other treatments may include injections, ice, rest, and physical therapy. Taping and a brace to stabilize the kneecap also can be helpful.

Now for the good news...
The good news is that although PFPS can be uncomfortable, usually it is only a short-term nuisance and inconvenience. It also generally does not lead to arthritis or any other joint problems.

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