Q. Am I too old for this surgery?

Age is not a problem, if you are in reasonable health and have the desire to continue living a productive, active life. You may be asked to see your personal physician for his/her opinion about your general health and readiness for surgery.

Q. What are the major risks involved with this surgery?

Most surgeries go well, without any complications. Infection and blood clots are two serious complications that concern us the most. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce risk of infection and blood clots. Complications can also occur to your skin, arteries, veins, nerves, tendons, ligaments, and bones. Overall, the complications rates are historically between 10-15%. Dr. Riddhivardhan will discuss these with you during your visit, but if you have any further questions or concerns, please call him anytime.

Q. Will I need blood?

Most patients do not require blood transfusions after knee replacement surgery. We use many techniques to reduce blood loss and the need for transfusion. You will have several tests, including blood work, done prior to surgery. The doctor will use these results to anticipate your need for blood products. All patients will be asked to take Vitamin C and Iron starting six weeks prior to surgery. The Vitamin C helps your body absorb the Iron, which assists in maintaining your haemoglobin before and after the surgery. You can purchase a low-cost package of both of these in our office. If you do need blood following surgery, we recommend the blood from the blood bank. This blood is screened thoroughly for infectious disease.

Q. How long will the surgery take?

We reserve approximately two to two-and-a half hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery. However, it is not uncommon for some surgeries to take over 3 hours.

Q. Do I need to be put to sleep for this surgery?

You may have a general anaesthetic, which most people call “being put to sleep.” However, an overwhelming majority of patients prefer to have a spinal anaesthetic. Spinal anaesthetic numbs your legs, providing you with prolonged pain relief, protecting you from blood clots and allowing for “twilight” sedation. The choice is between you and the anaesthesiologist.

Q. Will the surgery be painful?

You may have discomfort following the surgery, but we will keep you comfortable with appropriate medication and relaxation techniques. Generally most patients are able to stop very strong medication within one day. We continually improve and refine our pain control methods to assure a good recovery and fit the best method of pain relief to your specific needs.

Q. How long, and where, will my scar be?

The scar will be approximately six inches long. It will be straight down the centre of your knee, unless you have previous scars, in which case we may use the prior scar. Afterwards, there may be some numbness around the scar. This will not cause any functional problems. We use skill and care to make the scar as cosmetically appealing as possible.

Q. How long will I be incapacitated?

You will probably stay in bed the day of your surgery. However, the next morning you will get up, sit in a chair or recliner and should be walking with a walker or crutches later that day. Most patients receiving a uni-compartmental (1/2 knee) will be able to walk in the hallways the first day.

Q. How long will I be in the hospital?

Most knee patients will be hospitalized for three days after a total knee arthroplasty. Patients receiving a uni-compartmental (1/2 knee) will leave the next day. There are several goals that you must achieve before you can be discharged. These include availability of family or friends to assist with daily activities, home environment, safety considerations, post-operative functional status as evaluated by a physical therapist in the hospital, and overall evaluation by Dr. Riddhivardhan.

Q. Will I need a walker or crutches or cane?

Yes. For about six weeks, we do recommend that you use a walker, a cane or crutches. Arrangements for a walker or crutches will be made at orientation or during your hospital stay. However, you may bring your own or a borrowed one if you have one available to you.

Q. Will I need help at home?

Yes. The first several days or weeks, depending on your progress, you may need someone to assist you with meal preparation, ambulating, and normal daily activities. If you go directly home from the hospital, the Dr. Riddhivardhan’s staff will arrange for a home health care nurse to come to your house, as needed. Family or friends need to be available to help, if possible. Preparing ahead of time can minimize the amount of help needed.

Q. Will I need physical therapy when I go home?

Yes. You will either have outpatient or in-home physical therapy. Patients are encouraged to utilize outpatient physical therapy. If you need in-home physical therapy, Dr. Riddhivardhan’s staff can recommend a physical therapist to provide therapy at your home. Following this, you may go to an outpatient facility three times a week to assist in your rehabilitation.

Q. How soon can I take a bath or shower?

You can shower as soon as you feel comfortable doing so. You will have a waterproof bandage. That dressing will need to stay on until your first visit to the hospital.

Q. How do I take care of my knee incision?

You will have a waterproof bandage that will be put on before you leave the hospital. It should not be changed unless discussed with Dr. Riddhivarshan and his staff.

Q. What do I do about post-operative constipation?

It is very common to have constipation post operatively. This may be due to a variety of factors but is especially common when taking narcotic pain medication. A simple over the counter stool softener is the best prevention for this problem. In rare instances, you may require a suppository or enema.

Q. Should I use ice or heat after total knee replacement surgery?

Ice should be used for the first several weeks after total knee replacement surgery, particularly if you have a lot of swelling or discomfort. Once the initial swelling has decreased, you may use ice and/or heat.

Q. Why have I still got swelling?

Healing tissues are more swollen than normal tissues. This swelling may last for several months. Ankle swelling is due to the fact that each time we take a step the calf muscles contract and help pump blood back to the heart. If you are not putting full weight on the leg, the pump is not as effective and fluid builds up around the ankle. By the end of the day lots of people complain their ankle is more swollen.

Q. What can I do about it?

When sitting, the ankle pump exercises work the calf muscles and help pump the fluid away. Try to put equal weight through each leg and “push off” from your toes on each step. Have a rest on the bed after lunch for an hour. You can put one or two pillows lengthways under your leg whilst resting but do not use them at night.

Q. Why is my scar warm?

Even when the scar has healed there is still healing going on deep inside. This healing process creates heat, which can be felt on the surface. This may continue for up to six months. This is different warmth to that of an infection.

Q. Why do I get pain lower down my leg?

The tissues take time to settle and referred pain into the shin or behind the knee is quite common.

Q. Why do I stiffen up?

Most people notice that whilst they are moving around they feel quite mobile. After sitting down, the knee feels stiff when they stand and they need to take three or four steps before it loosens up. This is because those healing tissues are still swollen and are slower to respond than normal tissue.

Q. Is it normal to have disturbed nights?

Yes, very few people are sleeping through the night at six weeks after the operation. As with sitting, you stiffen up and the discomfort then wakes you up. Also, many people are still sleeping on their backs, which is not their normal sleeping position so sleep patterns are disturbed. You may sleep on your side when you feel comfortable. Most people find it helpful to have a pillow between their legs.

Q. I have a numb patch – is this okay?

Numbness around the incision is due to small superficial nerves being disrupted during surgery. The patch usually gets smaller but there may be a permanent small area of numbness.

Q. Why does my joint click?

This is normal and it is usually a sign that those swollen tissues are moving over each other differently than before. You should not let this worry you, as again this should improve as healing continues.

Q. When should I stop using a stick/cane?

Stop using a stick when you can walk as well without it as with it. It is better to use a stick you still have a limp so that you do not get into bad habits that are hard to lose. Limping puts extra strain on your other joints, especially your back and other leg. Use the stick in the opposite hand to your operated knee. Many people take a stick out with them for three to four months after the operation as they find they limp more when they get tired.

Q. How far should I walk?

This varies on your fitness and what your home situation is. You should feel tired, not exhausted when you get home, so gradually build up distance, remembering you have to get back.

Q. When can I put my socks on?

When you are able to reach your foot. This may take some time. It is different for everyone, so it is when it feels right which is when you are not forcing the bend.

Q. Can I go swimming?

You can go in a pool with steps as soon as the scar has healed and do gentle exercises. Serious swimming can be started after three months but make sure you are on sure footing (i.e. not in the sea). Breast stroke can be done if it feels comfortable, but start off gently.

Q. When can I drive a car?

You should wait to drive a car until after your first follow up appointment after surgery. Do not drive while taking narcotic pain medicine because it can impair your judgment and ability to operate the car safely. If it is your left knee that is replaced you may start driving as soon as you are not taking narcotic pain medication during the day and walking with a cane. If it is your right knee it will be around 4 to 6 weeks before you will be able to drive. Do not use your involved leg to operate machinery until at least 6 weeks after surgery.

Q. When can I return to work or hobbies?

Discuss returning to work or hobbies with Dr. Riddhiarvdhan and his staff. Ask your occupational therapist how your activity restrictions will affect your hobbies. Depending on the job (manual labour or sedentary work) some will get back to work in 2 to 4 weeks. Usually you will begin to go back gradually, half days for example. Normally by 8 to 12 weeks you can be back to full time work and effort.

Q. Will I be able to kneel on my new knee?

You may kneel on your knee, however most patients find this uncomfortable and may want to use a knee pad when doing so to make it more comfortable.

Q. When can I resume sexual activity?

You can resume sexual activity when you are ready. A firm mattress is recommended. Be the passive partner for the first 6 weeks after surgery.

Q. When do I follow up with Dr. Riddhivardhan and his team?

• 10 to 14 days post-operative for wound check, x-ray, removal of staples, discussion of pain management and DVT (deep venous thrombosis) management.
• 6 weeks post-op for wound check, discussion of any problems and activities.
• 1 year post op for X-ray and evaluation.
• 2 years post op for X-ray and evaluation.
• 5 years post op for X-ray and evaluation.

Q. Will I set off the security scanner alarm at the airport?

There should be no problem if your joint is made of titanium. Some joints are made of stainless steel and these may set off the alarm. If this happens, have a word with security staff and explain the situation. If you have metal walking sticks or crutches, they will be X-rayed and then can be used on the aircraft.

Q. How long can I expect the new knee to last?

90-95% percent of patients achieve good to excellent results with relief of discomfort and significantly increased activity and mobility. Current studies show that 5% of knee replacement patients are re-operated on before 10 years for a variety of reasons, such as infection, loosening, or fracture. With current technology it is extremely rare for a knee replacement to “wear out”. We would expect you to have a 95% chance of being satisfied with your knee in 10 years and a 90% chance of being satisfied in 20 years