Your orthopedic surgeon has examined your painful, stiff and swollen knee. You have answered questions regarding the pain you feel-the exact location, when it started, how long it lasts, whether it comes and goes, what activity causes it to hurt most-and responded to inquiries regarding past injuries to your knee, pain in other joints, family history of joint pain and whether or not any physician has ever given you a diagnosis of arthritis. Your physician suspects osteoarthritis, but to be sure, he/she will order a number of tests to confirm the diagnosis and to rule out any other possible causes of your pain.

X-ray and MRI

The first test you can expect is an x-ray of your knee which is taken from various angles to provide an accurate visualization of the damage in your joint. If the physician suspects damage to ligaments or a meniscus, you may also undergo an MRI (Magnetic Resonance Imaging).

Blood Tests

Inasmuch as there are several diseases that can cause arthritis or arthritis-like symptoms, your physician will order particular blood tests to detect and identify the presence of any disease other than osteoarthritis that may be the source of your pain. For example, patients with rheumatoid arthritis, as opposed to osteoarthritis, will have elevated levels of what is referred to as rheumatoid factor (caused by specific antibodies in the synovium or cell lining of flexible joints). Another blood test, called an erythrocyte sedimentation rate (ESR or “sed rate”) indicates an inflammatory arthritis or other related condition-such as rheumatoid arthritis or systemic lupus erythematosus-if the level is above a certain range. A test that measures the amount of uric acid in the blood may indicate or rule out gout as the cause of your joint pain. If your physician suspects a rheumatologic illness based on your health history, age and physical findings, there are a number of other blood tests that may be ordered to narrow the field.

Tests on Synovial Fluid

If the diagnosis is uncertain or your physician suspects an infection, a sample of synovial fluid may be withdrawn from your knee joint and sent for testing to confirm or rule out osteoarthritis. Examples of possible results are:
Cartilage cells in the fluid which are indicative of osteoarthritis.
A high white blood cell count which is a sign of an infection.
A high uric acid level which is an indication of gout.

There are a number of other factors in the synovial fluid that may be tested if the physician needs further elaboration.

Results

The results are in. Your orthopaedic surgeon informs you that your diagnosis is indeed osteoarthritis. If you think you are alone in your misery, here are a few facts you might like to know:
Osteoarthritis is the most prevalent form of arthritis, one of the most common diseases affecting humans and a common cause of disability. In 1998, it was estimated that more than 20 million Americans had symptomatic osteoarthritis (OA). As our population ages, the incidence of OA is expected to increase dramatically over the next 20 years.
OA is the second most common reason men over 50 claim work disability.
OA is a major cause of disability in persons over 65.
OA is often present, although asymptomatic, as early as the second or third decade of life.
By age 40, nearly everyone has some osteoarthritic changes in weight-bearing joints such as hip and knee.
At age 75, it is a truly amazing human that does not have arthritic changes in at least one joint.
According to radiologic studies (x-rays), OA of the knees is more common in women; OA of the hips is more common in men.

Options

Now that your diagnosis is confirmed, it is time to discuss your options. Your orthopaedic surgeon suggests a knee replacement and tells you about the several types of replacements that are currently considered state of the art. He/she explains the difference between a partial and a total knee replacement-including the new computer-guided minimally invasive approach used with total knee replacements-and the indications for each. In the end, your surgeon’s opinion is that you would benefit by having a total knee replacement.

Questions to Ask

Before you agree to consider your surgeon’s recommendation, make certain you ask the following questions:
What are the details of the procedure that you are recommending?
What is your experience with this procedure? How many have you done?
Are you board certified?
Why do you feel I need this operation now?
If I don’t have this surgery, what are the other options available to me?
How do you anticipate this surgery will improve my current situation?
Will the surgery be performed under local or general anesthesia?
What are the risks involved in this surgery?
What can I expect in the recovery process?

You may also want to get a second opinion as well as check to see that your health care company covers this procedure.

Preoperative Course

You are now ready to go to the next step which is planning for your surgery, but until you know exactly what to expect both pre-operatively and post-operatively, it is hard to know what adjustments you will have to make in your life.

You can anticipate further tests to ensure that you are healthy enough to withstand the surgery and the anesthesia and to make a full recovery. These may include (but not be limited to) a complete blood count, including electrolytes; tests to measure blood clotting time (APTT & PT); chest x-ray; electrocardiogram; and a blood test to detect your blood type and other blood type-related factors should a transfusion be required.

It is also commonplace to meet your anesthesiologist in advance of your surgery to discuss any past experiences with anesthesia that you may have had. The anesthesiologist will ask you if you have allergies to food or drugs and he/she will want to know if you have any false teeth, braces, bridge work or capped or bonded teeth that may require special consideration during the administration of general anesthesia. Finally, the anesthesiologist should be willing to answer any questions that you might have with respect to his/her part of the surgery such as the type of anesthesia (local or general) he recommends, how long you can expect to be under anesthesia, how long it will take you to fully awaken following the surgery and so on.

Either the orthopedic surgeon or the anesthesiologist (or both) should review any medications you currently take and advise you as to which ones you can continue (even on the day of surgery itself) and which ones you should discontinue several days prior to surgery, such as Warfarin or aspirin which purposefully lengthen the time it takes for blood to clot.

Ordinarily, patients are examined and given a pre-op work-up one or more days prior to surgery with the actual surgery performed on the day of admittance. Sometimes however, the patient is asked to come to the hospital the night before surgery.

Preoperative Preparation
Discontinue any medication as directed by your physician
You may be asked to scrub the operative area several times with a special antibacterial preparation on the day before or day of the surgery.
You will be told not to eat or drink anything after midnight on the day of your surgery.
You may be given an injection to help you relax just prior to surgery and if you are to have general anesthesia, the injection may include a medication designed to aid in the drying of secretions, the point being to reduce the amount of saliva produced while you are under anesthesia.
An intravenous may be started before you leave for the operating room or after you arrive there.
You will be taken by stretcher or wheel chair to the operating room.

Operating Room and Recovery Room

The surgery itself will take several hours and will vary from person to person based on the degree of damage that exists and the ease with which the implant is inserted. You can expect to have an incision about 3-4 in. long. If you have had general anesthesia, it will take some time (an hour or so) before you awaken. In some hospitals you will be sent to the Recovery Room and monitored until you are fully awake, then when your vital signs are stable and your surgical site meets a particular standard, you will be returned to your room. In other surgical centers and especially if you have had local anesthesia, you may be monitored in the operating area before being sent back to your room. You can expect to have an intravenous, a bandaged knee, and some discomfort, especially as the anesthesia wears off.

Post-operative Issues
Pain Management – Most hospitals today allow individuals to manage their own pain with a medication pump that delivers a pain killer intravenously as needed. When your intravenous is removed, you may receive medication for pain either by intramuscular injection or by mouth. The quantity, frequency of administration, length of time needed, method of delivery and kind of medication varies from person to person.
Blood Clot Prevention
Compression stockings – One of the primary risks in knee surgery is the formation of blood clots in the lower leg veins. These clots, once formed, can migrate to the heart, lungs or brain resulting in heart attacks, cessation of breathing or stroke, all of which can be catastrophic. The best way to manage clots is to prevent their formation in the first place; therefore, a great deal of post-operative therapy involves attention to this issue. Immediately after surgery, you can expect to have electrically operated compression stockings applied. These stockings prevent blood from pooling in the lower extremities-a common factor in the formation of clots-by helping to reduce swelling and by assisting your circulation. You can expect to wear them continuously for the first few days following surgery and then for as long as six weeks thereafter, especially while you are sleeping, sitting or prone.
Blood thinners – You can expect to take a blood thinning medication by subcutaneous injection for from 7-10 days. When you are discharged, you or a family member will be taught how to administer this medication. If you follow up your hospitalization in a rehabilitation center, the medication will be administered by hospital staff or if at home, it can be administered by a home health care representative.
Ambulation and exercise – Hospital staff will assist you in getting out of bed as early as the day following surgery, but it is important to walk with the assistance of a walker or crutches at every opportunity because exercise and ambulation increase the blood flow to the surgical area which in turn helps to prevent clots and aids the healing process. Plan on using some walking aid-crutches, a cane or a walker-for 36 weeks post-surgery.
Staples/Sutures:These are usually removed about 2 weeks following surgery.
Driving and Employment: It is recommended that patients abstain from driving until they no longer need to walk with crutches, a cane or walker. Plan to take a leave of absence from work for 3-6 weeks. Of course, how long you need to be away from work will depend on the particular requirements of your job.
Physical Therapy Individuals vary in their need for physical therapy, but despite differences you can be sure that some physical therapy will be ordered for you. The length of time that you will need to continue therapy will depend on your healing time, how well you can ambulate independently and your recovery in general. There are three primary types of rehabilitation services used: home health care, rehabilitation hospital, and out-patient rehabilitation.
Warning Signs of Blood Clots It is important to know the warning signs of a blood clot in the event that one begins to form despite all your efforts at prevention. Take immediate action if you have (1) increased pain or tenderness in your calf or the inside of your thigh (2) increased swelling in your calf, ankle or foot (3) sudden shortness of breath (4) sudden onset of chest pain (5) localized chest pain with coughing (6) any changes in vision.

In spite of the warning above, total knee replacements have a better than 90% success rate and are far more effective at restoring mobility and relieving pain in patients than non-surgical treatment. If you are contemplating a total knee replacement, approach the experience with a positive attitude, become an informed consumer, have confidence in your surgeon’s ability and look forward to an improved quality of life.

The information in the article is not intended to substitute for the medical expertise and advice of your health care provider. We encourage you to discuss any decisions about treatment or care an appropriate health care provider.


11 thoughts on “Knee Replacement: Before And After

  1. nikki

    I removed items left by tenants, can they sue me and win?
    *WARNING – THIS IS A REALLY LONG QUESTION-

    I rented a house out to a couple in 05; my very first rental. Rent was $600. Rent was due on 15th of each month. Rent came every month on time up until around November of 2009. The husband who was making the majority of the income got sick and the wife was only working part time. I worked with them until they caught up. Well back in August 2010 they got behind again. I talked to the wife and she said they money wasn’t coming in the same, they’d just found out that the husband had lupus. But he was still working and she had just starting working full time. Make a long story short.
    I told them that I was going to rent the house out to a company that takes care of the disabled for more money and asked could they be out by October. The husband talked to me and asked could I give them until the end of the year and I agreed. In October I received August rent.

    Went by the house one day and they were moving things out. I told the husband to call me when they were done. Never received a call from him so I went to the house and it looked as if they were done moving and had left things behind. So I went back to get my trailer and hauled some of the other things that were left in the house.

    At midnight I get a call from the husband asking had I been in the house and had I removed their things, I told him yes, I thought they were done moving. He immediately said “I’m calling the police”. I said ok and hung up.

    The next day I get a call from the sheriff and was asked did I take their things. I told her yes. She asked was I holding their things for money and I told her No , I thought they were done moving and was told I should contact him and make arrangements for these people to get their things back becasue i really thought they were done moving.

    I call the husband and he was talking really ugly to me so I told him he will get his things back when i get my keys to the house. Then he began naming off things that were missing that I don’t even think I took and told him he’d have to sue me to get them back and hung up the phone.

    Facts.

    I actually threw some things away, gave some away to goodwill and I still have some. (I honestly thought they were done moving)

    They are 3 months behind on rent.

    Lease haven’t been signed in 2 years but i thought they were good tenants. the terms of the lease states this

    This lease shall commente on 7-15-07 and extend for a period of 9 months. Thereafter, if the Tenants remain in the premises and meet all obligations under this Lease, the Lease Agreements shall continue from month to month and can be terminated only when a 30 day written notice is given by either party.
    – Husband saying I didn’t provide them with a WRITTEN NOTICE and since they haven’t signed anything in 3 years the lease is no good.

    Lease also states this-
    The tenants hereby give the Lessor a lien upon all property situated upon the premises including all furniture and household furnishings as security for the rent to be paid herein, for damage caused by the tenants, and for court costs and attorney’s fees incurred under the temrs herof.
    provided further, upon the tenants vacating the premises, the lessor has the right to take possession fo the personal property of the tenants and if not claimed by the tenants within five days for the date of the vacating of the premises, the landlord may discard or dispose of the property without liability to the tenants.

    I’m sorry this is so long, but this is really bothering me. My blood pressure has gone up and I believe the husband is very violent. What should I do? Can they sue me and win?

    I’ve tried contacting a lawyer but with no help.

    1. real estate guy

      Can they sue you? Sure. Will they win? In this case yes?

      The lease is still good and the terms need to be followed. So they didn’t give 30 days notice and still owe for the rent.

      Here is what I would do. Nothing. Return what you have of theirs. Make a list and even take pics. Have the person sign off on the list. If possible, when you meet with them, have them give you a list of items missing. Keep copies of EVERYTHING.

      While this is going on, make a list of all damages, cleaning etc that needs to be done to the house. Take pictures! Keep this and do not discuss with them. This will be used against them if you go to court.

      Then the ball is in their court. They will either sue you or not.

      If they sue you for replacement of their stuff, then countersue for the back rent, damages, cleaning, and the extra month of rent when they didn’t give notice.

      If they are going to play hardball, then hit them back HARD.

  2. sweetleka

    Diagnosing Lupus?
    I’ve been having some strange symptoms involving my immune system/lungs for a while now. There are members of my family with Lupus, but unfortunately I have no contact with them at this time. I’m going to see the doctor in about a week, but I would like to know if anyone knows of particular tests that I should ask to be done or particular symptoms/warning signs that make it pretty clear that I have it or something like it. Any help would be appreciated, I know I’m at the age that most people are diagnosed with it. PLEASE HELP. Thanx! 🙂

    1. mgnysgtcappo

      Ask for an ANA test. This is one indicator that a person has SLE. However, just having a positive ANA test doesn’t mean you have Lupus. You have to have four symptoms to be diagnosed.

      I’m confused why you mention that there are members of your family that have Lupus. I’m wondering how many actually have it and when/where they were diagnosed and what types of medications they take. You see Lupus has never been proven to be a genetic disease. Most of the research disproves a genetic link however environmental factors seem to play a part as well as some predetermined genetic factors. The chances you’ll have Lupus because someone in your family has it is the same chances that the general population will be diagnosed with Lupus. Remember the Lupus is more prevailant than breast cancer.

      As far as strange symptoms with your immune system can you be more specific? I’ve never really hear of a Lupus patient complaining of symptoms with their immune system. Usually, people present with joint pain, muscle weakness, rash, kidney/heart/brain issues. Lungs can be involved but usually only after a Lupus flare up has been occurring for a long while. I’d say that since you don’t complain of any joint pain that Lupus is highly unlikely.

      In any event, with an ANA test you’ll be able to rule out Lupus. If your ANA is positive, the doctor will order BUN, Creatine Clearance, a Chem-7 panel as well as a APS test. Bone density scans can also be taken if the disease has progressed and is causing arthritis. Organ biopsies are also indicated if the there appears to be organ involvement.

      Good Luck.

  3. hi1wolfyloveyou

    I have a question about my period…?
    I am 21 years old, & I do have some health problems. I have systematic lupus erythematosus & I had to go to the ER room on the 8th of December. I started my period on the 2th of December and ended on the day I had to go to the ER. They gave me pain pills called Hydromorphone. I also have been taking Methotrexate that my other Doc from before gave me for my Lupus. I am ok now but then I started again with my period on 26th of December. There were no warning signs of any, & my period is usually very heavy but this time it is very light. It does not show on my pad or when I go to the bath room, only on the toilet paper. Sometimes its light pink, little bet of red, sometimes nothing at all, & other times it’s light brown. It’s already the 5th of January & I am still on it. I can’t get a hold of my Doc. What do I do?

    1. drama gal

      If you can not get a hold of your doc, then you should go to the hospital. You never know, and it has been a long time for you to be bleeding! I may be nothing, but it maybe be something only the doctor can see by checking it out.

  4. Roast

    Could this have been a TIA?
    My mother who will be 53 this month suffered a very strange episode which I believe may have been a TIA. She is generally healthy, diagnosed with possible lupus of the joints about 5 yrs ago, had a disc in her back repaired 3 yrs ago and also suffers from occasional heart palpatations. She has also smoked for many years. The episode occured at a family friends bday dinner. She had been enjoying a few beer, just ate dinner and was taking plates to the kitchen. She went down and was completely unresponsive for no less than one minute. Her eyes were wide open and completely fixed and non reactive… At first glance they thought she had suddenly passed. 4 people at her side calling her name and in her face without reflex or reaction. When she came to… She was unable to move her legs or support her own weight. She was also semi hysterical yet her tone of voice and general demeanor was not that of her own self. Upon arriving @ hospital he legs had sensation of vibration or tingling…. Her demeanor how ever was NOT herself, very hostile and combative… Within about an hour the leg sensations started to resolve. However, the ER dr whom she was very unpleasant to thought her alchohol consumption was the reason for her behaivior. My mother refused to be admited to hospital… And subsequently went home. I truely believe whatever happened was NOT anything short of a warning sign of something else….. Maybe a seizure?? Possibly a mini stroke?

  5. DrasticGame

    Do you think I have leukemia?
    Over a day ago I pulled down my pants to go to the bathroom and was shocked to see my thighs covered in tiny little pinhead-sized spots, which I’m pretty sure are called petichiae. No reason I would have gotten those that I can think of. Also, I’ve been feeling very achy for the past week, like I was doing strenuous exercise and pulled my muscles everywhere- except I’ve been very lazy for the past few weeks and haven’t been in the mood to do anything at all, so I definitely shouldn’t feel achy. A few days ago I had a bad nosebleed (I didn’t hit my nose or anything, it just started bleeding) and for the past few weeks, there’s been blood in my mucous (I figured I had a cold, but it’s been sticking around and I’ve noticed blood in the mucous).

    I wouldn’t have known this was a symptom of leukemia except for the fact that- yes, this was stupid- I entered my symptoms into one of those online medical things and the only result it showed for all these was leukemia. So naturally I start reading about leukemia and the warning signs are exactly what I have, so I’m definitely a bit worried.

    Oddly, the main reason I keep thinking it *can’t* be leukemia is because I already have enough medical problems- I have epilepsy, and used to have lupus! And those aren’t even related to leukemia! And I’m only seventeen! I can’t handle this!

    But I don’t want to go to the doctor to check for sure because (yes, I’m an idiot) I’m a cutter and was cutting about a week ago and still have the marks (nothing deep, just scratches really, have been doing it for two years, and while it’s not a good thing, I’ve been getting it under control and doing it less and less… it’s just the stress from the lupus and the epilepsy thing, among other, more normal teenager things, were getting to me…) so I don’t want him to examine me now.

    What do you think? Is it likely I have something serious like leukemia, or can I wait a few weeks until my cuts have healed up and then go to the doctor just to check for my peace of mind?

    Thanks.

    1. GemmaBee

      No one can diagnose you with leukemia (or anything else) over the internet. The only way for you to know what is causing your symptoms is to go to your doctor. Being a cutter does not make you an idiot and given all the difficulties that you seem to have had it makes sense that you might find things difficult to cope with. Maybe it would be a good thing for your doctor to know about this- he might be able to help you to find support in relation to this issue too?

      Good luck.

  6. unsolvedmysteries

    spiritually speaking this woman is insane?
    I find it depressing I know I will leave it with God but I figure I should pop a question with a fair warning – hopefully it doesn’t get removed as I believe this is very important evidence and understanding to why there are so many heart attacks occuring…

    are nurses and doctors insane? they must be: this lady giving my echocardiogram said its normal it’s normal even after I told her I can’t even exercise for 5 min without my chest hurting please agree with me that she’s insane I find this very depressing

    at times it feels like I know more than doctors and it seems like they do not give a sh*t and love getting a sadistic thrill out of watching others suffer…

    she said in a monotone hateful voice as if I couldn’t understand how hateful and brazen she was..

    it feels like all the medical personell are just in it for the money and they are all soulless sickos..honestly every single doctor – nurse that I’ve encountered has said it’s normal blahblah mean while im suffering

    God gives knowledge this much I do know and sometimes I wish they would just be willing to admit they are wrong instead of just accepting a paycheck like I am nothing more than a number – and at best a number they can kill off..

    Any NORMAL human being would say no this isn’t normal – any woman (which she was a woman btw) would not disturbingly rub their body against my backside – while giving me that lame test..lame because they said they dont know yet at the end of the test they tell my mother whose in the room that it looks normal –

    lie after lie after lie as if I we are just brain dead..

    “oh it sounds like you want to have a problem” because I am stating that I do have a problem – my eyes hurt when I’m in the sun i’ve read about lupus – I have fevers also that wont go away I took 3-4 exedrin over time and it didn’t work when I get around people I feel a sensation of vomiting you can’t tell me it’s psychological when my head is hurting (that’s a sign of brain damage)

    your chest hurting (YES EVEN THE DOCTORS TV ARE A BUNCH OF SATANIC SNAKE LIARS sure 80% of what they say is true but they spin 20% of lies in their stories which I find sickening)

    sorry but your chest hurting is not normal at all

    well hope this stays up – has any one else had a similar experience? I could go on and on about other medical conditions that doctors do not seem to give one crap about..but I think the heart condition nails everything…
    “God” person that you are labeling your self to be if you don’t know how to read and are illiterate because you truly are then you will reread the part that I said I am giving this as evidence –

    I overdosed on aspirin – I wont write why or how or blahblah because it’s a longer story -but let me just say this much a necrotized heart isn’t something that beats very well – all my organs could be easily damaged via that.

    I know my heart is having problems

    you can call me a hypochondriac all you want but get this through your head – I will be right 50 years from now (if we aren’t all dead by then because of atheists and their damned society)

    heart pain IS NOT NORMAL and it is not a panic attack – if some one stabbed you in the chest with a knife you are going to panic trust me. you are going to feel pain in your chest
    it’s called a subtle heart attack – people can survived 4-5 or more strokes –
    I will be laughing when you all realize how retarded your answers sound this question is marked as evidence read and re read because your all obvious illiterate..
    oh sure a bunch of satanic morons thumbs up the brain dead mindless zombies

    read your bible I assure you there are a lot of evil doctors –
    IF YOU ALL THINK PEOPLE DON’T SUFFER THEN YOU ARE ALL TRULY BLIND – WOMAN WHO HAD 4-5 DIABETES BLOOD TESTS ALL CAME BACK NORMAL – FINALLY WHEN HER LEGS WERE AMPUTATED THEY SAID SHE HAD DIABETES KIND OF TOO LATE THOUGH.
    becky you are the only one on here with a brain thank GOD

    in the future people are going to see that I am right

    JUST REMEMBER THIS THE KNOWLEDGE IS COMMON SENSE

    and it comes from GOD

    and this doctor is evil God told me “they gape upon me with their jaws like a lion they feast corpses that are layed devoured”

    remember this when I am right remember this when you see all the thumbs downs and all the thumbs up who is promoting who

    because I see a lot of satanic people promoting satan on here and in reality

    your all disgusting as hell
    schnizzle you are going to look like a complete moron very soon when and if technology gets better I assure you

    your lies will be buried and you will look like an evil wench – because well you are.
    jd if I was angry I’d go shoot every person on the planet – no you haven’t seen angry

    but let’s not talk about evil let’s overcome evil with GOOD

    that’s what I’m trying to do here – and no you are wrong I will tell you why GOD DOES NOT LIE. read my other questions and you will understand.

    1. Pink Satin Pants

      I know what you’re talking about, but I’ve learned not to discuss it with most people. Most people believe medical “experts” know everything. But a lot of doctors today are even questioning how we practice Western medicine.

      Back in the day, before we had expensive tests and equipment, doctors could only diagnose based on symptoms. Today, they tend to ignore the symptoms and look only at the test. “I have chest pains,” you say, and they say, “not according to the test.”

      I think the insurance industry is partly to blame, as well as the pharmaceutical and medical instruments businesses. They are for-profit businesses, and they do their jobs well.

      As for the doctors and nurses, I look at that as I look at cops. Good people make good cops. Bad people make bad cops. Why? Because unhealthy people will abuse their authority, no matter what their profession.

      And a lot of people who go into medicine—especially psych professions, but all—do it to see themselves as providing a valuable service. So when they don’t have the answers, it’s a threat to their sense of self. That’s why they have so much trouble admitting they don’t know.

      Not all are like that, but feel your pain for when you encounter one who is.

      Sorry for the long reply. You’re fighting an uphill battle, I know. Check out the books below—they’re by doctors who question the system. It won’t fix your heart, but you might find comfort in knowing you’re not imagining things.

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