Total Knee Replacement Q & A

Will Dr. Yadav perform my total knee replacement?
Yes! Dr. C.S. Yadav will personally conduct your knee replacement operation assisted by his team and para medical staff.
What approach/technique does Dr. Yadav use for total knee replacement?
Dr. Yadav uses a midvastus surgical approach for Total Knee Replacement (Arthroplastiy}. From a clinical standpoint, the midvastus approach has an advantage over other approaches because the patients have significantly less pain and have the ability to straight leg raise at 8 days. Patients who have the midvastus surgical approach have less pain and earlier control of the operative leg, and may be discharged from the hospital earlier.
How long is the incision?
The incision for a total knee is about 4 to 5 inches long.
What type of anesthesia will be used?
Dr. Yadav prefers to use spinal anesthesia. Therefore, the patient is numb from the waist-down for the surgery and feels no pain, but may be awake during the procedure. This helps with recovery. If necessary, a sedative may be used in conjunction.
How long will the surgery take?
It takes 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.
Will I need blood?
Most patients do not require blood transfusions after knee replacement surgery. Many techniques are used to reduce blood loss and the need for transfusion. You will have several tests, including blood work, done prior to surgery. Dr. Yadav 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.
When can I walk again?
Dr. Yadav's patients are encouraged to walk within four hours of surgery with full weight-bearing status.
How long will I be in the Hospital?
Most knee patients will be hospitalized for three days after a total knee arthroplasty. 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. Yadav.
What is the recovery time?
Everyone heals from surgery at a different pace. It is difficult to compare yourself with others, as individual situations lead some patients to recover faster than others; however, in general, patients will use a walker or crutches while in the hospital. These devices are typically for balance, and patients may weight-bear as their comfort allows. It is our experience that as patients comfort, confidence, and strength allows, they may progress to a cane. Similarly, when patient's comfort, confidence and strength allows, they progress off of the cane. Typically, patients may progress to a cane at 2-3 weeks. By 4-6 weeks’ time, many patients are not requiring any external supports. It may take up to 3 months to return to normal function and patients continue to improve, as far as their comfort, mobility, and function for up to a year after their surgery.
How long will I be on pain medication?
It is not unusual to require some form of pain medication for approximately 8-12 weeks. Initially, the medication will be strong.. Most people are able to discontinue the strong pain medication after approximately 4-6 weeks and switch to an over-the-counter medication.
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. Yadav and his staff.
When do my stitches or staples come out after total joint replacement surgery?
Your stitches are absorbable and do not need to be removed. The steri-strips that have been applied can be kept in place until they fall off on their own. They will help keep the skin edges together. If they have not fallen off by 3-4 weeks, it is OK to peel them off. If you have staples, they should be removed 1- 2 weeks post-operatively in the office.
Can I go up and down stairs after a total joint replacement surgery?
Yes. Initially, you will lead with your non-operated leg when going up stairs and lead with your operated leg when going down stairs. You can use the phrase, "Up with the good, down with bad" to help you remember. As your leg gets stronger, you will be able to perform on stairs in a more regular pattern.
Will I need physical therapy/rehabilitation?
Yes! Each patient will need to work with their therapist on range of motion, strengthening, and balance several times per week for a few months. The physical therapist is a very important part of your team and your recovery.
Is it normal to have numbness along the outside of my knee following surgery?
You may experience some numbness on the outside of your knee, this occurs when making the incision damaging nerves. This usually goes away with time.
Is it normal to have a clicking or a clunk within my knee?
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.
When can I shower/bathe following my knee replacement?
Avoid showering or bathing until your incision is completely dry.
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.
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.
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.
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.
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.
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.
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.
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.
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.
I feel depressed, is this normal?
This is not uncommon. Various factors can contribute to this including:
  • Limited mobility

  • Discomfort

  • Increased dependency on others

  • Side effects from medications

  • As you return to your regular activities, these feelings should begin to disappear. If they do not fade, it is recommended you consult your internist.
    When can I drive my 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.
    When can I return to work or hobbies?
    Discuss returning to work or hobbies with Dr. Yadav 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.
    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.
    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.
    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.
    How long does a knee replacement last?
    Clinical research has shown a total knee replacement have a 98% survivorship and can last at least 20 years. The life of a total knee replacement largely depends on the patient’s age, weight, activity level and overall health. A knee replacement is a device which is subject to wear and tear.