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Knee Replacement Surgery: Whatever Do They Do with The Old One?
by Marjorie Dorfman

Is knee replacement the new cat’s meow among the aging? In our throwaway society, one can only wonder what happens to the older, used, if you will, parts? Is there a Boot Hill for bones and joints that have outlived their usefulness? Perhaps too, the great American Indian saga, Bury My Heart at Wounded Knee, may now take on another not so historical but just as painful perspective. This surgery may not be for everybody, but if you opt for it, you should understand as much as possible about both the procedure and the recovery process. Read on at your own risk, even if you are a person who never throws anything out.

A painful knee can severely affect one’s ability to lead a full and active life. The degeneration of the knee joint is certainly the result of aging; the knee (actually the cartilage between the surface of the bone inside the joint) simply wears down. As more and more people live longer and longer, knee replacement surgery is becoming commonplace. Over the last twenty-five years, major advancements in technology have greatly improved the outcome. The process involves the replacement of the injured or damaged parts of the knee joint with artificial parts made of metal and plastic. The surgery is performed by separating the muscles and ligaments around the knee to expose the knee capsule, which is then opened, revealing the inside of the joint.

About 85 to 90 percent of knee replacements last for ten years or longer. The major long-term problem is loosening. This occurs because either the cement crumbles or the bone melts away from the cement. (Fortunately, this doesn’t happen to our brains!) After the passage of ten years, some 20 percent may require re-operation. A great deal depends on the person’s weight and activity. It is because of this that surgeons do not usually perform the surgery either on patients who are very obese or who are very young. The results of a second operation are generally not as good as the first, and the risks of complications are higher.

All surgery involves acting like a Boy Scout. Be prepared! In the case of a knee, preparation begins several weeks ahead. Maintaining good physical health before surgery is very important. Exercise and activities, which increase upper body strength, will improve your ability to use a walker or crutches after the operation. Sometimes, a blood transfusion may be necessary after knee surgery. You may wish to donate your own blood, which you will then receive if it is needed. (In this case, it is not necessarily better to give than to receive, as the old adage goes.) The surgeon may also order blood tests and urinalysis two weeks before to ensure there is no urinary tract infection present.

While you are busy preparing for the day of surgery, don’t forget to think about the recovery period afterwards. You will need a few weeks at home, whether it is sweet or not. You may also need assistance from family or friends with dressing, showering, getting meals, etc. A physical therapist will most probably come to your home for treatment to ensure that you understand your exercise regimen. After two or three visits, you will begin outpatient physical therapy. One or more treatments may be recommended, such as heat, ice or electrical stimulation to help reduce persistent swelling or pain. Range of motion exercises will help you regain full bending and straightening of your knee. You will also be equipped with some very unattractive elastic support stockings, which you must wear for the first few weeks to reduce the risk of blood clots. (They are a pain in the neck (actually much lower), but necessary. You will never, however, think about support hose the same way again!

It is important to know that how well and how quickly you regain your walking ability is, in part, the direct result of how well you follow your physical therapy. This part of rehabilitation is something that you must do for yourself and can only be helped along by other people. After surgery, the natural, normal formation of scar tissue inside your new knee forms a kind of "cross-hatch" pattern. This healing tissue needs to be stretched by your therapist and your exercise routines so that it forms into a more "end to end" alignment. This is essential for "range of movement", which is the ultimate goal of post-operative therapy. A good friend who recently made a very successful recovery from a knee replacement told this author that his therapist recommended that a regular schedule of pain medication be set aside for just before the therapy!

You will need assistance and advice at first, but the ultimate responsibility for exercising is and can only be your own. Most important, know all there you can by asking questions. Don’t be afraid to ask for it is only the lack of information that can hurt you. Don’t put too much emphasis on what others tell you about their cousin or aunt’s procedure, for each knee, situation and person is different. Listen to what they say, but weigh it in terms of your own knowledge and don’t consider it gospel. Talk to your doctor as much as possible. That’s what he or she is there for. And look forward to a new lease on life with the help of a brand new prosthetic knee that will make you want to go and boogie.

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Copyright 2006