What to expect when expecting…journey to a knee replacement

What to expect when expecting…journey to a knee replacement

What to expect when expecting a knee replacement can be an unknown. This is especially true for patients not familiar with anyone that has had a knee replacement. This series will paint a picture of the knee replacement experience. The first entry in this series is about the journey to a knee replacement. It will cover things that happen before a knee replacement is performed.

  A knee replacement procedure can significantly improve the quality of life. It is done for end-stage knee arthritis. The journey to a knee replacement starts with the development of pain in the knee. The initial complaint is often made to a primary care physician. X-rays are obtained. Initial management is with non-surgical measures. These include oral pain medications, physical therapy, cortisone injections, weight loss, activity modification, and viscosupplementation (“gel injection,” “cock’s comb injection”). These measures can be successful. 

  The referral to an orthopedic surgeon occurs because of failed non-surgical measures or for continued non-surgical measures. The orthopedic surgeon would want to know what non-surgical measures have been tried. Non-surgical measures will be continued if previously successful. If not, a knee replacement will be considered. Not every patient is a surgical candidate. Not every patient is a surgical candidate at the time of evaluation. A patient that cannot be under any kind of anesthesia is not a surgical candidate. A patient that is not a great surgical candidate at the time of evaluation but can later be one is a patient with modifiable risk factors. These include chronic smoking, alcoholism, diabetes, and super obesity. 

  The patient for surgery then needs pre-operative laboratory work up and evaluation. This process results in medical optimization to include optimization of risk factors like diabetes. Most surgeons have a pre-operative HgA1c cut-off to contemplate surgical management. This cut-off is not uniform across all surgeons. Patients can also benefit from a rehabilitation program before surgery (“pre-hab”). A pre-operative visit would also be scheduled before surgery. This visit is for a detailed discussion about surgery, risks, benefits, expectations, and prognosis. A formal joints class, webinar, virtual visit, or in person visit with a nurse navigator helps with familiarization with knee replacement. It is a part of a knee replacement program.