Barry J. Waldman, MD
The Johns Hopkins School of Medicine
Dept of Orthopaedic Surgery
2700 Quarry Lake Dr,
Baltimore MD 21117
What is arthritis and why does my knee hurt?
In the knee joint there is a layer of smooth cartilage between the end of the thighbone and the top of the calf bone. This cartilage serves as a cushion and allows for smooth motion of the knee. Arthritis is a wearing away of this cartilage. Eventually it wears down to bone. Rubbing of bone against bone causes discomfort, swelling and stiffness. Pain in commonly in the knee but may radiate to the thigh, calf. or back of the knee. It will often hurt worse after periods of immobility. Most knees wear out on the inside first followed by the outside and kneecap.
What is a total knee replacement?
A total knee replacement is an operation that removes the arthritic bone and damaged cartilage from the knee joint. The knee is replaced with a metal and plastic covering that simulates the natural cartilage. This creates a smoothly functioning joint that does not hurt. The natural tendons and muscles are left in place to allow the joint to function smoothly.
What is a unicompartmental replacement?
A unicompartmental or uni replacement is appropriate for patients that have only one side or compartment of their knee worn out. These patients will have very specific pain on the inside or outside of their knees and little to no pain while climbing stairs. Only 20% of our patients are good candidates for uni or partial replacement. The recovery time is shorter and rehab is much easier, but the prosthesis tends to wear out sooner than a total knee replacement. Ask Dr. Waldman if you think you are a candidate for this kind or knee replacement.
What are the results of total knee replacement?
95% or our patients experience good or excellent results after the initial healing period. They have little to no pain and are able to enjoy a wide variety of activities with few restrictions. Most can pursue moderate exercise, walk long distances, dance or play active sports.
When should I have this type of surgery?
The decision is based on your history, exam and x-rays. There is usually no harm in waiting if conservative, non-operative methods are controlling your discomfort. When these methods no longer control your pain, surgery is usually indicated.
Am I too old for this surgery?
Age is not an issue 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.
How long will my new knee last and can a second replacement be done?
All implants have a limited life expectancy depending on an individual’s age, weight, activity level and medical condition. A total joint implant’s longevity will vary in every patient. the current combination of components used by Dr. Waldman have a 94% 15 year survival rate. Some of these implants may last much longer.
Why might I require a revision?
Wearing of the plastic spacer may result in the need for a new liner. However, only 7% of patients nationally ever require a revision and implants continue to improve.
What are the major risks?
Most operations go extremely well, without any complications. Infection and blood clots are two serious complications that can occur. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce the risk of infections. Dr. Waldman’s current infection rate is 0.7% and the symptomatic blood clot rate is 0%.
Should I exercise before the surgery?
Yes, exercise will do no further harm to your knee and will help to make rehabilitation easier after the surgery.
Will I need blood?
The chance of needing blood after the surgery is about 20%. This rate is lower in men and in relatively healthy woman. We generally don’t recommend donating blood because much of it is wasted. Additionally, the community blood supply is in general, very safe. Banked blood is considered very safe and complications are rate.
How long am I incapacitated?
You will probably stay in bed the day of your surgery. However, the next morning most patients will get up, sit in a chair or recliner and should be walking with a walker or crutches later that day. Most patients can try steps the second day after the surgery.
How long will I be in the hospital?
Most knee patients will be hospitalized for three days after their surgery. There are several goals that you must achieve before you can be discharged. Our rehabilitation physicians will evaluate your progress two days after the surgery, and recommend a rehabilitation stay if necessary. This stay may last anywhere from three days to two weeks.
What is the Rubin Institute for Advanced Orthopaedics?
The Rubin Institute is a stand alone hospital attached to Sinai Hospital. It provides specialized orthopaedic care to joint patients, physical therapy facilities and houses a number of ongoing research projects. Dr. Waldman is director of the joint replacement program at the Rubin Institute.
What if I live alone?
Most patients who live alone will qualify for inpatient rehabilitation. When patients leave rehab, they should be able to care for themselves independently.
Will I need a second opinion prior to the surgery?
The office secretary will contact your insurance company to pre-authorize your surgery. It is exceedingly rare that a second opinion is required by an insurance company. If a second opinion is required, you will be notified.
How long does the surgery take?
We reserve approximately 2½ – 3 hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery and to prepare the room for the next operation. The actual surgery takes about one hour.
Do I need to be put to sleep for this surgery?
You may have a general anesthetic, which most people call “being put to sleep.” In most patients we recommend a spinal anesthetic, which numbs only your legs and does not require you to be asleep. In general, spinals are more pleasant and provide better pain relief, however, choice is made individually for each patient after discussion with the anesthesiologist.
Will the surgery be painful?
You will have discomfort following the surgery, but we will try to keep you as comfortable as possible with the appropriate medication. Most patients control their own medicine with a special pump that delivers the drug directly into their IV for the first day. Generally most patients are able to stop very strong medication within a few days.
Who will be performing the surgery?
Dr. Waldman will perform the surgery. Jonas Griffin, PA-C assists on most of the procedures. We often have a resident physician there to assist and to help take care of you after the surgery. They are there to learn and not to perform your surgery.
How long, and where, will my scar be?
The scar will be approximately four to five inches long in most patients. The length of the scar is somewhat proportional to the size of the patient. It will be along the front of your knee.
Will I need a walker, crutches or cane?
Yes, for about three weeks we do recommend that you use a walker or crutches. The hospital will help provide these items if necessary. Most patients can use a cane for three to four weeks after the walker or crutches are discontinued. Your physical therapist will help to determine when you will advance from walker to cane to no assistance.
Where will I go after discharge from the hospital?
Most patients are able to go home directly after discharge. Some patients may transfer to an acute or sub-acute rehabilitation facility and stay there for 3–14 days. Many patients are transferred to Sinai Rehabilitation on the 5th floor of the main hospital, so no travel is needed. The social worker will help you with this decision and make the necessary arrangements.
Will I need physical therapy when I go home?
Yes, we will arrange for a physical therapist to provide therapy at your home. Following this, you may go to an outpatient facility two to three times a week to assist in your rehabilitation. The length of time required for this type of therapy varies with each patient.
How long until I can drive and get back to normal?
If the surgery was on your left knee and you have an automatic transmission, you could be driving at three weeks. If the surgery was on your right knee, your driving could be restricted as long as six weeks. Getting “back to normal” will depend somewhat on your progress.
When will I be able to get back to work?
We recommend that most people take at least six weeks off from work, unless their jobs are quite sedentary and they can return to work with crutches. An occupational therapist can make recommendations for joint protection and energy conservation on the job.
How often will I need to be seen by my doctor following the surgery?
You will be seen for your first postoperative office 6 weeks after the surgery. The frequency of follow-up visits after that will depend on your progress. Many patients are seen at six weeks, four months and then yearly.
Do you recommend any restrictions following this surgery?
Knee patients generally have no restrictions during the healing process. Activity is limited by swelling, but not to protect the new knee parts from harm.
What physical/recreational activities may I participate in after my surgery?
You are encouraged to participate in low-impact activities such as walking, dancing, golf, hiking, swimming, bowling and gardening. More aggressive sports are often possible, so please ask us about any specific activities you would like to pursue.
Will I notice anything different about my knee?
In many cases, patients with knee replacements think that the new joint feels completely natural. The leg with the new knee may be slightly longer than it was before, either because of previous shortening due to the knee disease or because of a need to lengthen the knee to avoid dislocation. Most patients get used to this feeling in time or can use a small lift in the other shoe. Some patients have aching in the thigh on weight bearing for a few months after surgery.