PATIENT CONCERNS

TOTAL  KNEE

Preoperative anxiety

You have  had no previous  experience with total knee replacement operation and it is only natural that you are anxious. Feeling of anxiety and depression before the total knee operation is usual for all patients. (Curiously enough,  patients with previous experience, people with the other knee already operated on, are anxious too).

The preoperative anxiety disappears during the week after the operation when you have realized that the surgery has succeeded and all is well. Your preoperative anxiety will be replaced be feelings of relaxation and relief.

Be prepared, however, that a bout of unmotivated anxiety may return during the first three postoperative months. You may be disappointed with the slow progress of your rehabilitation, you may feel that the new joint is still stiff and sometimes still painful. Relax, it takes several months before your new total knee shows its best.

The useful way to cope with the preoperative anxiety is to acquire more information. Make a list of questions about your concerns and then go and ask your doctor, your surgeon and anesthesiologist, the fellow patients about the things that bother you.

     FEAR   FOR PAIN

Pain during and immediately after surgery

Patients are surprised how little pain they experienced after the total knee surgery. This is due to the  modern forms of anesthesia which can keep you fully conscious and yet pain-free one or two days after the operation.

If you are scared about having pain during operation, speak with your anesthesiologist who will convince you that this does not happen’t happen.

Pain after return home

You will  probably notice that much of the old "arthritic pain" in your knee  disappeared  the next day after your total knee operation.

You must, however, realize that it  usually takes at least three months before the "surgical pain" (pain from the tissues severed during surgery) disappears, but be prepared for longer time. Expect also some pain during the training of your new joint at home.

Problems with bowel and urine during hospital stay

Here the skilled personnel will help you. You will not stay in bed more than perhaps one day, and when you will be mowing, these problems will disappear.

CONCERNS FOR THE LENGTH  OF  RECOVERY

The length of recovery after a total knee replacement varies according to the patient and the type of total knee prosthesis. For uncomplicated primary total knee operations you may return home one week after the operation ( and often even earlier), and you may be able to drive your car already after eight to twelve weeks. Be prepared, however, that you will need some form of training of your knee for at least six months.

Remember that the operation takes only about ninety minutes, but the rehabilitation of your new knee joint will take several months of arduous work.

   FEAR  FOR POSTOPERATIVE COMPLICATIONS

Fear for risk of getting AIDS from blood transfusion.

This risk is minimal and can be eliminated entirely if you can donate and spare your own blood before your operation.

 

Fear for postoperative wound infection

It is very rare nowadays, it occurs in less than 1,0 % of all primary total knee operations. The unicompartmental total knee operations, and total knee operations without replacement of the patella have less than 0,5%  postoperative deep infections

When it occurs it is a serious complication, but almost always treatable.

 

Fear for blood cloths after surgery.

Small blood clots in the veins of the lower extremity after total knee replacements occur in 50 to 60% of all operations, but in most cases this complication is not even discovered.

All  patients nowadays will get  preventive treatment against deep vein thrombosis, which diminishes the formation of blood clots.

Only in about 3% of all patients operated on with a total knee the blood clots (the deep vein thrombosis) causes pain and swelling in the leg, usually when the patient has already returned home. Treatment of an established blood is effective and many patients does not even need to return to the hospital.

 

Fear for  nerve damage

Damage to the nerves that cross the knee joint  occurs in about  1% of all total knee replacement operations.  The majority  of these patients   recover completely.

 

Fear for risk of heart failure and risk of dying

Total knee replacement is a major surgery and as such it caries with it some risks to the life of the patient. The mortality caused by the surgical trauma of the total knee replacement operation is very low. At higher risk are patients >75 years old, patients with heart condition, and patients with Simultaneous bilateral total knee operation with undetected heart condition.

The statistics  show that the risk to die during surgery and early after the  total hip and total knee surgery, although  already small, is steadily diminishing during the last years. The risk was 1death on 2 000 operations in the past, now it is three times lower still (1: 6 000) (Parvizi 1999)

If you have a total knee already operated on,  be glad! All statistics demonstrate that after total hip and total knee operation you have big chances of living longer then people in the general population.

  FEAR THAT THE NEW   TOTAL KNEE  WILL FAIL

 

Fear for the need to have the surgery redone.

Some people worry that the body will "reject" the knee joint prosthesis, or that the new  joint "wears out" and a  second operation will be necessary.

The fact is   that just like the joints you were born with, your new artificial knee joint wears out over time. How much, depends among other things on your age and activity.

In spite of improving quality of total knee prostheses,  there is a certain risk that your artificial knee joint will become loose in the future and a second operation will be necessary. The risk of the second operation increases with years since the total knee surgery.

The risk of loosening is almost equal for all modern total knee prostheses. In major statistics this risk is about 1 % per every postoperative year, so that ten years   after the total knee surgery, the risk is about ten per cent.

Fear to  get a faulty total knee prosthesis

Every artificial joint  gets a unique identification number at manufacture, that is included in the operation protocol.  When the manufacturer of the artificial knee joints discovers a fault in the  fabrication of  this artificial joint, ( a very seldom happening)  he contacts the surgeons who have been using these implants.

Patients who get   implants with some fabrication fault may be thus identified   by their surgeons and  followed closely. There are barriers that should prevent fabrication faults, but on  rare occasions such accidents  can still happen.

 

Fear that the new knee joint will be unstable

Modern total knee prostheses allow very precise balancing of ligaments of the knee joint. Instability of the total knee joints is thus rare, modern statistics show that it occurred in only 0,5% total knees (Furnes 2002)

For more information about postoperative complications visit also the following chapters:

Complications general

Deep Vein Thrombosis

Wound infection

Loosening

Other total knee complications

 

Before you take any action, please read the Disclaimer

References:

Hoerman S, Psychother Psychosom Med Psychol, 2001, 56-61).

(Aarons:JB-Br, 1996, Pacault-Legendre, Encephale 1999, 25, 202-12,.- Hoerman S, Psychother Psychosom Med Psychol, 2001, 56-61).

(Aarons, Short- term recovery..., J Bone Joint Surg-Br, 1996,  554-8 )

(Trousdale et al, 1999, modified, see also Aarons, JB-Br, 1996, pp 555, and Mancuso, J Arthroplasty , 1997, pp 387)

Parvisi, J Bone Joint Surg-Am, 2001, Oct, 83-A, 1524))

Furnes et al Acta Orthop Scand 2002;117-22)

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