How to have a good knee replacement 

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Artificial joint replacement is the last resort for most people when their knees have worn out. Fortunately, the procedure itself has become much less painful, far quicker, and more accurate, and it has a faster recovery time than ever before, if the best techniques are used. However, there are several key steps people can take to control their own outcomes. Here they are:

BEFORE

n Exhaust all the alternatives to total knee replacement first. Depending on your exam, X-rays and MRI, these may include a great physical therapy with gait, balance and muscle training; biologic joint replacement procedures with meniscus replacement and articular cartilage repair, if there is still joint space to work with; or partial joint replacement, if only one or two portions of the knee are worn out. Partial knee replacements work much better than in the past due to computer and robotic insertion techniques that have taken the inaccuracy out of the procedure.

n Prepare mentally. If you need a total knee replacement, look at the procedure as an opportunity to become fitter, faster and stronger than you have been in years. This is not usually possible when you are having pain, but it is a great goal to have once the knee pain is gone. Looking forward to the new you makes the experience much less worrisome and turns it into a positive event in your life.

n Line up a physical therapist, a trainer, a massage therapist and a nutritionist. Yes, all of them, if possible. All people with significant knee arthritis have walked for years with a limp, have decreased range of motion in their knee and often have compensated with abnormal gaits, decreased back and hip motion. Focus your presurgery efforts on increasing range of motion, developing exercise routines focused on trunk and core strengthening.

n See a nutritionist to help ensure that your dietary intake of protein is sufficient to respond to the stress of surgery. There is solid data that a low albumin level (protein level in the blood) correlates with increased infection at surgery. Protein matters. Optimizing your weight before and after surgery helps you achieve the goals of being fitter, faster and stronger and preserve your new joint.

The night before your procedure, go see a movie or watch a comedy. Relax, laugh and sleep well.

DURING

n The day of surgery, smile. Having a confident calm positive attitude affects you and your surgical team. Upbeat comments translate into happy outcomes. The advice of my surgical assistant, registered nurse Ann Walgenbach, is to just "Let it go" like the song. Be confident that you are in safe hands, you're going to have a really good nap and in a few minutes, you'll have a new knee.

n If you are anxious, consider a guided meditation or listen to music (some surgery centers will allow you to listen in the operating room).

n If you are particularly anxious, talk to your surgical team about whether you can take medication such as Valium in the morning, with a sip of water.

AFTER

n Set aside time to focus on physical therapy the day after surgery and every day. A great physical therapist will help work on the entire body, restoring each body part to work together. Some physical therapists will focus on training and fitness but others may not have the time or insurance permission to do so. Take enough time off work to get into the physical therapy clinic as often as possible in the first six weeks. While some surgeons don't believe physical therapy helps, we are adamantly in the opposite camp.

n Consider having a fitness trainer at a gym or have one come to your home. It's often less expensive and feels less like medical treatment. It is most important to see yourself as an athlete in training and not a patient in rehab. Focus on building muscle strength in your upper body, trunk and core as well as the lower extremities. Bike and pool exercises cannot be overdone.

n Book regular massages. A massage therapist can often augment the work the physical therapist does and keep your tissues flexible while your joint heals and your body retrains. Treat yourself as any pro athlete would, use all the tools of the fitness trade.

If you are thinking that only rich people or privately insured can follow this advice, think again. Physical therapy is usually covered at least for a few sessions. Gym trainers in group sessions are usually under $20 an hour. Self-massage works, too. Nutrition is often common sense with a new focus on increasing protein and water intake, decreasing carbohydrates, and exercising more than you eat.

Whether your sport is skiing or simply walking in the mall, our goal is to help you do these actively and without pain, to be better than you have been in years and then dropping dead at age 100 while enjoying your sport. To do that, seeing yourself as an athlete in training and treating yourself as the pros do is the trick.

About The Author

Dr. Kevin R. Stone

Bio:
Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco. He pioneers advanced orthopedic surgical and rehabilitation techniques to repair, regenerate and replace damaged cartilage and ligaments.
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