Total Knee Replacement Surgeon in Palm Beach Gardens, FL
A total knee replacement is a surgery to replace diseased or damaged knee joint with an artificial knee joint made of materials, such as metal or plastics. Dr. Robert Avino provides diagnosis and individualized non-operative and operative treatment plans in Palm Beach Gardens, FL. Dr. Robert Avino also provides highly specialized care during and after surgery. Contact Dr. Robert Avino’s office for an appointment today!
When arthritis or injury severely damages your knee, everyday activities like walking or climbing stairs can become difficult, and pain may persist even while resting.
If nonsurgical treatments like medications or walking aids no longer help, total knee replacement surgery can relieve pain, correct leg deformity, and restore mobility.
Introduced in 1968, total knee replacement has become a highly successful procedure, with over 700,000 performed annually in the U.S., according to the American Academy of Orthopaedic Surgeons.
Anatomy of the Knee
The knee, the body’s largest joint, is essential for everyday activities. It comprises the lower end of the thighbone (femur), the upper end of the shin bone (tibia), and the kneecap (patella). The ends of these bones are covered with articular cartilage, allowing smooth movement. Menisci, C-shaped wedges of cartilage between the femur and tibia, act as shock absorbers. Ligaments provide stability, while thigh muscles give strength. The synovial membrane lines the knee, releasing fluid to lubricate the cartilage and minimize friction. In a healthy knee, these components function together seamlessly. Injury or disease disrupts this balance, causing pain, weakness, and limited function.
What is Total Knee Replacement?
Total knee replacement (or knee arthroplasty) is more accurately called knee "resurfacing," as only the bone surfaces are replaced.
The procedure involves four basic steps:
- Prepare the bone: The surgeon removes damaged cartilage and a small amount of bone from the femur and tibia.
- Position metal implants: Metal components are placed to recreate the joint surface, either cemented or press-fit into the bone.
- Resurface the patella: The undersurface of the patella is cut and resurfaced with a plastic button, though some surgeons may skip this step.
- Insert a spacer: A plastic spacer is inserted between the metal parts to create a smooth gliding surface.
Is Total Knee Replacement Right for You?
The decision for total knee replacement should be made collaboratively with your family, primary care doctor, and orthopaedic surgeon. Your primary care doctor may refer you to an orthopaedic surgeon for a thorough evaluation to assess if surgery is right for you.
When is Total Knee Replacement Recommended?
Total knee replacement may be recommended for people with:
- Severe knee pain or stiffness that limits daily activities, like walking, climbing stairs, or standing.
- Moderate or severe pain while resting, day or night.
- Chronic knee inflammation that doesn't improve with rest or medications.
- Knee deformity, such as bowing.
- Failure to improve with other treatments like medications, injections, or physical therapy.
Candidates for Surgery
There are no strict age or weight limits for total knee replacement. Surgery is recommended based on pain and disability, not age. Most patients are aged 50 to 80, but surgery has been successful in patients of all ages, from young teenagers with juvenile arthritis to elderly patients with degenerative arthritis.
Orthopaedic Evaluation for Total Knee Replacement
An evaluation with an orthopaedic surgeon includes:
- Medical history: The surgeon gathers information on your health and knee pain.
- Physical examination: Assessing knee motion, stability, strength, and leg alignment.
- X-rays: To determine damage and deformity in the knee.
- Other tests: Blood tests or MRI scans may be needed to examine bones and soft tissues.
Dr. Avino will review your evaluation results and discuss if total knee replacement is the best option for pain relief and improved function. Other treatments, such as medications, injections, physical therapy, or alternative surgeries, will also be considered. Dr. Avino will also explain potential risks and complications related to the surgery and long-term outcomes.
Deciding to Have Total Knee Replacement Surgery
Importance of Realistic Expectations
Understanding the benefits and limitations of knee replacement surgery is crucial. Most patients experience significant pain relief and improved daily activity, but the surgery will not enable activities beyond pre-arthritis levels.
Normal use may lead to wear on the implant’s plastic spacer over time, and high-impact activities like running or jumping should be avoided. Low-impact activities, such as walking, swimming, golf, biking, and ballroom dancing, are encouraged. With proper care, knee replacements can last for many years.
Possible Complications of Total Knee Replacement
Serious complications are rare, with infection occurring in fewer than 2% of cases and major medical issues like heart attack or stroke being even less frequent. Chronic illnesses may raise complication risks. Discuss any concerns with your surgeon.
- Infection: Minor infections are treated with antibiotics; severe cases may require additional surgery.
- Blood clots: Common but preventable with circulation-boosting measures and blood clot prevention strategies.
- Implant issues: Wear and loosening of components can occur over time.
- Limited motion: Scarring may restrict motion but can often improve with physical therapy or manipulation under anesthesia.
- Continued pain: Rare, but some patients may still experience discomfort after surgery.
- Neurovascular injury: Rare injury to nerves or blood vessels around the knee.
Most patients experience excellent pain relief and improved quality of life following total knee replacement.
Preparing for Surgery
Medical Evaluation: Your orthopaedic surgeon may require a full physical exam with your primary care doctor to ensure you’re healthy enough for surgery and recovery. Patients with conditions like heart or kidney disease may need specialist evaluations.
Tests: Blood tests, urine tests, and an electrocardiogram may be needed to plan your surgery.
Medications: Inform your surgeon about all medications. They will advise which to continue or stop before surgery.
Dental and Urinary Evaluations: Complete major dental procedures beforehand to reduce infection risks. Consult your surgeon about antibiotics for future dental work. Those with frequent urinary infections or prostate issues should consider treatment before surgery.
Social Planning: After surgery, you’ll need help with cooking, shopping, and other tasks. If you live alone, a hospital social worker can assist in arranging home care or a short stay in an extended care facility.
Home Planning: Make your home safer and more accessible by adding:
- Safety bars in the shower
- Secure stair handrails
- A stable chair with armrests and a footstool
- A toilet seat riser
- A shower bench or chair
Remove loose carpets and cords, and set up a temporary living space on one floor to avoid stairs during early recovery.
Your Total Knee Replacement Surgery
You may be admitted to the hospital or return home the same day. Discuss your plan with your surgeon beforehand.
Anesthesia
The surgery may be performed under general anesthesia (you will be asleep during the procedure) or regional anesthesia (you will be awake but numb from the waist down).
Total Knee Replacement Procedure
The surgery typically lasts 1–2 hours. Your surgeon will remove damaged cartilage and bone, replacing them with metal and plastic implants to restore knee function and alignment.
After surgery, you'll spend several hours in the recovery room as your anesthesia wears off. Once awake, you'll either be taken to your hospital room or discharged home.
Your Hospital Stay
Most patients stay in the hospital overnight, though some may require a longer stay.
- Pain Management: Pain is a natural part of recovery, and your healthcare team will help manage it to speed up healing. Short-term pain relief may include a mix of opioids, NSAIDs, acetaminophen, and local anesthetics. Regional blocks may also be used for post-operative pain. Opioids should be used only as directed and stopped as soon as pain improves due to their addictive potential.
- Blood Clot Prevention: Your surgeon may recommend measures like leg evaluations, support stockings, compression boots, blood thinners, and foot exercises to reduce swelling and prevent clots.
- Physical Therapy: Patients usually begin knee exercises within hours of surgery. A physical therapist will guide you in strengthening your leg and restoring knee movement to resume daily activities.
- Preventing Pneumonia: Shallow breathing after surgery can lead to lung issues. Frequent deep breaths or using a spirometer helps prevent complications like pneumonia.
Recovery at Home after Total Knee Replacement
Your surgery's success depends on closely following your surgeon's instructions during the first few weeks. If discharged to a rehabilitation unit or skilled nursing facility, staff will manage your care.
Wound Care: Stitches, staples, or a suture beneath the skin will secure your wound. Stitches or staples are removed in a few weeks, but sutures beneath the skin do not need removal. Avoid soaking the wound until fully healed and keep it bandaged to avoid irritation.
Diet: A balanced diet, possibly with an iron supplement, aids healing and muscle recovery. Drink plenty of fluids, as appetite loss is common after surgery.
Activity: Exercise is vital for recovery, with most normal activities resuming in 3–6 weeks. Some pain during activity or at night is normal. Your program should include:
- A gradual walking routine, starting indoors and progressing outdoors.
- Normal household tasks, such as sitting, standing, and stair climbing.
- Specific knee exercises to restore strength and movement, either independently or with help from a physical therapist.
If you would like to have additional information on knee treatments or would like to learn more about total knee replacement, please contact Dr. Robert Avino, serving the communities of Palm Beach Gardens, FL.
