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Leg Injury

Knee Arthritis & Cartilage Injury

What is Arthritis?

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  • "Arthro-" means joint, and "-itis" means inflammation.

  • "Arthritis" is a general term given to any condition that causes knee inflammation

    • If infection causes knee pain, it is called septic arthritis​

    • If your body's immune system iflammes your knee joint, it is called rheumatoid arthritis

    • If you fracture your knee or tear a ligament and have pain afterwards, it is called post-traumatic arthritis

    • If you develop pain slowly over time due to "wear and tear" of the joint over many decades, it is called osteoarthritis


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Conservative Options

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  • Weight loss - The knee sees about four pounds of pressure for each pound of body weight, so reduced pain can be seen with even a small amount of weight loss (eg. 10 to 15 lbs).

  • Exercise/Physical therapy - Strengthening the muscles around the knee help take pressure off of the knee joint.  Motion of the joint helps to keep it from getting stiff.

  • Medications - These include anti-inflammatory medications such as acetaminophen (Tylenol), ibuprofen (Advil), and naproxen (Naprosyn).  It is important that patients discuss this option with their primary care provider to be sure the risk of side effects is low.

  • Knee bracing or shoe inserts - Both of these may help better align the leg/knee which distributes the weight more evenly within the joint.

  • Arthroscopy - A minimally-invasive procedure through small incisions that can address certain types of damage.

  • Osteotomy - A procedure in which the leg bone is cut and realigned to shift the weight from the damaged part of the knee to the healthy or less damaged side.  Usually reserved for "younger" patients with arthritis localized to one side of the knee.

  • Partial knee replacement - This involves replacing only one part of the knee joint.  There is some debate as to whether a partial or total knee replacement is better, so the risks and benefits of both should be considered.  

Surgical Options

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A total knee replacement (a.k.a total knee arthroplasty) is a surgical procedure in which parts of the knee joint are replaced with artificial parts (prostheses).

The knee joint functions as a hinge joint between the thigh bone (femur) and leg bone (tibia).  The surfaces where these bones meet can become worn out over time which can cause pain and swelling.

Approximately 700,000 knee replacements are performed annually in the U.S., and most studies demonstrate that 80-90% of total knee replacements will last between 15 and 20 years.

Total knee replacement in one option to decrease pain and improve function to an arthritic knee.  The most common reason people undergo knee replacement surgery is that they have failed all other conservative treatments.

The goal of a knee replacement is to reduce pain, maximize knee function, and improve quality of life.  There is no age minimum or limit, but most patients have significant pain and/or disability prior to considering the procedure

Because the replacement parts can wear out over time, we generally recommend you delay the surgery until it is absolutely necessary.

The surgery involves replacing the knee with artificial parts (prostheses).  In general, the patient is completely asleep for surgery (general anesthesia).  A nerve block injection can be administered by the anesthesiologist right before surgery to help control the pain after surgery.

After surgery, the patient will be in the recovery room for 2 to 3 hours for monitoring then sent up to the inpatient floor.  Most people stay two nights in the hospital after surgery.

Blood clots in the legs are a common concern after knee replacement surgery.  To reduce the risk, certain practices are common, including: early mobilization with a physical therapist, exercises in bed, blood thinning medication, and inflatable boots around your legs.

Infection is another major concern, and patients receive antibiotics before, during, and for 24 hours after surgery.  Factors that can increase your risk for infection include:  poor diet, obesity, smoking, and uncontrolled diabetes.

It is common to begin physical therapy the day of or one day after surgery while you are in the hospital.  After leaving the hospital, some patient will receive physical therapy in home or at a clinic while others may require a little more time in a rehabilitation facility.

It is important to avoid overworking or straining the knee during the recovery process.  Think "slow and steady."  After several months of rehabilitation, you will be able to have a more active lifestyle.

High-impact activities such as running and contact sports are not recommended after surgery, but you should be able to participate in walking, bicycling, and swimming activities.


  • Blood clots - Having a knee replacement increases the risk of a blood clot forming in a vein (a.k.a "DVT").  Symptoms of a DVT clot include leg pain and swelling.

  • Infection - Infection following a knee replacement is a relatively uncommon but serious complication.  Symptoms may include fever, chills, pain in the knee that gets worse suddenly, redness, or swelling.  Superficial infection may be treatable with antibiotics, but deep infections usually require removal of the joint implants.  A new artificial knee can then be placed again once the infection has been treated.

  • Stiffness - Despite compliance with physical therapy, a patient's knee may occasionally get stiff and not straighten or bend all the way.  They may require a return to the operating room where knee tissue can be stretched under anesthesia.

  • Early failure - Reasons a knee may not last the usual 15-20 years include: infection, loosening of the implants, fracture of the bone around the implant, and knee instability.  If these occur, revision surgery is usually necessary.

  • Peroneal nerve injury - The most common neurologic complication after a knee replacement.  It results in numbness, tingling, and a foot drop.  Certain knees are more at risk than others.

Wound Care

  • Keep ACE wrap on and keep knee dry for three days. 

  • After 3 days, you may remove the ACE wrap.

  • Once the ACE wrap is removed, you will see either an Aquacel or Dermabond Prineo dressing.  Leave these in place.

  • You may shower with either of these dressings 3 days after surgery.  You may sit in a shower chair or stand. Use crutches or a walker to get in and out of the shower

  • No bath tubs

  • The Aquacel Dressing should be left in place for 10-14 days.  If we have not removed it for you by then, you may remove it on your own. 

  • The Dermabond Prineo is left in place for 1-2 months and will "fall off" on its own

Ice Therapy

  • Cryotherapy (cold therapy) is a very important part of pain control after surgery.

  • The cold temperature will help control swelling and reduce pain.

  • Use an ice pack or cold therapy unit for 20 minutes, 4-6 times a day until the swelling is down and pain is improved.

  • Most patient use ice therapy for an average of 7-14 days following surgery.

Deep Vein Thrombosis (DVT) Prophylaxis

  • If you are at low risk for blood clots, you will take Aspirin 81 mg twice a day for 4 weeks following surgery.  If you were already on aspirin prior to surgery for another condition, restart the dose prescribed by the other provider.  For high risk patients, Lovenox is administered for 4 weeks.


  • Absolutely no driving while taking any narcotic pain medications (Vicodin, Percocet, Oxycodone, etc.).  These medications impair your ability to safely drive a vehicle.

  • In general, you should not drive until it is safe for you to do so, and different patients recover at different rates.

  • We will direct you in this regard during your post-operative visits


  • Please call the office to make or confirm your postoperative appointment.

  • The first appointment is usually 10-21 days after the surgery and may vary depending on the nature of the procedure.

  • Subsequent appointments are usually at 6 weeks, 3 months, 6 months, and 1 year after surgery.

  • Please bring your black Ortho.Boston folder with you to all of your post-operative appointments.

Pain Medications

  • Pain is a natural reaction to the work that was done in your knee.  Pain is your body's way of kicking off the healing process.  It is normal and expected for every patient.

  • Many modalities are used to control pain:  ice, narcotic and anti-inflammatory medications, physical therapy, elevation, and time. 

  • Your pain will improve gradually and predictably.

  • You will be given a prescription for a narcotic (opioid) medication to help with pain relief (refer to our practice's Opioid Policy).

  • As your pain improves, decrease the amount of pain medication either by taking fewer tablets and/or increasing the time between doses).

  • Hold your pain medication if you experience oversedation (sleeping too much), slurred speech, slow breathing, or hallucinations.

  • Pain medication often causes constipation. It is important to drink adequate liquid daily and take a stool softener.

  • Do not drive or operate heavy machinery while taking your pain medication.

  • Combining pain medication with alcohol, benzodiazepines, and other medications may cause respiratory depression and increased altered mental status.

Please Notify Our Office Immediately if any of the Following Occur:

  • Any drainage or bleeding from the incision more than three days from surgery

  • If your pain is increasing and not decreasing over the course of three consecutive days

  • Poor pain control with your medications.

  • Fever > 101.5° after postoperative day #3.  It is common to have an elevated temperature the first couple of days after surgery.

  • Increased redness along incision or concern for infection.

  • Calf pain or leg swelling.

  • Shortness of breath.

  • Chest Pain.

  • Any other concerns or questions.  If you feel it is an emergency and can not get a hold of our office, either call 911 or go to your nearest emergency room.

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