Dear Dr Garner,
I am about to have knee replacement surgery and am quite scared. It is the first operation I will have had in my life. I am otherwise in good health, although slightly overweight.
Could you please help me to be less scared?
Knee Replacement Fears in Flatbush

Dear Knee Replacement,
While any surgery has risks, having knee replacement can be very rewarding and is a very safe operation.
It seems like more and more people are having this surgery, perhaps as a result of the baby boomer generation aging.
I was at two birthday parties this weekend and it was topic of conversation at both parties.
Before we discuss the operation, I would like to recognize two individuals, who have touched the lives of many New Yorkers, who had birthdays this past week. Both are loyal Tablet readers.
Lou Carnesecca is not only a New York Institution, but is known internationally for his accomplishments as a Coach and mentor. He is a modest and kind man and it was heartwarming to see the many people he has touched in his life from all walks of life, in attendance at the party. I wish him and Mary many more years of happiness together.
The other New York Institution is Mary Kay Gallagher, who is a major civic leader in Brooklyn. She has worked tirelessly to keep many neighborhoods in Brooklyn safe, and fun to live in. I wish her and her family many more years of health and happiness together.
Knee replacement surgery is usually performed after other measures such as medication, or walking supports are no longer helpful. The first knee replacement was performed in 1968 and about 581,000 surgeries are now performed each year so you are in good company.
Some of the major reasons for knee replacement include, arthritis from overuse of the joint, rheumatoid arthritis in which the body actually attacks the join in error and causes it to break down, and post injury problems, in which a knee fracture or severe tear of the ligaments damage the join, limiting function.
To have a replacement or not, should be carefully reviewed, with input from your family and physician. Some things that might help you to decide include the following symptoms:

1. Severe knee pain that limits your everyday activities.
2. Moderate or severe knee pain while at rest, day or night
3. Chronic knee inflammation and swelling that does not improve with rest or medications.
4 Knee deformities in which there is a bowing in or out of the knee.
5. Knee stiffness and inability to bend and straighten your knee.
6. Failure to obtain relief from medications or physical therapy.
The last item is really an important one. You will know when the knee problems cause such pain or limitation of your activities that your life is being adversely affected.
While most patients undergoing surgery are age 60 to 80, there are more and more patients selected at younger ages.
It is important to keep in mind that the surgery will give you a dramatic reduction in knee pain and function, but will not make you a super athlete or allow you to do more than you could before you developed the knee problems.
Knowing what to expect regarding the actual procedure is helpful in alleviating some fears.

You will be admitted to the hospital on the day of the procedure.
An anesthesiologist will interview you to discus the anesthesia to be uses. It is usually general anesthesia in which you are asleep during the surgery, however you may be offered either spinal or epidural anesthesia in which you will remain awake, but your legs will be numb.
The procedure takes about 2 hours. Many different types of designs and materials are currently used in total knee replacement surrey you should discuss your options with your orthopedist. .After surgery; you will be moved to the recovery room where you will remain for 1-2 hours.
As an alternative to total knee replacement, your doctor may decide to do a more limited procedure, known as unicompartmental knee replacement. This is used to replace only a certain part of the knee. Is might be considered if the damage is limited to a specific area of the knee. The knee rehabilitation with this type of surgery is much faster and the hospitalization is shorter. Once again, this is something to discuss with your doctor.
Some doctors use an approach known as minimally invasive keen replacement. The incisions are much smaller, and there is quicker rehabilitation and less pain.
It seems to work beset in those who are non-obese with reasonable motion without major deformity in the knee.
The complication rate for knee replacement is low, and serious complications such as knee joint infections occur in fewer than 2% of patients.
Blood clots into the leg veins are the most common complication of knee replacement surgery. Your surgeon will instruct you regarding prevention methods, which may include elevation of your legs and exercises to increase circulation, as well as support stockings and medications to thin your blood.
Your knee replacement should last between 10-15 years.
The success of your surgery depends on how well you follow your surgeon’s instruction at home during the first few weeks after surgery.
Weight loss is very desirable and can improve your chances of success. You mention that you are slightly overweight, so this should be an important goal for you. It is also important to be in the best shape possible to give the procedure the best chance for success. If you smoke, it is important to stop, as smoking can increase your chances of getting a wound infection and slows your recovery.
You can exercise to strengthen your upper body prior to the procedure. . This will help you to get around after surgery when using crutches…
You should try to strengthen the muscles around your knee which will also speed recovery.
After surgery you will need to participate in regular light exercise to maintain the proper strength of your new knee. You should take precaution to avoid falls.
You should notify your dentist that you had a knee replacement and should be given antibiotic before all dental surgery for the rest of your life.
I hope this helps to lessen your fears, and wish you the best of luck.

*Reprinted with permission of The Tablet