If you are due to have total knee replacement surgery, here are some tips on how to help control your own outcome.
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. [5,7]
However, there are several key steps you can take before, during and after the surgery to help control your own outcome.
- 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. [1,3]
- 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.
- Line up a physical therapist (PT), 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 pre-surgery efforts on increasing range of motion, developing exercise routines focused on trunk and core strengthening.
- 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.
- 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, Ann Walgenbach, RN 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.
- If you are anxious, consider a guided meditation; listen to music (some surgery centers will allow you to listen in the operating room)
- 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.
- Set aside time to focus on physical therapy the day after surgery and everyday. A great PT will help work on the entire body, restoring each body part to work together. Some PTs 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 PT clinic as often as possible in the first six weeks. While some surgeons don't believe PT helps, we are adamantly in the opposite camp.
- 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.
- Book regular massages. A massage therapist can often augment the work the PT 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 dollars 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.
1. Jung KA, Kim SJ, Lee SC, Hwang SH, Ahn NK: Accuracy of implantation during computer-assisted minimally invasive Oxford unicompartmental knee arthroplasty. A comparison with a conventional instrumented technique. Knee 2009
2. Liu, Y. H., Wang, T. M., Wei, I. P., Lu, T. W., Hong, S. W., & Kuo, C. C. Effects of bilateral medial knee osteoarthritis on intra-and inter-limb contributions to body support during gait. Journal of biomechanics, 2014;47(2), 445-450.
3. Manzotti A, Cerveri P, Pullen C, Confalonieri N. Computer-assisted unicompartmental knee arthroplasty using dedicated software versus a conventional technique. International Orthopaedics. 2014;38(2):457-463. doi:10.1007/s00264-013-2215-8.
4. Palma, S., Cosano, A., Mariscal, M., Martínez-Gallego, G., Medina-Cuadros, M. and Delgado-Rodríguez, M. Cholesterol and serum albumin as risk factors for death in patients undergoing general surgery. Br J Surg, 2007;94: 369-375. doi: 10.1002/bjs.5626
5. Ranawat CS. History of total knee replacement. J South Orthop Assoc 2002;11:218-226.
6. Uth K, Trifonov D. Stem cell application for osteoarthritis in the knee joint: A minireview. World Journal of Stem Cells. 2014;6(5):629-636. doi:10.4252/wjsc.v6.i5.629.
7. Williams D, Garbuz D, Masri B. Total knee arthroplasty: Techniques and results. BC Medical Journal. 2010;52(9):447-54.