Knee Replacement Surgery

with Bruce Fauré, M.D., Orthopaedic Surgeon, Advanced Healthcare

Posted: May 1, 2005

Two important things to know about knee replacement surgery are that there are plenty of myths about it; and that it is an elective procedure.

That’s the word of Dr. Bruce Fauré, an orthopaedic surgeon with Advanced Healthcare, who performs between six and eight knee and hip replacement surgeries in a typical week.

The main reason for knee replacement surgery is osteoarthritis, or wear-and-tear arthritis. Rheumatoid arthritis, traumatic injury or other specific diseases can also cause cartilage to break down, necessitating medical treatment.

Bruce Fauré, M.D., Orthopaedic Surgeon, Advanced Healthcare "The person who makes the decision as to when the time is right is the patient. We instruct our patients to base that decision on quality of life."

Cartilage, a smooth material that provides cushioning at the ends of joints, absorbs force and prevents bone from rubbing on bone. Damaged or worn cartilage, or the complete erosion of the cartilage between any of the three bones that comprise the knee can mean intense pain. Bone rubbing on bone wears away the bone surface, causing cysts and spurs.

Initial interventions are non-surgical. Doctors may prescribe a course of anti-inflammatory drugs and/or recommend weight loss, if necessary, to reduce pressure on the knees. They may also recommend restricting high-intensity, high-impact activities such as jogging, running up and down stairs, or participating in contact sports.

If there is no relief, or more and more medication is necessary to control the pain, surgery might be the answer. But Dr. Fauré emphasized that that determination is made at the discretion of the patient.

“The person who makes the decision as to when the time is right is the patient,” he said. “We instruct our patients to base that decision on quality of life. Patients don’t need to know how many degrees of deformity they have, they need to ask “Does this wake me up at night? Do I struggle with going down a flight of stairs or getting out of a chair?”

What is knee replacement surgery?
Knee replacement surgery consists of removing the damaged bone surfaces, then replacing them with metal and plastic components. The operation takes approximately two hours, during which the bottom end of the femur (thighbone) is replaced with metal components. The tibia (shinbone) may be replaced with plastic or plastic on metal. A plastic surface is placed between the metal component of the femoral edge and the patella (kneecap), and plastic cushioning.

Patients usually leave the hospital three to four days after surgery. Some go home, others may go to an in-patient rehabilitation center or other facility. By then, they’re walking with a walker or crutches and have begun a series of post-operative strengthening exercises.

While in bed during their hospital stay, the patients are frequently hooked up to a CPM, or continuous passive motion machine. The knee rests on the device, which gently moves the knee in an effort to aid the healing process.

What to expect after surgery
While the swelling and pain are generally gone within six months, it can take up to a year to get used to the feeling of the new joint. It’s also not uncommon to have small areas of numbness, but for most patients, the degree of improved function is worth the effort.

While most published literature states that a knee replacement can last for 10 years, Dr. Fauré, said the truth is more complex.

“It’s a complicated engineering answer,” he said. “When you have two things rubbing against each other, they eventually wear, and it’s the same whether that’s a tire rubbing against a road or the components of an artificial joint. Every time you straighten or flex the knee, that’s a cycle, and like any bearings, no matter how sturdy they may be, they’re going to show some wear.”

The reason it’s impossible to predict how long a knee will last in any given person is because everyone reacts differently to the wear and tear, and to the minuscule particles of plastic that flake off and stay in the joint. Some people have little or no reaction; others are more sensitive.

“We have people who ignore every conceivable restriction we lay on them and 10 years post-surgery the joint looks completely normal, and we have others who follow instructions to the letter and end up with wear and tear,” he said.

Most of the myths and horror stories about the surgery are false, Dr. Fauré said. In the 14 years he’s been performing knee replacements, the failure rate – between 1 and 2 percent – has remained steady.

The classic myth – that it’s a dangerous operation, rife with complications and likely to fail, simply isn’t true, he said.

“People may develop down the line problems, such as trauma to the knee or infection,” Dr. Fauré said, “but for those who develop spontaneous mechanical problems over the years, that’s 1 or 2 percent. With most artificial knee designs, if the design is well done and the surgery is done well, the patient will do well.”

While there are always changes afoot in medicine, Dr. Fauré said he’s careful about what innovations he adopts. He’s not rushing to routinely implement the current trend, minimally invasive or quadriceps-sparing knee replacement surgery.

Individual approach
“You try to do what’s right for the individual,” he said, “and some people are physically built for a smaller incision and easier access, and some people are built for larger. What you have to guarantee is the excellence of the final result, not the way it was done.”

In other words, he said, choose a surgeon, not an incision. That said, Dr. Fauré touted improvements he has seen over the past 14 years. The most crucial, he said, have been in the areas of patient education and preparation.

Dr. Fauré sends his patients to Columbia St. Mary’s Joint Camp, a half-day seminar that informs joint replacement patients of what they can expect in terms of preparation, their hospital stay and post-operative recovery period.

He also starts his patients on a quadriceps (the four muscles located on the front of the thigh which help stabilize and move the knee) stretching and strengthening regimen.

“Surgeons weren’t aware of how de-conditioned a person gets when they get arthritis. Muscle mass and flexibility diminish and then someone has a joint replacement and expects a return to completely normal function,” he said. “That’s impossible, so we encourage patients, no matter how limited, to do some exercise and lift the joint so they retain or regain some muscle function before surgery in order to be ready for therapy afterward.

“The real advances are coming in terms of the bearings themselves and whether we can guarantee a one-operation intervention where you have it once and you’re done,” he said. “I don’t think that’s far off.”

Click here to read a patient’s experience with knee replacement surgery.

Dr. Bruce Fauré
Orthopaedic Surgeon
Good Hope Clinic
3003 West Good Hope Rd.
Milwaukee, WI 53209
414-352-3100

Cedar Creek Clinic
215 West Washington St.
Grafton, WI 53024
262-375-3700

East Mequon Clinic
12203 N. Corporate Pkwy
Mequon, WI 53092
262-387-8200

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