Patients

Pre-Surgery

Other forms of treatment

• Exercise / Diet – Before resorting to knee surgery, your doctor will probably recommend other forms of treatment to control your pain. Exercise, for example, is important to increase joint mobility. Water aerobics is especially encouraged because it is a non-impact, non-weight-bearing activity. For overweight patients, exercise and a proper diet can help reduce the stress on the joints.
• Medications – Most patients try different medications. For those whose pain is mild, over-the-counter medicines such as acetaminophen (e.g., Tylenol) and topical pain relievers (e.g., Aspercreme, Icy Hot) might be enough to provide relief. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are used to relieve pain and inflammation but are known to have side effects. More moderate pain is treated with stronger NSAIDs and COX-2 inhibitors, drugs that are available only by prescription. Cortisone injections are also given to the joint to relieve inflammation, but this relief is usually only short-term.

Knee replacement surgery

If none of these treatments is successful, knee replacement surgery may be the recommended alternative. Some of the factors you and your doctor should discuss in order to determine whether or not to have surgery include:

• The degree to which the surgeon believes that a knee replacement can improve function in your knee.
• Whether your age and physical condition (other than your knee) make you a good candidate for a successful knee surgery.
• The possibility that the knee implant will need to be replaced again at a later date, based on your age and activity level.

• Pre-operative testing – Testing before surgery is performed to evaluate your medical condition and usually includes blood tests, a urinalysis, a chest x-ray, and an electrocardiogram (EKG). These tests evaluate and assess your risks for anesthesia, to exclude occult urinary tract infections, and to see if you are mentally and physically prepared for your surgery. Your surgeon will decide if these tests will be administered in a local hospital or lab or in your primary care physician's office.
• Fasting – You will be given specific instructions by your surgeon about fasting before surgery. Usually patients are told not to eat or drink anything after midnight the day before the surgery.
• What to Wear – Typically you will be asked to wear comfortable clothing to the hospital, with no makeup, jewelry, or nail polish.
• Medications – Your doctor will provide you with instructions about which medications you can take the morning of your surgery.

To see if the ADVANCE® Medial Pivot knee is the right option for your knee replacement surgery, locate a physician in your area with our Physician Locator. Learn about other Wright options and partial knee replacements.

Contraindications – Absolute contraindications include:

1. overt infection;
2. distant foci of infections (which may cause hematogenous spread to the implant site)
3. rapid disease progression as manifested by joint destruction or bone absorption apparent on roentgenogram
4. skeletally immature patients
5. cases where there is inadequate neuromuscular status (e.g., prior paralysis, fusion and/or inadequate abductor strength), poor bone stock, or poor skin coverage around the knee joint that would make the procedure unjustifiable.

Conditions presenting increased risk of failure include:

1. uncooperative patient or patient with neurologic disorders, incapable of following instructions
2. marked bone loss, severe osteoporosis, or revision procedures for which an adequate fit of the prosthesis cannot be achieved
3. metabolic disorders that may impair bone formation or cause bone loss
4. osteomalacia, and
5. poor prognosis for good wound healing (e.g., decubitus ulcer, end-stage diabetes, severe protein deficiency and/or malnutrition).