• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
Howard J. Luks, MD

Howard J. Luks, MD

Orthopedic Surgeon Sports Medicine Specialist

  • Topics
    • Joint Pain
    • Longevity
    • Metabolic Health
    • Sports Medicine
    • Training
    • Top Articles
      • Zone 2 Training
      • Shoulder Pain Lifting Arm
      • Knee Injury Serious?
      • Medial Meniscus Tears
      • Front Of Knee Pain
      • Shoulder Snaps & Pops
    • All Articles
  • Newsletter
  • Podcast
  • Book
  • About
  • Consultation
Sports Medicine

Knee Replacements: Current concepts

Avatar photo

Howard J. Luks, MD Updated Sep 23, 2021 Read time: 4 mins

Featured image placeholder

Knee Replacement:

Many changes have taken place over the last decade with regards to knee replacements.   These changes have occurred in many areas:

  • Who is a candidate for a knee replacement: Decision making principles
  • Our approach – or how we open the knee joint 
  • Computerized placement of the knee replacement
  • MAKOplasty robot partial knee replacement
  • Pain management protocols
  • Pre-operative infection control

Am I a candidate for a knee replacement?

Millions of americans suffers from osteoarthritis of the knee.   Their cartilage has worn down, their knees are swollen and painful.  Many patients with osteoarthritis of the knee can be managed with oral medications, injectable medications such as Synvisc or Orthovisc, physical therapy and activity modification.   These methods work for many… for a while.  Then you notice you fail to respond as well. Then the injection works for only a brief period of time.  What next?  Your surgeon might mention that you are a candidate for a knee replacement.  Are you a candidate?  To be honest, that depends on you!  This is a quality of life decision.  This is a shared decision making process.  You are the one who ultimately determines when a knee replacement is necessary!  It is YOUR quality of life that is being interrupted.

 “Minimally invasive knee replacement”

Our surgical approach to the knee has evolved over years.  Our incisions are shorter… but more important… once we are under your skin we are minimizing the amount of muscle or tendon which is cut.  This “minimalistic” approach to the knee can shorten your recovery process (although it is still a very painful procedure with a long recovery process).   Some of us, myself included, will utilize a “sub-vastus”, muscle sparing approach for your knee replacement.  This approach can improve your post-operative function since no muscle or tendon was cut during the process of placing the knee replacement.

Computer Navigation and Knee Replacements:

Computer navigation has improved our ability to “nail the alignment” of your knee replacement more often than previous techniques allowed.   Computer navigation enables us to see how the new knee is being placed before any cuts are made for your new knee replacement.  We now know that if the knee is not placed within a few degrees of what we call a neutral axis that it may go on to loosen too early and thus fail and potentially require further surgery.

VOLUME MATTERS!

This is an extremely important consideration.  Recent scientific literature has shown that the number of knee replacements your surgeon and the hospital performs can significantly affect the chance of you having a good results and avoiding a complication.   Currently accepted suggestions are that your surgeon performs at least 75 knee replacements a year and an institution, nearly 300 knee replacements per year.   Your risk of having a knee not put in properly, or the risk of developing an infection, or other complication increases significantly if these numbers are not used as a baseline for comparing the surgeons you are considering.

MAKOplasty Robot:

The manufacturers of the MAKO robot will tell you that this is the only way that a partial knee replacement should be performed.  Well… that not necessarily true.  While the MAKOplasty robot can be a useful tool, however,  the experience of your surgeon, the proper sizing of the implant, the surgical approach to your knee and the pain protocol used after surgery have more to do with the overall success of the procedure than the MAKOplasty robot.  There are some other issues with the robotic approach that are beyond the scope of this brief introduction that I would be more than willing to discuss with anyone.  Robots may have a roll in the future of knee replacments and there is a lot of research being performed in this space.

How much will my knee replacement hurt?

Knee replacements are by far one of the more painful procedures we perform.  Thankfully our ability to manage that pain has changed dramatically over the last few years.  This is termed a multi-modal approach to pain management of a knee replacement and it involves:

  • The use of regional (spinal) anesthesia
  • The use of nerve blocks or catheters to drip pain medicine on the nerves for days after surgery
  • The use of a variety of medications to deal with the multitude of pain “pathways” that exist in our body
  • The use of a complex mixture which is injected around your knee during surgery. 
  • Early mobilization or movement
  • Surgery without the use of a tourniquet which minimizes bleeding and swelling after surgery
  • The use of a medication we can TXA which limits bleeding and thus swelling after a knee replacement.

Minimizing Risk of Infection of a Knee Replacement:

An infected knee replacement (general risk about 1%) is a nightmare from a patient’s perspective.  It requires more surgery and ends with a knee that is usually stiff and bothersome.  What can you do to minimize the risk of developing and infected knee replacement?

Do you have questions regarding an Orthopedic injury or longevity? 

Do you want to talk to an expert who can listen to you for 45-60 minutes and explain the options in detail? 

Dr. Howard Luks offers remote guidance sessions to review your X-ray or MRI images and explain your options. 

Dr. Luks has also received hundreds of requests for educational sessions on the topics discussed in his book, Longevity Simplified.

Schedule Remote Session

  • Let you surgeon know if you have history of resistant infections (MRSA).
  • Gargle with anti-septic mouthwash the night before and the morning of surgery
  • Consider a full dental exam and cleaning two weeks or so before your replacement
  • Brush your teeth twice, the night before, and the morning of surgery
  • Shower with an anti-septic soap the evening before, AND the morning of surgery
  • Do NOT shave that leg for at least one week prior to surgery
  • Do not allow the skin to become sun-burned prior to surgery. 
There’s a lot for you to read about and research when contemplating a knee replacement… I hope this helps you in planning what you might want to learn more about.   Find an experienced surgeon, be sure you are proceeding for reasons of your choosing… and not your surgeon’s … understand the significant risks involved…. prepare yourself to minimize infection risk — and good luck to you!
Feel free to leave comments with further questions.

 

Categories: Sports Medicine, Surgery Tags: knee replacement, Makoplasty, pain management, Volume matters

Disclaimer:  this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.
Dr. Howard J. Luks

Howard J. Luks, MD is a leading orthopedic surgeon & sports medicine specialist. An expert in shoulder, knee, and other sports injuries, and author of Longevity... Simplified.

About · Contact · Private Consultation

Remote Guidance Sessions
  • Facebook
  • X
  • Instagram
  • LinkedIn
  • YouTube

Like what you're reading?

Join the thousands of followers who rely on Dr. Howard J. Luks, a board-certified orthopedic surgeon specializing in Sports Medicine, with tools, tactics, and techniques for simplifying longevity.

Further Reading:

Results of Orthopedic Surgery – Volume Matters
Considering a Total Knee Replacement?
should I have surgery
Sometimes our joints just hurt, and it’s ok not to know why
Bowed legs and medial knee pain
High Tibial Osteotomy For Knee Arthritis Pain In Active People

Reader Interactions

Comments

  1. Cheryl

    Aug 10, 2015 at 5:17 pm

    I am scheduled for knee replacement surgery and am having mixed feelings about proceeding as scheduled. I dont want to have surgery but feel I must because my knee has started to go crooked. This worries me far more than the pain. The doctors say it will only get worse, and I don’t want to end up unable to walk. Do you think I should proceed even though I have all this apprehension about doing it?

    • Avatar photoHoward J. Luks, MD

      Aug 12, 2015 at 4:14 pm

      That’s impossible for me to answer :-( Everyone is nervous as the date of surgery gets closer. This is a quality of life decision. Maybe a second opinion will help you make an informed decision.

Primary Sidebar

Dr. Howard J. Luks

Howard J. Luks, MD is a leading orthopedic surgeon & sports medicine specialist. An expert in shoulder, knee, and other sports injuries, and author of Longevity... Simplified.

About · Contact · Private Consultation

Remote Guidance Sessions
  • Facebook
  • X
  • Instagram
  • LinkedIn
  • YouTube

Top Articles

The importance of VO2 Max

VO2 Max. It’s not just about your mitochondria

Walking is exercise

Walking IS Exercise: Why All Movement Matters

Zone 2 heart rate training

Zone 2 Heart Rate Training For Longevity and Performance

Do I have a serious knee injury

Is My Knee Injury Serious? 5 Signs to Look For.

Newsletter

Join the thousands of followers who rely on Dr. Howard J. Luks, a board-certified orthopedic surgeon specializing in Sports Medicine, with tools, tactics, and techniques for simplifying longevity.

Read the Book

An easy-to-read guide that tosses out the myths and clears up the truth behind living longer. As you read this book, you will:

  • Understand the science behind the recommendations for living a longer and healthier life.
  • Understand that all our bodies’ systems are interconnected and rely on one another.
  • Connect the dots to poor metabolic health and take steps to reverse this path.
  • Recognize that fear doesn't need to be your reality.
  • Recognizing that most people view “exercise” as unpleasant work.
  • Stop going down “rabbit holes” of false information.
  • Realize you don't have to change as much as you think.
Find Out More
Read Reviews
Longevity... Simplified: Living A Longer, Healthier Life Shouldn’t Be Complicated

Available at:

Bookshop
Amazon
Barnes & Noble

Trending Now

  1. Zone 2 heart rate training
    Featured
    Zone 2 Heart Rate Training For Longevity and Performance
  2. The importance of VO2 Max
    Featured
    VO2 Max. It's not just about your mitochondria
  3. Reframe why exercise is important. Not to lose, but to gin.
    Muscle and Strength
    We Exercise To Gain, Not To Lose.
  4. Seasoned Doctors Want to Leave Medicine.
    Sports Medicine
    Seasoned Doctors Want to Leave Medicine.

Howard J. Luks, MD

Orthopedic Surgery & Sports Medicine

128 Ashford Avenue
Dobbs Ferry, NY 10522

(914)-559-1900
[email protected]
Book Private Consultation

Topics

  • Joint Pain
  • Longevity
  • Metabolic Health
  • Sports Medicine
  • Running
  • Training

Browse All Articles

Joint Pain

  • Ankle
  • Elbow
  • Hip
  • Knee
  • Osteoarthritis
  • Shoulder

More Orthopedic Education

  • Topics
  • Newsletter
  • Podcast
  • Book
  • About
  • Consultation

© 2025 · Howard J Luks, MD · Disclaimer & Terms · Privacy Policy
The information on this site is not intended or implied to be medical advice, diagnosis, or treatment.
This site should be used for informational purposes only.