A person may want to consider knee replacement surgery if they have a stiff, painful knee that prevents them from performing even the simplest of activities and other treatments are no longer working.

What Happens During Knee Joint Replacement Surgery?

Once you are under general anesthesia (meaning you are temporarily put to sleep), spinal, or epidural (numb below the waist) anesthesia, an eight- to twelve-inch cut is made in the front of the knee. The damaged part of the joint is removed from the surface of the bones, and the surfaces are then shaped to hold a metal or plastic artificial joint. The artificial joint is attached to the thigh bone, shin and knee cap either with cement or a special material. When fit together, the attached artificial parts form the joint, relying on the surrounding muscles and ligaments for support and function.

What Are Recent Advances in Knee Joint Replacement Surgery?

Minimally invasive surgery (MIS) has revolutionized knee replacement surgery as well as many fields of medicine. Its key characteristic is that it uses specialized techniques and instrumentation to enable the surgeon to perform major surgery without a large incision.

MIS knee joint replacement requires a much smaller incision, three to five inches, versus the standard approach and incision, which is typically eight to twelve inches. The smaller, less invasive approaches result in less tissue trauma by allowing the surgeon to work between the fibers of the quadriceps muscles instead of requiring an incision through the tendon. It may lead to less pain, decreased recovery time and better motion due to less scar tissue formation.

Currently this less invasive procedure is performed by only a small percentage of orthopaedic surgeons in North America. Because this type of surgery is still relatively new, research has been initiated to determine how the immediate and long-term results will compare to traditional surgery.

What Happens After the Surgery?

The average hospital stay after knee joint replacement is usually three to five days. The vast majority of people who undergo knee joint replacement surgery have dramatic improvement. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is relieved when the new gliding surface is constructed during surgery.

After knee joint replacement, people are standing and moving the joint the day after surgery. At first, you may walk with the help of parallel bars, and then a walking device -- such as crutches, walker, or cane -- will be used until your knee is able to support your full body weight. After about 6 weeks, most people are walking comfortably with minimal assistance. Once muscle strength is restored with physical therapy, people who have had knee joint replacement surgery can enjoy most activities (except running and jumping).

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Cymbalta is approved for the management of fibromyalgia.

Important Safety Information

Cymbalta^® (duloxetine HCl) is approved for the treatment of depression and generalized anxiety disorder, and for the management of diabetic peripheral neuropathic pain and fibromyalgia.

What should I talk about with my healthcare provider?

Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, unusual changes in behavior, thoughts of suicide, anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or extreme hyperactivity. Call your healthcare provider right away if you have thoughts of suicide or if any of these symptoms are severe or occur suddenly. Be especially observant within the first few months of antidepressant treatment or whenever there is a change in dose.

You should also know that:

Suicide is a known risk of depression and some other psychiatric disorders.
Antidepressants may increase suicidal thoughts or behaviors in some children, adolescents, and young adults especially within the first few months of treatment or when changing the dose. No increased risk has been shown for adults over age 24, and risk decreased for those over age 65.
All patients starting therapy should be monitored appropriately and observed closely for new or worsening depression symptoms, suicidal thoughts or behavior, or unusual changes in behavior.
Cymbalta^® is not approved for use in patients under age 18.

Who should NOT take Cymbalta?
You should not take Cymbalta if:

You have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI)
You have uncontrolled narrow-angle glaucoma (an eye disease)
You are taking Mellaril^® (thioridazine)

What other important information should I discuss with my healthcare provider?
Before starting Cymbalta, tell your healthcare provider:

about all of your medical conditions, including kidney problems, glaucoma, or diabetes
about your alcohol use
if you are taking nonprescription or prescription medicines, including those for migraine, to address a possible life threatening condition
if you are taking NSAID pain relievers, aspirin, or blood thinners. Use with Cymbalta may increase bleeding risk
if you are pregnant, plan to become pregnant during therapy, or are breastfeeding an infant

While taking Cymbalta, tell your healthcare provider:

if you have itching, right upper belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of liver problems. Severe liver problems, sometimes fatal, have been reported
if you have high fever, confusion, and stiff muscles to address a possible life-threatening condition
before stopping Cymbalta or changing your dose
if you experience dizziness or fainting upon standing, especially when first starting Cymbalta or when increasing the dose. Your healthcare provider may periodically check your blood pressure while you are taking Cymbalta

If you have any questions, talk to your healthcare provider before taking Cymbalta.

What are the possible side effects of Cymbalta?

The most common side effect of Cymbalta was nausea. For most people who had it, the nausea was mild to moderate. Other common side effects included dry mouth, sleepiness, constipation, decreased appetite, and, increased sweating. This is not a complete list of side effects.

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