Innovative Mri Technique Helps Identify Mystery Knee Pain Following Knee Replacement
The Huffington Post
Recently, a police officer underwent two surgeries including a partial knee replacement. When he walked he had severe pain and would hear a popping noise. He also had trouble walking, even with a cane. As a police officer he needed to be mobile.
He was directed by a friend to see , assistant attending orthopaedic surgeon, Hospital for Special Surgery. Dr. Della Valle suspected that the ligament that prevents the shin bone from sliding backwards, the posterior cruciate ligament , was deficient and was causing the pain and popping noises as he walked.
The diagnosis was challenging because of the partial knee replacement. To confirm his suspicions, Dr. Della Valle sent his patient for a , in the at Hospital for Special Surgery.
The standard x-rays that had been taken in the past were masking the real problem. An x-ray cannot image soft tissue such as the PCL, stated , Chief, Magnetic Resonance Imaging, at Hospital for Special Surgery. The MRI Division has worked on the development of MRI protocols that allow us to capture images of the soft tissue around a total joint replacement. This technique helped us determine that the PCL was, in fact, deficient. In the past it was impossible to image soft tissue using MRI, because the metal in replacement hardware would negatively interact with the high powered imaging magnets. Our research and new techniques have helped to change that fact.
Read the full story at huffingtonpost.com.
What Will Weather Changes Feel Like In The Knee
Some patients report increased pain and stiffness, or can feel changes in the weather after knee surgery, especially with an artificial joint. These sensations are not common though, and usually will disappear over one to two years after surgery. For the first couple of years, the bone adapts and grows around the metal prosthesis, and this bone activity probably leads to increased sensitivity to weather and pressure changes that some patients can feel in their joints.
What Can I Do To Help My Recovery After Knee Replacement
Soon after surgery, you will be able to walk with a cane or a walker. But you will need help with everyday activities, such as:
- Bathing.
- Cooking.
- Shopping.
Plan ahead to have a friend or loved one help you after surgery, or tell your healthcare provider if youll need help.
Your recovery will also be easier and safer if you adjust your home ahead of time. Things to consider include:
- Bench or chair in the shower, as well as secure safety bars.
- No tripping hazards, like cords and loose carpets.
- Secure handrails along any stairs if you use stairs.
- Stable chair with a back, two arms and a firm seat cushion, along with a footstool to elevate your leg.
- AVOID reclining chairs as they DO NOT allow for proper elevation of your post surgical leg.
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Can You Have An Mri With Orthopedic Hardware
Reality: Fortunately, the majority of orthopedic devices used to care for patients can be safely scanned. This includes orthopedic joint replacements, orthopedic pins and rods and most hardware that is implanted in bone. Most patients wait 4 weeks after having an orthopedic or spinal implant before getting an MRI.6 2015 .
How Does Partial Knee Replacement Differ From Total Knee Replacement
Most arthroplasties target the entire knee joint, an operation called a total knee replacement. But some people choose to have a partial knee replacement.
To understand the difference, it helps to know the knees compartments, or sections. It has three:
- Inside .
- Outside .
- Under the kneecap .
The partial approach fixes a single section. So healthcare providers call it unicompartmental replacement. A total knee replacement addresses all three sections. Generally, only younger adults with symptoms in one knee section benefit from partial replacement.
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What Are The Limitations Of A Knee Mri
High-quality images are assured only if you are able to remain perfectly still while the images are being recorded. If you are anxious, confused or in severe pain, you may find it difficult to lie still during imaging. Constant coughing and shaking might also interfere with the scan. A bent knee that cannot be extended is also difficult to image.
A person who is very large may not fit into the opening of a conventional MRI machine.
The presence of an implant or other metallic object sometimes makes it difficult to obtain clear images and patient movement can have the same effect. In some cases, metal artifact reduction imaging is performed in patients who have metallic surgical implants at the knee and require MR imaging.
Present data show no convincing evidence that non contrast MRI harms the fetus of a pregnant woman. However, if the need for the exam is not time sensitive your doctor may delay the exam until after delivery. MRI gadolinium contrast agents are generally avoided during pregnancy except in very specific circumstances. Your doctor will discuss the benefits and risks of any MRI procedure with you. Doctors may perform MRI after the first trimester to assess the fetus for findings that are not fully evaluated by ultrasound.
An MRI exam typically costs more and may take more time than other imaging exams. Talk to your insurance provider if you have concerns about the cost of MRI.
Causes For A Knee Mri
Your doctor may order an MRI scan if they suspect any abnormalities within your knee joint. The test helps your doctor visualize the anatomy of your knee to determine the possible cause of your pain, inflammation, or weakness, without having to do surgery.
- problems with implanted medical devices
- sports- or trauma-related injury
- tumors
Your doctor may order other imaging tests, such as an X-ray, along with your knee MRI. They could also order an MRI before performing a knee arthroscopy. This is a minor surgery where a doctor views the inside of your knee by making a small incision and inserting a scope with a camera.
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What Are Some Common Uses Of The Procedure
In combination with conventional x-rays, MRI is usually the best choice for examining the body’s major joints like the knee.
The examination is typically performed to diagnose or evaluate:
- knee pain, weakness, swelling or bleeding in the tissues in and around the joint
- damaged cartilage, meniscus, ligaments or tendons
- sports-related knee injuries, such as sprains and torn ligaments, cartilage, or tendons
- bone fractures that may not be visible on x-rays and other imaging tests
- a feeling that your knee is giving away at the joint
- knee cap injury or pain
- complications related to implanted surgical devices
- pain or trauma following knee surgery
Your doctor may also order an MRI to determine if knee arthroscopy or another surgical procedure is needed, and to monitor your progress after knee surgery.
A special form of MRI called an MR arthrogram injects contrast material into the joint so that the radiologist can get a better look at the knee’s structures.
Key Takeaways From Dr Schaffers Interview
There are so many helpful points in Dr. Schaffers video, I wanted to jot them down quickly:
- Patients should have no issues getting an MRI after heart surgery that required the use of sternum wires.
- Sternum wires are used during a sternotomy to help the breast bone heal. The wires are made from stainless steel or titanium. Metals exhibit different charges that are commonly referred to as ferromagnetic, paramagnetic or minimally-paramagnetic.
- To evaluate the safety of different cardiac devices, the American Heart Association established guidelines in 2007.
- MRISafety.com is a unique website where patients and health professionals can search for medical devices to determine their safety specific to MRI testing.
- Patients who struggle with pain after heart surgery resulting from sternum wires can have their wires removed.
- The procedure to remove sternum wires is brief and requires the patient to be under general anesthesia. The patient typically has some discomfort after the surgery. Most patients are in-and-out of the hospital during the same day.
- Dr. Schaffer typically performs 1-2 sternum wire removal procedures a year.
- Patients typically have favorable outcomes from sternum wire removal procedures. However, the outcome will not be known until the procedure is complete and the patient has healed.
Keep on tickin!Adam
P.S. For the hearing impaired members of our community, I have provided a written transcript below of my interview with Dr. Schaffer.
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Who Gets Knee Replacement Surgery
You may consider knee replacement surgery if:
- Arthritis in the knee or a knee injury has severely damaged the mating surfaces of the joint.
- Pain and stiffness give you trouble doing everyday activities, such as walking up or down stairs or getting in and out of a car.
- Swelling and inflammation dont go away with rest and medication.Your knee is deformed, such as looking swollen or not shaped normally.
Predictive Value Of Magnetic Resonance Imaging Measures For The Occurrence Of Total Knee Arthroplasty In Knee Osteoarthritis
Tianyu Chen1,2, Weiyu Han1, Yujin Tang3, Changhai Ding1,4
1Clinical Research Centre, Zhujiang Hospital, Southern Medical University The Third Affiliated Hospital of Southern Medical University , 3Department of Orthopedics, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise 533000, 4Menzies Institute for Medical Research, University of Tasmania , Australia
Correspondence to:
Provenance and Peer Review: This article was commissioned and reviewed by the Academic Editor Dr. Liang Gao .
Submitted Feb 04, 2020. Accepted for publication Feb 18, 2020.
doi: 10.21037/atm.2020.02.174
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Will I Need Any Treatments After Knee Replacement
Your healthcare team will prescribe medications to help you manage pain after surgery, such as:
- Acetaminophen.
To prevent blood clots and control swelling, your healthcare team might also recommend:
- Blood thinners, such as aspirin or injectable Enoxaparin based on individual risk of blood clot formation.
- Compression devices, usually used while hospitalized. These are mechanical devises which provide intermittent compression.
- Special support hose.
Your team will ask you to move your foot and ankle around frequently to maintain blood flow at home. Theyll also show you special exercises to help strengthen your knee and restore motion. Exercises are very important to the success of your knee replacement. Initially, physical therapy will be in the home. Arrangements for this in home PT are made at the time of discharge from the hospital.
When Imaging Might Be Necessary
MRIs or x-rays are recommended for anyone whos experienced a specific injury to their knee thats resulted in pain or discomfort. Trauma is when imaging is needed more urgently, Richardson says. Any injury in which the person can not bear weight on the leg or trauma that caused immediate pain, such as falling, someone or something hit you, or any other mechanism that caused extreme force to your knee. Richardson says those types of traumatic events typically warrant an X-ray to look for broken bones or joint misalignment. If the results do notindicate any breaks, doctors typically recommend a few weeks of rest and an exercise regimen to strengthen and stretch the legs.
If, however, the pain and/or instability persists, thats when additional imaging may be necessary. An MRI is helpful to look for torn internal structures of the knee like your anterior cruciate ligament and meniscus, Richardson says. There is rarely a need for an urgent MRI, so it is reasonable to wait a few weeks before having one done.
Here are the most likely reasons to discuss imaging with your doctor:
- Immediate pain after some sort of trauma
- Unable to bear weight on the knee
- Knee pain that does not improve after 6 weeks of strengthening and conditioning
Not sure if you need imaging or just want to talk to a provider for more information? Visit onemedical.com to find care in your area.
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Preoperative Planning And Psi Manufacturing
In the MRI group, preoperative MRI data acquisition was performed using an MRI scanner according to the PSI system manufacturing protocol: 1-mm high-resolution slices of the knee and selective 5-mm spot images of the hip and ankle were acquired to measure the MA and to correct rotation of the lower extremity. The MRI images in DICOM format were uploaded onto the software to construct three-dimensional models. Then, the patient-specific cutting jigs were generated based on the surgeons predetermined default settings. The femoral component rotation was set to be parallel to the trans-epicondylar axis, perpendicular to the MA on the coronal plane, and in 3° flexion on the sagittal plane, and medial distal resection was set at 9mm. The default settings for tibial component alignment were perpendicular to the MA on the coronal plane and at a 3° posterior slope on the sagittal plane, and tibial resection was set at 10mm below the highest point of the lateral tibia. The tibial component rotation could not be adjusted by the software.
Why Computer Imaging May Be Used Prior To Knee Replacement
Successful treatment of knee problems is aided by gathering as much information as possible about the diseased joint before forming a plan of treatment. Patients who are candidates for a knee replacement may have some form of diagnostic imaging performed as part of the process of determining the best implant for their knee. Your orthopedic surgeon has many diagnostic imaging tools available to help evaluate the extent of your disease.
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Can I Have A Mri Scan After Knee Replacement
Yes. MRI scans of other parts of your body are safe after knee replacement. Although some old MRI scanning equipment may not be compatible with your prosthesis, the majority of MRI scanning equipment today is safe and compatible with knee replacement parts. You may also have a CT scan of any part of your body after a knee replacement.
Underlying Mechanisms Linking Cartilage Damage To Tka
This study by Everhart et al. provides a more detailed understanding of the prediction of prognosis of OA, but it is also important to understand the possible mechanisms linked cartilage defects with TKA risk. We would concur with the supposing mechanisms, âfull–thickness defects could simply be predictive of future accelerated cartilage loss, leading to progressively worsening symptoms.â . Pain of OA is of multi-factorial and complex origin, associating with damaged joint structures, such as subchondral bone and meniscal damages. Cartilage is not a direct source of pain in OA for the absence of innervation of sensory nerve fibres. However, cartilage defect with subchondral bone plate exposure was demonstrated to be linked to knee pain in OA patients. A study has shown a positive relationship between tibiofemoral denuded areas of subchondral bone and knee pain, especially when the dABs are located centrally . Full-thickness cartilage defects would respond poorly to non-surgical treatments, and this would be another reason why full-thickness cartilage defects were associated with increased risks of TKA.
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What Other Situations Will I Need Antibiotics For After The Knee Replacement
Antibiotics given for other medical procedures may vary. Contact your doctor for advice if there is any doubt. Keep in mind that it will be necessary for you to be treated with a full course of antibiotics if you develop an infection such as an abscessed tooth, pneumonia, bronchitis, and skin or urinary infections.
If you cut your foot, or have broken skin on the leg, or infection in a toenail after a knee replacement, seek medical attention immediately. Ignoring a festering sore means that there is a risk the bacteria could migrate to the knee implant, resulting in a serious deep infection, even though it happens rarely.
Can Patients Whose Artificial Knee Is Comprised Of Oxinium Safely Undergo An Mri Scan Or Is There An Alternative
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Do You Really Need An X
Whether youre a runner, an aspiring athlete, or just someone dealing with the aches and pains of getting older, youve likely at some point felt a twinge of discomfort in your knee. Considered one of the largest and most complex joints in the body, the knee is subject to a lot of wear and tear and overall stress. And while it may seem logical to explore the root cause of any discomfort with the sophisticated tech tools out there namely x-rays and magnetic resonance imaging it turns out, thats not always necessary.
Knee pain is one of the most common sports injuries I see, says Boston-based One Medical provider Michael Richardson, MD. It can be very debilitating, which in turn causes a lot of anxiety for my patients and a strong desire to fix things fast. Many patients request either an MRI or x-ray when they get knee pain, but this is not always needed.
Can You Have An Mri After Joint Replacement
I guess I am lucky to have great hearing and a radar sensitive ear for discussion about X-rays and medical problems. The other day my ears perked up as I was sitting in a restaurant eaves dropping on two couples speaking about their total joint replacements and imaging studies. One of them had a knee replacement and the other had a hip replacement. They were chatting about postoperative imaging studies and mentioned that “you know, it is not possible to take an X-ray because of the metal in the new joint.” The other woman agreed and added that, “I’m glad I can have an MRI and I was told it won’t hurt the machine.”
If you are considering a total joint replacement or currently have one and need imaging to evaluate pain or discomfort, speak with your physician about all of the available imaging options. Know your options and make sure your referring physician knows what information he/she is looking for when ordering an imaging study.
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