Make Preparing For Knee Surgery A Priority
Taking certain steps to prepare for knee replacement surgery and the recovery process is important. This can help reduce stress in the lead up to the surgery and set you up for a successful recovery.
For example, one prep step should be making adjustments to your home to make it more safe and comfortable for life after surgery. This can include clearing clutter, rearranging furniture to create larger walkways and adding safety rails to your bathroom.
I Dont Kneel Because I Do Not Want To Damage The Hardware
The idea that doctors are not sure which knee replacement hardware will help the patient the most in their desire to kneel is reflected in the idea that maybe patients should avoid kneeling.
A June 2021 update study fin The Journal of Knee Surgery comes to us from researchers at Massachusetts General Hospital, the University of Miami Miller School of Medicine, and the Rothman Institute of Orthopaedics. In their study of 404 patients who had knee replacement and difficulty kneeling the researchers found:
- Sixty percent of patients were unable to kneel after total knee replacement
- Men and patients with occupations or hobbies requiring kneeling were more likely to kneel after surgery.
- People who had kneeling difficulties had:
- Too much weight or a high body mass index.
- It was too painful to kneel
- They did not have physical inability
- Fear of damaging the prosthesis. .
About Total Knee Replacement
A Total Knee Replacement is a surgical procedure whereby the diseased knee joint is replaced with an artificial material. The procedure involves cutting away damaged bone and cartilage from your thighbone, shinbone and kneecap and replacing it with an artificial joint made of metal alloys, high-grade plastics and polymers.
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Sleeping On Your Side
Some people find sleeping on their sides more comfortable, and if you are one of them, do not lie on your operative side. Also, put a cushion or pillow between your legs to provide cushion to the knee. In case you need more support, add another pillow to pad your knee to make the leg comfortable.Sleeping on the side can be painful because the leg is not straight enough. However, gradually, you can start sleeping on your side as the knee heals. But avoid sleeping on the operative side at all costs, as it puts a lot of pressure on the surgery site.
The Benefits Of A Treadmill After Knee Surgery And Knee Replacement
Continuing to use the muscles and ligaments around your knee will promote a fast recovery. Treadmills are a common part of rehabilitation and therapy after surgery because of their minimal impact on your healing knee. The use of an electronic treadmill also allows you or your therapist to set a consistent pace and to track your progress more precisely. A treadmill’s rails allow you to shift support of some body weight to your arms, taking pressure off a delicate knee after surgery. As you progress, the treadmill can be reprogrammed to simulate a faster pace or greater distance. You can also make less use of your arms as you grow more comfortable with putting weight on your knee.
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Can Rehabilitation Be Done At Home
All patients are given a set of home exercises to do between supervised physical therapy sessions and the home exercises make up an important part of the recovery process. However, supervised therapy–which is best done in an outpatient physical therapy studio–is extremely helpful and those patients who are able to attend outpatient therapy are encouraged to do so.
For patients who are unable to attend outpatient physical therapy, home physical therapy is arranged.
Mayo Clinic Q And A: Pain After Knee Replacement Surgery
DEAR MAYO CLINIC: It has been months since I had knee replacement surgery, but my knee is still hurting. Can anything be done at this point, or does the surgery just not eliminate pain in some patients?
ANSWER: Although its uncommon, a small percentage of patients continue to have chronic knee pain after knee replacement surgery. But when that happens, you dont have to just put up with the pain. Have your situation evaluated. Several additional treatment options may ease chronic knee pain after knee replacement.
Knee replacement surgery, also known as knee arthroplasty, is one of the most common orthopedic surgeries performed today. It is most often used to repair joint damage caused by osteoarthritis or rheumatoid arthritis that causes severe knee pain and makes it hard to perform daily activities.
During knee replacement, a surgeoncuts away the damaged bone and cartilage from your thighbone, shinbone andkneecap, and replaces it with an artificial joint. For most people, kneereplacement significantly improves mobility and relieves knee pain. But in somepatients, the pain persists after surgery.
Your first step in dealing withongoing knee pain in this situation is to make an appointment to see thesurgeon who performed your knee replacement. He or she can evaluate your kneeand check for possible complications from the surgery, such as an infection ora problem with the artificial joint.
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Here Are Some Of The Reasons You Might Need Knee Surgery:
- Stiffness in the joint and pain makes it difficult to walk, stand up, or climb stairs
- You often have swelling in the knee area
- Chronic pain bothers you when resting
- The pain is disrupting your sleep
- The knee has defects or is bowed
- Medication and physical therapy havent been effective in managing the pain
If you can relate to any of these symptoms, then its time to talk to a sports medicine doctor about your treatment options.
The Unexplained Noises My Knee Is Making
This is something we typically hear in a post-knee replacement patient who is having some challenges.
I started to become concerned when I noticed a clunking and clicking sound coming from my knee. Like metal on metal. My doctor told me that this was no concern, some people who get knee replacements have these old car, sounds come from their knee. Not to worry. My doctor did advise me that the sounds if they continued could be caused by weakened muscles and tendons in my knees and I should consider an exercise program to tighten them up.
I did ask if the knee implant was coming loose. My doctor said, if it were, I would not be able to walk up and down stairs or even put weight on that foot. I would have a lot of swelling and I would feel like my knee may give out. I looked at the doctor and said, BUT I DO HAVE THOSE SYMPTOMS, Yes you do, the doctor said, but it is not from implant loosening. You probably just need to strengthen that knee up.
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Technical Details Of Total Knee Replacement
Total knee replacement surgery begins by performing a sterile preparation of the skin over the knee to prevent infection. This is followed by inflation of a tourniquet to prevent blood loss during the operation.
Next, a well-positioned skin incision–typically 6-7 in length though this varies with the patients size and the complexity of the knee problem–is made down the front of the knee and the knee joint is inspected.
Next, specialized alignment rods and cutting jigs are used to remove enough bone from the end of the femur , the top of the tibia , and the underside of the patella to allow placement of the joint replacement implants. Proper sizing and alignment of the implants, as well as balancing of the knee ligaments, all are critical for normal post-operative function and good pain relief. Again, these steps are complex and considerable experience in total knee replacement is required in order to make sure they are done reliably, case after case. Provisional implant components are placed without bone cement to make sure they fit well against the bones and are well aligned. At this time, good function–including full flexion , extension , and ligament balance–is verified.
Finally, the bone is cleaned using saline solution and the joint replacement components are cemented into place using polymethylmethacrylate bone cement. The surgical incision is closed using stitches and staples.
Length of total knee replacement surgery
Pain and pain management
What Should You Expect After Knee Revision Surgery
Most patients who undergo revision procedures can expect to have good to excellent results. Although expected outcomes include pain relief with increased stability and function, complete pain relief and restoration of function is not always possible.
Up to 20% of patients may still experience some pain following revision knee surgery. This can persist for several years after the procedure. Additionally recovery after revision total knee surgery is heavily dependent on the state and function of the knee prior to the revision surgery.
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Sleeping On Your Back
The best sleeping position just after your surgery is sleeping on your back. You should make sure that your operative leg stays as straight as possible to avoid hypertension of the knee and keep proper blood flow to the surgery site.If you are sleeping on your back, put the pillow under your calf and knee. This will not only cushion the knee from pressure but also keep your leg straight. If your pillow is flat, use a second pillow. You must, however, avoid placing the pillow under your foot, as it will put stress on your knees and increase your pain.
Can You Sit Cross
If you are considering knee replacement surgery you likely have a lot of questions. Most questions have to do with post-surgery activities and range of motion. In this article I answer a question I received from a reader:
Will I be able to sit cross-legged after knee replacement surgery?
When I first read this question I wondered if it meant sitting on the floor cross-legged or sitting in a chair cross-legged. Ive decided to answer both and share my thoughts.
Remember, we all have knee surgery for different reasons so your ability to sit cross-legged might be easier, or more challenging, than my experience.
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What Are The Signs Of Knee Replacement Failure
The most common symptoms of a failed knee implant are pain, decrease in joint function, knee instability, and swelling or stiffness in the knee joint.
Persistent pain and swelling can indicate loosening, wear or infection, and the location of the pain can be all over the knee or in one particular area . A decline in knee function may result in a limp, stiffness or instability. Patients who demonstrate these symptoms and signs may require revision joint surgery.
Preparation For Total Knee Replacement Surgery
Patients undergoing total knee replacement surgery usually will undergo a pre-operative surgical risk assessment. When necessary, further evaluation will be performed by an internal medicine physician who specializes in pre-operative evaluation and risk-factor modification. Some patients will also be evaluated by an anesthesiologist in advance of the surgery.
Routine blood tests are performed on all pre-operative patients. Chest X-rays and electrocardiograms are obtained in patients who meet certain age and health criteria as well.
Surgeons will often spend time with the patient in advance of the surgery, making certain that all the patient’s questions and concerns, as well as those of the family, are answered.
The surgeon’s office should provide a reasonable estimate of:
- the surgeon’s fee
- the degree to which these should be covered by the patient’s insurance.
Total Knee Replacement Surgical Team
The total knee requires an experienced orthopedic surgeon and the resources of a large medical center. Some patients have complex medical needs and around surgery often require immediate access to multiple medical and surgical specialties and in-house medical, physical therapy, and social support services.
Finding an experienced surgeon to perform your total knee replacement
Some questions to consider asking your knee surgeon:
- Are you board certified in orthopedic surgery?
- Have you done a fellowship in joint replacement surgery?
- How many knee replacements do you do each year?
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Our Patient Jeannette Had Issues With Spinal Stenosis And Problems Post Knee Replacement
- Jeannette starts discussing the knee replacement complications at 3:50 into the video. Jeannette is 81 years old.
Jeannette describes a foot-tingling problem. She cannot sit down and relax at the end of the day, it is uncomfortable for her to put her feet up or down because it is tingling. She had a nerve conduction study that shows an injury to her peroneal nerve. The peroneal nerve branches out from the sciatic nerve. As it provides sensation to the front and sides of the legs and to the top of the feet, damage to this nerve would result in burning and tingling or numbness sensation in these areas. Further damage to this nerve would also cause loss of control in the muscles in the leg that help you point your toes upward. This can lead to walking problems and possibly foot drop, the inability to lift the front of the foot or ankle. Knee and hip replacement are leading culprits in the cause of peroneal nerve injury.
In Jeannettes case, she had two knee replacement surgeries in that knee. After the first knee replacement surgery, the implant started to protrude away from the limb. The knee replacement became loose. The second surgery to fix the first one occurred in 2015.
It was determined after examination that Jeannettes knee ligaments were loose. Her knee was hypermobile and unstable. This was causing pressure on her peroneal nerve. Knee ligament damage and weakness is also a complication of knee replacement surgery and is discussed further below.
What Not To Do After Knee Replacement Surgery
As a Physical Therapist, I work with patients in all stages of their knee replacement. We do our best to instruct our patients on what to do, but there are a few things that you should not do after knee replacement surgery. Here are the top 7 things you should not do after a knee replacement surgery.
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I Thought I Would Be Able To Kneel After Knee Replacement I Cant An Expectation Of The Total Knee Replacement To Improve Patients Ability To Kneel Was Associated With Lower Odds Of Satisfaction
Lets remind ourselves here that many people have very successful knee replacement surgeries and they can function better afterward. These are not the patients we see. We see the patient who had an over expectation of what their knee replacement could do for them and then they found out, the knee replacement could not help them do all the things they thought it could.
Lead by researchers at the University of Toronto and the University of Calgary, a 2021 study published in the journal Arthritis & Rheumatology assessed the relationship between patients expectations for total knee replacement and satisfaction with surgical outcome.
What the researchers did was look at patients who received total knee replacement surgeries and then they gave questionnaires that measured depression scale, body mass index , comorbidities , and prior joint replacement), at 1-year post- total knee replacement to assess overall satisfaction with total knee replacement results.
The researchers then divided up responses to see what the patients considered important factors in their satisfaction or dissatisfaction with the knee replacement.
Here is what 1,266 patients who had a knee replacement had to say:
- 74.7% of patients were very satisfied,
- 17.1% were somewhat satisfied,
- and 8.2% were dissatisfied.
An expectation of the total knee replacement to improve patients ability to kneel was associated with lower odds of satisfaction
What Helps Knee Pain While Sleeping
Besides managing your medication and taking them as prescribed, a couple non-medication methods of managing pain at night is a gentle massage using a rolling pin or other massage device. You can also try some gentle stretches and a little walking or biking 15-20 minutes before bed. Some clients report a warm shower helps to calm the body and if you enjoy any kind of soothing music or medication ritual that quiets the mind and prepares the body for sleep then it is definitely recommended.
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Similar Conditions That Affect The Knee
Sometimes patients with knee pain don’t have arthritis at all. Each knee has two rings of cartilage called “menisci” . The menisci work similarly to shock absorbers in a car.
Menisci may be torn acutely in a fall or as the result of other trauma or they may develop degenerative tears from wear-and-tear over many years. Patients with meniscus tears experience pain along the inside or outside of the knee. Sometimes the pain is worse with deep squatting or twisting. Popping and locking of the knee are also occasional symptoms of meniscus tears.
Since some of these symptoms may be present with arthritis and the treatment of arthritis is different from that of meniscus tears, it is important to make the correct diagnosis. A good orthopedic surgeon can distinguish the two conditions by taking a thorough history, performing a careful physical examination, and by obtaining imaging tests. X-rays and Magnetic Resonance Imaging scans may be helpful in distinguishing these two conditions.
Knee Joint Infections
Also called infectious arthritis or septic arthritis, a joint infection is a severe problem that requires emergent medical attention. If not treated promptly knee infections can cause rapid destruction of the joint. In the worst cases they can become life-threatening.Symptoms of a knee joint infection include:
- severe pain
- fevers and
Again, a joint infection is a serious condition that requires immediate medical attention.
Fear Of Harming The Prosthesis
The limited research available on this topic suggests a real difference between perceived and actual ability to kneeland for those who don’t think they can kneel, fear of harming the prosthesis is the motivating factor.
According to the American Academy of Orthopedic Surgeons, kneeling is not harmful to your knee after a total knee replacement, although it may be uncomfortable.
Any difficulty in kneeling should become easier with time, but people generally always have the sensation that the knee is artificial and not “normal.”
Overall, it’s important to remember that the goal of a total knee replacement is an improvement in knee motion, but regaining full knee motion is unlikely.
Also, if you undergo a total knee replacement because of arthritis, it’s important to remember that surgery is not going to allow you to do things that you couldn’t do prior to the surgery.
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