What Is The Recovery Time After Knee Revision Surgery
It varies, but in most cases, physical therapy will be initiated within 24 hours of the procedure and will continue for up to three months.
Some patients take longer to recover. In some cases, protective weightbearing or limiting the knees range of motion is needed to promote appropriate healing. Therapy will usually continue for up to three months following the surgery. Assistive devices, such as a walker or crutches, will be used early in the convalescence period, and patients will progress to a cane or walking without any assistance as their condition improves.
Why Patients Delay Or Decline Knee Replacement Surgery
It’s not uncommon for patients to initially postpone but eventually undergo knee replacement surgery. Certainly, many patients have the procedure done. Every year in the United States alone, more than 600,000 knee replacements are performed. So why the apprehension about something that is supposed to improve a patient’s physical function and relieve pain that interferes with daily living activities?
How Long Do Knee Replacements Last
Knee replacements eventually wear out. Because the knee replacement implants are made of metal and plastic, over time, these materials begin to wear, just like the rubber on your car tires. While knee replacements are designed to last a long time, they will not last forever.
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Good Data On Joint Replacement Are Hard To Find
Its difficult to predict how long a joint replacement will last for several reasons. One is that it can take a decade or more to collect data on past operations to predict the success of future operations. Another challenge is that in recent years, theres been a tendency to operate on younger people, including baby boomers who are more active in their 50s and 60s and may expect more of their new joints than prior generations. Age is of particular importance, because a person with a life expectancy of 15 years has a much better chance of avoiding a future operation than a person with a life expectancy of 30 years. In addition, younger patients tend to be more active and put more stress on their new joint. For these reasons, some surgeons advise younger patients to put off surgery as long as possible, even if that means suffering with pain, stiffness, and reduced mobility.
Sports With High Impact Or Quickly Changing Directions
While recovering from knee replacement surgery, avoid participating in contact sports or sports that may lead to a sudden twisting or jerking of the knee. Some examples include:
. Its important to work with your orthopedic surgeon after surgery to build the best program possible.
Here are some examples of exercises that surgeons recommend at different stages of recovery.
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Risks Of Knee Replacement Surgery
Knee replacement surgery is a common operation and most people do not have complications. However, as with any operation, there are risks as well as benefits.
Complications are rare but can include:
- stiffness of the knee
- infection of the joint replacement, needing further surgery
- unexpected bleeding into the knee joint
- ligament, artery or nerve damage in the area around the knee joint
- persistent pain in the knee
- a break in the bone around the knee replacement during or after the operation
In some cases, the new knee joint may not be completely stable and further surgery may be needed to correct it.
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.
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Knee Replacement Surgery Sets The Stage For Another
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Nearly a quarter of people who have total knee replacement surgery are likely to need a second surgery on their other knee within five years, research shows. This may be the result of abnormal walking patterns after surgery.
If we can change the way someone moves or improve their walking ability after surgery while also reducing the need for a second knee replacement, we may also be able to reduce healthcare costs and other issues that arise with having to undergo surgery, says lead author Joseph Zeni, an associate professor in the rehabilitation and movement services department at Rutgers School of Health Professions.
The study, which appears in the Journal of Orthopaedic Research, looks at whether movement patterns after total knee replacement surgery are associated with future surgery as a result of unbalanced movement that put more pressure on the other knee.
The researchers found that many people do not regain normal movement in their operated knee when walking and continue to walk with a stiffer knee after surgery. This means they may rely more heavily on the good knee for support. This can put more pressure on the good knee and cause the cartilage to wear away, increasing the risk of future surgery.
The National Institutes of Health and the National Institute on Aging funded the study.
The Pros And Cons Of Double Knee Replacement
Choosing a surgeon that has performed a high volume of knee replacements may increase the likelihood of successful knee replacement surgery. SeeChoosing a Surgeon for Total Knee Replacement
Double knee replacements have similar results to single-knee replacements. Both groups of patients report less knee pain and an improved knee function.1,2 However, there are important differences between having a double knee replacement surgery and two single knee replacement surgeries.
The advantages of bilateral knee replacement tend to be associated with cost and convenience.
Less time off from workPeople who have a double knee replacement only have to schedule one recovery period, and miss less work.
For example, experts suggest that a person may return to a desk job 4 to 6 weeks after knee replacement surgery.3 A person who has two separate knee replacements will take 4 to 6 weeks off work for each knee.
Less time spent in the hospitalDouble knee replacement patients tend to spend at least a half-day longer in the hospital than single knee replacement patients4,5but they only have to stay in the hospital one time. In other words, a double knee replacement might require one 4-day hospital stay while two separate knee replacements might require two 3-day stays .
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Helping Patients To Make Informed Decisions
We’re funding research to improve patient experience before, during and after knee replacement surgery. This includes a project based at the University of Sheffield which aims to help patients make informed decisions about their surgery. The research team will use the UK National Joint Registry dataset to develop and validate a personalised, web-based decision aid to help patients considering knee joint replacement to make informed choices about their treatment.
Recovering From Knee Replacement Surgery
You’ll usually be in hospital for 3 to 5 days, but recovery times can vary.
Once you’re able to be discharged, your hospital will give you advice about looking after your knee at home. You’ll need to use a frame or crutches at first and a physiotherapist will teach you exercises to help strengthen your knee.
Most people can stop using walking aids around 6 weeks after surgery, and start driving after 6 to 8 weeks.
Full recovery can take up to 2 years as scar tissue heals and your muscles are restored by exercise. A very small amount of people will continue to have some pain after 2 years.
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When A Knee Replacement Is Needed
Knee replacement surgery is usually necessary when the knee joint is worn or damaged so that your mobility is reduced and you are in pain even while resting.
The most common reason for knee replacement surgery is osteoarthritis. Other health conditions that cause knee damage include:
- knee deformity with pain and loss of cartilage
What Are The Alternatives To Revision Surgery
Alternatives to revision knee surgery are rarely used as they can sometimes be more complex and lead to worse results than revision surgery, but they include knee fusion or .
The following alternatives are employed depending on the seriousness of the problem affecting the knee:
- of the knee joint may relieve pain but at the expense of keeping the knee in a fixed, non-bending position.
- may be used in extreme cases in which the knee joint has a severe infection that cannot be eradicated
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Why Replace Multiple Joints
Other patients, especially those with arthritis, have pain in several joints. Arthritis can attack both knees, your shoulder and hip, etc. In this case, you may need to replace multiple joints.
What Does The Doctor Do Prior To Revision Surgery
When the decision for revision knee replacement is made, the surgeon will do a thorough clinical exam and order and laboratory tests. If infection is suspected, aspiration of the knee may be required. The aspirated fluid will then be sent to a laboratory for analysis to identify the specific type of infection.
In addition to X-rays, other imaging modalities may be helpful, such as bone scans, or . These advanced imaging technologies can demonstrate changes in the position or condition of the prosthetic components as well help to pinpoint the cause, location and the amount of bone loss to help plan for the surgery.
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When Can I Go Home
You will usually be in hospital for 3 to 5 days, depending on what progress you make and what type of knee replacement you have. Patients who have a half knee replacement usually have a shorter hospital stay.
If you are generally fit and well, the surgeon may suggest an enhanced recovery programme where you start walking on the day of the operation and are discharged within 1 to 3 days.
How To Avoid An Early Knee Replacement
There are three randomized controlled trials showing how best to avoid an early knee replacement . One published by our group and two by Herigou in France. All three use the patients own bone marrow concentrate. Looking at this data, you have a 4 in 5 chance of not needing an early knee replacement at 15 years after the procedure if you pursue these much less invasive bone marrow concentrate injection that contains your own stem cells.
The upshot? Early knee replacement is a big problem. You want that procedure to be one and done. Hence, do your homework on non-surgical options to avoid needing a second knee replacement procedure,
Ferket BS, Feldman Z, Zhou J, Oei EH, Bierma-Zeinstra SM, Mazumdar M. Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative. BMJ. 2017 Mar 28 356:j1131. doi: 10.1136/bmj.j1131. PMID: 28351833 PMCID: PMC6284324.
Singh JA, Lewallen DG. Time trends in the characteristics of patients undergoing primary total knee arthroplasty. Arthritis Care Res . 2014 66:897-906. doi:10.1002/acr.22233
Singh JA, Lewallen DG. Are outcomes after total knee arthroplasty worsening over time? A time-trends study of activity limitation and pain outcomes. BMC Musculoskelet Disord. 2014 Dec 17 15:440. doi: 10.1186/1471-2474-15-440. PMID: 25519240 PMCID: PMC4301928.
Chris Centeno, MD
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Risks Of The Procedure
As with any surgical procedure, complications can occur. Some possiblecomplications may include, but are not limited to, the following:
Blood clots in the legs or lungs
Loosening or wearing out of the prosthesis
Continued pain or stiffness
The replacement knee joint may become loose, be dislodged, or may not workthe way it was intended. The joint may have to be replaced again in thefuture.
Nerves or blood vessels in the area of surgery may be injured, resulting inweakness or numbness. The joint pain may not be relieved by surgery.
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.
Things No One Ever Tells You About Getting A Knee Replacement
Heres what you need to know thats not in the brochure: 1. You might not be a good candidate.A study published last year by researchers from Virginia Commonwealth University in Richmond questioned the value of knee replacement for some of the people rushing to get it. After analyzing data from a large study of men and women who had the operation, the researchers found that fully one-third of them were not actually good candidates for the surgery, which is why they got only a very modest benefita 2-point improvement on a common measure of knee function, compared with a 20-point improvement for people who started out with really bad knees.
“Pain that doesnt go away and moderate to severe arthritis are necessary for a knee replacement to do its job,” Lajam says. “If you have the surgery, but its actually a problem of nerve pain, hip pain, or circulation, its not going to help you.” The advice here is not to wait until your knees are completely destroyed before seeking surgery, but to make sure that youve tried other measures first and that you meet both criteriaconsistent pain and advanced arthritis.
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Use Pain Medications With Care
Except in very rare cases, the American Association of Hip and Knee Surgeons advises against using opioid medications for knee osteoarthritis. Opiate pain relievers, in addition to being addictive, are not proven to address knee pain over the long term any better than nonsteroidal, anti-inflammatory drugs .
Though safer than opioid drugs, NSAIDs arent for everyone, and Valaik advises caution in using them. Even over-the-counter drugs like naproxen and ibuprofen can have side effects, so check with your doctor, he says.
You can get an increase in blood pressure with NSAIDs. Larger studies have linked some of these pain relievers with a small increase in the risk of heart attack.
And the more you take, the more likely you are to have heartburn, stomach irritation or even bleeding ulcers, he notes.
Avoiding A Manipulation After Knee Surgery
A lot of factors that are out of your control, mixed with some bad luck, help determine who will experience knee stiffness and require a manipulation. However, there are some things that you, someone who is preparing for and recovering from a knee replacement, can do.
Heres how to avoid a manipulation after a knee replacement.
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How Will I Feel When I Get Home
Do not be surprised if you feel extremely tired at first. You have had a major operation and muscles and tissues surrounding your new knee will take time to heal. Follow the advice of the surgical team and call your GP if you have any particular worries or queries.
You may be eligible for home help and there may be aids that can help you. You may also want to arrange for someone to help you out for a week or so.
The exercises your physiotherapist gives you are an important part of your recovery. It is essential you continue with them once you are at home. Your rehabilitation will be monitored by a physiotherapist.
Knee Replacement: The Third Chapter In Treating Knee Pain
Man or woman, knee replacement is a significant surgery. But there has been tremendous progress made in the procedure and recovery process in recent years with patients rarely needing more than one day in the hospital. I like to think of knee replacement as a journey with different chapters.
- Chapter 1: Non-surgical care like medications, physical therapy, bracing and weight loss.
- Chapter 2: Osteoarthritis is characterized by inflammation. There are a range of injectable therapies that may provide long-lasting relief for some people.
- Chapter 3: Knee replacement surgery is a safe and effective treatment for finding relief from the pain and swelling associated with knee osteoarthritis.
After surgery, the tissue around the knee needs time to heal before you can start a program to help strengthen the knee. The replacement joint will continue to mend for up to a year after the procedure, typically allowing you to achieve the goal of a pain-free lifestyle and the ability to move better.
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The Second Knee Replacement Surgery
All of this also brings up a critical issue, when young people get a knee replacement, what happens when they need a second procedure? As a physician, I know that while the first surgery may take 60-90 minutes, the second knee replacement is a 2-4 hour affair. Why? Parts of your body have grown into the prosthesis and all of that has to be carefully dissected out so that complications like serious nerve or blood vessel injury dont happen.
We also know that the size of the bone tunnels must be expanded. Meaning that the new prosthesis needs fresh bone to latch onto, so the doctor has to ream out the existing tunnels and make them bigger.