Nerve And Other Tissue Damage
There’s a small risk that the ligaments, arteries or nerves will be damaged during surgery.
- Fewer than 1 in 100 patients have nerve damage and this usually improves gradually in time.
- About 1 in 100 have some ligament damage this is either repaired during the operation or protected by a brace while it heals.
- About 1 in 1,000 suffer damage to arteries that usually needs further surgery to repair.
- In about 1 in 5,000 cases blood flow in the muscles around the new joint is reduced . This usually also needs surgery to correct the problem.
What Does Bone On Bone Mean
The distance between the femur and the tibia is really the amount of space the cartilage should take up.
For instance, if there is a lot of room between the femur and tibia, that means there is good joint space or a normal amount of cartilage is inferred.
If there is minimal space between the bones the joint is worn and the cartilage has thinned out, this is advanced arthritis of the knee.
It may occur on the inside , on the outside or both compartments. Quite often patients are told they are bone on bone when in fact there is still good joint space.
Are There Any Reasons Why I Cant Have A Knee Replacement
Unfortunately, some people may not be able to have a knee replacement even though their arthritis is very bad. This may be because:
- your thigh muscles are very weak and may not be able to support your new knee joint
- there are deep or long-lasting open sores in the skin below your knee, increasing your risk of infection.
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Final Word From Dayton Orthopedic Surgery About No Cartilage In Knee
Loss of cartilage in the knee is expected as we get older. Weight loss and exercise are the best medicines to reduce pain and improve activity. Only use injections sparingly to help with lifestyle factors with a preference for knee gel and PRP. Avoid any expensive treatments like stem cells that promise regeneration. Finally, consider a knee replacement if all other treatments fail and your ability to exercise drops.
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.
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Can I Run With Knee Arthritis
There are no simple answers. An exercise program aims to improve symptoms and general exercise tolerance, including running. We always say to people that running should be your goal if you enjoy it. However, some people might need to reduce their running depending on pain. If you have true bone on bone knee cartilage damage, you should find a lower impact form of exercise.
The good news in this study: running at your own pace does not worsen cartilage loss in knee on X-ray and may improve your pain.
Possible Complications Of Surgery
The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, occur in fewer than 2% of patients. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery.
Discuss your concerns thoroughly with your orthopaedic surgeon prior to surgery.
Infection. Infection may occur in the wound or deep around the prosthesis. It may happen within days or weeks of your surgery. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.
Blood clots. Blood clots in the leg veins are one of the most common complications of knee replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopaedic surgeon will outline a prevention program, which may include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings, and medication to thin your blood.
Blood clots may form in one of the deep veins of the body. While blood clots can occur in any deep vein, they most commonly form in the veins of the pelvis, calf, or thigh.
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What Is Osteoarthritis And What Is The Cause
Osteoarthritis is a condition in which the cartilage, or cushioning on the end of bones, deteriorates over time. This leads to changes in bone structure and alignment, while also affecting all the structures associated with the specific joint. Knees are one of the most common joints affected by osteoarthritis, so what really does cause knee arthritis? There are many different factors including mechanical, metabolic health, and previous injury or surgery.
Nonsurgical Treatments Are No Longer Effective
If you have arthritis of the knee, youll probably start with more conservative measures such as medications, steroid injections or physical therapy to alleviate your symptoms. But at some point, they may not be enough.
Anti-inflammatories, injections and physical therapy are temporary measures to provide pain relief, but they dont reverse the underlying cause of pain and dont allow cartilage to regenerate, Heckmann says. As time passes, these arthritic conditions tend to progress in severity, rendering these types of treatments less and less effective.
At that point, surgery may be an option.
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What Is Partial Knee Replacement Surgery
Partial knee replacement is where the bone surfaces of only compartment of the knee joint are removed and replaced with implants or resurfaced, while the bone surfaces of other compartments as well as unaffected cartilage and other soft tissues are preserved.
Patients with unicompartmental knee arthritis have cartilage degeneration in only one section or compartment of the knee. In cases where nonsurgical techniques do not provide symptom relief, surgeons can remove damaged cartilage and bone in the diseased area only, while preserving the ligaments that help support the knee joint, explains , Attending Orthopedic Surgeon at HSS.
A prosthesiswhich may also be called an implanttakes the place of the damaged area of the knee, leaving the other compartments intact.
Over the past 15 years, improvements in surgical techniques and instrumentation have made partial knee replacement a viable option for a growing number of patients in fact, recent data suggests that anywhere from 10 to 15% of all patients with osteoarthritis of the knee may be eligible for the procedure.
What Are Possible Side Effects Of The Surgery
Urquhart: All surgeries have a risk of complications. Less than 1% of healthy patients undergoing any type of surgery can experience a cardiovascular event, such as a heart attack or stroke. About 0.5% of knee replacement surgery patients develop an infection.
But an important side effect or outcome to talk about is this buyers remorse idea I brought up earlier. About 15 to 20% of patients that undergo total knee replacement surgery have buyers remorse because they still experience discomfort, clicking or a sensation of instability in their knee, making them regret having the procedure. That is exactly why we consider non-surgical options first and remind patients that they should not make the decision to have surgery without careful consideration.
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Viscosupplementation & The Knee
Viscosupplementation is a procedure during which hyaluronic acid is injected into the joint, as an effective knee pain treatment. Hyaluronic acid is a normal component of the cartilage and fluid in the joint. Because the weight-bearing knee joint is particularly prone to injury, and osteoarthritis, Flexogenix® has created the Knee-Flex 5-Step protocol that offers nonsurgical knee pain treatment.
This treatment is administered weekly over the course of about 4-5 weeks and provides more substantial pain relief, better mobility, and better long term results. This protocol takes the very latest FDA approved non-surgical knee pain treatment, and enhances it to provide a level of results that few others can match.
The steps of the protocol are as follows:
1. First, we provide immediate pain relief.
Our day 1 priority is to help you experience life without knee pain. Using our advanced imaging techniques, we map the sensory nerves around the knee. Next, utilizing innovative procedures to reduce nerve pain around the joints, the nerves are prevented from continuing to transmit pain signals. This replaces the use of steroids and protects patients from the long-term damage often associated with steroid injections. While the pain relief is significant, it is temporary and we must remind patients that it does not replace the reconditioning necessary in steps two through five of the Knee-Flex 5-Step protocol.
2. Next, we lubricate and protect the knee joint.
Looking After Your Knee Replacement
Your new knee will continue to improve for as much as two years after your operation as the scar tissue heals and you exercise your muscles. You’ll need to look after yourself and pay attention to any of the following problems:
Stiffness Sometimes the knee can become very stiff in the weeks after the operation for no obvious reason. Try placing your foot on the first or second step of the stairs, hold on to the banister and lean into your knee. This should help to improve movement and flexibility in your knee. Its very important to continue with the exercises you were working on in the hospital.If the stiffness doesnt improve after about six weeks your surgeon may need to move or manipulate your knee. This will be done under anaesthetic.
Pain Pain caused by bruising from the operation is normal in the first two months, and you’ll probably still need to take painkillers at six weeks to help you sleep through the night. You may still have some pain for as long as six months. If you still have pain after this, speak to your physiotherapist or GP.
Infection You should speak to your GP or hospital if you notice any signs of infection, for example:
- breakdown of the wound with oozing/pus or sores
- increased pain
- redness and the affected area feeling warmer than usual or smelling unpleasant.
You should also look after your feet see a doctor or podiatrist if you notice any problems such as ingrown toenails that could become infected.
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When Surgery Is Recommended
There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from total knee replacement often have:
- Severe knee pain or stiffness that limits everyday activities, including walking, climbing stairs, and getting in and out of chairs. It may be hard to walk more than a few blocks without significant pain and it may be necessary to use a cane or walker
- Moderate or severe knee pain while resting, either day or night
- Chronic knee inflammation and swelling that does not improve with rest or medications
- Knee deformity a bowing in or out of the knee
- Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries
Total knee replacement may be recommended for patients with bowed knee deformity, like that shown in this clinical photo.
How Can We Help
At Windsor Chiropractic, we take a holistic approach to how the body works and responds to any weakness.
We know that your body will compensate around your knee. Thats why we dont solely focus on your knee but on its supporting structures too. We aim to improve the function of everything around the knee so that it has the best chance of healing.
Our approach is to improve pelvic and lower limb alignment with chiropractic care, mobilisation and a number of other techniques to help improve your ability to move and exercise.
Your treatment plan may include:
- Manipulation to balance the spine and pelvis
- Mobilisation to help reduce pain and improve knee function
- Cold laser treatment to reduce pain and inflammation, and promote tissue repair.
Chiropractic may also improve the effects of exercise. To give you the best chance of regaining function, its important that you do your exercises in the correct order, mastering the basics before progressing to something harder. We can help with a suitable program.
There is hope for knee osteoarthritis even if it is supposedly bone on bone. Wed love to help you regain confidence in moving and feel more positive about your future.
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Thorough Initial Consultation & Report of Findings at our Windsor or Stafford location.
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Full Postural Assessment
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X-rays if clinically indicated
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Chiropractic Treatments
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Specific Exercise & Ergonomic Advice
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Who Is A Candidate For Partial Knee Replacement
People with medial, or lateral, knee osteoarthritis can be considered for partial knee replacement. “Medial” refers to the inside compartment of the joint, which is the compartment nearest the opposite knee, while “lateral” refers to the outside compartment farthest from the opposite knee. Medial knee joint degeneration is the most common deformity of arthritis.
Other factors to consider:
- You may want to consider a knee replacement if your knee pain persists despite your taking anti-inflammatory drugs and maintaining a healthy weight.
- Your provider will ask you to identify the area of pain in your knee, then check your range of motion and the knee’s stability. An X-ray of the knee will determine your eligibility for partial knee replacement. However, your surgeon may not know for certain if you are a good candidate until the surgery has begun.
- You must have an intact anterior cruciate ligament, a sufficient range of knee motion, damage to only one compartment and a stable knee. The angulation of the deformity is also considered.
- In the past, a partial knee replacement was considered only in people 60 and over who were sedentary. Now younger, more active people are increasingly being considered.
My Predicament: How Long I Waited Before Getting Knee Replacement
I waited over 15 years after my first orthopedic surgeon told me I was a candidate for TKR. He told me that it was up to me and that when the pain became too much for me to handle that I should come back and make an appointment for TKR.
I had had two previous meniscus surgeries in my 20s. There had always been some pain after those surgeries.
The pain increased slowly over a period of 40 years and I just lived with the pain. By my early 60s the pain was severe, I had developed a limp and my leg had begun to bow.
I was still fearful of the procedure and wanted to put it off as long as possible. After many non-invasive procedures and after two visits to two different orthopedic surgeons who both wondered how I was even walking, I made my decision to go forward with the surgery.
After doing the surgery the doctor told me that the wear was extensive and he was surprised I was able to wait as long as I had.
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Surgery For Bone On Bone Cartilage Loss In Knee: What Are The Options
Firstly, keyhole surgery for knee cartilage loss is ineffective and could accelerate knee damage.
High tibial knee osteotomy can reduce pressure on the knee joint if there is a malalignment problem. However, evidence for effectiveness is not strong, and risks are real.
Finally, knee replacement surgery effectively reduces pain and improves function compared to physical therapy. Still, the sting in the tail is that 16% of people have problems after this surgery some of these are serious. The bottom line is that surgery should only be done once your pain and activity levels become unacceptable.
How Bad Should My Knee Feel Before Getting Knee Replacement
Have you had knee pain for a long time and cant handle the pain anymore?
You may be thinking about having knee replacement surgery. The surgeon may have already told you that you need TKR surgery.
You may have been putting the surgery off like me until the pain and lack of mobility became unbearable. TKR surgery is a big decision and it took me a long time to commit.
Delaying TKR can greatly affect your lifestyle by not allowing you to enjoy the activities that you choose to participate in. Delaying the surgery can cause further wear on the joint, your leg may begin to bow and it can also cause you to develop a limp when walking .
The doctor can tell you that you need the surgery but you are the only person who can determine how much pain and inconvenience is enough.
In my case the results were amazing and I often wonder if I should have had the surgery sooner.
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Who Needs Knee Revision Surgery
A knee revision may be necessary for anyone whose prosthetic knee implant fails due to injury or wear, or who gets an infection in the area around implant.
In elderly people who have a knee replacement, the artificial knee implants may last for life. But in younger patients, especially those who maintain an active lifestyle, knee prostheses may eventually fail, requiring a second replacement later in life.
The most common reasons people for knee revision are:
- Infection: The risk of infection from a total knee replacement is less than 1%, but when infections do occur, a knee revision of one kind or another is necessary.
- Instability: This occurs when the soft tissues around the knee are unable to provide the stability necessary for adequate function while standing or walking.
- Stiffness: In some patients, excessive scar tissue may build up around the knee and prevents the joint from moving fully.
- Wear and tear: This can include loosening or breakage of prosthesis components due to friction over time.