Reasons For The Procedure
Knee replacement surgery is a treatment for pain and disability in theknee. The most common condition that results in the need for kneereplacement surgery is osteoarthritis.
Osteoarthritis is characterized by the breakdown of joint cartilage.Damage to the cartilage and bones limits movement and may cause pain.People with severe degenerative joint disease may be unable to donormal activities that involve bending at the knee, such as walking orclimbing stairs, because they are painful. The knee may swell or”give-way” because the joint is not stable.
Other forms of arthritis, such as rheumatoid arthritis and arthritis thatresults from a knee injury, may also lead to degeneration of the kneejoint. In addition, fractures, torn cartilage, and/or torn ligaments maylead to irreversible damage to the knee joint.
If medical treatments are not satisfactory, knee replacement surgery may bean effective treatment. Some medical treatments for degenerative jointdisease may include, but are not limited to, the following:
Cortisone injections into the knee joint
There may be other reasons for your doctor to recommend a knee replacementsurgery.
Sitting Supported Knee Bends
While sitting at your bedside or in a chair with your thigh supported, place your foot behind the heel of your operated knee for support. Slowly bend your knee as far as you can. Hold your knee in this position for 5 to 10 seconds.
Repeat several times until your leg feels fatigued or until you can completely bend your knee.
Sitting supported knee bend
How Do I Know If I Need Knee Replacement Surgery
You may need surgery if:
- Your knees are stiff and swollen.
- There is pain throughout the day, even at rest.
- Walking, getting up or climbing stairs is difficult and painful.
- Medication and therapy do not offer enough relief.
- Knee cartilage is so damaged and worn away that you are walking “bone on bone,” in which the bones of the joint are scraping together.
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Tests Before Knee Replacement Surgery
About six weeks or so before your operation you will have an appointment for a ‘pre-admission’ or ‘pre-assessment’ clinic. At this clinic a nurse will assess your fitness for your knee surgery.
There are several tests that may be needed and they include:
- Blood tests – to check that you aren’t anaemic and that your kidneys and liver are working well enough for you to undergo the operation.
- Urine test – to make sure you haven’t got a urine infection and that there isn’t any glucose in your urine.
- Blood pressure.
- Infection screen – this includes looking for meticillin-resistant Staphylococcus aureus . MRSA is a germ that is difficult to treat and can cause complications of a knee replacement.
- A heart tracing .
You may have the chance to speak with an anaesthetist, physiotherapist, occupational therapist or social worker at this clinic but this isn’t always possible.
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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What Happens During Joint Replacement Surgery
Hip and knee replacement are two of the most commonly performed operations in orthopedic surgery. Both procedures are very successful at eliminating pain, correcting deformity and improving patient mobility so patients can regain quality of life and get back to the activities they enjoy.
During hip replacement, the damaged ball of the hip ball and socket joint is removed and replaced with a metal or ceramic ball that attaches to a stem that fits into the femur. The prosthesis is usually coated with a special material into which the bone will grow over time. In some instances, however, the prosthesis is cemented into the bone. The socket portion of the ball and socket joint is also replaced with a metal cup that is placed into the pelvis. A plastic liner is then snapped into the metal cup and rotates with the new ball on the end of the femoral stem. The prostheses and implants come in a variety of shapes and sizes that can be tailored to the individual.
Total joint replacement surgery usually takes one to two hours and is typically performed in a hospital setting with a one- to two-day hospital stay. The procedure is usually performed under spinal anesthesia in combination with a nerve block. This prevents the need for general anesthesia and intubation during the surgery and can help patients avoid many of the side effects of general anesthesia such as post-operative nausea. This allows for better pain control and quicker recovery.
How Do I Get Ready For Total Knee Replacement
Ask your provider how you should plan to get ready for your surgery.
Tell your provider about any medicines you are taking, including:
All prescription medicines
Over-the-counter medicines such as aspirin or ibuprofen
Herbs, vitamins, and other supplements
Ask if there are any medicines you should stop taking ahead of time, like blood thinners.
If you smoke, try to quit before your surgery.
If you are overweight, your provider may advise you to try to lose weight before your surgery.
Donât eat or drink after midnight the night before your procedure.
You may want to make some changes to your house, to make your recovery smoother. This includes things like adding a handrail in your shower.
In some cases, your provider might want additional tests before you have your surgery. These might include:
X-rays, to get information about your hip
MRI, to get more detailed information about your hip
Electrocardiogram , to make sure your heart rhythm is normal
Follow any other instructions from your healthcare provider.
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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.
Protecting Your Knee Implant
You can extend the life of your knee implant by doing several things. After surgery, use a cane or walker until your balance improves — taking a fall can cause serious damage to a new joint. High-impact exercise can also take a toll on knee implants, so most doctors warn against jogging, jumping, and contact sports.
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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.
How Do I Prepare
Preparation for surgery is important to minimize the risk of complications. Prior to surgery, you may be asked to exercise or lose weight in preparation for surgery. Your doctor may do a complete medical history and in some cases, you may need permission from your other doctors. Those who smoke will be asked to stop before surgery. Diabetic patients will need to verify good blood sugar management.
Make a list of all the medicines you are currently taking. Be sure include any prescription medications, over-the-counter medicines , inhalers, patches, vitamin supplements, and herbal remedies.
You can also attend a joint replacement class offered by Intermountain Healthcare. The classes are taught by registered nurses with special training in orthopedic care and will help you prepare for the surgery and answer questions.
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What Kind Of Physical Therapist Do I Need
Although all physical therapists are prepared through education and experience to treat people who have a total knee replacement surgery, you may want to consider:
- A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, problems
- A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in orthopedic physical therapy, giving the physical therapist advanced knowledge, experience, and skills that may apply to your condition
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you’re looking for a physical therapist:
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapist’s experience in helping people with knee replacements.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
How Long Is The Recovery
All patients heal from surgery at their own pace. Your doctor will tell you when it is safe to go back to your normal activities. Here are some guidelines:
- Household chores: 3-6 weeks
- Work: 4 weeks or more- depending on your job requirements
- Swimming: 6-8 weeks
- Driving: Before you can drive, will need to be off pain medicine and be abele to get in and out of the car. You may be able to start driving within 2 to 6 weeks–even if your driving leg was operated on.
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What You Need To Know About Total Knee Replacement Surgery
Most patients with advanced arthritis reach a point where medications, physical therapy, and lifestyle changes no longer provide relief from symptoms. Quality of life is very important and is a primary consideration when recommending knee replacement surgery to patients. If you are considering a total knee replacement, heres what you need to know about the procedure.
Surgical Treatment Of Knee Pain
Partial knee replacement: The surgeon replaces the damaged portions of the knee with plastic and metal parts.
Total knee replacement: In this procedure, the knee is replaced with an artificial joint. It requires a major surgery and hospitalization.
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Rapid Recovery For Total Knee Replacement
Typically, patients can expect to experience some swelling and pain after undergoing knee replacement surgery. Dr. Sculco is dedicated to improving your recovery by limiting post-surgical pain and other side effects. Over the years, he has been involved with extensive research on topics including less invasive surgical techniques, anesthesia use, anti-inflammatory medications, and specific instruments used during the procedure. This research has led Dr. Sculco to a fine-tuned recovery approach that has been proven to decrease inflammation and pain following surgery, as well as accelerate the bodys healing process so patients can get back to doing what they love faster. Learn more about Dr. Sculcos recovery approach by visiting our Rapid Recovery page.
If youre suffering from lowered range of motion and pain in your knee joint, the first step to getting back to your normal life quickly is scheduling an evaluation with an experienced orthopedic surgeon. Dr. Peter K. Sculco provides customized treatment plans and personalized care paired with world-class orthopedic training. Call today to request an appointment.
Total Knee Replacement Surgical Procedure
The goal of total knee replacement surgery is to relieve knee pain and increase knee function by resurfacing the bones that meet at the knee joint. The surgeon removes damaged portions of bone at the end of the femur and top of the tibia and replaces them with prosthetic components. Some surgeries also resurface the back of the patella, or kneecap.
Below is a step-by-step description of a typical total knee replacement surgery. The actual surgery typically lasts for 2 hours per knee.
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Ive Lost Weight And Did Physical Therapy But Im Still In Pain Whats Next
Urquhart: When all of the non-operative options listed above do not work, patients should consult with an orthopaedic surgeon to discuss partial or total knee replacement surgery.
The consult will usually include discussing symptoms, a few strength and ligament tests, X-rays and discussing the benefits and risks of surgery.
What Are Knee Replacement Implants Made Of
The selection of knee replacement prosthesis design and materials depends on each individual patient. The main implant components are made of metal â usually titanium or chrome-cobalt alloys. The implants are fixated in place either with a cement bonding agent or by osseointegration, in which a porous metal stem extends into the tibia and the patient’s natural bone grows into it. A plastic platform or spacer will be inserted between the tibial and femoral implant surfaces. The spacer is made of polyethylene.
Most femoral components are made of metal alloys or metal-ceramic alloys . The patellar component is plastic . The tibial insert component is also plastic . The tibial tray component can be made of the following materials:
- cobalt chromium
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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.
What Is Total Knee Replacement Surgery
If your knee is damaged by arthritis or injury, it may be hard for you to do your daily activities. You may also have severe pain that keeps you from enjoying hobbies such as running and skiing.
The most common reason forknee replacement surgery is osteoarthritis. Osteoarthritis occurs when the cartilage that cushions the bones of the knee wears away. A serious knee injury may also be a reason for total knee replacement surgery.
Total knee replacement is a surgical procedure to replace a damaged or diseased knee joint with an artificial joint. It is a common and safe procedure.Total knee replacement resurfaces the bones around the knee with metal and plastic to allow pain free movement.
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What The Alternatives To Knee Replacement
A healthcare provider may recommend knee replacement surgery after other treatments for knee pain dont help anymore. These earlier options may include:
- Exercise or physical therapy to strengthen the muscles around the joint which will provide stability.
- Medications such as NSAIDs and cortisone shots.
- Walking aids or supports and bracing.
When To Seek Emergency Care
Warning signs of a blood clot in the lungs include sudden shortness of breath, chest pain, and coughing. Signs of infection include fever, worsening redness or tenderness of the knee, and pus draining from the surgical wound. If you feel or see any of these symptoms after knee replacement, call your doctor immediately. Call 911 for chest pain or if you are having any trouble breathing.
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What Is Involved With The Pre
Before surgery, the joints adjacent to the diseased knee are carefully evaluated. This is important to ensure optimal outcome and recovery from the surgery. Replacing a knee joint that is adjacent to a severely damaged joint may not yield a significant improvement in function as the nearby joint may become more painful if it is abnormal.
- Furthermore, all medications that the patient is taking are reviewed. Blood-thinning medications such as warfarin and anti-inflammatory medications such as aspirin may have to be adjusted or discontinued prior to knee replacement surgery.
- Routine blood tests of liver and kidney function and urine tests are evaluated for signs of anemia, infection, or abnormal metabolism.
- Chest X-ray and EKG are performed to exclude significant heart and lung disease that may preclude surgery or anesthesia.
- Finally, a knee replacement surgery is less likely to have a good long-term outcome if the patient’s weight is greater than 200 pounds. Excess body weight simply puts the replaced knee at an increased risk of loosening and/or dislocation and makes recovery more difficult.
Another risk is encountered in younger patients who may tend to be more active, thereby adding trauma to the replaced joint.