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.
Dental Antibiotics After Tkr
I have read that many of you take antibiotics before any dental work. I want to get back to my dental cleanings, I’m 4 months post-op from bilateral. My OS said he doesn’t believe in prescribing antibiotics for dental work, but my dentist said it’s the first he’s heard of a DR not prescribing and would want my OS to put that in writing for him before he would do any work. Now I’m wondering what’s the harm of taking them before dental work? An ounce of preventionthanks for any replies to this.
I had a partial replacement and needed to wait 6 months after surgery before I could go to the dentist for a cleaning, and needed to do antibiotics prior.
I had a partial replacement and needed to wait 6 months after surgery before I could go to the dentist for a cleaning, and needed to do antibiotics prior.
Maybe It Is Not In Your Knee But In Your Head Nerve Pain Versus In Your Head Pain
We have been helping people with a lot of musculoskeletal difficulties for 28 years. The number of people who have been in our office because they were constantly told that their problems were not in their joints but in the head was vast. Many times we find the problems are not in the patients head but are actually in the joints.
This concept that a patient is having difficulty kneeling because they have a fear of kneeling or rather a fear of the pain kneeling may cause them is not a new idea but it is the subject of a lot of current research. A study from March 2019 published in the medical journal Knee from doctors in the United Kingdom asked the question, Why do patients not kneel after total knee replacement? Is neuropathic pain a contributing factor?
Here are the summary points of this research:
- Despite kneeling being an important and valued function of the knee, a proportion of patients are unable to kneel following knee replacement. This study explores the reasons for this and assesses whether neuropathic pain is a contributing factor or something else.
- 88% of patients in this study had tried kneeling post-operatively.
- There was no change in kneeling ability for the whole study group from pre- to post-operatively. .
- Patient reasons for not kneeling varied. However, the average test scoring for pain and function for all kneeling abilities lay within the nociceptive rather than neuropathic range.
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People Should Be Able To Kneel After Knee Replacement Why Arent They Research: It Has Nothing To Do With The Knee Replacement
Lets look at a January 2019 study in the Journal of Knee Surgery. It comes from the Department of Orthopaedic Surgery, The Johns Hopkins University.
Here are the summary points:
- The ability to kneel is one of the many patient goals after total knee replacement.
- Given the altered biomechanics of the knee after total knee replacement, the various implant designs, and multiple surgical approaches, there is a need to further understand the patients kneeling ability after total knee replacement.
- In patients who do kneel after surgery, data show that increased range of motion promotes improved kneeling performance. Targeted interventions to encourage kneeling after total knee replacement, including preoperative education, have not shown an ability to increase the frequency with which patients kneel after total knee replacement.
- Reasons for patient avoidance of kneeling are multifaceted and complex. There is no biomechanical or clinical evidence contraindicating kneeling after total knee replacement. There are insufficient data to recommend particular prosthetic designs or surgical approaches to maximize kneeling ability after surgery. Musculoskeletal health care providers should continue to promote kneeling to allow patients to achieve maximum clinical benefit after total knee replacement.
So Can We Do Anything About It When It Is A Problem With The Other Knee
Clearly knee weakness and instability in the other knee, will present problems in kneeling. If your knee is not bad enough for another knee replacement and you would like to explore other options please consider a review of the following information:
In this article, we are updating research and clinical observations in the use of Platelet Rich Plasma Therapy for the treatment of knee osteoarthritis. We will also explain why PRP may not work and how getting a single PRP injection is NOT PRP Therapy and will usually lead to unsatisfying long-term results.
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Briglia Dental Cares About Your Health
Your health, recovery, and peace of mind are important to us. Before going in for joint replacement surgery, a dental health clearance can really make a difference in the outcome of the procedure. It will protect your new joint and the incision area, along with lowering your risk of other problems throughout the body. We can help you get treated properly and decrease the risk of complications.
To schedule an appointment with Briglia Dental Group, call us at .
Editors Note: This post was originally published in November 2017 and has been updated for accuracy and comprehensiveness.
Can I Sit Cross
Ability to sit depends upon quality of bone which can be normal or weak. You also need a sound hips and spine for such activities. Most important your ability to sit or squat before the surgery. Some studies have suggested that those who have knee cap replaced nd it easier to squat. Having said that researchers have shown that it does load your knee implant and causes high wear rates.
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How Implant Infection Occurs
The most common route of a bacterial infection into the body is through broken skin. While normal tissue can typically defend itself against the invading bacteria, the inorganic materials of a prosthesis cannot. It is there that an infection can seed and cause damage to surrounding bone and tissue.
Another possible route involves oral infections and certain types of dental work. During a dental procedure , bacteria can often enter the bloodstream if the tissue is broken.
With little immune protection, any infection of a knee replacement and hip replacement can quickly turn serious, increasing the risk of complications and disability.
To avoid this, healthcare providers will often recommend a course of antibiotics before any invasive procedure. In this way, the natural bacteria on the skin or in the mouth will be dramatically suppressed.
While this would certainly be recommended in advance of major surgery, persons undergoing certain dental procedures may also be reasonable candidates.
Summary Of This Video: A Patient With Back Pain And Clicking In The Knee
The patient in this video came into our office for low back pain. I did a straight leg raise test, on this patient to help determine if his back pain was coming from a herniated disc. During the test I noticed a clicking sound coming from his knee. The patient had a knee replacement. It is very common for us to see patients after knee replacement who have these clicking sounds coming from knee instability. This is not an instability from hardware failure. The hardware may be perfectly placed in the knee. It is instability from the outer knee where the surviving ligaments are. I believe that this is why up to one-third of patients continue to have pain after knee replacement.
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My Surgeons Instructions About Dental Work Post Tkr
My surgeon advised me to avoid any dental work including routine cleaning for 4 to 6 months post TKR. He also told me that if I had an emergency and needed invasive dental work that I should call his office and that he might prescribe an antibiotic for me to take prior to my dental visit.
I usually have my teeth cleaned every 6 months but to be on the safe side I was able to wait 10 months for my routine cleaning after TKR.
Fortunately, I did not have any dental problems that required immediate work.
It has been two months since my routine cleaning and so far,no problems.
Some doctors suggest that you have your teeth cleaned andhave any other dental work done a few months prior to your surgery.
Antibiotics And Dental Treatment
So what is the story with antibiotics and dental treatment? There is no definitive scientifically based answer only recommendations from various bodies. It would be very difficult to set up a proper scientific study to examine this issue because we are talking about a very small number of infections in a very large number of patients. The American Dental Association and the American Academy of Orthopaedic Surgeons have produced a number position statements on this topic. In 2009 these bodies recommended that antibiotics should be given before any kind of dental treatment or examination but in 2012 watered this recommendation down, leaving it up to the surgeon and patient in each case. Guidelines regarding antibiotic use in this circumstance are certainly not uniform across the world.
At the moment, until there is definitive evidence to the contrary, I would recommend all joint replacement patients are given antibiotics an hour before any significant dental treatment . Amoxycillin 1g or Erythromycin is generally what I prescribe. It is thought that there is increased risk in patients with diabetes or those with suppressed immune systems and early days after joint replacement surgery .
As an aside, any patient with a joint replacement who develops a bacterial infection anywhere should seek medical attention early and have appropriate antibiotic therapy instituted.
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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.
Exact Answer: Six To Eight Weeks
Deep Infection after Total Joint Replacement can be a significant, severe, and expensive consequence, needing a longer hospital stay, several surgical procedures, and long-term antibiotic usage in certain circumstances.
Bacteria that typically reside in the mouth or oral cavity are considered to be responsible for a tiny percentage of such infections. It is widely understood that oral germs enter the circulation during dental treatment or even aggressive tooth cleaning/flossing. These newly circulating bacteria can lodge themselves on the edge of a joint replacement implant, where they cling tightly to the metal and proliferate, potentially leading to an infection that is difficult for the body to remove.
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Dental Treatment After Hip Or Knee Replacement
Deep Infection after Total Joint Replacement can be a serious, devastating and costly complication, often necessitating an extended hospital stay, multiple operative procedures and prolonged antibiotic use which in some cases can be lifelong. Speak to anyone who has had a serious infection and they will let you know its not a pleasant experience.
It is thought that a small proportion of late infections result from bacteria which normally live within the mouth or oral cavity. It is well recognized that these oral bacteria travel into the bloodstream at the time of dental treatment or even with vigorous teeth cleaning/flossing. These now circulating bacteria can deposit themselves onto the surface of a joint replacement implant and once there adhere strongly to the metal where they multiply and if unlucky lead to an infection which is difficult for the body to eradicate. It has been advocated that antibiotics given before dental treatment may reduce the chances of a blood borne infection occurring.
How Soon Will I Be Up And About
The staff will help you to get up and walk about as quickly as possible. If you’ve had keyhole surgery or are on an enhanced recovery programme, you may be able to walk on the same day as your operation. Generally, you’ll be helped to stand within 12 to 24 hours after your operation.
Walking with a frame or crutches is encouraged. Most people are able to walk independently with sticks after about a week.
During your stay in hospital, a physiotherapist will teach you exercises to help strengthen your knee. You can usually begin these the day after your operation. It’s important to follow the physiotherapist’s advice to avoid complications or dislocation of your new joint.
It’s normal to have initial discomfort while walking and exercising, and your legs and feet may be swollen.
You may be put on a passive motion machine to restore movement in your knee and leg. This support will slowly move your knee while you are in bed. It helps to decrease swelling by keeping your leg raised and helps improve your circulation.
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Preparing For Knee Replacement Surgery
If you and your surgeon decide that knee replacement surgery is the best treatment for you, our medical team will give you the information you need to prepare, including personalized instructions, during appointments before your surgery. To get started, here are the basics.
Why Patients With Joint Implants No Longer Need Antibiotics Before A Dental Visit
QUESTION: When my knee was replaced with an artificial joint, the surgeon said I should always take antibiotics before any dental procedure. He said the bacteria in my mouth could get into my bloodstream and cause an infection around the implant. But my dentist said not to worry and that I actually dont need antibiotics. Who is correct?
ANSWER: For several years, orthopaedic surgeons and dentists have given conflicting advice about whether a patient with a prosthetic joint implant needs antibiotics to prevent potential infections a practice known as antibiotic prophylaxis.
The surgeons believed that antibiotics were necessary because a joint infection could jeopardize the implant. Dentists, on the other hand, felt that mouth bacteria didnt pose a risk to the implants and patients shouldnt be taking the drugs needlessly.
The mixed messages have certainly caused confusion for a lot of patients. But, thankfully, the dentists and surgeons have finally settled their differences and come to a common position. After reviewing the available scientific evidence, they recently concluded that antibiotics arent needed before dental procedures after all.
The national bodies that represent the two professions , plus infectious disease specialists have issued a joint statement calling for an end to the practice.
To understand how we got to this point, its worthwhile reviewing the long history of this controversy.
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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