This Common Procedure Can Help Reduce Pain And Restore Your Ability To Move Better But How Do You Know When Its Time For Surgery
Knee replacement surgery is one of the most successful procedures in all of medicine, according to the American Academy of Orthopaedic Surgery . Its also very common: Over 790,000 knee replacements are performed each year in the United States. A complete knee replacement more correctly, a resurfacing places metal pieces to recreate the surface of the joint, with a plastic separator in between and possibly a plastic resurfacing of the inside of the kneecap .
Although youll need a little help afterward, you should be able to begin walking again either the same day or the day after surgery. And the procedure is overwhelmingly successful: The AAOS estimates that 90% of modern total knee replacements are still working more than 15 years after surgery.
How do you know if you need a knee replacement in the first place? Deciding when its time is a personal decision between you and your doctor, but there are some factors that make you a more likely candidate for surgery.
Who Is Offered Knee Replacement Surgery
You may be offered knee replacement surgery if:
- you have severe pain, swelling and stiffness in your knee joint and your mobility is reduced
- your knee pain is so severe that it interferes with your quality of life and sleep
- everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
- you’re feeling depressed because of the pain and lack of mobility
- you cannot work or have a social life
You’ll also need to be well enough to cope with both a major operation and the rehabilitation afterwards.
What Is Physical Therapy
Physical therapy is a health care service that helps you restore body movement and your physical functionality through non-invasive methods.
For example, a physical therapist may help someone learn to walk again following a stroke or injury. For those who have had a knee replacement, a physical therapist is an important part of the healthcare team. By working closely with your physical therapist, you can regain the range of motion in your leg, helping you return to the activities you once enjoyed.
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One Third Of Knee Replacements For Arthritis May Be Unnecessary
A new study calls for better and more modern ways to evaluate patients before total knee replacement surgery. Under current guidelines, many patients may be receiving the procedure when it could be avoided.
A new study finds that about one-third of total knee replacement surgeries performed in the U.S. are not appropriate according to international guidelines. The study authors hope to see better patient selection criteria in the future to make sure that those going under the knife really need the procedure.
The study was published yesterday in Arthritis & Rheumatology.
According to the Agency for Healthcare Research and Quality, Americans undergo about 600,000 knee replacements each year. Between 1991 and 2010, Medicare-covered knee replacements skyrocketed by about 162 percent per year. Some experts say the procedure is popular because its so effective, while others say the surgery is overused.
Daniel Riddle, Ph.D., a professor in the department of physical therapy at Virginia Commonwealth University in Richmond, Va., examined the criteria used to determine whether or not a total knee replacement is appropriate for a particular patient. He believes his study is the first in the U.S. to compare validated criteria for appropriateness to actual cases of knee replacement surgery.
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.
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What Are The Risk Factors For A Failed Knee Replacement
Age, activity level, surgical history and a persons weight can contribute to implant failure. Younger, active patients, people who are obese, and those who have had prior knee surgeries all have a higher increased risk of a failed implant.
Younger, more active patients have a higher rate of revision than older, less active patients because they place more stress on their prosthesis over more time. Obese patients have a higher incidence of wear and loosening because of the increased force of their weight, and they are more prone to infections because of their increased risk of wound healing. Patients with previous knee surgeries are at higher risk for infection and implant failure.
Do You Meet The Criteria For A Knee Replacement
To qualify for a knee replacement, you need to meet two major requirements. One is that you have a significant amount of cartilage loss. This is usual evaluated by taking X-rays of the knee while you are in a standing position. The loss of cartilage is seen as narrowing of the space between the knee bones. The other is that the loss is bad enough that its having a negative impact on your quality of life due to pain, limited function or a combination of the two.
Usually by the time people come to one of the , they have tried everything else and are ready to have surgery.
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After Knee Replacement When Can I Plan On Returning To Work
When could I have gone back to work?
I believe that I could have resumed my duties as a school principal 4 to 6 weeks after TKR on a limited basis. I would have had to adapt my schedule to spend most of my time in the office where I could elevate and ice my knee 3 to 5 times a day.
Short walks to visit classrooms and the playground would have been okay. I could have done some flexion and extension exercises in my office while I worked.
My duties included several after school and evening meetings and activities that I would have had to ask the assistant principal to cover for several weeks. This would have allowed me to leave early enough to continue my physical therapy. This is why I would have opted to have the surgery during school vacation.
If I had been working at a job that was physically demanding and that I had to be continually on my feet, Id estimate it would be more like 4 months before returning to full-time work.
If you can work from home or arrange a part-time transition back to work you may able to get back to work even sooner.
Remember that it may take you some time before you can drive, especially if the surgery is on your right knee. Returning to work might mean that you will need someone else to drive you to and from work.
Some Possible Answers To The Above Questions
As I have mentioned in earlier articles, I believe the best time to have TKR is in the spring or in the fall because I would want to avoid extremely hot or cold weather. If I had still been working I would have had the surgery in late May as soon as school was out.
The weather would be great for getting outside and exercising, plus it would be summer break and as an educator, I would have the time off . If I had had my TKR during summer break I would have received my regular check.
If you are still working and go beyond vacation days, check with your employer to make sure your benefits include full or partial pay. Maybe there is a slow time in your business or a time when you can combine vacation and holidays for your surgery.
Workers Compensation might also be an option during your time off.
The high cost of TKR surprised me, but what was more surprising was that my Medicare paid for all the costs of TKR and the therapy following the surgery . If you can stand the pain until you receive Medicare benefits you may want to put the surgery off until you qualify.
If not, check your health insurance before surgery and find out what the cost will be for you.
In my case, physical therapy and my personal exercise program were the keys to my recovery. If you go back to work, make sure you have time for formal therapy and additional time to exercise regularly after formal therapy is over.
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Thoughts On Insight Into Icing And A Total Knee Replacement
I had TKR sevens wks ago, I was just about to quit until I read your articleon icing. I had my first TKR over 15 yrs ago and not one of my caregiversstress the importants to keep long after the swelling has gone down. I willfollow this advice on both knees when I get through playing golf. Thanks,
Im in my 10 the month of knee replacement surgery , so do I still have to ice my replacement , no pain , but there is still swelling in the knee joint !! I do my exercise, walking, & stationary bike , so should I keep iceing my knee ?
Hello Sammie, Thanks for posting your tkr comment about icing. As I state throughout my site, I do not dispense medical advice. I only talk about what I have experienced in the hopes of helping others. I have written about icing after a tkr in other posts on this site. Take a look around! If it is any helpI still ice occasionally YEARS after my tkr. Good luck!
Who Should Consider Total Knee Replacement Surgery
It is usually reasonable to try a number of non-operative interventions before considering knee replacement surgery of any type. Prior to surgery an orthopedic surgeon may offer medications knee injections or exercises. A surgeon may talk to patients about activity modification weight loss or use of a cane.
The decision to undergo the total knee replacement is a “quality of life” choice. Patients typically have the procedure when they find themselves avoiding activities that they used to enjoy because of knee pain. When basic activities of daily life–like walking shopping or reasonable recreational pastimes–are inhibited or prevented by the knee pain it may be reasonable to consider the surgery.
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Should You Have Knee Replacement Surgery
Some experts question whether the surgery is being done too often or too soon on patients who have not adequately explored less invasive approaches.
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For the vast majority of patients with debilitating knee pain, joint replacement surgery is considered an elective procedure.
While its true that ones life doesnt depend on it, what about quality of life? Many people hobbling about on painful knees would hardly regard the surgery as optional. Consider, for example, two people I know: a 56-year-old man passionate about tennis who can no longer run for a bus, let alone on the court, and a 67-year-old otherwise healthy woman with bone-on-bone arthritis who cant walk without a cane or stand for more than a few minutes.
They have reason to think it may be time to replace their worn-out knees with artificial ones, an operation that is now among the most frequently performed costly medical procedures in the United States. But some leading medical economists are asking whether this surgery is being done too often or too soon on patients who have not adequately explored less invasive approaches to relieve their pain and improve their mobility.
A detailed discussion with the doctor should precede a decision about surgery, and the decision should be a shared one, Dr. Teutsch said.
Knee Replacement Surgery Isnt Typically Recommended If Youre Younger Than 50
Recommendations for surgery are based on a patients level of pain and disability. Most patients who undergo a total knee replacement are age 50-80. This is because, knee replacements are not as durable as your own knee and eventually wear out. On average, a total knee replacement lasts about 15-20 years. So if you have the procedure in your 40s, youll likely need another or revision surgery later in life. Whats worse than having to go through another surgery, is that the second surgery is much harder than the first.
The goal of the second knee replacement surgery is the same as the first to relieve pain and improve function. However, revision surgery is a longer, more complex procedure that requires extensive planning, specialized implants and tools, prolonged operating times, and mastery of difficult surgical techniques. Youll also be older and less resilient when you need the second surgery which is why doctors dont usually recommend knee replacement for younger patients.
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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.
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.
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Preparing For Knee Replacement Surgery
Before you go into hospital, find out as much as you can about what’s involved in your operation. Your hospital should provide written information or videos.
Stay as active as you can. Strengthening the muscles around your knee will aid your recovery. If you can, continue to do gentle exercise, such as walking and swimming, in the weeks and months before your operation. You can be referred to a physiotherapist, who will give you helpful exercises.
Read about preparing for surgery, including information on travel arrangements, what to bring with you and attending a pre-operative assessment.
Knee Replacement Recovery Tips
Here’s some top tips for four common questions about total knee replacement recovery time:
You can find the answers to loads more similar questions in the total knee replacement recovery questions section.
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Taking Care Of Yourself At Home
Be guided by your doctor or surgeon, but general suggestions include:
- The pain and stiffness take time to ease, so be patient. It may take around three months before you feel fully recovered.
- Keep your wound site clean and dry.
- Avoid smoking cigarette smoke can increase your risk of lung infections.
- Avoid any sporting activities for at least two months.
- Follow the suggestions given to you by medical staff on how to walk, climb stairs, and get in and out of chairs safely.
- Avoid jumping, jolting the knee joint or kneeling down.
- Use aids to help you around the home for example, handrails at the bath and toilet, footstools, raised toilet seats, crutches and walking sticks.
- Check your knee carefully for any signs of infection. These can include redness, swelling, warmth or seepage.
- See your doctor or surgeon if you experience anything unusual, such as clicking or popping sounds coming from the knee joint, or a sudden loss of joint control or movement.