Genicular Nerve Block With Radiofrequency Ablation
Instead of more invasive surgical options, many patients turn to a genicular nerve block to treat and diagnose persistent knee pain. A genicular nerve block uses anesthetic injected into one or more of the genicular nerves to interrupt pain signals being sent to the brain.
Unfortunately, a genicular nerve blocks effects only last eight to 24 hours. Doctors use genicular nerve blocks to test the effectiveness of the procedure on a persons knee pain. Many patients who experience relief with genicular nerve blocks will then get radiofrequency ablation. When combined, these two procedures can offer pain relief that lasts anywhere from six months to a year.
Returning To Activities / Sports
With knee replacement recovery time is one of the biggest healers. Over time the swelling will reduce, your muscles will get stronger and your knee should free up becoming more flexible than beforehand.
It is important to take things easy for the first few weeks but after that, you can start thinking about returning to your favorite activities. Here are some helpful tips on knee replacement recovery time:
- You can resume most activities after 6-12 weeks, for example swimming
- Some activities should be carried out with care e.g. golf dont wear shoes with spikes
- Some activities are not advised following a total knee replacement as they put too much stress on the new knee joint. These include: jogging, contact sports e.g. basketball and football, squash, badminton, jumping activities and skiing. If you are unsure, discuss things with your doctor.
Pain and swelling can take up to 3 months to settle and knee replacement recovery time continues up to 2 years after your operation.
My Tips To Ease Pain The Week After Tkr Surgery
Take my advice dont try to tough it out.
- Stick to the medication plan developed with your hospital team.
- As time goes by and the pain decreases wean yourself off the Percocet. Dont make an arbitrary decision to stop cold turkey.
- You will be sitting or lying down initially so elevate your knee. Icing doesnt always feel good but it dramatically reduced my swelling and pain after therapy.
- If you can, stay busy, read, watch TV, do puzzles anything to keep your mind off the pain.
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Hip And Knee Replacement Recovery Timeline
The following pain milestones and recovery timeline is a general trend for joint replacement patients. Your post-operative pain levels and experience may not be identical to those outlined below. Every patient and every joint is different.
Its important to note your pain levels throughout the recovery process. These are the key pain milestones to track:
- Before surgery
- While youre still in the hospital
- The first two weeks
- The weeks that follow as your mobility and therapy increase
- And more passively, from the 3 month mark on .
What Are My Treatment Options
Treatment for a meniscus tear will depend on its size, what kind it is, and where itâs located within the cartilage. Most likely, your doctor will recommend that you rest, use pain relievers, and apply ice to you knee to keep the swelling down. They may also suggest physical therapy. This will help to strengthen the muscles around your knee and keep it stable.
If these treatments donât work or if your injury is severe they might recommend surgery. To be sure, your doctor will probably have an MRI done. And they might look at the tear with an arthroscope. Thatâs a thin tool that has a camera and light at the end. It allows doctors to see inside your joints.
If your doctorâs exam shows your meniscus tear is mild , you may not need surgery. If itâs Grade 3, you probably will. Your doctor might choose to do any of the following:
- Arthroscopic repair. Your doctor will make small cuts in your knee. Theyâll insert an arthroscope to get a good look at the tear. Then theyâll place small devices that look like darts along the tear to stitch it up. Your body will absorb these over time.
- Arthroscopic partial meniscectomy. Your doctor will remove a piece of the torn meniscus so your knee can function normally.
- Arthroscopic total meniscectomy. During this procedure, your doctor will remove the whole meniscus.
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Prolotherapy And Platelet Rich Plasma Therapy
We are going to briefly address two treatment options that we offer here at Caring Medical. We will explore these treatments more deeply below. These are non-surgical, injections. They are not cortisone, they are not gel shots.
Prolotherapy is an injection technique utilizing simple sugar or dextrose which causes a small controlled inflammation at weakened tissue. This triggers the immune system to initiate repair of the injured tendons and ligaments. Blood supply dramatically increases at the injured area. The body is alerted that healing needs to take place and reparative cells are sent to the treated area of the knee that needs healing. The body also lays down new collagen at the treated areas, thereby strengthening the weakened structures. Once the tendons and ligaments are strengthened, the joint stabilizes and the tendonitis or tendinosis condition resolves.
Platelet Rich Plasma Therapy is the use of a patients blood platelets and healing factors to stimulate repair of a tendon it is considered when tendon damage is more severe. We will be discussing these treatments further below and try to provide a realistic outlook as to if these treatments may benefit you.
Problem: Difficulty And Pain In Kneeling
Most people had difficulty kneeling because of pain or discomfort in the replaced knee. Many patients described how this limitation affected their daily lives, including housework, gardening, religious practices, leisure activities, and getting up after a fall. Patients often adapted to these limitations by finding alternatives to kneeling, assistance from others, or home adaptations. Many patients had accepted that they could not kneel, however some still expressed frustration. Few patients had consulted with healthcare professionals about kneeling difficulties, and unmet needs included the provision of information about kneeling and post-operative physiotherapy.
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Benefits Of Effective Pain Control
- Increased patient comfort. Every joint replacement patient has some degree of post-operative pain, and effectively managing that pain can significantly affect patient comfort.
- Earlier rehabilitation. A patient whose pain is under control is more likely to get out of bed and perform rehabilitation exercises. When done under the guidance and supervision of a surgeon and physical therapist, post-surgical exercise can help reduce the development of scar tissue, increase range of motion, and increase the likelihood a successful recovery.
- Patients who have undergone a joint replacement are at greater risk for developing a blood clot in a deep vein. When a patients pain is under control, he or she can move about and perform rehabilitation exercises, which improve blood flow and therefore decrease the risk of DVT.
- Earlier hospital discharge. The sooner a patients pain is under control, the sooner he or she can return home.
- Increased patient satisfaction. Patients who are able to be self-sufficient and return to their normal routine on schedule or ahead of schedule tend to be more satisfied with their joint replacement surgery.
Knee Arthroscopy Is Among The Most Common Surgeries Performed
If you went ahead with surgery, youd be in good company. Each year, an estimated 750,000 arthroscopic knee operations are performed in this country at a cost of $4 billion. Among the most common reasons for this surgery is a torn meniscus that causes intermittent and severe pain, catching, or locking.
During arthroscopy, an orthopedist inserts a hollow-tubed instrument with a camera and light on the end into an anesthetized knee. After examining the inside of the knee, instruments can be passed through the hollow tube to remove debris, smooth ragged edges, and cut away cartilage that is impairing knee function.
Many people have both a torn meniscus and osteoarthritis . The combination is common, not only because these conditions become more common with age, but also because a meniscal tear is a risk factor for developing osteoarthritis. And arthroscopic surgery itself may also promote osteoarthritis.
We already know that arthroscopy for osteoarthritis doesnt help most people. But how good is it for the combination of osteoarthritis and a meniscal tear?
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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 coming 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.
What Does Knee Replacement Surgery Involve
The team at Tri-State Orthopaedics provide the latest advancements in treating chronic knee problems. When conservative options arent enough, your provider may recommend knee replacement surgery. Also called arthroplasty, this procedure involves replacing the structure of the damaged knee joint with metal and plastic parts to restore the normal function of the knee and relieve chronic pain.
Knee replacement is an incredibly common and successful procedure. Over 90% of people who have knee replacement experience significant improvement in pain and their ability to get around. For most people, knee replacement restores a good quality of life, giving back independence and allowing you to engage in activities you used to enjoy. However, recovery is often a long road. If youre scheduled for or considering knee surgery, here are some helpful dos and donts in your path to recovery.
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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.
What To Expect After Knee Replacement Surgery Heals
Once your knee replacement heals and you’re feeling ready to take on the world again, there are a few things to keep in mind.
Just keep in mind you may still have some slight pain, and the area in your knee may be swollen for 3 to 6 months after surgery. Your knee will continue to improve for 6 to 12 months as long as you stay committed to your rehab.
It’s always recommended to get your knee checked regularly to ensure everything is progressing in the right direction and avoiding any unnecessary setbacks. You’ll also benefit from continuing to work with a physiotherapist who can guide you towards gaining more strength, flexibility and mobility in your knee.
Moving forward, here are our top tips for anyone who’s recently recovered from a full or partial knee replacement surgery:
- Don’t do any more than you need to
- Avoid biking uphill
- Avoid activities that put stress on your knee joints including running, jumping and sport that involves running and jumping
- Avoid sitting for more than 1 hour at a time
- Sit on the edge of the seat when riding in cars and tuck your feet in
It may never feel like the knee you were born with but a knee replacement can truly be a miracle for those who need them.
Many people who’ve had knee replacement surgery come to Physio Inq for both rehabilitation and regular upkeep. As we’ve mentioned quite a lot, working with a physiotherapist after a knee replacement is absolutely essential.
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How Can We Help These Problems The Often Overlooked And Ignored Cause Of Pain After Knee Replacement The Knee Ligaments
When a knee replacement is performed, the joint itself has to be stretched out so the surgeons can cut out bone and put it in the prosthesis. When the joint is stretched out, the knee ligaments and tendons that survive the operation will cause pain as they heal from the surgical damage. Sometimes the ligaments and tendons heal well. Sometimes they do not heal as well.
In this video, Ross Hauser, MD explains the problems of post-knee replacement joint instability and how Prolotherapy injections can repair damaged and weakened ligaments and that will tighten the knee. This treatment does not address the problems of hardware malalignment that our patient Jeannette described in the video above.
Summary of this video:
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.
Looking After Your New Knee
- continue to take any prescribed painkillers or anti-inflammatories to help manage any pain and swelling
- use your walking aids but aim to gradually decrease the amount you rely on them as your leg feels stronger
- keep up your exercises to help prevent stiffness, but do not force your knee
- do not sit with your legs crossed for the first 6 weeks after your operation
- do not put a pillow underneath your knee when sleeping as this can result in a permanently bent knee
- avoid twisting at your knee
- wear supportive shoes outdoors
- do not kneel on your operated knee until your surgeon says you can
- raise your leg when sitting and apply an ice pack wrapped in a tea towel for 20 minutes every 3 or 4 hours to reduce any swelling
Page last reviewed: 02 August 2019 Next review due: 02 August 2022
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Knee Replacement Complications In Former Athletes
In a recent paper, doctors from NYU Langone Medical Center, Hospital for Joint Diseases suggest that total knee arthroplasty is often the best answer for end-stage, post-traumatic osteoarthritis after intra-articular and periarticular osteoarthritic fractures the knee.
However, total knee replacement in the setting of post-traumatic osteoarthritis is often considered more technically demanding surgery and the surgical outcomes are typically worse for these patients. The goal of the NYU paper was to create a new classification label for post-traumatic osteoarthritis patients and improve medical documentation and improve patient care.
- The researchers looked at post-traumatic osteoarthritis patients who suffered from osteoarthritis as a result of high demand or athletic activity. These were on average were younger and healthier than the primary total knee replacement population .
- The healthier post-traumatic total knee replacement group had the following complications:
- higher rates of superficial surgical site infections,
- bleeding requiring transfusion,
- increased length of hospital stay,
- and 30-day hospital readmission.
In a similar study, doctors at Duke University also recognized that Total Knee Arthroplasty as an important treatment for post-traumatic arthritis. However, these researchers also found complications that should not be expected in a mostly healthy patient population.
- knee wound complications
- need for revision surgery.
Why Does My Ankle Hurt After Knee Replacement Surgery
Pain on the inside or outside of the ankle is usally caused by changes in the alignment of the tibia after knee replacement.
The alignment of the knee directly affects the compression placed on the ankle. Your ankle is made up of several bones, but the two bones you feel on either side of your ankle are called your malleolus and are part of the tibia and fibula.
When the knee is bowed out it causes compression on the outside of the ankle.
When the knee is bowed in it causes compression on the inside of the ankle.
Before surgery your ankle and hip had time to adapt to these positions over years of gradual bony changes.
After your knee surgery, the replacement makes the leg almost perfectly straight and now your ankle has to instantly adapt to the new force and new position.
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