Characteristics Of Severe Arthritis Of The Knee
Pain
Pain is the most noticeable symptom of knee arthritis. In most patients the knee pain gradually gets worse over time but sometimes has more sudden flares where the symptoms get acutely severe. The pain is almost always worsened by weight-bearing and activity. In some patients the knee pain becomes severe enough to limit even routine daily activities.
Stiffness
Morning stiffness is present in certain types of arthritis. Patients with morning stiffness of the knee may notice some improvement in knee flexibility over the course of the day. Rheumatoid arthritis patients may experience more frequent morning stiffness than patients with osteoarthritis.
Swelling and warmth
Patients with arthritis sometimes will notice swelling and warmth of the knee. If the swelling and warmth are excessive and are associated with severe pain, inability to bend the knee, and difficulty with weight-bearing, those signs might represent an infection. Such severe symptoms require immediate medical attention. Joint infection of the knee is discussed below.
Location
The knee joint has three compartments that can be involved with arthritis . Most patients have both symptoms and findings on X-rays that suggest involvement of two or more of these compartments for example, pain on the lateral side and beneath the kneecap . Patients who have arthritis in two or all three compartments, and who decide to get surgery, most often will undergo total knee replacement .
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How Long Does Bruising Last After Knee Replacement Surgery
Typically, bruising around your surgically repaired knee will last 1 to 2 weeks. Bruising often appears as a purplish discoloration that indicates there is blood in the area .
Its common and normal to develop bruises in your thigh, calf, ankle and foot because that is where blood pools in the leg.
The blood will track along the tissue planes of your leg resulting in bruising .
In many cases patients are hooked up to compression machines right after surgery that stimulate the circulation of blood through the leg. This helps push blood in and out of the leg and may reduce the amount of bruising.
Pain After Knee Replacement: Six Months
If you are still experiencing pain six months after surgery, you may be wondering how long it will be until you feel normal again. Unfortunately, there is no easy answer.
In some cases, it may take up to a year for all of your swelling to completely go away. Your knee will continue to recover for years to come, as scar tissue forms and your muscles become stronger with continued physical therapy and light exercise.
As previously mentioned, if you are still experiencing debilitating levels of pain at this stage, you could be suffering from chronic pain. While you may be tempted to tough it out, its important to talk with your doctor. Together, you can find what is causing your persistent pain and come up with a plan to fix it.
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Understanding Why Some Joint Replacements Fail
We’re also supporting research to improve the outcome of knee replacement surgeries, such as a project aimed at increasing the understanding of why joint replacements sometimes fail by investigating whether there are genetic risk factors that influence surgery outcome. This research has the potential to improve patient experience and increase the life of the joint replacement.
Cause Of Knee Pain And Swelling Eight Weeks Out From Replacement Surgery
Scientific Animations, CC/BY-SA/Attribution-ShareAlike 4.0 International
Dr. Bergin explains, The surgeon has cut the ends of the bones off with a saw, completely dislocated the kneecap, cut out all the cartilages between the two bones, and then spread the filleted soft tissues apart with vigor, in order to expose the knee for the operation.
Then we pound in a metal prosthesis on top of burning cement, which is used to glue the metal in place.
Then immediately following the surgery, the patient must move the painful site immediately, and every day after that until they achieve full range of motion, or risk developing a permanent contracture.
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Bruising After Knee Replacement Surgery
Bruising after total knee replacement surgery is normal. I experienced mild bruising and you may experience mild or extensive bruising. Bruising will be slightly different for each individual.
After TKR there are multiple areas that have the potential to bruise. There could be bruising on the thigh, around the knee, down the shin, and even as far as your toes.
The bruising will eventually clear up and it may take several weeks to disappear.
Bruises evolve as they heal. They may turn different colors in the process. It is important to remember that these bruises have nothing to do with deep vein thrombosis or blood clots .
Dont worry, bruising is part of the healing process and they are rarely permanent. Below, Ill share a few tips to help reduce bruising after knee replacement.
How To Reduce Swelling After Surgery
Compression stockings
There are several simple things you can do. First, wear a pair of TED hose, or compression stockings. This will help to literally squeeze the fluid out of your legs and feet. You can wear these almost 24 hours a day.
Elevation
Keep your leg up and elevated. The higher the better. This will help to drain fluid out of your leg.
Ice
Ice your knee. This can be done with ice packs, or with a ice machine a special pad and a pump that circulates cold water through the pad like the one shown here. The cold helps to reduce inflammation which will decrease the swelling and effusion.
Ibuprofen / Naproxen or other anti-inflammatory medicine
These medicines work to stop inflammation and thereby reduce the swelling after surgery. I often suggest 600-800mg of ibuprofen 3 times a day, or 440mg of naproxen twice a day. Be sure to check to see if this is something you are allowed to take after surgery. Patients on strong blood thinners should not take any anti-inflammatories.
Ive put a number of products that Ive seen help patients with knee swelling on my related products page. I dont sell these but refer you to amazon to find them. .
Patients ask a lot of questions about swelling feel free to ask me below if you have some of these questions and Ill try to answer them for you. I want you to understand what knee swelling means and when it is important to see your doctor.
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How Long Does Pain And Stiffness Last After Knee Replacement
Early treatment of the stiff TKA includes physical therapy and manipulation under anesthesia . MUA performed within 3 months may have the greatest increase in ROM but notable improvement can occur up to 6 months after TKA. After six months, arthroscopic or open surgery is recommended for persistent stiffness.
Solutions To Knee Pain And Swelling From Joint Replacement Surgery
Once the patient understands the mechanical reasons for why pain and swelling continue to linger eight weeks after the operation, that individual will psychologically be better able to tolerate the pain and the visibility of the edema.
They will no longer fear that something went wrong or that the surgeon left something in there.
Quite frankly, the knee pain following a joint replacement can be brutal. Some patients have described it as the worst pain to have.
Additionally, every patient is different with regard to their tolerance for pain, says Dr. Bergin.
While one patient might take pain pills for about a week after their surgery, another patient might need them for longer.
Each physician must make a decision with regard to their patients experience of pain, based on their knowledge of that patient.
Dr. Berginis a general orthopedist, surgically and conservatively treating all manner of bone and joint conditions. She enjoys educating patients so they can emerge stronger than they were before their orthopedic injury or surgery.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. Shes also a former ACE-certified personal trainer.
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Returning To Activities / Sports
Here is some more guidance relating to specific activities and knee replacement recovery time:
- You can resume many 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.
Those Whove Had A Knee Replacement
With a knee replacement, you will want to be sure to elevate your leg while icing. This helps cut down swelling and inflammation, which speeds up healing. While icing, lay on your back and prop your surgical leg with 3 or more pillows. DO NOT put pillows directly under your knee as this cause stiffness . Pillows should prop your heel. When icing, keep your knee as straight as possible. Your surgical leg must be elevated higher than your heart.
- Once elevated, ice you 15-20 minutes at a time.
- Wrap ice in a tea towel, t-shirt, or thin cloth. DO NOT apply directly to skin .
- Repeat icing at least 3-4 times a day. If you think you would benefit from icing more frequently, ask your doctor if this is a good idea.
How long to ice a knee after knee replacement surgery? Its important to keep icing daily in the first 90 days of surgery and beyond. As long as you have pain and swelling, icing is a great tool to overcome these recovery setbacks.
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What Not To Do After Knee Replacement
After undergoing a partial or total knee replacement, there are certain movements to refrain from to avoid re-injuring your knee or causing pain.
Avoid any risk of falling After knee surgery, it will take a while before you regain strength and balance in the leg, making you more likely to experience a fall. Avoid activities like climbing ladders and take care to hold on to handrails when using stairs. Hiking or walking on the uneven ground should also be avoided until your knee is properly healed.
Dont sit for long periods Sitting for long periods after knee replacement surgery is correlated with a higher risk of blood clots. Make sure youre getting enough light activity to support healing after your operation.
Running Running puts three times the amount of pressure on the knee as walking. Avoid running while youre healing from knee replacement surgery until cleared to do so by your doctor.
Is A Knee Replacement Painful
Knee replacement surgery is a common orthopedic surgery in the U.S. with the number of surgeries performed each year expected to hit 1 million by 2040. Knee replacement surgery is proven to provide pain relief, improve mobility and quality of life, but it has a reputation of being painful. Patients considering this procedure are often hesitant because theyve heard that the surgery itself has a long recovery time and they wonder if the pain and time recovering will be worth the benefits.
Are you considering knee replacement surgery? Lets first look at the facts- Most knee replacements are expected to last more than 15 years, and according to recent statistics, three to six weeks after surgery is the average time it will take to resume to most daily activities.
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How To Effectively Use Opioids After Knee Replacement
My advice, which I offer in more detail in my book, is simply this. The first two weeks you will experience a great deal of chemical pain, which is related to the molecules that rush into the area in an acute injury and bone pain, pain that is caused by cutting the ends of the long bones. Most people in order to feel comfortable will need some type of opioid during this time to get them through. Opioids have some well known side effects like nausea in limited cases, constipation quite frequently and well lets just call it brain fog.
Constipation can usually be managed effectively with a preemptive strategy, taking in plenty of water, taking over the counter prescriptions for constipation before you get constipated and paying attention to the types of food you eat. Consuming lots of cheese and meat, which are tough to digest, will exacerbate the problem.
I recommend taking the opioids after knee replacement during this two week time periodat the prescribed levels on a time managed program and work your tail off on your range of motion, the hardest task to complete following a knee replacement.
Since you need to be on the pain medicine secondary to the chemical and bone pain, use it to your advantage and knock out the hardest task out right at the start. Most of my patients can get off of narcotics after the week two if they follow the program and transition to over the counter medications allowing them to drive and return to work sooner than average.
Preparation For Total Knee Replacement Surgery
Patients undergoing total knee replacement surgery usually will undergo a pre-operative surgical risk assessment. When necessary, further evaluation will be performed by an internal medicine physician who specializes in pre-operative evaluation and risk-factor modification. Some patients will also be evaluated by an anesthesiologist in advance of the surgery.
Routine blood tests are performed on all pre-operative patients. Chest X-rays and electrocardiograms are obtained in patients who meet certain age and health criteria as well.
Surgeons will often spend time with the patient in advance of the surgery, making certain that all the patient’s questions and concerns, as well as those of the family, are answered.
Costs
The surgeon’s office should provide a reasonable estimate of:
- the surgeon’s fee
- the degree to which these should be covered by the patient’s insurance.
Total Knee Replacement Surgical Team
The total knee requires an experienced orthopedic surgeon and the resources of a large medical center. Some patients have complex medical needs and around surgery often require immediate access to multiple medical and surgical specialties and in-house medical, physical therapy, and social support services.
Finding an experienced surgeon to perform your total knee replacement
Some questions to consider asking your knee surgeon:
- Are you board certified in orthopedic surgery?
- Have you done a fellowship in joint replacement surgery?
- How many knee replacements do you do each year?
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What Are The Risks And Complications Of Revision Knee Replacement
Any surgery can have potential complications. The complexity of revision joint surgery increases the chance of surgical complications, which include but are not limited to:
- wound drainage
- damage to nerves or blood vessels
- intra-operative fractures
- pulmonary embolism
Infection, bleeding, damage to nerves or blood vessels, and intra-operative fractures can be minimized by using antibiotics before and after surgery, employing sterile surgical techniques and utilizing well-planned surgical exposures. Patients who are obese are particularly at increased risk of infection and wound drainage issues post operatively.
Similar to primary knee replacement, some mild swelling of the knee or ankle may be present after surgery for as long as three to six months. Swelling can be treated by elevating the leg, applying an ice pack, and wearing compression stockings.
Prior medical conditions, such as heart and lung complications or stroke conditions, can be aggravated by a revision procedure. These conditions may also develop in patients after revision surgery. Very rarely, death can occur. The decision to perform revision joint surgery is made when the benefits of pain relief and functional improvement outweigh the risk of potential complications.
Nerve Damage From Surgery
Nerve damage can happen during surgery, but it usually goes away within six months.
Surgeons must cut and stretch skin and muscle during surgery. The American Academy of Orthopaedic Surgeons says pressure, stretching or cutting can damage nerves in the leg or around the joint.
Knee surgery may involve special tourniquets to restrict blood flow in the leg. According to a 2013 study in the journal Acta Orthopaedica, these devices may put damaging pressure on nerves.
Symptoms of nerve damage include radiating pain, tingling sensation in the leg, and numbness in the leg or foot.
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Should Others Anticipate Knee Rehabilitation Setbacks
Thankfully, I have had few setbacks. Ive read a number of stories about others who have struggled to regain their mobility. I even know a few people who had to go in a few months after surgery to have their joint manipulated under anesthetic .
Early on I didnt feel like dealing with the painful exercises, but Im glad I pushed through the pain and remained active. I feel a little better and stronger each day.
The hot tub has been soothing after swimming and other heavy workouts.
I still feel soreness and some aching around my knee after workouts and activity so I take time to elevate my knee with my wedge pillow and ice my knee after activity even if it does not feel swollen.
Sleeping was difficult in the days after knee replacement, but now I have no trouble sleeping. I sleep on either side, on my back, or on my stomach. Ive made it a habit to do ankle pumps and ankle circles before standing up in the morning.
One thing Im not pleased with is its still uncomfortable to stand in one place for long periods of time. Driving also requires stops every 45 minutes to an hour for a break where you can walk around for 5 or 10 minutes .