When A Knee Replacement Is Needed
Knee replacement surgery is usually necessary when the knee joint is worn or damaged so that your mobility is reduced and you are in pain even while resting.
The most common reason for knee replacement surgery is osteoarthritis. Other health conditions that cause knee damage include:
- knee deformity with pain and loss of cartilage
Are There Any Reasons Why I Cant Have A Knee Replacement
Unfortunately, some people may not be able to have a knee replacement even though their arthritis is very bad. This may be because:
- your thigh muscles are very weak and may not be able to support your new knee joint
- there are deep or long-lasting open sores in the skin below your knee, increasing your risk of infection.
Lets Talk About Your Knee
Kaye reached her breaking point late one night after being unable to comfortably sit, stand or sleep for weeks due to her worsening knee pain. Desperate at 1:30 a.m., she booked an appointment through MyAtriumHealth for the following day with her primary care physician, Tara Branton, MD, of Atrium Health Weddington Family Medicine.
My knees killing me, she explained in the exam room while visibly struggling with the pain. Dr. Branton immediately referred Kaye to Dr. Weiss, getting her in to see him that same day.
From the moment I stepped into their office, they were like family, Kaye says of the care and compassion she received at Atrium Health MSKI. After they took some initial X-rays, Dr. Weiss sat down with her. Hes in a league of his own, she says. When hes talking to you, he makes you feel like youre the only one who matters.
Dr. Weiss told Kaye that her knee pain stemmed from severe osteoarthritis, a degenerative form of arthritis that gradually wears away the knees cartilage. After discussing her treatment options, Dr. Weiss recommended a total knee replacement in order to eliminate her arthritis and allow Kaye to do the things she wanted to without pain, including her long-planned 50th wedding anniversary celebration.
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Know All Of Your Treatment Options
Your doctor may give you additional or alternate information regarding knee pain and total knee replacement surgery. If you have questions about treatment options, schedule an appointment to discuss whats right for you. Contact us today to learn more about NUsurface as a knee pain treatment option.
Your Knee Is Always Swollen
Swelling is another sign your knee is not responding to other treatments.
A knee that is consistently swollen despite the use of anti-inflammatory medications, steroid injections and physical therapy suggests degeneration of the cartilage and/or instability of the knee, which can be confirmed with an X-ray, Lieberman explains. This can make you a candidate for a total knee replacement, he says.
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Good Data On Joint Replacement Are Hard To Find
Its difficult to predict how long a joint replacement will last for several reasons. One is that it can take a decade or more to collect data on past operations to predict the success of future operations. Another challenge is that in recent years, theres been a tendency to operate on younger people, including baby boomers who are more active in their 50s and 60s and may expect more of their new joints than prior generations. Age is of particular importance, because a person with a life expectancy of 15 years has a much better chance of avoiding a future operation than a person with a life expectancy of 30 years. In addition, younger patients tend to be more active and put more stress on their new joint. For these reasons, some surgeons advise younger patients to put off surgery as long as possible, even if that means suffering with pain, stiffness, and reduced mobility.
Who Gets Knee Replacement Surgery
You may consider knee replacement surgery if:
- Arthritis in the knee or a knee injury has severely damaged the mating surfaces of the joint.
- Pain and stiffness give you trouble doing everyday activities, such as walking up or down stairs or getting in and out of a car.
- Swelling and inflammation dont go away with rest and medication.Your knee is deformed, such as looking swollen or not shaped normally.
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Is It Better To Have Knee Replacement Or Hip Replacement
It may not be exactly the same as before your knee was affected by arthritis or injury, but the quality of life improves significantly with this procedure. The pain does disappear or lessen after recovery. A lot. Total knee replacements, like hip replacements, have been performed by surgeons for decades.
Nerve And Other Tissue Damage
There’s a small risk that the ligaments, arteries or nerves will be damaged during surgery.
- Fewer than 1 in 100 patients have nerve damage and this usually improves gradually in time.
- About 1 in 100 have some ligament damage this is either repaired during the operation or protected by a brace while it heals.
- About 1 in 1,000 suffer damage to arteries that usually needs further surgery to repair.
- In about 1 in 5,000 cases blood flow in the muscles around the new joint is reduced . This usually also needs surgery to correct the problem.
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Total Knee Replacement: The Joint Of The Decade
Hip replacements were developed in the 1960s and within a decade had revolutionised the treatment of hip arthritis in elderly patients. This success heightened interest in other joints, particularly the knee. With no constraint on the development and use of surgical implants there was a short period of divergent evolution, and a great variety of knee replacements were produced. Natural selection soon occurred and many designs failed rapidlyhinged knees caused particular problems. Thus, in the 1970s and early 1980s knee replacement was widely considered to be a poor operation. Some designs were successful, however: these attempt to resurface the joint and reproduce normal knee anatomy with a low friction joint. The remaining knee ligaments provide stability, allowing some rotational movement and good function. Total knee replacements have subsequently undergone a period of convergent evolution, and most implants now adhere to the same basic design principles. With this success, knee replacement has become one of the most common major surgical procedures, with almost 35000 operations performed each year in the United Kingdom.
Possible Complications Of Surgery
The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, occur in fewer than 2% of patients. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery.
Discuss your concerns thoroughly with your orthopaedic surgeon prior to surgery.
Infection. Infection may occur in the wound or deep around the prosthesis. It may happen within days or weeks of your surgery. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.
Blood clots. Blood clots in the leg veins are one of the most common complications of knee replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopaedic surgeon will outline a prevention program, which may include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings, and medication to thin your blood.
Blood clots may form in one of the deep veins of the body. While blood clots can occur in any deep vein, they most commonly form in the veins of the pelvis, calf, or thigh.
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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.
The National Joint Registry
The National Joint Registry collects details of knee replacements done in England, Wales, Northern Ireland and the Isle of Man. Although it’s voluntary, it’s worth registering. This enables the NJR to monitor knee replacements, so you can be identified if any problems emerge in the future.
The registry also gives you the chance to participate in a patient feedback survey.
It’s confidential and you have a right under the Data Protection Act to see what details are kept about you.
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How Long Will My Hip Or Knee Replacement Last
- By Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing
For people considering hip or knee replacement surgery, its something they want and need to know.
In the US alone, surgeons perform more than 600,000 knee replacements and about 330,000 hip replacements each year. These operations can provide a and function for those with severe arthritis. On the other hand, there are risks associated with the operation , there is a long road to recovery even when all goes well, and these operations arent cheap. For knee replacement surgery alone, an estimated $9 billion or more is spent each year in the US .
So, if the first joint replacement is unsuccessful for some reason , a second operation may be necessary. And thats a big deal, especially since “revision surgery” is technically more difficult, recovery can take longer, and success rates may be lower than first operations.
When Should I Seek Medical Attention After Knee Replacement
After you go home, call your healthcare provider right away if you develop any of the following symptoms:
- Chest pain and/or shortness of breath.
- Fever higher than 101 degrees Fahrenheit .
- Incision problems, like bleeding, leaking, swelling, redness or odor.
- Pain in your calf, ankle or foot that is new and gets worse.
A note from Cleveland Clinic
If you have severe knee pain but medications and therapy arent helping, knee replacement may provide the answer. This common and effective surgery can reduce pain and get you back to everyday activities. Talk to your healthcare provider or an orthopedic provider about whether knee arthroplasty is a good option for you.
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How Long Replacements Last
Most knee replacements last several decades, some longer. However, there are also times when a knee replacement needs to be redone after years or even just months. Understanding why a knee replacement has worn out is critical to performing a successful revision knee replacement.
The average knee replacement lasts more than two decades, but there are reports of implants lasting longer, and new materials and surgical techniques are hoped to provide even longer-lasting knee replacements. That said, there are times when knee replacements may last a very short time, even in otherwise healthy patients. A small percentage of patients end up needing their knee replacement revised within a few years of their initial surgery.
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When Can I Get Back To My Everyday Activities After Knee Arthroplasty
Your doctor will give you specific instructions. But many people can get back to their everyday activities three to six weeks after surgery.
Your healthcare provider will give you specific instructions about recovery. You will gradually increase activity, starting with a slow walking program. You will be encouraged to stand, climb stairs and perform other normal household activities as soon as possible.
Will I Need Any Treatments After Knee Replacement
Your healthcare team will prescribe medications to help you manage pain after surgery, such as:
To prevent blood clots and control swelling, your healthcare team might also recommend:
- Blood thinners, such as aspirin or injectable Enoxaparin based on individual risk of blood clot formation.
- Compression devices, usually used while hospitalized. These are mechanical devises which provide intermittent compression.
- Special support hose.
Your team will ask you to move your foot and ankle around frequently to maintain blood flow at home. Theyll also show you special exercises to help strengthen your knee and restore motion. Exercises are very important to the success of your knee replacement. Initially, physical therapy will be in the home. Arrangements for this in home PT are made at the time of discharge from the hospital.
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Possible Benefits Of Total Knee Replacement Surgery
Regardless of whether a traditional total knee replacement or a minimally-invasive partial knee replacement is performed the goals and possible benefits are the same: relief of pain and restoration of function.
The large majority of total knee replacement patients experience substantial or complete relief of pain once they have recovered from the procedure. The large majority walk without a limp and most dont require a cane, even if they used one before the surgery. It is quite likely that you know someone with a knee replacement who walks so well that you dont know he even had surgery!
Frequently the stiffness from arthritis is also relieved by the surgery. Very often the distance one can walk will improve as well because of diminished pain and stiffness. The enjoyment of reasonable recreational activities such as golf, dancing, traveling, and swimming almost always improves following total knee replacement.
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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You Have Bad Arthritis
Most people who undergo a knee replacement have either osteoarthritis, the wear-and-tear type of arthritis rheumatoid arthritis, an autoimmune condition that causes joint pain and damage or post-injury arthritis.
Osteoarthritis, rheumatoid arthritis and posttraumatic arthritis affect the knee through different mechanisms. However, these different conditions are similar in that they all result in loss of cartilage, which causes pain and loss of motion, says Nathanael Heckmann, MD, an orthopaedic surgeon at Keck Medicine of USC and assistant professor of clinical orthopaedic surgery at the Keck School of Medicine of USC. When these symptoms become severe, knee replacement surgery may provide considerable symptom relief by replacing the worn-out surfaces of the knee.
What Is Genicular Artery Embolization
Abnormal blood vessel formation, also known as angiogenesis, is one of the causes of knee pain in osteoarthritis patients. Angiogenesis is a key step in the initiation and maintenance of inflammation in the joint capsule. Abnormal vessels that breach into avascular cartilage in the knee is a hallmark of osteoarthritis, so much so that it is one of the diagnostic features of the disease.
GAE is an interventional radiology treatment that can relieve osteoarthritis pain by treating the offending abnormal blood vessels. The procedure blocks the abnormal blood vessels. Doing this reduces inflammation and its resultant pain.
An interventional radiologist performs the procedure. An IR is trained to perform minimally invasive vascular procedures to treat multiple conditions. They treat their patients using procedures such as angioplasty and embolization .
An IR is a medical doctor that has obtained at least six additional years of specialized training in radiology and interventional radiology.
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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.
Youre Of A Certain Age
Knee replacement is generally done in older people over 60, in part because younger peoples more active lifestyles may put too much stress on the artificial knee, causing it not to last as long second replacement surgeries may not be as successful. But knee replacements can be performed in people of all ages depending on your individual case, so discuss with your doctor whether youre a good candidate.
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