Patient Expectations Of Greater Independence Immediately Following The Surgery Not Met Patients Upset That They Cannot Walk As Well As They Thought They Could
- Important functions to the patients such as how fast they can walk are typically not measured in determining patient outcome scores, compromising;true patient outcome surveys.
- For many patients, simple expectations turned out to be unrealistic expectations as witnessed by research that;suggested that people who receive knee replacements expect to have greater independence immediately following the surgery.
People Who Used Opioids Prior To Surgery And More Often To Help Them Manage Their Pain Prior To Surgery Were At Greater Risk For Failed Knee Replacement
Is it far-fetched to imagine that people who are waiting for knee replacement surgery or putting it off without treatments that are helping them are more prone to taking opioids and other medications to help them manage their pain?
In December 2020, researchers writing in the European Journal of Pain again touched on a common theme among surgeons, that One in five patients experiences chronic pain 12 months following total knee arthroplasty , and again looked for those pre-operative reasons for what would put a patient at risk for a poorer outcome. Here is how this research team conducted their study and sought to help isolate those risk factors. What did they find? More medication usage.
Learning points:
Use Pain Medications With Care
Except in very rare cases, the American Association of Hip and Knee Surgeons advises against using opioid medications for knee osteoarthritis. Opiate pain relievers, in addition to being addictive, are not proven to address knee pain over the long term any better than nonsteroidal, anti-inflammatory drugs .;;
Though safer than opioid drugs, NSAIDs arent for everyone, and Valaik advises caution in using them. Even over-the-counter drugs like naproxen and ibuprofen can have side effects, so check with your doctor, he says.
You can get an increase in blood pressure with NSAIDs. Larger studies have linked some of these pain relievers with a small increase in the risk of heart attack.
And the more you take, the more likely you are to have heartburn, stomach irritation or even bleeding ulcers, he notes.
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One Injection Stem Cell Treatments Are Not Sustainable Pain Relief
In the video below, Ross Hauser, MD explains the 5 myths we see concerning Stem Cell Therapy. The biggest one is that people believe that one stem cell injection will make all their pains go away. For most this is not true. It is not true for the same reasons outlined above, a single injection will not be comprehensive enough to reverse years and possibly decades worth of damage affecting the entire knee structure. This one-shot thinking leads to an unrealistic expectation of pain relief and joint regeneration.
How Can I Fix My Knee Without Surgery
Non-Surgical Alternatives to Knee Surgery
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Tips To Avoid Or Delay Tkr Surgery: Total Knee Replacement Alternatives
I tried to avoid knee replacement for many years. In this article, I share my personal research along with the advice I received from doctors and knee suffering friends.
If if it wouldnt have a negative effect on my health, I was willing to try new ideas for relieving pain and avoiding knee replacement. I hope some of these ideas might help others that are seeking pain relief and alternatives to knee replacement.
So Why Were You Recommended For Knee Replacement Surgery
There are several reasons why your doctor may recommend knee replacement surgery. Recently, the American Academy of Orthopaedic Surgeons published general criteria which included the following reasons:
- Patients with bowed knees.
- The severity of the knee osteoarthritis
- Structural damage to the knee causing reduced or severely impeded knee range of motion
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Things You Should Know Before Considering Knee Replacement Surgery
Whether your doctor tells you this or not, there are several great knee replacement alternatives available today. The alternatives are designed for those people who want relief from their knee injury or;osteoarthritis, without the need for invasive surgery.
Below is a closer look at just what is involved in knee replacement surgery, and several successful knee replacement alternatives that are proven very effective at treating injuries, arthritis and osteoarthritis.
Who Is A Good Candidate For Knee Therapy
If youre tired of taking prescription medication or over-the-counter painkillers to treat your knee arthritis with limited effectiveness, gel injections could be right for you. Good candidates for knee therapy experience moderate to severe knee pain when walking, climbing flights of stairs, or playing sports. To be eligible, you should have no significant mechanical or alignment issues with your knees, which can only be corrected with surgery.
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Can Our Treatments Help You
Perhaps the most important prognostic indicator that Comprehensive Prolotherapy, PRP Prolotherapy, or Stem Cell Prolotherapy is going to work for your osteoarthritis is knee range of motion. When a persons range of motion has been relatively maintained, it typically means the architecture of the joint is still relatively intact, meaning the osteoarthritis destruction has not progressed yet to the point of massive osteophytes for stabilization, osteonecrosis or complete articular cartilage collapse.
In regard to which Prolotherapy solution often depends on several factors including the amount of joint instability, range of motion, suspect pain sources, amount of degeneration, joint configuration, exercise or ambulatory goals, lifestyle considerations, adjacent joints, and others.
As osteoarthritis starts with ligament injury, the most important aspect of Prolotherapy is to stimulate ligament tightening and strengthening, even when the joint has little remaining cartilage.
For many years, the undisputed primary treatment for advanced knee osteoarthritis was a total or partial knee replacement. With patients as those mentioned in the above study questioning whether a total joint replacement is a way for them to go, medicine is moving towards providing alternatives to knee replacement. This is a shift away from surgery towards biomedicine and the use of patients own stem cells and blood platelets as a healing alternative;to knee replacement is occurring.
What Can Be Done For A Knee That Is Bone On Bone
How Is Osteoarthritis of the Knee Treated?
- Weight loss.
- Pain relievers and anti-inflammatory drugs.
- Injections of corticosteroids or hyaluronic acid into the knee.
- Alternative therapies.
- Using devices such as braces.
- Physical and occupational therapy.
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You Lose Your Independence
For months after your surgery you will suffer from a major loss of independence. Some folks require long-term help to put underwear, pants and socks on every day.
Patients are often shocked at how greatly this loss of independence affects them.
The inability to care for yourself can be very embarrassing and demoralizing. Sometimes after surgery, patients withdraw from friends and family and even become depressed.
Think about it We strive our entire lives to have the freedom and independence to go and do what we want: Jump in the car and go visit your friend or walk up the steps to get to the movie theater or do anything wed like, whenever wed like
And in a day, a total knee replacement surgery takes that away from you, and you dont get it back for months.
And thats not even the worst part. A loss of independence will seem like a godsend if youre one of the many people who suffer
Lower Your Stress Levels
Stress can worsen plenty of chronic conditions and knee osteoarthritis is no exception. The Arthritis Foundation says that stress can cause muscle tension, which then increases the perception of pain. And that, the organization notes, can trigger frustration and even depression.
To break the cycle, try to find a relaxation therapy that fits your lifestyle. Deep breathing , meditation, progressive relaxation, and yoga can all help ease your stress levels and make it easier for you to stay relaxed.
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Knee Replacement Alternatives To Consider
Crunching sounds as you climb stairs, chronic aching and swelling: Knee osteoarthritis is a real pain. If youre suffering with it, you may be considering surgery.
Getting a knee replacement is one approach, but you may not need surgery, at least not right away. ;And some patients cannot undergo knee replacement surgery for various reasons. Other people with knee pain are too young for a knee replacement the artificial knee is only likely to last 15 or 20 years, after which the person may need revision surgery.
There are several things you can try first, on your own or with a professionals help, that can help with knee pain and even delay the need for replacement, says Daniel Valaik, M.D., orthopaedic hip and knee specialist at Suburban Hospital in Bethesda, Maryland.
Arthritis doesnt go away, he explains. Of the thousands and thousands of patients Ive treated, Ive never seen anyones X-rays improve in terms of arthritis, unfortunately. But there are things you can do to lessen pain and stay more active.
Caring Medical Research Case Studies
Our research team has published research on patient outcomes and case studies using bone marrow aspirate. Here is a sample of those outcomes. Again, we must remind you that this treatment does not work for everyone. Unfortunately, if you are reading this article you are probably very attuned to medical treatments that do not work.
In the medical journal;Clinical Medicine Insights Arthritis and Musculoskeletal Disorders, our Caring Medical research team published our findings in seven patients. You can read all the case histories here:;Bone marrow stem cell therapy and Prolotherapy: Published review 7 case histories.
Patient case; Knee pain: A 69-year-old man
A 69-year-old male came into our office with pain in both knees, with his right knee significantly more painful. Pain resulted in frequent sleep interruption and limitation of exercise.
- Two months after the final treatment, the patient reported that he was completely free of pain or stiffness in both knees, had regained full range of motion, no longer suffered sleep interruption, and was no longer limited in exercise or daily life activities.
Patient case; Knee pain A 56-year-old woman
A 56-year-old female came into our office with pain in both knees and her right hip. The pain was severe in the right knee, with frequent crepitus and instability, and had forced the patient to discontinue running.
The patient received bone marrow/dextrose treatments;for six visits with 810 week intervals.
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Tip #3 Adopt Low Impact Exercises
There are many options available for those of us that want to avoid the high impact exercises. When I made the switch, I found that most low impact exercises did not involve competitive activities that I once thrived on.
Walking, swimming, biking, hiking, and elliptical machines are some of the most obvious.
You can find competitive activities like table tennis, bocce ball, horseshoes, and shuffleboard to name a few.
Most of the activities I mentioned to not involve much cardio workout. You may have to go to the gym to use machines that are low impact and get your heart beating.
Top 5 Ways To Delay The Need For A Knee Replacement
Knee replacement surgery is becoming a more common, with osteoarthritis becoming more prevalent in younger patients. The Journal of Bone and Joint Surgery claims that there will be a 670% increase in the total number of knee replacements by 2030. While there have been numerous advances in the field of knee replacement surgery, this is still considered a major operation. Here are some steps that you can take to delay the need for this surgery:
1. Lose Excess Weight
The knee joints bear a significant amount of pressure from supporting our body weight. Each pound of excess weight can exert up to four pounds of pressure on the knee, meaning a person who is 10 pounds overweight exerts 40 pounds of excess pressure on his knees with every step he takes. The damage builds over time, leading to degenerative diseases such as osteoarthritis. Compliance to a diet and exercise plan may be the simplest way to avoid surgery later on.
2. Strengthen Your Joints
You can increase the stability of your knees by strengthening the muscles that support the joints. The quadriceps and hamstring muscles are of particular importance, as they absorb the shock and weight-bearing loads. Building joint strength is done through exercises such as resistance training , swimming, cycling and other activities. Building strong leg muscles has been correlated with less risk of joint replacement surgery.
Physical therapy can help strengthen ones knees and take pressure off the arthritic joint.
3. Wear a Brace
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Tip #12 Avoid Walking Down Opt For Any Surface Besides Concrete
We are encouraged to walk stairs and not use elevators for health reasons. That sounds like good practice for someone with healthy knees.
In my case, I enjoyed the exercise I got from walking up stairs with very little if any pain.
Walking down the stairs was another story. The constant catching of the muscles around the knee and the impact on my knee as I hit each step was painful.
I found myself always trying to land on my left foot because the left knee was healthy and absorbed the impact just fine. I also began to use the rail more and more like a walking stick to lessen the impact on my knee.
It was the same for me while hiking. Uphill was fine but when you go up you usually have to go down and downhill was always the most painful part of any hike.
As a youngster I spent a lot of time playing in the street and on concrete courts and playgrounds. Playing sports on hard surfaces began to cause swelling and pain in my knee.
Walks with the family on sidewalks around the neighborhood became painful as well. I began to look for more comfortable surfaces to walk, run and play on.
Wooden courts were much easier on my knee that concrete playgrounds. All weather tracks with some bounce and give were now my choice for running.
For walks and hiking, I looked for dirt trails instead of sidewalks. Softball was okay because I played on dirt and grass.
Even now when I have the choice I veer off the sidewalk and walk on grass when I have the choice.
Exercise And Physical Therapy
Exercise and physical therapy may be prescribed to improve strength and flexibility. Exercises may include strengthening exercises such as riding a stationary bike; and stretching exercises such as flexing the ankle up and down, tightening and holding thigh muscles, sliding the heel forward on the floor, leg lifts, and knee extensions.
Exercise can strengthen your leg muscles and reduce your pain. If you really need knee surgery, this may not help, but many forms of knee pain can be mitigated by exercise.
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Build Up Knee Strength
Another way to relieve knee pain and slow down arthritis is to build up the muscles around your knee. These muscles can then take on more of the work of walking and moving, reducing strain on your joint.
You should build up strength in ways that dont stress your joint. For instance, swimming builds muscle but takes all the weight off your knee. You may even find that as you swim, you have no knee pain at all. Other great exercises include:
- Bodyweight Exercises Like Leg Lifts
- Elliptical Training
Exercise also improves your mobility so you move more smoothly and are more balanced.
Patients Should Be More Well Educated On The Realistic Expectation Of Knee Replacement Of What The Surgery Can Actually Do For Them
In February 2019, researchers opened a study to see if patients were being well informed about the appropriateness of their knee replacement recommendation. Publishing in the journal BioMed Central Musculoskeletal Disorders, the research team wrote: While the rates of total knee replacement continue to rise worldwide, there are concerns about whether all surgeries are appropriate. Guidelines for appropriateness suggest that patients should have realistic expectations for total knee replacement and that the patient and their surgeon should agree that the potential benefits outweigh the potential harms.
The team then designed various education aids that they are testing to investigate whether the self-reported outcomes of patients who previously underwent total knee replacement can be used to improve decision quality about the appropriate use of total knee replacement; They note that many health systems have been routinely collecting patient-reported outcome measures pre and post total knee replacement. Further, While these data have been collected to support decision-making at a health systems level, we believe there is a role for these data to inform setting realistic expectations for patients, and promoting shared decision-making with their care provider.
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Avoiding Knee Or Hip Surgery
Losing weight, strengthening muscles, and increasing flexibility may help you stave off joint replacement.
You may be putting off a doctor visit to address knee or hip osteoarthritis because you believe it will end with joint replacement surgery, but that’s not always the case. “Exercise and weight loss are actually the first line of defense,” says Dr. Eric Berkson, director of the Sports Performance Center at Harvard-affiliated Massachusetts General Hospital. “It may help prevent the pain and prevent surgery.”