Obesity And Knee Replacement
The review of found that obese patients faced additional risks when they had a knee replacement procedure. Such risks include a shorter life of the joint replacement, a greater chance of misalignment or implant failure, and more post-surgical complications. Obesity already puts people at risk for a number of health risks, including cancer, diabetes, and heart disease. This recent finding only adds to the list of possible implications.
Although they do realize the benefits of having the procedure, knee replacements do not last as long in obese patients. The study found that, at 7 years post-op, obese patients were much more likely to have an implant failure. This leads to a much higher rate of revisions in obese patients as well.
Any patients struggling with obesity that may need a knee replacement should speak with their doctor about managing their weight. A knee replacement can do wonders with eliminating pain and restoring the ability to participate in everyday activities. Obesity can only get in the way of these benefits.
What Are Some Types Of Knee Surgery
The most common knee surgeries involve arthroscopy â a surgical technique used to repair many different types of knee problems â or knee replacement.
Arthroscopic surgery
Arthroscopy is a type of keyhole surgery used to diagnose and treat a wide range of knee problems. A keyhole surgery is one in which long, thin instruments are inserted into the patientâs body through small incisions.
For arthroscopic knee surgery, the surgeon inserts a probe with a small camera, called an arthroscope, into the knee joint. The scope displays pictures on a video monitor to help guide the surgeonâs work. Surgical instruments are inserted into the joint through a second incision.
The American Academy of Orthopaedic Surgeons describes the following as the most common arthroscopic procedures for the knee:
- Removal or repair of a torn meniscus â a type of cartilage in your knee that cushions and stabilizes the joint
- Reconstruction of a torn anterior cruciate ligament , which is a ligament that helps stabilize the knee joint
- Removal of inflamed synovial tissue
- Trimming of damaged articular cartilage
- Removal of loose fragments of bone or cartilage
- Treatment of patella problems
- Treatment of knee sepsis
Knee replacement
In a knee replacement operation, the surgeon removes damaged parts of the knee joint and replaces them with new parts made of materials such as metal, ceramic, or plastic. Contrary to the name of the procedure, the surgeon does not replace the entire knee joint.
Joint Health Restoration Post Knee Replacement Surgery
Orthopedics design concept with doctor in workplace examining patient on crutches flat vector illustration
Knee replacement surgery is a major treatment for the knees that significantly improves mobility and eases knee pain. Proper recovery and rehabilitation help you to return to everyday activities much faster than you anticipate.
But, knee replacement surgery holds certain limitations for a few weeks after the treatment. Those who undergo knee replacement surgery should be cautious while doing daily activities. Understanding knee precautions can reduce the chances of injury and fasten the healing process.
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Reasons For Knee Replacement Surgery
The most common reason to undergo knee replacement surgery in Singapore and worldwide is to treat degeneration from osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis caused by severe injury. Knee replacement surgeries are generally suitable for people who experience:
- Severe knee discomfort that causes difficulty in performing everyday tasks
- Chronic knee inflammation
- A knee deformity, where you may notice an arch on the inner or outer side of the knee
- Pain that impacts your quality of life, including your mental wellbeing.
If medication or physical therapy has not been effective in treating your knee stiffness and pain, your doctor may recommend total or partial knee replacement surgery as the best treatment option. Be sure to talk to your orthopaedic doctor to check if you are eligible for the procedure.
What Can Be Expected In Recovery And Rehabilitation After A Knee Replacement Surgery
Recovery after knee replacement may depend on factors like your underlying medical condition or the type of knee replacement surgery performed. Some people may go home soon after surgery, while others may need to stay back longer. However, in normal conditions, a patient may expect to stay in the hospital for 3-5 days after the surgery. Physical therapy is advised to increase knee strength and mobility gradually. It is very important to follow the physiotherapists advice to avoid any complications. Post discharge, it may require about 12-14 weeks to recover and resume normal functioning even though the knee tissues continue to heal. While you are back home, you should take care of the following:
- Continue with your medication and therapy as advised
- Try and reduce the usage of walking aids gradually
- Continue your exercises but do not force your knee
- Do not sit cross legged for at least six weeks after the surgery
- Do not place any object like a pillow under your knee while sleeping
- Avoid any kind of twisting motion of the knee
- Wear comfortable and supportive shoes
- Do not bend excessively or kneel on the operated knee till full recovery
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Technical Details Of Total Knee Replacement
Total knee replacement surgery begins by performing a sterile preparation of the skin over the knee to prevent infection. This is followed by inflation of a tourniquet to prevent blood loss during the operation.
Next, a well-positioned skin incision–typically 6-7 in length though this varies with the patients size and the complexity of the knee problem–is made down the front of the knee and the knee joint is inspected.
Next, specialized alignment rods and cutting jigs are used to remove enough bone from the end of the femur , the top of the tibia , and the underside of the patella to allow placement of the joint replacement implants. Proper sizing and alignment of the implants, as well as balancing of the knee ligaments, all are critical for normal post-operative function and good pain relief. Again, these steps are complex and considerable experience in total knee replacement is required in order to make sure they are done reliably, case after case. Provisional implant components are placed without bone cement to make sure they fit well against the bones and are well aligned. At this time, good function–including full flexion , extension , and ligament balance–is verified.
Finally, the bone is cleaned using saline solution and the joint replacement components are cemented into place using polymethylmethacrylate bone cement. The surgical incision is closed using stitches and staples.
Anesthetic
Length of total knee replacement surgery
Pain and pain management
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 have had minimally invasive surgery or are on an enhanced recovery programme, you may be able to walk on the same day as your operation. Generally, you will be helped to stand within 12-24 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 but this can vary depending on the individual.
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 is important to follow the physiotherapist’s advice to avoid complications or dislocation of your new joint.
It is normal to experience 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.
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How Does The Patient Continue To Improve As An Outpatient After Discharge From The Hospital What Are Recommended Exercises
For an optimal outcome after total knee replacement surgery, it is important for patients to continue in an outpatient physical-therapy program along with home exercises during the healing process. Patients will be asked to continue exercising the muscles around the replaced joint to prevent scarring and maintain muscle strength for the purposes of joint stability. These exercises after surgery can reduce recovery time and lead to optimal strength and stability.
The wound will be monitored by the surgeon and his/her staff for healing. Patients also should watch for warning signs of infection, including abnormal redness, increasing warmth, swelling, or unusual pain. It is important to report any injury to the joint to the doctor immediately.
Future activities are generally limited to those that do not risk injuring the replaced joint. Sports that involve running or contact are avoided, in favor of leisure sports, such as golf, and swimming. Swimming is the ideal form of exercise, since the sport improves muscle strength and endurance without exerting any pressure or stress on the replaced joint.
Patients with joint replacements should alert their doctors and dentists that they have an artificial joint. These joints are at risk for infection by bacteria introduced by any invasive procedures such as surgery, dental or gum procedures, urological and endoscopic procedures, as well as from infections elsewhere in the body.
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 an 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.
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Who Might Need A Knee Replacement
Knee surgery may be suitable for patients who experience:
- Severe knee pain or stiffness that prevents them from carrying out everyday tasks and activities, such as walking, going upstairs, getting in and out of cars, getting up from a chair
- Moderate but continuous knee pain that continues while sleeping or resting
- Chronic knee inflammation and swelling that does not improve after taking medications or resting
- Knee deformity, where there is a noticeable arch on the inside or outside of the knee
- Depression, resulting from an inability to carry out daily or social activities
If the other available treatment options have not worked, surgery may be the best option.
Conditions That Can Be Treated With Knee Replacement
Knee replacement can be used to replace a knee joint affected by a range of conditions including:
- Severe osteoarthritis
- Ligament damage or infection that leads to severe osteoarthritis
- Rheumatoid arthritis
- Crystal deposition diseases such as gout and pseudogout
- Avascular necrosis death of bone following loss of blood supply
- Bone dysplasias disorders of the growth of bone.
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Surgical Treatment Of Knee Pain
Partial knee replacement: The surgeon replaces the damaged portions of the knee with plastic and metal parts.
Total knee replacement: In this procedure, the knee is replaced with an artificial joint. It requires a major surgery and hospitalization.
Expected Range Of Motion
After knee replacement surgery, it is important to work with a physical therapist to achieve the maximal range of motion. Typically, the range of motion will progress quickly during the first three months and can continue to increase for up to two years following surgery.
Normal motion after knee replacement is defined as the ability to get within 5 degrees of a straight knee and the ability to bend the knee back to 90 degrees. Most knee replacements have movement ranging from 0 degrees to 110 degrees or more.
The optimal motion of the replaced knee can be achieved with a combination of stretches, exercises, and gradual resumption of normal activities. Some surgeons will recommend the use of a machine to bend the knee, called a CPM, .
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Exercises After Knee Replacement Surgery
Exercises play a significant role in strengthening the muscles surrounding the knee joint. But, some movements should be done with the doctors suggestion as it might cause harm to the knee joint. A physiotherapist will teach you specific leg exercises while you are on the hospital bed. Leg exercises will prevent the formation of blood clots after the surgery.
Some of the post-operative knee exercises to restore strength and mobility of the knee are:
- Straight leg raises
- Sitting knee extension
Stay active for a better quality of life
Within 2-3 days of the knee replacement surgery, the physiotherapist will encourage you to walk for short distances with the support of a walker, canes, or crutches. You will be able to do regular activities with minimal assistance.
To enable faster recovery from surgery:
- Adhere to an active lifestyle
- Exercise regularly
- Maintain a healthy weight avoid excessive stress in knee joints
- Take necessary medications and supplements
- Eat a healthy diet that promotes the fastest recovery
Extending The Life Of Your Knee Implant
Currently, more than 90% of modern total knee replacements are still functioning well 15 years after the surgery. Following your orthopaedic surgeon’s instructions after surgery and taking care to protect your knee replacement and your general health are important ways you can contribute to the final success of your surgery.
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Disadvantages Of Knee Replacement Surgery
Every step is a reminder of your knee pain. Physical therapy and steroid injections did not help. Your doctor is referring you for surgery. What is knee replacement surgery? What are the disadvantages of knee replacement surgery? What is the success rate of knee replacement surgery? What are the alternatives to knee replacement surgery? Lets dig in.
Other Surgeries Using Arthroscopy Of The Knee
Arthroscopy of the KneePlica Removal From the Knee
The plica is a remnant of tissue from fetal development. Generally, it is lost over time, but in some cases, some of the plica will remain. If conservative treatment of plica irritation does not resolve the symptoms, arthroscopy can be used to remove the excess plica from the knee.
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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 .
How Long Will A Replacement Knee Last
Wear and tear through everyday use means your replacement knee will not last forever. However, for most people it will last at least 15-20 years, especially if cared for properly and not put under too much strain.
Revision knee replacement surgery is usually more complicated and a longer procedure than the original surgery. There is no set limit to the number of times you can have revision surgery, but it is widely accepted the artificial knee joint becomes less effective each time it is replaced.
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Tests Before Knee Replacement Surgery
About six weeks or so before your operation you will have an appointment for a ‘pre-admission’ or ‘pre-assessment’ clinic. At this clinic a nurse will assess your fitness for your knee surgery.
There are several tests that may be needed and they include:
- Blood tests – to check that you aren’t anaemic and that your kidneys and liver are working well enough for you to undergo the operation.
- Urine test – to make sure you haven’t got a urine infection and that there isn’t any glucose in your urine.
- Blood pressure.
- Infection screen – this includes looking for meticillin-resistant Staphylococcus aureus . MRSA is a germ that is difficult to treat and can cause complications of a knee replacement.
- A heart tracing .
You may have the chance to speak with an anaesthetist, physiotherapist, occupational therapist or social worker at this clinic but this isn’t always possible.
Common Conditions That Can Lead To Knee Replacement
We treat the entire spectrum of knee problems. Many can be treated without surgery, but some may lead to partial or total knee replacement surgery, including:
- Osteoarthritis Osteoarthritis is one of the leading causes of knee replacement. It is a chronic, degenerative condition, meaning it will continue to get worse over time. While there are many non-surgical treatment options, partial or total knee replacement may become necessary for some patients with osteoarthritis. Rheumatoid arthritis and post-traumatic arthritis can also lead to the need for knee replacement surgery.
- Avascular Necrosis Avascular necrosis happens when the blood supply to the bone is cut off temporarily or permanently. This can cause the bone tissue to die, which can affect nearby joints. If avascular necrosis affects the knee, a total knee replacement may be a treatment option.
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