New Quad Sparing Technique May Provide Faster Recovery For Patients With Arthritis Of The Knee
If you have any questions about Total Knee Replacement, feel free to email Dr. Manner at , or schedule an appointment at 425.646.7777.
OverviewKnee replacement is a surgical procedure that decreases pain and improves the quality of life in many patients with severe knee arthritis. Typically patients undergo this surgery after non-operative treatments have failed to provide relief of arthritic symptoms. Surgeons have performed knee replacements for over three decades generally with excellent results most reports have ten-year success rates in excess of 90 percent.
Broadly speaking there are two types ways to insert a total knee replacement: the traditional approach and the newer minimally-invasive approach.
Traditional total knee replacement involves a roughly 8 incision over the knee a hospital stay of 3-5 days and sometimes an additional stay in an inpatient rehabilitation setting before going home. The recovery period typically lasting from one to three months. The large majority of patients report substantial or complete relief of their arthritic symptoms once they have recovered from a total knee replacement.
The main potential benefits of this new technique include:
The major apparent risks of the procedure compared to traditional total knee replacement:
How Implants Wear Out
Most knee replacements are made with metal caps that cover the end of the thigh bone and the top of the shin bone. Between these metal caps is a piece of plastic that provides a smooth surface for bending of the implant. The plastic can wear out over time, either as a slow, gradual wearing away, or a sudden catastrophic failure.
There are some situations where the wearing out can be accelerated. These situations include when the alignment of the implants was not ideal, when the knee is unstable , or if the patient performs activities that put too much stress on the implant. Knowing which activities can cause damage to knee replacement implants can help ensure the parts last as long as possible.
Help With Medical Appointments
Keeping a calendar can help you track the persons daily needs, and can also help you stay on top of their appointments.
Missing an appointment may lead to setbacks or other complications, so its important to take note of their follow-up visits and plan accordingly. This includes transportation.
The person youre caring for will likely be unable to drive for the first 4 to 6 weeks following surgery. This means they will need someone to drive them to their appointments.
If any issues arise between appointments, dont hesitate to reach out to the healthcare team.
This may include questions about:
- medications or unusual reactions to them
- elevated temperature
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Unispacer Knee Replacement Alternative
When a patient has osteoarthritis, their knee cartilage progressively wears away, leaving the femur and tibia bones to rub against each other without a cushion. The result is pain, stiffness, inflammation, and bone spur development.
Scientists have developed a device called the Unicondylar Interpositional Spacer or Unispacer. The device is inserted into the knee joint. It acts as a spacer to separate the two leg bones. The procedure is less invasive than knee replacement surgery but is not as effective for most patients with advanced arthritis.
Elevate Even When You Feel Good
Ice and elevation are the keys to your recovery. You can ice throughout the day and you can elevate your knee anytime you are sitting or lying down.
If you are like me, you will find yourself sitting around in your recliner a lot between exercise times. Keep your leg elevated with a wedge pillow even if your recliner elevates your knee somewhat.
If it is comfortable continue to sleep at night with your knee elevated. Again just because you feel good, dont stop elevating your knee.
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Take A Pain Pill Or Tylenol Substitute Before Exercises
Early on I always took a pain pill 30 minutes before my in-home therapy session. Once I weaned myself off the pain medicine, I took a Tylenol pill.
I continued to take a Tylenol pill before my off-site therapy sessions too. Taking the medication made it easier for me to do my rehab, especially the range of motion exercises.
Alternatives To Knee Replacement Surgery Are They Really Effective
You want to avoid surgery if possible, but what options do you have? Learn about the latest alternatives to knee replacement surgery and if they really work.
On January 14, 2021, an orthopedic surgeon in Vancouver, Canada, performed a knee replacement surgery outside of a hospital setting.
The procedure was done in an outpatient surgery center and allowed the patient to go home the very same day.
Technology is allowing medical professionals to accomplish amazing things through the use of AI and robotics.
Still, many wonder: are there alternatives to knee replacement surgery?
It is a valid question since even minimally invasive surgeries put the body through a lot of stress. Fortunately, technology has advanced to the point where, for some people, surgery may not be necessary.
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Common Knee Surgery Alternatives A Doctor May Recommend
Most orthopedic surgeons are going to recommend knee replacement surgery to their patients. They feel that even the best alternatives to knee replacement are just temporary. Eventually, their patients will need to have a partial or total knee replacement.
And right now, surgeons are excited to recommend surgery because of the many advancements that make the procedure less time-consuming and more comfortable for the patients. AI and robotics scientists are producing incredible surgical tools and aids.
However, if a patient wants to avoid surgery or at least put it off a surgeon will likely recommend the following options.
Plan Activities That You Can Do During Recovery
Plan some sedentary activities that you can accomplish while recovering. Puzzles, video games, and TV can occupy your recovery time.
However, you may want to make better use of your time. You may have a hobby or a project or two that you have been wanting to do such as sorting old photographs, writing letters, knitting, reading or drawing to name a few.
Have materials nearby and ready so that they are easy to access once you feel like doing something.
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A Word About The Newest Knee Replacement Implants
One temptation of patients and surgeons alike is to be attracted to the newest knee replacement on the market. Undoubtedly, this implant will claim to function better and last longer than other knee replacements. While these newer implants may be better, it is also important to understand they do not have long-term data on how well these implants will function over time.
Ask any orthopedic surgeon about the implants they have seen come and go over the course of their career. Just because an implant is newer does not necessarily mean it is better.
Patients and surgeons should try to find an appropriate balance between modern design and not being a ‘test’ patient. Your surgeon can help guide you to an appropriate knee replacement that is best for you.
Knee Replacement Recovery Tips
Need some tips to enhance your knee replacement recovery? Some of these ideas I learned from friends and acquaintances that had already had knee replacement surgery and they shared their experiences with me.
I read as much as I could before my TKR so that I would have a good understanding of what my recovery was going to entail. Then, I learned the old fashioned way by experiencing TKR and the recovery process myself.
You dont have any control over the actual surgery , but once the operation is complete it is solely up to you to decide how hard you are going to work at recovery. Below are my suggestions for a successful TKR recovery.
As I mentioned in other articles, the rehab starts immediately after your surgery. Physical therapy begins in the hospital, continues at home, and then to an offsite therapist and finally, you can continue the rehab as long as you want it to last.
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How To Avoid An Early Knee Replacement
There are three randomized controlled trials showing how best to avoid an early knee replacement . One published by our group and two by Herigou in France. All three use the patients own bone marrow concentrate. Looking at this data, you have a 4 in 5 chance of not needing an early knee replacement at 15 years after the procedure if you pursue these much less invasive bone marrow concentrate injection that contains your own stem cells.
The upshot? Early knee replacement is a big problem. You want that procedure to be one and done. Hence, do your homework on non-surgical options to avoid needing a second knee replacement procedure,
Ferket BS, Feldman Z, Zhou J, Oei EH, Bierma-Zeinstra SM, Mazumdar M. Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative. BMJ. 2017 Mar 28 356:j1131. doi: 10.1136/bmj.j1131. PMID: 28351833 PMCID: PMC6284324.
Singh JA, Lewallen DG. Time trends in the characteristics of patients undergoing primary total knee arthroplasty. Arthritis Care Res . 2014 66:897-906. doi:10.1002/acr.22233
Singh JA, Lewallen DG. Are outcomes after total knee arthroplasty worsening over time? A time-trends study of activity limitation and pain outcomes. BMC Musculoskelet Disord. 2014 Dec 17 15:440. doi: 10.1186/1471-2474-15-440. PMID: 25519240 PMCID: PMC4301928.
Chris Centeno, MD
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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.
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Expanding Markets Despite The Evidence
Knee replacement device companies have a problem. While there is a slow market expansion year over year as the last of the baby boomers shift into retirement age, if you want to really blow out the size of your market, you must start to offer your product to younger and younger people. In fact, thats exactly what these companies have done . Younger and younger patients and those who likely shouldnt be getting knee replacements have been pushed to get the surgery and this is reducing the outcomes of the procedure .
Do You Need A Revision Total Knee Replacement
Total knee replacement surgery is a very popular and successful surgery. In most cases, people who receive total knee replacement surgery live a more pain free life post-surgery. Obviously, that makes sense because total knee replacement surgery is supposed to alleviate the patients pain. However, surgery might not be a complete and permanent fix. Overtime, it is possible for knee replacements to fail. When this happens the knee can become painful. Swollen, and stiff. In this article, you will learn all about revision total knee replacements, like why people need to get them, how to prepare for surgery, what surgery is like, possible complications and risks, and what the recovery process is like.
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Work On Your Walking Form
Pre-surgery my leg was bowed and walked with a noticeable limp. Once you start walking after TKR you may have to relearn to walk correctly.
My in-home therapist made it a point to walk behind me reminding me to walk with proper form. On your other walks, have your caregiver or walking partner critique your walking form.
Discard those old shoes that show wear from walking incorrectly.
If you can, video record you walking form before surgery and then have your walking partner video your new form occasionally.
Why Have Simultaneous Knee Replacements
The main benefit of bilateral knee replacements is convenience, Dr. Greene says. Its one surgery time, one time away from work and one recovery period.
Other than that, there are no specific medical benefits to having both knees replaced at the same time.
Simultaneous surgeries may shorten your rehabilitation, he says. But youll still need to adopt an aggressive approach to your strength and flexibility training to maximize your recovery.
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Knee Replacements Dont Work As Well As Hip Replacements True Or False
Some people with knee arthritis worry more about having a knee replacement than those with hip arthritis do about having a hip replacement. Why is this? Well the worry usually arises when people talk to others who have had a knee replacement or know someone who has had a knee replacement that hasn’t gone so well. But that’s not the whole story. As with most things in life, there can be some truth behind the concerns, but it is also true that modern knee replacements done by experienced specialist knee surgeons give reliable results in a vast majority of patients.
How Much Time Should I Wait Between Knee Surgeries
Doubling up: Knee replacement surgeries and the pros and cons of a double knee surgery
If you have ever had an issue with your knee, you know how it can impact your daily life and limit your mobility. It can even be debilitating. If the problem is severe enough, a knee replacement is needed. But what do you do if your condition requires a double knee replacement? Dr. Daniel Wagner is a board certified orthopedic surgeon at Texas Hip & Knee, a part of Texas Health Physicians Group. Hes on the medical staff at Texas Health Southwest Fort Worth. In addition, he is on the medical staff at Texas Health Hospital Clearfork, which is a destination orthopedic hospital location that is part of Texas Health Southwest Fort Worth.
Recently we sat down with Dr. Wagner to get some advice on how to know when its time for surgery. It can be tough to know, but a clear indicator is when you cant spend time doing the things you love.
Q: Are there any nonsurgical solutions to a knee injury?
Q: How long is long lasting?
A: Sometimes it can be six months or a year. Every patient is different, but a lot of times trying a shot is easier than trying surgery.
Q:Im assuming you see patients who are experiencing pain in one knee, but find out they actually need double knee replacement. How is that determined?
Q:Sometimes people end up favoring the knee they dont feel pain in does that affect the other knee?
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About Knee Replacement Surgery
One of the most important orthopedic surgical advances of this century, knee replacement was first performed in 1968. Improvements in surgical materials and techniques since then have greatly increased the procedures effectiveness. According to the American Academy of Orthopaedic Surgeons. about 267,000 total knee replacements are performed each year in the United States.
Most Common Causes for Knee Replacement
- Arthritis: Arthritis is a wearing away of the surfaces of the joint, caused either by aging or disease. As the cartilage wears away, the raw bones rub together whenever the joint moves. This rubbing causes pain and a roughening of the surfaces of the bone.
- Osteonecrosis: If the blood supply to the thigh bone is decreased, part of the bone will die and break from weight-bearing activity. The result is a very painful joint.
- Injuries: Injuries include trauma and accidents, or continue abuse from sports injuries.
If medications, changing activity level, and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. By replacing the knee’s damaged and worn surfaces, total knee replacement surgery may relieve pain, correct leg deformity, and helps many patients to resume their normal activities.
Total Knee Replacement: Traditional Procedure
Partial Knee Replacement
Mini-Incision Knee Replacement
This careful placement of the knee replacement usually leads to the following benefits:
Revision Surgery For Infection
Typically, a revision required because of infection involves two separate operations: Initially, the orthopedist removes the old prosthesis and inserts a polyethylene and cement block known as a spacer that has been treated with antibiotics. Occasionally, theyll make cement molds like the original prosthesis and insert antibiotics in that and implant it as the first stage.
During the second procedure, the surgeon removes the spacer or molds, reshapes and resurfaces the knee, and then implants the new knee device. The two procedures usually take place about six weeks apart. Inserting the new device typically requires 2 to 3 hours in surgery, compared to 1 1/2 hours for a primary knee replacement.
If you require a bone graft, the surgeon will either take bone from another part of your own body or use bone from a donor, usually obtained through a bone bank. The surgeon might also install metal pieces such as wedges, wires, or screws to reinforce the bone for the implant or fasten the implant to the bone. A revision requires the surgeon to use a specialized prosthetic device.
Complications that may follow knee revision surgery are similar to those for knee replacement. They include:
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Who Is A Candidate For Partial Knee Replacement
People with medial, or lateral, knee osteoarthritis can be considered for partial knee replacement. “Medial” refers to the inside compartment of the joint, which is the compartment nearest the opposite knee, while “lateral” refers to the outside compartment farthest from the opposite knee. Medial knee joint degeneration is the most common deformity of arthritis.
Other factors to consider:
- You may want to consider a knee replacement if your knee pain persists despite your taking anti-inflammatory drugs and maintaining a healthy weight.
- Your provider will ask you to identify the area of pain in your knee, then check your range of motion and the knee’s stability. An X-ray of the knee will determine your eligibility for partial knee replacement. However, your surgeon may not know for certain if you are a good candidate until the surgery has begun.
- You must have an intact anterior cruciate ligament, a sufficient range of knee motion, damage to only one compartment and a stable knee. The angulation of the deformity is also considered.
- In the past, a partial knee replacement was considered only in people 60 and over who were sedentary. Now younger, more active people are increasingly being considered.