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.
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.
Five Reasons Why Knee Replacements Fail
Wear and loosening
Properly functioning implants depend on their appropriate fixation to the bone. Fixation is usually achieved by cementing the implant onto the bone. Some surgeons prefer instead to use biologic fixation, meaning no cement placed between the implant and the bone.
Although implants are firmly fixed at the initial knee replacement surgery, they may become loose over time. The cause of loosening may not always be clear but high impact activities, excessive body weight and wear of the polyethylene component may all act as contributing factors. Friction caused by the joint surfaces rubbing against each other wears away the surfaces of the implant, creating tiny particles that accumulate around the joint. In a process called aseptic loosening, the bond of the implant to the bone is destroyed by the body’s attempt to digest these wear particles. During this process, normal, healthy bone is also digested , which can weaken or even fracture the bone.
When the prosthesis becomes loose, the patient may experience pain, change in alignment, or instability.
Revision surgery of the infected knee can take several forms. Depending on the degree of infection and damage, the surgeon will determine one of two basic courses of action:
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Articles On Knee Osteoarthritis
Knee osteoarthritis can affect your every move: walking, climbing stairs, even sitting or lying down. Surgery can help bring relief, but doctors almost always advise trying other treatment options first. These include:
Medications you take by mouth. Over-the-counter options include acetaminophen as well as nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen . NSAIDs fight inflammation. Stronger NSAIDs are available by prescription.
Creams or ointments you rub onto the skin. Different forms are sold over the counter. You can get stronger versions with a prescription.
Medications injected into the joint. Corticosteroid injections, also called cortisone shots, fight inflammation and can offer fast pain relief that may last up to several months. Injections of hyaluronic acid boost the natural joint fluid that keeps knees moving smoothly. They may take up to a couple of months to have their full effect but can last up to 6 months or more.
Exercise and physical therapy. Exercise strengthens the muscles that support your knee. Physical therapy also helps. A physical therapist can design the program for you and see if you need supportive braces, splints, or canes. If you need to lose weight, diet and exercise can help you shed some pounds and take some of the pressure off your knees.
Immediately After The Operation
After the operation, you can expect:
- Your knee is covered with a dressing and a drainage tube removes excess fluids from the wound.
- You are monitored by nursing staff who regularly check your vital signs .
- You are given antibiotics to reduce the risk of infection.
- You are given medications to thin your blood and reduce the risk of clots both during and after the operation.
- Strong pain relief can be given via an epidural or drip.
- You can start eating again on the second day after your operation.
- Nurses encourage you to move your feet and bend your other leg as soon as you can this helps to reduce the risk of clot formation.
- You are encouraged to walk around on the second day after surgery.
- Physiotherapists show you how to perform knee exercises.
- Occupational therapists advise you on how to best modify your home to make daily life easier during your recovery .
- Knee replacement surgery without complications usually involves a seven to 10 day hospital stay.
- Your stitches are removed about 10 days after surgery.
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How Long Will My New Joint Last
In recent years, improvements in medical equipment and surgical techniques have meant that many knee replacements last longer than they did in the past.
A new study looking at over 6,000 people who have had knee replacement shows:
- More than 4 in 5 people who have total knee replacements can expect them to last for at least 25 years.
- 7 in 10 people who have a unicompartmental knee replacement can expect it to last for at least 25 years.
Clearly this will vary between different people, and you still need to take care of your new knee.
What To Expect The Day Of Your Kneecap Replacement
In general, the day of your surgery you can expect to:
- Talk with a preoperative nurse. The nurse will perform an exam, ensure all necessary tests are in order, start an IV, and answer questions. Youâll also sign medical consent forms.
- Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.
- Talk with the or nurse anesthetist about your medical history and the type of anesthesia you will have.
You will likely have sedative medication before the team takes you to the operating room . The anesthesiologist or will start your anesthesia once youâre in the OR. The surgical team will monitor your vital signs throughout the procedure and during your recovery. The surgery takes about an hour.
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When Can A Patient Return To Work
This is a common question after knee replacement surgery and entirely depends on the nature of work the patient performs as part of their occupation. For those patients who work in jobs that are relatively sedentary such as office work, returning to work after 2 to 3 weeks is perfectly reasonable however, for patients whose work demands more of them physically, e.g., fireman, police officer, these patients are usually recommended to wait at least 6 weeks before returning to work.
This is because muscle recovery is usually sufficient by 6 weeks to allow for the normal duties of these more physically demanding occupations at this point in time. However, it is also a case that even for the more physically demanding occupations, if a modification of these duties is available to the patients for the postoperative recovery period then this would potentially allow for an early return to work.
Who Needs Knee Revision Surgery
A knee revision may be necessary for anyone whose prosthetic knee implant fails due to injury or wear, or who gets an infection in the area around implant.
In elderly people who have a knee replacement, the artificial knee implants may last for life. But in younger patients, especially those who maintain an active lifestyle, knee prostheses may eventually fail, requiring a second replacement later in life.
The most common reasons people for knee revision are:
- Infection: The risk of infection from a total knee replacement is less than 1%, but when infections do occur, a knee revision of one kind or another is necessary.
- Instability: This occurs when the soft tissues around the knee are unable to provide the stability necessary for adequate function while standing or walking.
- Stiffness: In some patients, excessive scar tissue may build up around the knee and prevents the joint from moving fully.
- Wear and tear: This can include loosening or breakage of prosthesis components due to friction over time.
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Knee Replacement Recovery Time And Recuperation
Total knee replacement surgery generally takes about 60 to 90 minutes, but you should expect to be in the operating room for over two hours. Rehabilitation will begin within 24 hours of surgery.
After your surgery, the nursing staff will position you in bed and help you turn until you are able to move on your own. You may have a pillow between your legs if ordered by your surgeon.
Very soon after surgery, a physical therapist will come to your room to teach you appropriate exercises and review your progress. Gentle exercises to improve your range of motion can help prevent circulation problems as well as strengthen your muscles.
Your rehabilitation program will begin as soon as you are medically stable and there are orders from your doctor to begin postoperative mobility. All patients begin rehabilitation within 24 hours of their surgery. Your motivation and participation in your physical therapy program is key to the success of your surgery and recovery. The physical therapist will assist you in the following activities:
- sitting at bedside with your feet on the floor
- transferring in and out of bed safely
- walking with the aid of a device
- climbing stairs with aid of a device
How Long Will It Take To Recover
You will stay in the recovery room after surgery until you are alert and your vital signs are stable. In some cases, doctors plan an outpatient procedure and you can go home after your recovery room stay. Otherwise, you will have a brief hospital stay, usually a night or two.
Recovery after a kneecap replacement is a gradual process. The time it takes to recover varies depending on your age, general health, and other factors. You may need to use crutches, a cane, or a walker for a few days after your surgery. These devices will help you bear weight on the knee.
Physical therapy will be an important part of your recovery. It typically starts about a week after surgery. The outcome of your recovery depends on regaining strength in your quadriceps muscles. Physical therapy can help you do this safely and successfully.
You will likely be able to return to work and daily activity in 2 to 6 weeks. This part of the recovery is usually faster than with a total knee replacement. Full kneecap replacement recovery time can take 6 to 12 months.
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Injections For Knee Pain
There is good science behind cortisone shots and other injections, such as hyaluronic acid injections, that lubricate the inner workings of the knee and help relieve arthritis pain.
According to experts, there is less evidence supporting the benefits of other injectable substances, including platelet-rich plasma and concentrated bone marrow or stem cells, but further studies will reveal more about their efficacy in treating knee arthritis.
Injections can provide temporary relief typically a few months which can help you stay on your feet and postpone surgery.
Types Of Arthritis That Affect The Knee
This broad category includes a wide variety of diagnoses including rheumatoid arthritis, lupus, gout and many others. It is important that patients with these conditions be followed by a qualified rheumatologist as there are a number of exciting new treatments that may decrease the symptoms and perhaps even slow the progression of knee joint damage.
Patients with inflammatory arthritis of the knee usually have joint damage in all three compartments and therefore are not good candidates for partial knee replacement. However, inflammatory arthritis patients who decide to have total knee replacement have an extremely high likelihood of success. These patients often experience total, or near-total, pain relief following a well-performed joint replacement.
Osteoarthritis is also called OA or degenerative joint disease. OA patients represent the large majority of arthritis sufferers. OA may affect multiple joints or it may be localized to the involved knee. Activity limitations due to pain are the hallmarks of this disease.
OA patients who have symptoms limited to one compartment of the knee sometimes are good candidates for minimally-invasive partial knee replacement .
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What Is The Recovery Time After Knee Revision Surgery
It varies, but in most cases, physical therapy will be initiated within 24 hours of the procedure and will continue for up to three months.
Some patients take longer to recover. In some cases, protective weightbearing or limiting the knees range of motion is needed to promote appropriate healing. Therapy will usually continue for up to three months following the surgery. Assistive devices, such as a walker or crutches, will be used early in the convalescence period, and patients will progress to a cane or walking without any assistance as their condition improves.
Reasons For The Procedure
Knee replacement surgery is a treatment for pain and disability in theknee. The most common condition that results in the need for kneereplacement surgery is osteoarthritis.
Osteoarthritis is characterized by the breakdown of joint cartilage.Damage to the cartilage and bones limits movement and may cause pain.People with severe degenerative joint disease may be unable to donormal activities that involve bending at the knee, such as walking orclimbing stairs, because they are painful. The knee may swell or”give-way” because the joint is not stable.
Other forms of arthritis, such as rheumatoid arthritis and arthritis thatresults from a knee injury, may also lead to degeneration of the kneejoint. In addition, fractures, torn cartilage, and/or torn ligaments maylead to irreversible damage to the knee joint.
If medical treatments are not satisfactory, knee replacement surgery may bean effective treatment. Some medical treatments for degenerative jointdisease may include, but are not limited to, the following:
Cortisone injections into the knee joint
There may be other reasons for your doctor to recommend a knee replacementsurgery.
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Am I A Candidate For Total Knee Replacement
Urquhart: I always start by telling patients that total knee replacement surgery shouldnt be thought of as the only way to treat knee pain.
Patients who can walk on level ground without much difficulty, or who only have pain when going up and down stairs, are not good candidates for knee replacement surgery. Patients in their fifties or older who have a hard time walking, despite trying non-surgical treatments first, may be good candidates for knee replacement surgery.
Before considering knee replacement surgery, I always recommend patients start with improving their diet and exercise routine. Many Americans are overweight and just losing a few pounds can improve symptoms in the knee, which carries five times a persons body weight when going up a single stair. Targeted physical therapy and exercise can improve and strengthen the muscles in the knee, which may result in less pain symptoms.
We also recommend patients try non-steroidal medications such as ibuprofen or acetaminophen to reduce swelling and pain. For some patients, we recommend trying steroid injections, such as cortisone injections, before electing knee replacement surgery.
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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Why Have Knee Replacement Surgery
There are three common reasons for the procedure:
Osteoarthritis: this type of arthritis is age related, caused by the normal wear and tear of the knee joint. It mostly affects patients aged over 50 years, but younger people may have it.
Osteoarthritis is caused by inflammation, breakdown, and the gradual and eventual loss of cartilage in the joints. Over time, the cartilage wears down and the bones rub together. To compensate, the bones often grow thicker, but this results in more friction and more pain.
Rheumatoid arthritis: also called inflammatory arthritis, the membrane around the knee joint to become thick and inflamed. Chronic inflammation damages the cartilage, causing soreness and stiffness.
Post-traumatic arthritis: this type of arthritis is due to a severe knee injury. When the bones around the knee break or the ligaments tear, this will affect the knee cartilage.
Getting Back To Normal
It will be some weeks before you recover from your operation and start to feel the benefits of your new knee joint. Make sure you have no major commitments including long-haul air travel for the first six weeks after the operation.
Keeping up your exercises will make a big difference to your recovery time. Youll probably need painkillers as the exercise can be painful at first. Gradually youll be able to build up the exercises to strengthen your muscles so that you can move more easily.
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Looking For Alternatives To Total Knee Replacements
We’re also funding research which is investigating alternative approaches to total knee replacement. For example, total knee replacement is not recommended for many young people. This study aims to develop a new method called ToKa®, which uses images of the patient’s joint and specially designed software to design a patient specific implant that will be made via 3D printing. If successful, this technique could prevent osteoarthritis patients from needing total joint replacement.