Pain Management Techniques And Rehabilitation
The MIS techniques forced surgeons to look at the entire TKA approach for patients. Many criticizers felt that the rapid recovery was not just the operation itself but also the associated pain management and rehabilitation changes that occurred at the same time. Pain management included not only the operation but also preemptive medicating before the surgery and postoperative support. Opioids came under scrutiny because of the associated nausea and vomiting. Combinations of drugs that included non-steroidal anti-inflammatories and even steroids were added to protocols.
The anesthetic programs changed with greater emphasis on spinal and epidural techniques to avoid the cardiovascular problems associated with general anesthesia. Peripheral nerve blocks became popular and fit well with early hospital discharge. The blocks had to be modified to avoid injury to the injected nerves and also to try to decrease weakening the quadriceps muscle group after the surgery. This weakening led to a longer period of knee immobilizer usage to avoid inadvertent falls in the immediate postoperative period. Femoral and sciatic nerve blocks were replaced with adductor nerve blocks in an attempt to avoid the muscle weakening.
Is Visionaire Patient Matched Technology Minimally Invasive
In general, any talk about minimally invasive knee replacement centers around the resulting size of a patient’s scar. The reason behind this is that a primary cause of post surgical pain is the swelling that occurs whenever the soft tissue of the body is cut or manipulated. Therefore, when it comes to surgery, smaller may be better. Thanks to advancements in surgical instrumentation, including VISIONAIRE Patient Matched Technology, surgeons may be able to replace entire knee joints with incisions that are up to 75 percent smaller than those used in the past.
However, for a knee replacement to be truly minimally invasive, we believe you must look beyond the scar and address what happens inside the body as well.
VISIONAIRE Patient Matched Technology addresses the issue of alignment by using the data from your MRI and x-ray to build special cutting blocks that attach directly to the ends of your bones without the use of an IM rod. Not only do these blocks help ensure that your new knee will be positioned in precise, correct alignment to your hip, they also allow the surgeon to remove as little bone as possible to achieve that fit.
Equally important, by eliminating the use of an intramedullary rod, there is a reduced risk of fat embolism, caused when the IM rod forces body fat into the patient’s blood stream. If fat travels through the blood stream, it could become lodged in the heart or brain and cause heart failure, dementia or stroke.
Am I A Good Candidate For A Minimally Invasive Knee Replacement
Patient size, anatomy, and degree of arthritis or deformity may play a role in the decision as to whether or not a minimally invasive incision is right for you. After viewing your x-rays and examining your knee, your physician can counsel you on whether or not minimally invasive surgery is right for you.
Total Knee Replacement Surgery
Your doctor may have told you that you are a candidate for total knee replacement surgery. This surgery removes the damaged and painful areas of the thigh- and shinbones. These areas are then replaced with specially designed metal and plastic parts.
Standard surgical incision for knee replacement
The standard surgical incision is between 8 to 12 inches. The incision is made through the quadriceps tendons and muscles to position the replacement parts. Patients generally have two to three months recovery time. Much of the postoperative pain a patient feels is a result of the cutting of the tissues. While tissues are healing, scar tissue forms, which may cause pain and stiffness.
Minimally invasive total knee replacement procedure
This new technique at Midwest Orthopaedics at Rush has revolutionized total knee replacement surgery . The short incision total knee replacement is a surgical modification using a smaller incision that requires less muscle dissection, which generally results in more rapid and less painful recovery with better early range of motion and improved function.
Potential benefits of this minimally invasive technique include increased range of motion sooner after surgery, less blood loss during surgery, faster recovery and a shorter hospital stay. In fact, many patients leave the hospital the same day.
For additional information about the Midwest Orthopaedics at Rush experts in minimally invasive total knee replacement, call 877 MD BONES .
Good Candidates For Minimally Invasive Surgery
Most patients who are candidates for a traditional total knee replacement are candidates for a minimally invasive approach with the robotics system. Dr. Martin, however, determines candidacy based on several factors including body structure, knee deformity, previous surgeries, and other disease processes that may affect the replacement and subsequent healing.;
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However Some Other Advantages Of Minimally Invasive Surgery For Knee Replacement Are As Follows
- In a minimally invasive knee replacement, the surgical procedure is similar, but there is less cutting of the tissue surrounding the knee. The artificial implants used are the same as those used for traditional knee replacement.
- Minimally invasive knee replacement is through a shorter incision. That is typically 4 to 6 inches versus 8 to 10 inches for traditional knee replacement. A smaller incision allows for less tissue disturbance.
- In general, techniques used in minimally invasive knee replacement are quadriceps sparing, meaning they avoid trauma to the quadriceps tendon and muscles in the front of the thigh. Because the techniques used involve less disruption to the muscle, it may lead to less postoperative pain and reduced recovery time.
- The hospital stay after minimally invasive surgery is similar in length to the stay after traditional knee replacement surgery. This ranges from outpatient surgery to a hospital stay of 1 to 4 days.
However, Physical rehabilitation is a critical component of recovery. Your surgeon or a physical therapist will provide you with specific exercises to help increase your range of motion and restore your strength.
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Frequently Asked Questions: Joint Replacment
Because of advancements in instrumentation and surgical technique, a vast majority of patients can elect to undergo a small incision joint replacement. There is no weight or size limit, nor an age limit for these procedures. The size of the incision is, to some degree, driven by the size of the implants that are placed at the time of surgery.
Larger bones require larger replacement implants and longer incisions. Obese patients may require larger incisions for exposure of the joint that is being replaced, but the same care is taken to minimize the disruption of soft tissue structures at the joint level.
Depending on your medical conditions and your level of physical fitness before surgery, typically patients undergoing less invasive joint replacement stay 1-2 days before going home. Dr. Miller believes it is usually necessary to stay one night after joint replacement surgery for medical observation for even the most fit and health patients.
Despite our many advancements in recent years, less invasive joint replacement is still a major orthopaedic surgery and can have significant complications that your medical team will be watching for during your hospital stay.;The majority of these complications are observed in the first 1-3 days after surgery.
Dr. Miller has performed over 3,500 orthopaedic surgeries. More than 1,000 have been less invasive hip and knee replacements.
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What Should I Expect During Minimally Invasive Knee Surgery
Knee replacement surgery begins with an incision over the front of the knee. A second lengthwise incision is made beneath the skin going around the kneecap. This allows the surgeon access to the knee joint. In traditional knee replacement surgery, blocks of metal are aligned and fixed to the bone to guide the surgeon as he removes the ends of the bones with a special saw.; Metal implants are then fixed to the ends of the bones with a piece of plastic fixed in between. A plastic button is also sometimes fixed to the underside of the kneecap to complete the joint replacement. The soft tissue incisions are then repaired with suture material and a soft tissue dressing is applied. Patients are encouraged to start walking as soon as possible after surgery.; A physical therapist often helps the patient get out of bed and walk during their stay in the hospital.; ;
What Is A Minimally Invasive Knee Replacement
A total knee replacement surgery involves replacing the diseased knee joint with a metal prosthesis. A minimally invasive knee replacement involves the replacement of the knee joint using a smaller incision. This can have many benefits, including a shorter recovery time and less pain in some patients.
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Am I A Candidate For A Minimally Invasive Orthopaedic Surgery
For many orthopaedic injuries and conditions, non-surgical treatment options and traditional surgery are still the preferred methods of treatment. The physicians at Raleigh Orthopaedic are trained in the full spectrum of treatment options and will help guide you to the best treatment for your individual needs.
Minimally Invasive Surgery V/s Traditional Open Surgery
- The size of the incision in minimally invasive surgery is around half of the size of incision made in an open surgery.
- For an open surgery, the tibia has to be dislocated from the femur before inserting the implant. However, for minimally invasive technique no such dislocation is required.
- During an open surgery the quadriceps muscles at the front of the thigh and some soft tissues are cut. Whereas in minimally invasive surgery, certain muscles are just shifted or pushed out of the way rather than cut. However, the incision may extend to some deeper soft tissues.
- In an open surgery, the kneecap is turned over 180 degrees so as to give surgeon an easy access to the bones that form the knee joint. For minimally invasive surgery, the knee cap is just pushed out the way.
- Bleeding during the surgery, for minimally invasive technique is lesser than for the traditional open surgery.
- Surgery time for minimally invasive technique is generally greater than the time taken for an open surgery.
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Benefits Of Minimally Invasive Surgery
One example is outpatient joint replacement.; Healthy patients undergoing minimally invasive surgery are usually candidates for returning home the same day as surgery.; This promotes rapid recovery with early walking and decreases the chances of hospital-acquired infection. Many other advances will be discussed in upcoming articles.;;
The overall concept of knee replacement surgery is the same for minimally invasive and traditional knee replacement. Biomaterials are used to resurface the worn-out cartilage on the ends of the knee joint.; The most commonly used materials are cobalt chrome, titanium, and polyethylene plastic. The design of the implants is fairly standardized with slight differences between manufacturers. The same implants can be used for either minimally invasive or traditional knee replacement.; It may be best to think of minimally invasive and traditional knee replacement as different techniques used to perform the same procedure.;;
Am I A Candidate For Knee Replacement Surgery
When you have failed non-operative treatment for arthritis, you should consider a knee replacement. Non-operative treatment includes injections, anti-inflammatory medications, or exercise.The goal of a knee replacement surgery is to alleviate your pain and improve function. The best time to think about surgery is when you are having difficulty with the following scenarios:
- Your daily living activities: household chores and grocery shopping
- Leisure activities: golf, gardening, long walks, bike riding
- Loss of ability to work due to pain
- Avoidance of seeing friends or family
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Minimally Invasive Surgical Technique For Knee Replacement Improves Recovery Time
Small Incision Total Knee Replacement is a new, less invasive surgical technique that enables patients to recover faster, regain more mobility and experience less pain. Dr. Steven B. Haas, Chief of the Knee Service at HSS pioneered this new technique.
According to Dr. Richard Laskin, Co-Chief of the Knee Service at the Institute for Hip & Knee Replacement at HSS, in a recent study of over 100 Small Incision TKR surgeries, the new procedure has shown that patients recover far faster and regain excellent range of motion in four to six weeks compared to over three months with traditional TKR surgery. Traditionally, the TKR surgery involves using large instruments that require flipping the knee cap over and cutting the quadriceps tendon. By using the new Small Incision TKR technique, surgeons do not cut the quadriceps tendon, they do not flip over the knee cap and they cut less uninvolved tissue. “By doing less cutting and less stretching of the tissue,” Dr. Haas said, “we do less damage to the healthy tissue, which I believe leads to a faster recovery.”
“At HSS, our mission is to constantly improve upon standard methods of surgery,” said Dr. Richard Laskin. “Our success with this new procedure promises to be of enormous benefit to patients requiring such surgery.” In addition to less tissue damage, a study on pain control conducted by Dr. Laskin at HSS showed that patients used the PCA pump demand button 20% fewer times with Small Incision TKR versus traditional methods.
Traditional Knee Replacement Vs Minimally Invasive Knee Replacement
Minimally invasive knee replacement is an example of how the medical field is continually evolving and trying to improve outcomes for patients. Though thousands are performed every year, minimally invasive knee replacements are the subject of ongoing research and are not considered standard practice.
In the meantime, patients and doctors must use the knowledge available to make informed choices. The bullet points below summarize much of what we know about the pros and cons of minimally invasive knee replacement surgery.
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Minimally Invasive Total Joint Replacement
Many different types of joint replacement, including hip, knee, and shoulder, can now be performed through minimally invasive surgery.
In a total joint replacement, the damaged or worn surfaces of the joint are removed and replaced with artificial joint components that are cemented or screwed into place. In traditional joint replacement surgery, a large incision is necessary in order to expose the entire joint.
Minimally invasive joint replacement uses small incisions and disturbs the surrounding soft tissue as little as possible. The incision in a minimally invasive knee replacement surgery is usually less than 6 inches, compared to the 10 inches in traditional surgery, according to the American Academy of Orthopaedic Surgeons.;
Not all patients who are considering a joint replacement are candidates for a minimally invasive joint replacement, but it is an option worth discussing with your orthopaedic surgeon at our outpatient surgery center in Raleigh.
Who Is A Suitable Patient For Total Knee Replacement
Patients who have disabling pain in the knees as the result of arthritic involvement are, as a rule, candidates for replacement of the knee joint. Many measures will generally be tried before the decision is made to perform the knee replacement. The use of exercises, anti-inflammatory medication and injections into the knee may be tried prior to surgery. In the patient who has advanced arthritic changes in the knee, the function of the knee is inadequate, and pain will be felt when walking, and many times while at rest. Deformity of the knee will also frequently result, and the patient may notice that the knee is becoming bowed or knock-kneed. Stiffness and swelling may also be present in the patient with the arthritic knee.
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Whats The Recovery Like For A Total Knee Or A Knee Replacement
As the operation is over, you will use your new knee. Most patients begin to walk on the day of surgery with the help of a physical therapist. Your physical therapist will show you how to walk again with a walker as you are recovering. As your muscles heal, you will have some pain. During the first couple of weeks your pain and motion will improve. Over time, you will regain your strength. Pain after a knee replacement usually resolve over the next few weeks to months. We will provide you with pain medication after surgery and monitor you, making sure that you are comfortable.
What are my goals after Surgery?
Six weeks after surgery, most patients with sedentary jobs may return to work. Often, patients are able to walk comfortably by 3 months. Full recovery usually occurs at one year, but may take up to 2 years to have all of your aches and pains improve after knee replacement
Knee replacements are designed to allow you to enjoy many activities such as long walks, dance, playing golf, gardening, and riding a bicycle. Knee replacements have an excellent track record for improving your quality of life, reducing your pain, and providing independence.
The Minimally Invasive Approach To Knee Surgery
A minimally invasive surgery is a procedure that avoids cutting into deep tissues and muscles. Typical incisions are approximately 4 to 6- inches in length, rather than the 8 to 11- inch incisions used in traditional surgery.
There are two main approaches to minimally invasive total knee replacement surgery:
- Quad Sparing This procedure avoids cutting into the quadriceps muscles in the front of the thigh. Patients are often back on their feet within hours of undergoing this surgery, although some rehabilitation is still required.
- Mini Total Knee Replacement This procedure does make one or two small cuts into the quadriceps muscles, but less so than a traditional knee replacement.
Which procedure is right for you will depend on several factors, including your size, the type of condition you are dealing with, and current range of motion in your knee.
Mini knee surgery may take longer to perform than traditional knee surgery, but it also speeds up recovery time for the patient. However, not everyone will be a candidate for minimally invasive knee replacement surgery. These procedures are generally not recommended for patients who are obese or who have had a prior knee surgery.
Muir Orthopaedic Specialists provides minimally invasive knee surgery in Walnut Creek, San Ramon, Brentwood, and Concord. Contact usto learn more.
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