Home And Outpatient Physical Therapy
If you are sent home from the hospital, you may choose to have a home care physical therapist come to your house for your rehabilitation. This is usually reserved for people who may have a difficult time traveling to an outpatient physical therapy facility.
The focus of home physical therapy is to maximize your safe functional mobility in your home. You will likely continue on working on knee ROM and strength. Functional mobility like walking and stair climbing may also be a part of your home physical therapy after TKR.
As your surgical incision heals, your physical therapist may begin gentle scar tissue massage and mobilization to help improve the mobility of your incision. This can help the skin and other tissues around your knee move better and more freely.
If you are able to travel to a physical therapy facility, you may begin outpatient physical therapy. Here, your physical therapist will continue to work on improving your knee ROM, and it is expected that you are able to bend your knee to a 90 degree angle be the end of week 2.
Why Might I Need A Total Knee Replacement
You might need a total knee replacement if you have significant damage to your knee joint. Different types of medical conditions can damage this joint, such as:
Injury or fracture of the knee joint
Bone tumor in the knee joint
This damage might be very painful and limit your normal activities. The procedure may help decrease your pain, improve your joint mobility, and quality of life. Usually, healthcare providers only recommend total knee replacement when you still have significant problems after trying more conservative treatments, like pain medicines and corticosteroid shots .
Talk with your doctor about the benefits and risks of having minimally invasive total knee replacement instead of traditional total knee replacement. Minimally invasive total knee replacement uses a smaller incision than a traditional knee replacement, so it may lead to less pain and decreased recovery time. It is not yet clear whether the procedure leads to an increased risk of certain complications, though.
In some cases, you may have other surgical options, like shortening the bone or a partial knee replacement. Talk with your doctor about the risks and benefits of all your options.
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.
Implanting The Tibial Component
The bottom portion of the implant, called the tibial tray, is fitted to the tibia and secured into place using bone cement. Once the tray is in place, the surgeon will snap in a polyethylene insert to sit between the tibial tray and the femoral component, and act as a kind of buffer. This insert will provide support for your body as you bend and flex your knee.
Implant Loosening And Wear
In order for a total knee replacement to function properly, an implant must remain firmly attached to the bone. During the initial surgery, the implant was either cemented into the bone or press-fit to allow bone to grow onto the surface of the implant. In either case, the implant was firmly fixed. Over time, however, an implant may loosen from the underlying bone, causing the knee to become painful.
The cause of loosening is not always clear, but high-impact activities, excessive body weight, and wear of the plastic spacer between the two metal components of the implant are all factors that may contribute. Also, patients who are younger when they undergo the initial knee replacement may “outlive” the life expectancy of their artificial knee. For these patients, there is a higher long-term risk that revision surgery will be needed due to loosening or wear.
In some cases, tiny particles that wear off the plastic spacer accumulate around the joint and are attacked by the body’s immune system. This immune response also attacks the healthy bone around the implant, leading to a condition called osteolysis. In osteolysis, the bone around the implant deteriorates, making the implant loose or unstable. Advances in material science and plastic quality have made osteolysis less common today than in past decades.
Osteolysis has occurred around the tibial component, causing it to become loosened from the bone .
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What Is Total Knee Replacement Surgery
Knee Total Knee Replacement is a procedure that removes the bone and cartilage of the knee that has been damaged due to arthritis and replaces them with metal and plastic components. These components mimic the anatomy and function of a healthy knee so that you can return to activities without the pain caused by arthritis. The procedure is one of the most well-known and most effective in orthopedic surgery because it dramatically decreases knee pain and improves quality of life. The Board Certified Orthopedic Surgeons at OrthoNeuro have performed thousands of Total Knee Replacements and are experts of this procedure using the latest advancements in surgical techniques. Total Knee Replacement Surgery may be recommended to treat severe osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis that does not respond to nonsurgical treatment.
How Common Is Knee Replacement Surgery
The surgery is very common. Surgeons started doing it in the 1960s, with regular updates to techniques and implants along the way.
Almost 800,000 knee replacements currently get performed each year in the United States. The surgery is often done in older adults whose knees have worn down over time. But its also become popular in middle age, as people want to stay active.
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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.
What Happens During The Procedure
Most knee replacement surgery is performed under a combination of general anesthesia, peripheral nerve blocks, and spinal anesthesia. You will also receive at least one dose of antibiotics to reduce the risk of infection.
During the procedure, the surgeon will remove bone and diseased cartilage from where your thigh bone and shin bone meet at your knee joint.
Those surfaces are then replaced with a metal implant. A piece of special plastic is normally used to replace the backside of the kneecap and finally, this same plastic material is placed in between the two metal parts.
This gives both bones of your knee joint smooth surfaces again so they can flex and bend more freely and painlessly.
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Can I Avoid Or Postpone A Knee Replacement
The choice on whether to have surgery to address arthritis of the knee joint depends on multiple factors, including:
- the condition of the knee joint
- the patientâs age and activity level
In cases where the damage from arthritis is minimal, and/or if the patient does not have a very active lifestyle, nonsurgical treatments by be tried, including:
- physical therapy
- , such as ibuprofen
- weight loss to reduce pressure on the knee
Possible Benefits Of Total Knee Replacement Surgery
Regardless of whether a traditional total knee replacement or a minimally-invasive partial knee replacement is performed the goals and possible benefits are the same: relief of pain and restoration of function.
The large majority of total knee replacement patients experience substantial or complete relief of pain once they have recovered from the procedure. The large majority walk without a limp and most dont require a cane, even if they used one before the surgery. It is quite likely that you know someone with a knee replacement who walks so well that you dont know he even had surgery!
Frequently the stiffness from arthritis is also relieved by the surgery. Very often the distance one can walk will improve as well because of diminished pain and stiffness. The enjoyment of reasonable recreational activities such as golf, dancing, traveling, and swimming almost always improves following total knee replacement.
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What Are Knee Replacement Implants Made Of
The selection of knee replacement prosthesis design and materials depends on each individual patient. The main implant components are made of metal â usually titanium or chrome-cobalt alloys. The implants are fixated in place either with a cement bonding agent or by osseointegration, in which a porous metal stem extends into the tibia and the patient’s natural bone grows into it. A plastic platform or spacer will be inserted between the tibial and femoral implant surfaces. The spacer is made of polyethylene.
Most femoral components are made of metal alloys or metal-ceramic alloys . The patellar component is plastic . The tibial insert component is also plastic . The tibial tray component can be made of the following materials:
- cobalt chromium
Similar Conditions That Affect The Knee
Sometimes patients with knee pain don’t have arthritis at all. Each knee has two rings of cartilage called “menisci” . The menisci work similarly to shock absorbers in a car.
Menisci may be torn acutely in a fall or as the result of other trauma or they may develop degenerative tears from wear-and-tear over many years. Patients with meniscus tears experience pain along the inside or outside of the knee. Sometimes the pain is worse with deep squatting or twisting. Popping and locking of the knee are also occasional symptoms of meniscus tears.
Since some of these symptoms may be present with arthritis and the treatment of arthritis is different from that of meniscus tears, it is important to make the correct diagnosis. A good orthopedic surgeon can distinguish the two conditions by taking a thorough history, performing a careful physical examination, and by obtaining imaging tests. X-rays and Magnetic Resonance Imaging scans may be helpful in distinguishing these two conditions.
Knee Joint Infections
Also called infectious arthritis or septic arthritis, a joint infection is a severe problem that requires emergent medical attention. If not treated promptly knee infections can cause rapid destruction of the joint. In the worst cases they can become life-threatening.Symptoms of a knee joint infection include:
- severe pain
- fevers and
Again, a joint infection is a serious condition that requires immediate medical attention.
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How Does Partial Knee Replacement Differ From Total Knee Replacement
Most arthroplasties target the entire knee joint, an operation called a total knee replacement. But some people choose to have a partial knee replacement.
To understand the difference, it helps to know the knees compartments, or sections. It has three:
- Inside .
- Outside .
- Under the kneecap .
The partial approach fixes a single section. So healthcare providers call it unicompartmental replacement. A total knee replacement addresses all three sections. Generally, only younger adults with symptoms in one knee section benefit from partial replacement.
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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Preparation For Total Knee Replacement Surgery
Patients undergoing total knee replacement surgery usually will undergo a pre-operative surgical risk assessment. When necessary, further evaluation will be performed by an internal medicine physician who specializes in pre-operative evaluation and risk-factor modification. Some patients will also be evaluated by an anesthesiologist in advance of the surgery.
Routine blood tests are performed on all pre-operative patients. Chest X-rays and electrocardiograms are obtained in patients who meet certain age and health criteria as well.
Surgeons will often spend time with the patient in advance of the surgery, making certain that all the patient’s questions and concerns, as well as those of the family, are answered.
The surgeon’s office should provide a reasonable estimate of:
- the surgeon’s fee
- the degree to which these should be covered by the patient’s insurance.
Total Knee Replacement Surgical Team
The total knee requires an experienced orthopedic surgeon and the resources of a large medical center. Some patients have complex medical needs and around surgery often require immediate access to multiple medical and surgical specialties and in-house medical, physical therapy, and social support services.
Finding an experienced surgeon to perform your total knee replacement
Some questions to consider asking your knee surgeon:
- Are you board certified in orthopedic surgery?
- Have you done a fellowship in joint replacement surgery?
- How many knee replacements do you do each year?
How Is A Total Knee Replacement Performed
First, the orthopedic surgeon makes an incision in the knee and moves the patella to the side. If are any bone spurs are present, as sometimes occurs in osteoarthritis, they will be removed.
Next, the two menisci between the femur and tibia are removed, as are the anterior cruciate ligament and, in some cases, the posterior cruciate ligament . In some types of knee replacement, the PCL is retained.
During the main phase of the operation, the surgeon cuts and remove cartilage and some bone from the upper part of the tibia and lower sections of the femur. The femoral sections removed are two knobby protuberances called the femoral condyles. The tibia and femur are then be capped with metal implants to create new surfaces for the joint. The surface of the femoral component mimics the shape of the original femoral condyles. If the kneecap has also degraded, the surface on its underside may also be cut away and replaced with a polyethylene implant.
Finally, the various layers of tissue are repaired with dissolvable sutures and the skin incision is closed with sutures or surgical staples. A bandage will be wrapped around the knee and the patient is be taken to recovery.
Fixed-bearing knee implant with a polyethylene articulating surface sandwiched between the metal tibial implant and metal femoral implant.
Side-view illustration of a knee with a fixed-bearing knee implant in place.
X-ray of a knee after total knee replacement, showing the implanted prosthesis)
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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.
What Is A Total Knee Replacement
Total knee replacement is a type of surgery to replace a damaged knee joint. A minimally invasive surgery uses a smaller cut than a traditional total knee replacement. This type of surgery typically requires special tools so that the surgery team can see and do the procedure through the smaller incision.
The knee has several parts: the lower end of the thigh bone , the upper end of the shin bone , and the kneecap . A smooth substance called cartilage caps the ends of these bones and keeps the bones from grinding together. When there is damage to the knee joint, these bones may scrape together abnormally and cause pain.
During minimally invasive total knee replacement, your surgeon makes an incision to access your shinbone and thigh bone. Next, he or she removes a portion of the bones that make up the knee joint. Your surgeon replaces these bone parts with metal components that recreate the joint surface. A layer of plastic is placed between the metal components for smooth gliding.
Minimally invasive total knee replacement often takes place under general or spinal anesthesia.
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