Posterior Cruciate Ligament Retaining
The posterior cruciate ligament runs along the back of the knee, connecting the femur to the tibia. This design keeps the PCL intact, but it depends on several patient factors: good bone quality, few defects in the bones, intact soft tissue around the knee and a functional PCL.
There are two types of PCL implants: retaining and substituting. The difference between the two comes in part from how the PCL is affected by the implant surgery. A surgeon may remove the ligament to implant a PCL substituting implant. But if the ligaments are in good condition, the surgeon may want to preserve it. In that case, he or she will use a PCL retaining implant.
Preserving the ligament may not necessarily result in better post-operative knee function. A simple polyethylene bearing attaches to a metal component implanted in the tibia, and a metal implant in the femur hinges on the polyethylene. It is a minimal design dependent on the PCL to stabilize the implant but a tight PCL may lead to excessive wear on the bearing.
Less bone is removed with a PCL retaining implant. A PCL retaining implant is less likely than a PCL substituting version to result in a condition called patella clunk syndrome. This syndrome results from scar tissue forming near the implant and becoming caught in part of the device as the knee is fully extended.
Differences Between Total And Partial Knee Replacement
Knee replacement surgery is recommended when conservative treatments like physical therapy, braces, steroid injections and anti-inflammatory medication fail to alleviate pain.
If a patient requires surgery on both knees, its called a bilateral knee replacement. The two procedures can be done simultaneously or doctors may choose to use a staged bilateral approach that schedules the second surgery several days, weeks or months later.
The decision to have a total versus a partial knee replacement is based on a doctors recommendation after a full patient evaluation is performed.
Helping Them Take A Bath
One unavoidable activity is of course going to the bathroom and taking a shower. Bathing is a task that is difficult to accomplish after you have had knee replacement surgery. This surgery is a major operation due to which your body will take ample time to heal and recover.
During this period, as a caregiver, you will have to help the patient bathe. You will have to take them to the shower, and also assist by standing next to them. There are many kinds of shower chairs available on which the patient can sit down to take their baths.
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Depuy Attune Knee Replacement Lawsuits
Attune knee lawyers filed the first DePuy Attune knee replacement lawsuit in September 2017. Several more Attune patients have filed suits since then.
People filing Attune knee replacement lawsuits claim:
- The Attune knee failed earlier than expected
- They experienced tibial loosening with an Attune knee
- Patients needed revision surgery
Attune lawsuits are still in the early stages. There have been no court verdicts or publicized settlements yet. Attune knee lawyers are taking new cases.
Based on the number of reported failures, there could be hundreds of Attune knee replacement lawsuits. If that happens, attorneys may ask to combine them in a multidistrict litigation . MDLs let several, similar cases move more quickly through the legal process.
What Is Knee Replacement
Total knee replacement surgery replaces parts of the knee joint with artificial parts.
What is Knee Replacement Used For?
Total knee replacement is usually used:
- To relieve pain caused by severe arthritis
- To restore function to an arthritic knee
- To correct significant deformity
- For severe patellofemoral arthritis
Total knee replacement may be considered when other treatments have failed to relieve the pain, which must be significant and disabling.
About 82% of total knee replacements last 25 years and can be affected by a patients activity levels. The procedure is usually reserved for older patients who perform modest activities or younger patients with limited function due to severe arthritis.
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What Are The Risks Of Total Knee Replacement
Most people do very well with their minimally invasive total knee replacement. But as with any surgery, the procedure does carry some fairly rare risks. Possible complications of the surgery include:
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Infection
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Loosening of the components of the knee
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Limited motion of the knee
There is also a very slight risk that the procedure might not relieve your pain. Your own risk of complications may vary according to your age and your other medical conditions. Ask your provider about the risks that most apply to you.
Pre-Operative Education
Johns Hopkins offers in-person educational sessions to help you prepare for knee replacement surgery. During your class, we’ll review important aspects of your care and what to expect before and after surgery. You will be able to ask questions and meet many of the staff who will be caring for you in the hospital.
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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When To Call Your Doctor
If your pain and swelling are gettingworse and you can no longer put weight on your knee, see your doctor. A simpleX-ray can show if there is osteoarthritis and, if needed, an MRI scan can checkfor meniscal tears or loose chips of cartilage.
Arthroscopic surgery can sometimes remove loose cartilage. Partial or total knee replacements are other surgical options, especially for those who can no longer stay as active as theyd like. Sometimes computer assistance is used for some complicated knee replacements.
Surgery is a last resort, though,says Dr. Nickodem. Its something to consider when nonoperative treatmentsarent helping.
How To Put On A Knee Brace
- Choose the right style of knee brace. There are different styles of knee braces for different severity of your condition. If you have moderate pain, then you can also wear a compression sleeve.
- Most knee braces come with straps or velcro, so they can be put directly on the knee . All you need to do is to roll up the pants, and put the knee brace on.
- Keep the knee brace at the center of your knee for best results.
- After wearing the knee brace, tighten its straps to get the best compression effect.
Watch the video below to see how to put on a knee brace
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What Type Of Anaesthetic Will I Need
There are two different types of anaesthetic for this operation:
- A spinal anaesthetic
- A general anaesthetic
At the pre-assessment clinic you can talk about the type of anaesthetic for your knee replacement. An anaesthetist will explain to you which type of anaesthetic is most suitable for you but your preference will always be taken into account. Most people have a spinal anaesthetic.
Cemented And Cementless Knee Replacement
Total knee replacement is one of the most commonly performed joint replacement surgeries. Total knee arthroplasty is a surgical procedure to replace diseased ends of the knee joint with prosthetic materials. Traditionally knee replacement surgery has been performed used cemented prosthesis. Recently however a number of cementless total knee replacement surgeries are being done with excellent results.
There has been a constant debate between cemented and cementless knee replacement. Compared to cemented prosthesis cementless prostheses have been proposed to have long term survivorship. Cementless implants have a biological fixation with bone growth.
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Are You A Candidate For Knee Replacement
To determine the most appropriate knee replacement surgery for you, our knee surgeons consider a wide range of factors, including severity of symptoms, overall health and response to previous treatment.
If you are experiencing the following, surgery may be advised.
- Severe pain that prevents you from participating in everyday activities
- Have weakness in your knee and cannot move it fully
- If your symptoms dont improve with non-surgical treatments
For those who may have been diagnosed with advanced osteoarthritis, the condition of your knee joints will determine your surgical options. Surgery on the knee is common for severe osteoarthritis with a high success rate.
Are There Other Implants That Are Used To Treat Knee Arthritis
In unusual cases of knee arthritis and in relatively young patients, a shim-like device called the uni-spacer may be used. This device acts like a spacer to separate the worn-out knee surfaces and keep them from grinding against each other. Very few patients meet the criteria for this type of surgery, and a uni-spacer is a temporary option, best reserved for very young patients with knee arthritis.
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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.
Knee Replacement Surgery In Fort Myers
Total joint replacements have been performed since the 1960s and have changed the lives of millions. Today, these procedures have been found to result in significant restoration of function, as well as have helped reduce joint stiffness and pain for millions of patients across the country. Total joint replacements of the knee, hip, and shoulder joints are some of the most common joint replacement surgeries performed at the Institute for Orthopaedic Surgery & Sport Medicine in Fort Myers.
There are significant potential benefits of replacing an injured or diseased knee:
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Joint pain is drastically reduced or completely eliminated
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Mobility is greatly improved or completely restored
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The artificial will continue to perform, as intended, for several years
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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.
Costs
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?
Troubled By Knee Arthritis But Not Ready For Knee Replacement Here Are 5 Alternatives
Millions of Americans suffer from knee arthritis, which can cause pain, stiffness and a decrease in activity level and quality of life. Eventually, this often leads to knee replacement surgery, which remains the most effective treatment for permanent pain relief. However, knee replacement should be reserved as a last resort. There are several minimally invasive options you and your surgeon can try before committing to knee replacement surgery:
MAKING THE DECISION
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What Are The Risks Of Knee Replacement Surgery
Most people have much less pain after knee replacement surgery and are able to return to many of their activities. But as with any surgery, there are some risks, including:
Pain relief with surgery
The evidence about knee replacement surgery suggests that most people are happy with the results.
Take a group of 100 people who have the surgery. Six months after knee replacement, about 80 out of 100 people have less pain and can do more activities than they could before the surgery.footnote 1
Need for repeat surgery
Most artificial knees last for many years. But they can wear out or have other problems. Some people have to repeat the surgery to have the joint replaced again.
Take a group of 100 people who have the surgery. Within 10 years after surgery, about 5 to 12 out of 100 will need to have the knee replaced again.footnote 2, footnote 3, footnote 4, footnote 5, footnote 6
Problems after surgery
The evidence suggests that, like most surgeries, knee replacement may have some risks.
Your doctor might recommend knee replacement if:
- You have very bad arthritis pain, and other treatments have not helped.
- You have lost a large amount of cartilage.
- Your knee pain is keeping you from being active enough to keep up your strength, flexibility, balance, or endurance.
- You don’t have health problems that would make it dangerous for you to have surgery.
Talk To An Orthopedic Surgeon About Your Knee Pain
If your knee pain is getting in the way of you living your life, its time to talk to a board-certified orthopedic surgeon about your options.
Call or with Dr. Alexander at an office in North Tampa, Wiregrass, or Zephyrhills. For patients experiencing chronic pain and immobility, total knee replacement can provide a life-changing, long-term solution.
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How To Sit On A Toilet After Knee Replacement
Sitting down on the toilet was a much larger challenge. Youll consider using the free-fall technique.
The free-fall technique begins with standing over the toilet. As you begin to lower yourself you realize squatting is painful and youll start thinking about physics and the law of gravity.
Youll wonderwhat if I just drop or do I have enough cushion to withstand a 2-foot drop. The free-fall technique is possible but most definitely painful.
Ideally, you need to gently lower yourself down on the seat while letting your surgical knee slide forward. You need something stable to help you get up and down.
Do not rip the toilet roll hanger and towel bars off the wall. Try not to use the toilet tank . Use your walker, walking poles or the edge of a sink counter for stability.