Rheumatologists: For Knee Pain With Systemic Symptoms
A rheumatologist is an internist or pediatrician with further training in joint pain. But, they often focus on treating systemic autoimmune diseases.
These are medical conditions where your immune system attacks your own body. These cause joint pain and swelling. But, they also affect other organs, like the skin, eyes, or liver.
Also, rheumatologists dont perform surgery. Their treatments focus on medications and other strategies.
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 .
What Happens During Total Knee Replacement
Your provider can help explain the details of your particular surgery. An orthopedic surgeon will perform the surgery aided by a team of specialized healthcare professionals. The whole procedure may take a couple of hours. In general, you can expect the following:
Most likely, you will be given spinal or general anesthesia so that youâll sleep through the surgery and wonât feel any pain or discomfort during the procedure. Or you may receive local anesthesia and a medicine to keep you relaxed but awake.
A healthcare professional will carefully watch your vital signs, like your heart rate and blood pressure, during the surgery.
You may receive antibiotics, during and after the procedure, to help prevent infection.
Your surgeon will make an incision over the middle of your knee, cutting through your skin and underlying tissue.
He or she will remove the damaged portions of your thigh and shin bone, removing a little of the bone beneath as well.
Next, metal implants are placed into the joint space, usually cementing them into the remaining bone.
In most cases, your surgeon will also remove part of the underside of the kneecap.
A plastic spacer is inserted into the space between the metal implants, for ease of movement.
The layers of your skin and muscle will be surgically closed.
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When Can I Drive
If you had surgery on your right or left knee and drive an automatic transmission, you should not drive for at least 4-6 weeks. After 4-6 weeks you may return to driving as soon as you feel comfortable, are not taking narcotic pain medications, and can safely and quickly move the leg from the accelerator to the brake petal. For a stick shift, or standard transmission, it will be at least 4-6 weeks regardless of which leg you had surgery. Again, you should not drive if you are taking narcotics.
How Do I Prepare For Surgery
- Preparing for knee replacement surgery usually involves a health evaluation, including blood tests, a cardiogram and a urine sample. Patients should discuss all medications and supplements with his or her physician.
- Patients should attend a pre-operative education class designed especially for those undergoing knee replacement surgery. Physical and occupational therapists will discuss how to prepare the home for a safe post-surgical environment.
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Office Staff And Environment
The nurses and office staff are your gateway to the surgeon, and they will help you schedule and prepare your surgery and recovery. Among other things, the nurses and staff will:
- handle your appointments
Its important you feel comfortable around the staff and are sure that they:
- have genuine concern for your well-being
- will address your needs
- will provide you with good service
If the service isnt up to par, it could negatively impact your experience.
Questions You Should Ask Your Knee Replacement Doctor
The following guide is provided to patients of Dr. Gregory Raab, an orthopedic surgeon in Nashville, TN that specializes in total joint replacement and revisions in the knee and hip. If you are suffering from knee pain, schedule an appointment with a knee replacement doctor near you to find out if you are a candidate for total knee replacement surgery.
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Different Types Of Knee Replacement Implants
Oct 3, 2016 | Patient
*This post was co-authored by Grace McClure and Dr. Trevor North
This checklist of factors to finding the best implant may seem overwhelming, but luckily, this decision is usually left in the hands of your orthopedic surgeon. After all, surgeons have preferred implant manufacturers and only a couple different styles they work with. Very rarely do surgeons operate with multiple brands and more than a few styles. Your surgeon should be an expert in the exact type of implant you will receive.
With that said, lets get you acquainted with all things knee replacement implants, shall we? This way, you can assist your care team in matching you with an implant that best matches your lifestyle, activity level and other requirements.
Protecting Your Knee Replacement
After surgery, make sure you also do the following:
- Participate in regular light exercise programs to maintain proper strength and mobility of your new knee.
- Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.
- Make sure your dentist knows that you have a knee replacement. Talk with your orthopaedic surgeon about whether you need to take antibiotics prior to dental procedures.
- See your orthopaedic surgeon periodically for a routine follow-up examination and x-rays. Your surgeon will talk with you about the frequency and timing of these visits.
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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.
Risks Of The Procedure
As with any surgical procedure, complications can occur. Some possiblecomplications may include, but are not limited to, the following:
Blood clots in the legs or lungs
Loosening or wearing out of the prosthesis
Continued pain or stiffness
The replacement knee joint may become loose, be dislodged, or may not workthe way it was intended. The joint may have to be replaced again in thefuture.
Nerves or blood vessels in the area of surgery may be injured, resulting inweakness or numbness. The joint pain may not be relieved by surgery.
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.
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What Happens During Total Knee Replacement Surgery
During total knee replacement surgery, your orthopaedic surgeon replaces damaged bone and cartilage in a step-by-step process:
- Knee replacement surgeons often replace the entire surface at the ends of the thigh and lower leg bones.
- Surgeons cap the end of these damaged bones, as well as the kneecap, with artificial surfaces lined with metal and plastic.
- Surgeons usually secure knee joint components to the bones with cement.
- Surgeons remove the damaged cartilage and replace it with new joint surfaces.
Most patients are under general anesthesia for joint replacement surgeries. That means you’ll be unconscious during the surgery. Regional anesthesia which only numbs the knee area and keeps you awake, but sleepy may be an option for some patients.
Whats The Recovery Process
- Patients should make arrangements to have someone help at home during the first few days, especially if extensive rehabilitation is required.
- Recovery rates vary from person-to-person. Intensive rehabilitation might take up to several months. In addition to outpatient physical therapy, a patient might be given an in-home exercise regimen to help build strength and endurance. Most individuals gradually return to their normal activities in about 8 12 weeks.
- Knee replacement patients should avoid high-impact sports, such as running and high-impact aerobics. These types of activities might loosen the prosthesis and can be painful.
- An orthopedic surgeon will monitor a patients progress over a few months. He or she will discuss further appointments prior to discharge.
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Causes Of Chronic Knee Pain
Chronic knee pain is often caused by some type of arthritis in the knee, including:
- Osteoarthritis, when shock-absorbing cartilage in the joint has worn away
- Post-traumatic arthritis, when old knee injuries continue to cause pain
- Rheumatoid arthritis, when your immune system mistakenly attacks your joints because of this autoimmune disease
The most common reason for a knee replacement is severe osteoarthritis in 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.
Getting A Second Opinion
Be sure you consider a second opinion, even if you feel completely comfortable with the first orthopedic surgeon you consult. A second opinion, preferably at a different clinic, can give you valuable insight and perspective. You may want to visit three or four doctors, or more. If you receive conflicting information, dont be shy about going back to each doctor and asking additional questions.
You will have many questions and concerns about your knee replacement surgery. In the making your final decision, be sure to do the following:
- Take your time choosing your doctor.
- Do research.
Why Revisions Are More Complex
Revision replacement is difficult for several reasons. First, when someone has surgery, scar tissue develops, and soft tissues become less identifiable. Performing the second surgery is always more difficult. Second, when performing a knee replacement, bone is removed. When performing a revision knee, often more bone has to be removed, and some may be lost as a result of the problem with the implant. Maintaining adequate bone to support the new implant can be a challenge. Finally, obtaining a knee that is flexible enough to allow for motion, yet stable enough to keep you steady, is also more difficult in revision situations.
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Tests Before Knee Replacement Surgery
About six weeks or so before your operation you will have an appointment for a ‘pre-admission’ or ‘pre-assessment’ clinic. At this clinic a nurse will assess your fitness for your knee surgery.
There are several tests that may be needed and they include:
- Blood tests – to check that you aren’t anaemic and that your kidneys and liver are working well enough for you to undergo the operation.
- Urine test – to make sure you haven’t got a urine infection and that there isn’t any glucose in your urine.
- Blood pressure.
- Infection screen – this includes looking for meticillin-resistant Staphylococcus aureus . MRSA is a germ that is difficult to treat and can cause complications of a knee replacement.
- A heart tracing .
You may have the chance to speak with an anaesthetist, physiotherapist, occupational therapist or social worker at this clinic but this isn’t always possible.
Do I Need A Continuous Passive Motion Machine
In general, no. However, depending on the circumstances of your surgery, you may benefit from a CPM. If so, most patients will be started on the CPM on the first post-operative day.
The amount of bend will gradually increase while you are in the hospital. Typically, patients will use the machine for 1-2 hours at a time, 2-3 times a day. Except under rare circumstances, you will not need a CPM when you go home.
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Minimally Invasive Total Knee Replacement
At Rush, our surgeons are able to perform most knee replacement surgery through a small incision instead of the large 8- to 12-inch incision used in traditional knee replacement.
Your joint replacement surgeon will talk to you about which approach will give you the best results. These are some reasons you may be a good candidate for minimally invasive knee replacement:
- Your knee structure is stable and you don’t have severe bone loss around your knee
- You have not had previous open knee surgery on the same knee
- Your weight is proportionate to your height
There are several potential advantages to minimally invasive total knee replacement:
- Less damage to the muscles and tendons
- Increased range of motion sooner after surgery
- Less blood loss
- Shorter hospital stay
- Faster recovery
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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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:
Ial Knee Replacement Surgery
Partial knee replacement involves removing only the parts of the knee that are worn out. This procedure is also known as unicompartmental knee replacement.
We frequently do partial knee replacement for certain people, like those with arthritis in only one part of the knee. Learn more about arthritis.
People recover faster from partial knee replacement than total knee replacement because the incision is smaller. Our doctors will recommend a knee replacement that is right for you.
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Before You Have A Total Knee Replacement
If your knees crunch and creak when you climb stairs, feel achy and stiff in the morning, swell or feel like they lock up or buckle, youre probably experiencing the symptoms of osteoarthritis. If its been going on long enough, your doctor may have suggested you consider a total knee replacement.
Before you agree to surgery, you owe it to yourself to get all the facts about total knee replacement surgery and what it can do for your health. Fortunately, help is here thanks to Total Knee Replacement, a new guide from the experts at Harvard Medical School and you can download and begin reading this report right now.
In concise, easy-to-understand terms, this information-packed guide walks you through everything you need to know from why knee joints wear out to deciding if knee replacement is right for you to the types of implants available to the risks and complications of surgery to your recovery and your life with your new knee.
Harvard Medical School experts including the guides medical editor, Scott D. Martin, Associate Professor of Orthopedics created Total Knee Replacementto reveal:
Whether your just beginning to consider a total knee replacement or have surgery scheduled, Harvard Medical Schools Total Knee Replacementguide is a must-have that will help you make the choices to keep you active and healthy for life.