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HomeMust ReadWhat Muscles Are Cut During Total Knee Replacement

What Muscles Are Cut During Total Knee Replacement

What Are Possible Side Effects Of The Surgery

Muscle Retraining After Knee Replacement

Urquhart: All surgeries have a risk of complications. Less than 1% of healthy patients undergoing any type of surgery can experience a cardiovascular event, such as a heart attack or stroke. About 0.5% of knee replacement surgery patients develop an infection.

But an important side effect or outcome to talk about is this buyers remorse idea I brought up earlier. About 15 to 20% of patients that undergo total knee replacement surgery have buyers remorse because they still experience discomfort, clicking or a sensation of instability in their knee, making them regret having the procedure. That is exactly why we consider non-surgical options first and remind patients that they should not make the decision to have surgery without careful consideration.

How Long Will I Be On Pain Medication After My Knee Replacement Surgery

Every patient experiences recovery from a knee replacement surgery differentially and as such, everyone will require pain medication at different intervals and for different amounts of time. There is no standard approach to this, although generally we do expect patients to be weaned off their narcotic analgesics within 2 to 3 weeks of the surgery and by 6 weeks after the surgery should only be requiring occasional Tylenol or a less potent analgesic to control their pain.

With that being said, there are a number of different factors that can affect a persons ability to tolerate pain medication or indeed their ability to have the pain medication kill their pain. As such, each medication regimen will be tailored to the individual. It is important to regularly communicate with your surgeon or healthcare provider regarding your experience of the pain and your current pain medication regimen, so that it can be altered to suit you and your needs.

Osteotomy Of The Anterior Tibial Tuberosity

Preferred and used routinely by some authors in knee joints that are difficult to expose, this is an approach that offers excellent exposure.

A midline skin incision is made that extends 810 cm below the ATT. The medial parapatellar arthrotomy begins at a point about 6 cm proximal to the patella and ends distally on the anterior tibial crest.

A trapezoidal osteotomy is performed , leaving the periosteum and lateral muscular attachments intact to the bone fragment . Once the ATT has been overturned, the extensor mechanism can be raised proximally allowing complete exposure of the joint. However, this approach is technically demanding, carries a high risk of complications and should be reserved for selected cases.

The rate of complications occurring with this approach and reported in the literature, such as loss of reduction, impaired synthesis and fracture of the tibia, ranges from 7% to 22% . Wolff reported a risk of loss of reduction if the bone block of the ATT is too short . Whiteside highlighted a risk of fracture of the tibia if the tibial bone block is too long .

Engh and Rorabeck , in 185 revision knee arthroplasties, used a standard approach in 54% of the cases, a quadriceps snip in 29%, a VY approach in 13%, and ATT osteotomy in only 4%.

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Special Precautions To Take

  • Remember this is an artificial knee and must be treated with care.
  • In general, the more active you are the quicker your knee will wear out.
  • You can drive when you have regained muscle control, usually by 6 weeks.
  • Avoid situations where you might fall.
  • Your knee may go off in a metal detector at the airport. You can receive a note from our rooms to say you have had a joint replacement.
  • Prevention of infection is vital. If you have any infections anywhere make sure you see your local doctor straight away for treatment. If you get increasing pain in your joint and are sick and have temperatures you should go to hospital to get checked out.
  • USE OF ANTIBIOTICS Antibiotics should be prescribed if you have an infection anywhere in the body, if you have surgery in contaminated areas such as teeth, nose, bowel or bladder, podiatry treatment or urinary catheterisation.

Is The Patella Replaced In A Total Knee Replacement

Minimally Invasive Vs Total Knee Replacement

4.3/5total knee replacementreplacingjointjointtotal knee replacementreplacingkneecap

Subsequently, one may also ask, is the patella removed during knee replacement?

Damaged cartilage and bone are removed from the knee joint. Upper end of the shin bone, which is the large bone in your lower leg — This bone is called the tibia. The replacementpart is usually made from metal and strong plastic. Back side of your kneecap — Your kneecap is called the patella.

Beside above, what is replaced in a total knee replacement? A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with artificial material. The knee is a hinge joint that provides motion at the point where the thigh meets the lower leg. During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell.

Consequently, is the kneecap replaced in a total knee replacement?

In a total knee replacement, both sides of your knee joint are replaced. Your surgeon makes a cut down the front of your knee to expose your kneecap. This is then moved to the side so the surgeon can get to the knee joint behind it. The damaged ends of your thigh bone and shin bone are cut away.

Can the patella be replaced?

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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.

How Long Is Recovery From A Knee Replacement

The most critical period of recovery occurs during the first 3 months, when you are working hard to decrease pain and swelling, improve range of motion and wake up the muscles around the knee using physical therapy, home exercises and often a stationary bicycle.

Most people are able to return to work within a month, if their job does not require them to stand all day or lift, push or pull heavy objects. The majority of patients continue to take over the counter medications and ice daily for several months. Some patients are able to return to activities such as light hiking after just a few months.

There will be days and nights during those first few months that you will wish you had not had the surgery, but in the end, most people comment they wonder why they waited so long. You may continue to see improvements for 1-2 years after surgery as you regain overall strength and endurance.

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What Are The Possible Complications Of Total Shoulder Replacement Surgery

Fortunately the complications rate after surgery is small . Infection is a concern but happens rarely since antibiotics are given to prevent it. Nerve or artery damage is very rare. Since the shoulder is a ball and socket, the ball can shift out of the socket . Again, this is very uncommon. Lastly the components of the replacement can get loose from the bone over time, especially if the arm is used excessively. After ten years approximately 3 percent of the shoulders are loose, but revision surgery is rarely needed.

Fear Bending And Baby The Knee

Dr. William Stanton explains muscle sparing knee replacement surgery

I have been in the field working as a therapist for over 20 years and havent yet seen an incision split open with active bending exercises, however I do understand how this fear can overwhelm early on in the recovery. The rule is baby the knee went it comes to walking but dont baby the knee when it comes to bending. That doesnt mean you aggressively bend the knee. You must use frequent low loads and the knee will respond delightfully and give you back your range of motion in steady increments.

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Life After Knee Replacement

The goal of knee replacement surgery is to improve your quality of life and restore function that has been lost as a result of arthritis in the knee, there are a number of activities that knee replacement patients find that even years after the surgery, they are unable to do comfortably. The most common complaint in knee replacement patients is that they have difficulty performing tasks that require kneeling. This is normal and whether or not the patient has had their kneecap replaced as part of their knee replacement does not seem to affect this phenomenon.

Total knee replacement prosthetic components

The image shows the prosthetic components consisting of cobalt chromium alloy metallic tibial and femoral components and polyethylene insert. The femoral component and insert are cruciate retaining. The choice between cruciate retaining and posterior stabilized implant is made depending upon the disease in the knee joint and the integrity of the posterior cruciate ligament.

Modular femoral and tibial components along with polyethylene insert

Modular prosthetic components differ from primary knee replacement components as they allow the surgeon to make intraoperative changes. The surgeon may add bone augments or stems to achieve additional stability. The constrained insert allows stable range of motion.

Modular femoral component

Femoral component stem

Risks Of The Procedure

As with any surgical procedure, complications can occur. Some possiblecomplications may include, but are not limited to, the following:

  • Bleeding

  • Blood clots in the legs or lungs

  • Loosening or wearing out of the prosthesis

  • Fracture

  • 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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How Do I Know If I Need Knee Replacement Surgery

You may need surgery if:

  • Your knees are stiff and swollen.
  • There is pain throughout the day, even at rest.
  • Walking, getting up or climbing stairs is difficult and painful.
  • Medication and therapy do not offer enough relief.
  • Knee cartilage is so damaged and worn away that you are walking “bone on bone,” in which the bones of the joint are scraping together.

Minimal Invasive Surgery Approaches

About the Surgery

The needs to reduce surgery complications, hospital stay, and the need to accelerate functional postoperative recovery have lead surgeons to use smaller incisions that disrupt less tissue. Additionally, blood loss is significantly lower than that in the classic incision cases some patients may experience less postoperative pain, some may be able to resume their daily activities sooner, and some prefer the aesthetic aspect of the shorter scar .

Figure 21.

MIS incision versus classical in TKA.

The need for faster recovery time in total knee arthroplasty with less tissue disruption helped develop the mini-incision TKA technique in which the same surgical concepts are utilized, the same alignment goals are followed, but the original instruments have been minimized. A surgeon performing this technique should first have a good background in using the standard TKA procedure and should be familiar with the classical prosthesis components.

The mini-incision TKA is not indicated for all patients. Candidates for mini-incision arthroplasty must have preoperative flexion greater than 90% and must not be obese.

Extreme varus or valgus cases are contraindicated and also patients suffering from rheumatoid arthritis, for structural tissue reasons.

Figure 22.

MIS skin incision vs classical.

Figure 23.

Different MIS incisions.

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What Is The Recovery Like After Total Shoulder Replacement Surgery

Most patients are given a morphine pump after surgery so they can control their own pain medicine. After a day or so most patients switch over to pain medicine by mouth. The arm will be in a brace but it can be taken off to do therapy. Antibiotics are given by vein for a day to prevent infection. Physical therapy begins the day after surgery and begins with moving the fingers, wrist and elbow. Some motion of the shoulder is begun within a day or so after surgery. The physical therapist will show the patient a program of exercises to do at home. Most patients stay in the hospital from three to five days.

Arthritis: The Leading Cause Of Knee Pain

Inflammation, pain, inactivity, and lifestyle factors can cause extreme tiredness and fatigue, especially when you live with arthritis. As we age, our joints can experience what is called natural wear-and-tear. Over the years, the cartilage and connective tissues in our joints can deteriorate. This deterioration can cause our joints to be stiff or inflamed. Without connective tissues or cartilage, the joint no longer has the cushioning or lubrication it needs to move and perform properly. The knee joint is most commonly affected by arthritis. Patients who have severe arthritic conditions or joint-related injuries are the most common candidates for total joint replacement surgery. Sometimes, people living with arthritis and related conditions can experience different types of pain at the same time. Thatâs why itâs important to work with your health care provider to develop the best pain management plan for your specific needs.

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What Are The Benefits Of A Knee Replacement

You do not have to live with a painful knee for the rest of your life. During this surgery your problem knee joint is replaced with an artificial joint . After a knee replacement you can look forward to moving more easily and without pain. Most people gain all the following benefits

  • Stops or greatly reduces knee pain.
  • Improves quality of life by allowing you to do your activities of daily living and low impact activities in greater comfort.
  • Enables you to sleep without pain.
  • Provides years of reliable function. Most total knee replacements last for many years.

Don’t Let Knee Pain Slow You Down

Minimally Invasive Knee Replacement and the Quadriceps Tendon

You donât have to live with severe knee pain and the limitations it may put on your activities. If you havenât experienced adequate relief with medication or other conservative treatments, knee replacement surgery may provide relief from pain and enable you to return to your favorite activities. If conservative treatments have not offered you any relief, knee replacement surgery may provide you with the pain relief you need.

The Institute for Orthopaedic Surgery & Sport Medicine can help you become one of the millions of people across the country who have had a successful and life-changing knee replacement. It’s our job to help treat your acute and chronic pain so you can comfortably function in everyday life.

For more information visit or contact a Fort Myers orthopedic surgeon today to schedule a consultation.

Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Stryker and X3. All other trademarks are trademarks of their respective owners or holders.

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Robotic Assisted Total Knee Replacement

I need to have my second knee done and since I have had some problems with my first one, I’m considering the Mako robotic assisted surgery and was wondering if anyone has had this done and your experience and advantages, if any.

I have not had that surgery, but I do know a woman who did have it and she had a great recovery and was extremely happy with it. Of course, much depends on the doctor doing it also.JK

I asked my surgeon about robotics and said the surgeries tend to go quite well, but he is holding off until more long term data is available.

My uncle had the robotic surgery done Feb 2019 and had a great recovery. I was reading that there can be less pain during recovery because the robot is able to more precisely adjust bone alignment and can use its computer brain to calculate individual measurements of the tendons, ligaments and muscle. I assume this means there is less manual manipulation of these soft tissues / stretching.

It is hard to know what to do.

I have not had that surgery, but I do know a woman who did have it and she had a great recovery and was extremely happy with it. Of course, much depends on the doctor doing it also.JK

I asked my surgeon about robotics and said the surgeries tend to go quite well, but he is holding off until more long term data is available.

It is hard to know what to do.

Possible Benefits Of Direct Anterior Approach Total Hip Replacement

Total hip arthroplasty is one of the most effective operations available in the field of orthopedic surgery. Surgery first involves removing the arthritic ball and socket using specialized instruments. A metal stem is placed within the femur and a metal socket is placed within the pelvis. A ceramic or metal ball is then placed on the stem and a dense plastic bearing is placed within the socket. The metal components are roughened and coated with a biological material which allows a patients own bone to grow into the metal, which allows the metal to become rigidly fixed. The artificial ball and plastic bearing are extremely smooth, which allows the hip to function and move similar to a normal hip.

Regardless of the surgical approach, hip replacement has a success rate approaching 95% in terms of “success” .

The major advantages of direct anterior hip replacement in comparison to traditional approaches include a more rapid recovery, less pain in the immediate post-operative period, more normal gait mechanics, and a more stable artificial hip without the need for hip precautions.

Regardless of surgical approach, the most important factor in terms of technical success involve placing the hip replacement components in a optimal position.

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