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When Is Total Knee Replacement Necessary

Minimally Invasive Knee Replacement

Total Knee Replacement Surgery at Boston Medical Center

In 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. However, specially designed surgical instruments are used to prepare the femur and tibia and to place the implants properly.

Minimally invasive knee replacement is performed through a shorter incisiontypically 4 to 6 inches versus 8 to 10 inches for traditional knee replacement. A smaller incision allows for less tissue disturbance.

In addition to a shorter incision, the technique used to open the knee is less invasive. 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. Other minimally invasive techniques called midvastus and subvastus make small incisions in the muscle but are also less invasive than traditional knee replacement. Because the techniques used to expose the joint involve less disruption to the muscle, it may lead to less postoperative pain and reduced recovery time.

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Possible Complications Of Surgery

The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, occur in fewer than 2% of patients. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery.

Discuss your concerns thoroughly with your orthopaedic surgeon prior to surgery.

Infection. Infection may occur in the wound or deep around the prosthesis. It may happen within days or weeks of your surgery. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.

Blood clots. Blood clots in the leg veins are one of the most common complications of knee replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopaedic surgeon will outline a prevention program, which may include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings, and medication to thin your blood.

Blood clots may form in one of the deep veins of the body. While blood clots can occur in any deep vein, they most commonly form in the veins of the pelvis, calf, or thigh.

Why Patients With Joint Implants No Longer Need Antibiotics Before A Dental Visit

QUESTION: When my knee was replaced with an artificial joint, the surgeon said I should always take antibiotics before any dental procedure. He said the bacteria in my mouth could get into my bloodstream and cause an infection around the implant. But my dentist said not to worry and that I actually dont need antibiotics. Who is correct?

ANSWER: For several years, orthopaedic surgeons and dentists have given conflicting advice about whether a patient with a prosthetic joint implant needs antibiotics to prevent potential infections a practice known as antibiotic prophylaxis.

The surgeons believed that antibiotics were necessary because a joint infection could jeopardize the implant. Dentists, on the other hand, felt that mouth bacteria didnt pose a risk to the implants and patients shouldnt be taking the drugs needlessly.

The mixed messages have certainly caused confusion for a lot of patients. But, thankfully, the dentists and surgeons have finally settled their differences and come to a common position. After reviewing the available scientific evidence, they recently concluded that antibiotics arent needed before dental procedures after all.

The national bodies that represent the two professions , plus infectious disease specialists have issued a joint statement calling for an end to the practice.

To understand how we got to this point, its worthwhile reviewing the long history of this controversy.

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Technical Details Of Total Knee Replacement

Total knee replacement surgery begins by performing a sterile preparation of the skin over the knee to prevent infection. This is followed by inflation of a tourniquet to prevent blood loss during the operation.

Next, a well-positioned skin incision–typically 6-7 in length though this varies with the patients size and the complexity of the knee problem–is made down the front of the knee and the knee joint is inspected.

Next, specialized alignment rods and cutting jigs are used to remove enough bone from the end of the femur , the top of the tibia , and the underside of the patella to allow placement of the joint replacement implants. Proper sizing and alignment of the implants, as well as balancing of the knee ligaments, all are critical for normal post-operative function and good pain relief. Again, these steps are complex and considerable experience in total knee replacement is required in order to make sure they are done reliably, case after case. Provisional implant components are placed without bone cement to make sure they fit well against the bones and are well aligned. At this time, good function–including full flexion , extension , and ligament balance–is verified.

Finally, the bone is cleaned using saline solution and the joint replacement components are cemented into place using polymethylmethacrylate bone cement. The surgical incision is closed using stitches and staples.


Length of total knee replacement surgery

Pain and pain management

What Is Physiotherapys Role In Total Knee Replacement

Total Knee Replacement Surgery

Physiotherapy plays a very important role in pre- and post-surgical management of a TKR:

a) The surgeon may send the patient to Physiotherapy before the operation in order to have Pre-Operative Physiotherapy, which aims to:

  • aid in gaining strength before the operation
  • educate the patient about the operation
  • teach the patient how to walk with crutches and to do exercises that will be done post- surgery, as well as
  • discuss the plan for rehabilitation after the operation.
  • It has been shown that even one pre-operative session can shorten the hospital stay of patients and is thus highly recommended.

    b) Immediately following the surgery, the surgeon will request that the patient be seen by a Physiotherapist:

  • Recent research in the UK has suggested that the first session of in-hospital Physio is performed on the same day of surgery, once the patient is back in the ward and awake and alert.
  • Physio will assist in teaching the patient to walk with crutches or a walking frame, how to safely go up and down stairs, regain movement in the knee and start some simple strengthening exercises.
  • Patients are discharged usually after five days, or once they are able to walk safely on their own.
  • c) Following discharge, it is the role of the Physiotherapist to:

  • help with return to normal function,
  • ensure that the patient regains most of their movement,
  • ensure that movement is pain-free,
  • help patients with strengthening exercises and a slow return to everyday activities.
  • References: NHS, Medscape.

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    Types Of Arthritis That Affect The Knee

    Inflammatory arthritis

    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 .

    Your Persistent Knee Pain Doesnt Improve With Anti

    When most of us experience knee pain, our go-to methods of relief usually include:

  • Anti-inflammatory medications such as Advil or Aleve
  • The RICE method
  • These methods work well for anyone dealing with general knee pain. They give quick relief and can help speed up the recovery process in most cases.

    Unfortunately, these methods hardly do anything when it comes to solving chronic knee pain.

    You may have experienced this yourself. Have you tried both methods of relief only to find that the pain still persists?

    This is another telltale sign that youre not dealing with general knee pain and instead facing chronic knee pain.

    With this, further corrective action, such as a total knee replacement, may be needed in order to sustain long-term relief.

    Losing weight is also another method to help ease your knee pain but its not a guarantee your pain will go away.

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    Important Points In Treatment

    Knee replacement is a safe operation. Complications occur in less than 1% of patients.

    The replacement knee lasts between 10 and 15 years before it begins to show wear. Need for replacement is likely after about 10 years.

    Recovery from knee replacement surgery is a matter of gradual improvement in function over a period of months. Although the stay in the hospital may be short, an interval of physical rehabilitation is necessary before full recovery.

    Even with full recovery, some limitation of motion in the knee remains. Prosthetic joints cannot fully recapture all of the motion of a natural joint. A slight limp may persist.

    David T. Felson, in, 2017

    How Your New Knee Is Different

    Total Knee Replacement Guideline | SYNOPSIS

    Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery can be predicted by the range of motion you have in your knee before surgery. Most patients can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently to climb stairs and get in and out of a car. Kneeling is sometimes uncomfortable, but it is not harmful.

    Most people feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities.

    Most people also feel or hear some clicking of the metal and plastic with knee bending or walking. This is a normal. These differences often diminish with time and most patients find them to be tolerable when compared with the pain and limited function they experienced prior to surgery.

    Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated.

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    How Painful Is Physical Therapy After Knee Replacement

    You may feel some discomfort with your exercises, but this should be reasonable discomfort. If pain is excessive or lasts more than one hour after exercise, inform your therapist at your next visit. You may need to change the number of repetitions, the amount of pressure, or the how often you are doing the exercises.

    You Have Bad Arthritis

    Most people who undergo a knee replacement have either osteoarthritis, the wear-and-tear type of arthritis rheumatoid arthritis, an autoimmune condition that causes joint pain and damage or post-injury arthritis.

    Osteoarthritis, rheumatoid arthritis and posttraumatic arthritis affect the knee through different mechanisms, however, these different conditions are similar in that they all result in loss of cartilage, which causes pain and loss of motion, says Nathanael Heckmann, MD, an orthopaedic surgeon at Keck Medicine of USC and an assistant professor of clinical orthopaedic surgery at the Keck School of Medicine of USC. When these symptoms become severe, knee replacement surgery may provide considerable symptom relief by replacing the worn-out surfaces of the knee.

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    Can Rehabilitation Be Done At Home

    All patients are given a set of home exercises to do between supervised physical therapy sessions and the home exercises make up an important part of the recovery process. However, supervised therapy–which is best done in an outpatient physical therapy studio–is extremely helpful and those patients who are able to attend outpatient therapy are encouraged to do so.

    For patients who are unable to attend outpatient physical therapy, home physical therapy is arranged.

    What Activities Will I Be Able To Engage In

    Revision Total Knee Replacement

    Most patients require an assistive device for approximately 3 weeks after knee replacement surgery although this varies significantly from patient to patient.

    You will also be able to do low-impact exercise such as riding a stationary bike, walking, and swimming after 68 weeks. Your physical therapist can advise you on introducing new activities during this time.

    You should avoid running, jumping, as well as other high-impact activities.

    Discuss with your orthopedic surgeon any questions concerning your activities.

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    More About The Advantages Our Surgeries Provide

    Our mini-incision knee replacement surgeries are performed by board-certified orthopedic surgeons and facilitated by innovative medical technologies, such as MAKOplasty® knee resurfacing procedures to minimize incisions and scarring, and the RIO Robotic Arm Interactive Orthopedic system that helps ensure optimal implant positioning. This leading-edge approach to knee replacement helps our patients experience streamlined recoveries and encourages a more natural knee motion once the joint has healed. Our surgeons also perform minimally invasive joint replacement revision surgeries for patients whose prostheses have broken or worn out.

    If youve been considering knee replacement surgery and would like to discuss possible knee pain treatment options with a Tampa General Hospital orthopedic surgeon, call 1-800-822-DOCS or use our online Physician Finder to receive a referral to our orthopedics program.

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    Youre Ok With Avoiding Certain Activities Afterward

    Patients should know what to expect after knee replacement surgery and understand that regular high-impact activities may not be advisable.

    Total knee replacement is quite successful in enabling patients to return to an active lifestyle patients can perform all types of recreational activities, including hiking, bicycling, skiing, surfing, tennis and golf, Lieberman says. In general, we do not limit activities but suggest that patients avoid impact activities on a consistent basis to reduce wear of the prosthesis.

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    Looking After Your Knee Replacement

    Your new knee will continue to improve for as much as two years after your operation as the scar tissue heals and you exercise your muscles. You’ll need to look after yourself and pay attention to any of the following problems:

    Stiffness Sometimes the knee can become very stiff in the weeks after the operation for no obvious reason. Try placing your foot on the first or second step of the stairs, hold on to the banister and lean into your knee. This should help to improve movement and flexibility in your knee. Its very important to continue with the exercises you were working on in the hospital.If the stiffness doesnt improve after about six weeks your surgeon may need to move or manipulate your knee. This will be done under anaesthetic.

    Pain Pain caused by bruising from the operation is normal in the first two months, and you’ll probably still need to take painkillers at six weeks to help you sleep through the night. You may still have some pain for as long as six months. If you still have pain after this, speak to your physiotherapist or GP.

    Infection You should speak to your GP or hospital if you notice any signs of infection, for example:

    • breakdown of the wound with oozing/pus or sores
    • increased pain
    • redness and the affected area feeling warmer than usual or smelling unpleasant.

    You should also look after your feet see a doctor or podiatrist if you notice any problems such as ingrown toenails that could become infected.

    Setting The Stage For A Successful Outcome: Surgery At Hss

    Total knee replacement surgery at Sunnybrook’s Holland Centre

    Partial knee replacement is widely recognized as a technically demanding surgery. As demonstrated in the scientific literature, data shows that choosing an orthopedic surgeon and institution with extensive experience with this procedure can help ensure a good result. In fact, at high-volume institutions like HSS, in well-selected patients, surgeons achieve the same longevity for partial knee replacement as that reported for .

    Its important to understand that partial knee replacement is a challenging procedure to perform, says , Attending Orthopedic Surgeon at HSS. At HSS, we collect data on partial knee replacement patients on an ongoing basis. This allows us to continuously refine screening and surgical techniques to achieve predictable results and the best outcome possible.

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    Why Come To Hss For Your Knee Replacement

    I call knee replacement surgery a team sport. The two most central players are the surgeon and the patient, but there are many other people on the team who help make it successful. At HSS, our knee replacement surgeons are among the most skilled surgeons in the world. In addition to their deep expertise and extensive training, they have a singular focus on joint replacement surgery. This experience allows them to achieve very high success rates, avoid complications and help effectively relieve our patients pain.

    Another advantage is that the knee replacement surgeons at HSS embrace the multidisciplinary aspects of orthopedic care. They work closely with anesthesiologists, rehabilitation specialists, nurses, dietitians, and many others to keep our patients safe and healthy so they can get back to what they love to do.

    The fact that HSS is a specialty hospital focused solely on orthopedics and rheumatology is a great advantage. All our staff have great experience and a singular focus. Since we do not have to compete with other departments for resources, we can concentrate all our efforts on obtaining the best outcomes for our patients without any compromise.

    Know All Of Your Treatment Options

    Your doctor may give you additional or alternate information regarding knee pain and total knee replacement surgery. If you have questions about treatment options, schedule an appointment to discuss whats right for you. Contact us today to learn more about NUsurface as a knee pain treatment option.

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