Your Pain Prevents You From Doing Normal Activities Or Caring For Yourself
If you cant get relief from other treatments, your knee pain may start interfering with your daily life.
In general, the timing of a total knee replacement is determined by the impact the knee is having on your quality of life, says Jay Lieberman, MD, chief of orthopaedic surgery at Keck Medicine and chair and professor of orthopaedic surgery at the Keck School. If conservative treatments are not working and you have significant pain while walking, you may be a good candidate for surgery.
The National Joint Registry
The National Joint Registry collects details of knee replacements done in England, Wales, Northern Ireland and the Isle of Man. Although it’s voluntary, it’s worth registering. This enables the NJR to monitor knee replacements, so you can be identified if any problems emerge in the future.
The registry also gives you the chance to participate in a patient feedback survey.
It’s confidential and you have a right under the Data Protection Act to see what details are kept about you.
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.
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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.
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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Dangers And Risks Of Putting Off Knee Replacement Surgery
Patients often delay knee replacement surgery because of fear of the procedure or concerns about the recovery process. Interestingly, while many people worry about what could possibly happen if they undergo knee replacement surgery, fewer stop to think about what will likely happen if they wait:
- Increased knee pain
- Further damage to the joint
- Reduced mobility and ability to use the knee
Continuing to delay knee replacement surgery can bring about serious consequences, such as the inability to walk, work and perform normal daily tasks.
Knee Replacement Surgery May Be More Complex the Longer You Wait
The longer a patient waits to have knee surgery, the more complicated the surgery can become. Here are some ways the procedure can become more complex when a person delays knee replacement surgery:
- The knee may become deformed and therefore harder to replace
- The surgical procedure can take longer
- Kneecap resurfacing may be required
- Options may become more limited. For instance, early on, a patient may only need a partial knee replacement, but if they wait, they may need total knee replacement which is a more complex procedure.
Delaying Knee Replacement Surgery May Diminish Health
Make a Knee Replacement Surgery Appointment
Most patients who have had knee replacement surgery not only report positive outcomes including reduced pain or complete freedom from knee pain, many say they would have had knee replacement surgery sooner.
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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How Long Does It Take To Recover From A Knee Replacement
For most people, it will take three months after surgery before they can do their regular activities again. It may take six months to a year before your knee regains full function.
How quickly you recover from surgery will depend on your:
- how strong your knee was before surgery, and
- whether you have other health problems like diabetes or rheumatoid arthritis.
These diseases weaken your immune system and can slow down healing.
An Artificial Meniscus May Soon Be Available
If you are suffering from knee pain following meniscus surgery or are without viable treatment options, the NUsurface®Meniscus Implant may provide an alternative option, once it has approval from the U.S. Food and Drug Administration. NUsurfaces design mimics the function of the natural meniscus and redistributes weight across the knee joint. The implant is made from medical grade plastic and, as a result of its unique materials, composite structure, and design, does not require fixation to bone or soft tissues.
NUsurface can potentially address the treatment gap of those who are too old for meniscus repair and too young for total knee arthroplasty. U.S. clinical trials completed enrollment in June 2018, and the company expects to file for U.S. Food and Drug Administration approval soon.
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Other Forms Of Treatment
Without replacement surgery, a severely osteoarthritic knee joint may continue to deteriorate until it is impossible to go about your normal daily activities, such as standing up, walking or getting up from a seated position. Other forms of treatment include:
- The use of walking aids, such as frames or walking sticks
- Non-steroidal anti-inflammatory drugs
- Corticosteroid injections
- Other surgery, such as osteotomy an operation in which diseased bone is cut away in an attempt to properly align the malformed joint.
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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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My Predicament: How Long I Waited Before Getting Knee Replacement
I waited over 15 years after my first orthopedic surgeon told me I was a candidate for TKR. He told me that it was up to me and that when the pain became too much for me to handle that I should come back and make an appointment for TKR.
I had had two previous meniscus surgeries in my 20s. There had always been some pain after those surgeries.
The pain increased slowly over a period of 40 years and I just lived with the pain. By my early 60s the pain was severe, I had developed a limp and my leg had begun to bow.
I was still fearful of the procedure and wanted to put it off as long as possible. After many non-invasive procedures and after two visits to two different orthopedic surgeons who both wondered how I was even walking, I made my decision to go forward with the surgery.
After doing the surgery the doctor told me that the wear was extensive and he was surprised I was able to wait as long as I had.
What About Exercise Following A Knee Replacement
Exercise and sport are recommended after knee replacement, apart from contact sports, which may weaken the cement and lead to loosening of the joint components. Recreational sports including golf, tennis and skiing will gradually become possible depending on how fit and sporty you were before the operation. Cycling is a very good way of building up strength and mobility after knee surgery.
Exercising the main muscle groups around your knee is very important both before and after having a knee replacement. You can download a selection of exercises that are designed to stretch, strengthen and stabilise the structures that support your knee. Try to perform these exercises regularly, for instance for 10 minutes six to eight times a day. However, its important to find a balance between rest and exercise so you dont overwork your knee. Its a good idea to get advice from your doctor or physiotherapist about specific exercises before you begin.
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All In The Timing: Many Get Knee Replacement Too Late Or Too Soon
MONDAY, Jan. 13, 2020 — It’s a question many aging Americans face: Is it time to replace my aching knee, or should I wait?
New research suggests that for far too many patients, the procedure is done either too late or too soon.
Much of the success of knee replacement surgery for knee osteoarthritis depends on timing, but a team at Northwestern University’s Feinberg School of Medicine in Chicago found that 90% of patients who could benefit from the procedure waited too long to have it, while about 25% of patients who didn’t need it underwent the procedure too soon.
In most cases, “people are waiting and waiting to have the procedure and losing the most benefit,” said lead investigator Hassan Ghomrawi, associate professor of surgery.
“When people wait too long, two things happen,” Ghomrawi explained in a university news release. “The osteoarthritis causes deterioration of their function. Some of them wouldn’t be able to straighten out their legs, affecting their walking and mobility. When you can’t get exercise, you can start to develop other health problems such as cardiovascular problems. You may also become depressed. The overall impact can be huge.”
Nearly 1 million knee replacements are performed in the United States each year, and a large increase in that number is expected by 2030, the study authors said.
Another problem with delaying knee replacement surgery is that it’s less effective, the research team explained.
Study author Ghomrawi agreed.
How Does A Knee Replacement Work
A total knee replacement surgery can take from one to three hours. During that time, an orthopedic surgeon will remove damaged cartilage and bone before fitting the replacement joint, called an implant, with help from the latest robotic-assisted technology. Using this device, your surgeon can pre-plan the procedure and get the most accurate measurements, ensuring that your implant is perfectly fitted. It also helps with bone resurfacing and the removal of cartilage. Implants come in a variety of different designs created by different manufacturers, but will always contain metal and plastic components that fuse to the resurfaced bone. Your orthopedic surgeon will select the design that best fits each patient based on their lifestyle habits and the severity of the biological joints deterioration, said Dr. Doherty.
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Is It Possible To Have Osteoarthritis In Your Knee And Not Feel It
In healthcare, a common way of diagnosing osteoarthritis is through an X-ray. On an X-ray, knee osteoarthritis will show up as decreased joint space. This is what people commonly refer to as bone on bone. With all of the damage that osteoarthritis does to the knee, and the effect this has on a persons ability to do daily activities, it may be confusing to be told you have knee osteoarthritis after getting an X-ray, but you have no pain.
X-rays are an important tool in healthcare. Generally, the more severe that arthritis appears on an X-ray, the more likely it is that symptoms, such as pain, are present. Although this is not always the case! While it is normal to have pain accompanied by an X-ray that shows knee osteoarthritis, it is actually just as common to have no pain. 44-53% of people with these positive X-ray findings have no pain in the knee. This doesnt mean that you should not have pain with arthritic X-ray findings, but rather it shows that X-ray findings ALONE are not a good tool to show if someone has knee pain or difficulty functioning, due to knee osteoarthritis.
The reason one person with an arthritic X-ray might have pain and another person might not is related to the persons leg strength, presence of other medical conditions, and mental health status. Increased leg strength, proper management of other medical conditions, and good mental health are likely factors that contribute to having less pain in your arthritic knee.
Who Is Offered Knee Replacement Surgery
You may be offered knee replacement surgery if:
- you have severe pain, swelling and stiffness in your knee joint and your mobility is reduced
- your knee pain is so severe that it interferes with your quality of life and sleep
- everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
- you’re feeling depressed because of the pain and lack of mobility
- you cannot work or have a social life
You’ll also need to be well enough to cope with both a major operation and the rehabilitation afterwards.
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Are There Nonsurgical Treatment Options
Before discussing knee replacement, your doctor may prescribe an anti-inflammatory over-the-counter pain medication such as ibuprofen or naproxen to help with pain and reduce swelling. Cortisone, a steroid hormone, may also be injected into the knee to relieve pain. You might also want to try glucosamine or chondroitin sulfate, common supplements containing material found in the joints, which help with regeneration.Losing weight, thanks to changing your diet and exercising more, also have a positive effect on the joints. Our knees receive four pounds of pressure for each pound of body weight, giving even a slight reduction considerable impact. Beyond that, the increased strength and mobility from exercise can reduce pressure.
Alternatives To Total Knee Replacement Surgery
There are several different conservative or less invasive options that may be attempted prior to having a total knee replacement.
Injections are often used in an attempt to decrease inflammation, friction, and pain in the joint. Surgical options to consider aim to preserve or restructure remaining tissue and to prevent or put off a total knee replacement.
Physical Therapists provide non-invasive treatment options to improve strength, flexibility, and body mechanics for functional activities to reduce knee pain. PTs can also educate patients on an exercise program for improving body composition.
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Your Knee Is Always Swollen
Swelling is another sign your knee is not responding to other treatments.
A knee that is consistently swollen despite the use of anti-inflammatory medications, steroid injections and physical therapy suggests degeneration of the cartilage and/or instability of the knee, which can be confirmed with an X-ray, Lieberman explains. This can make you a candidate for a total knee replacement, he says.