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When To Do Knee Replacement

This Common Procedure Can Help Reduce Pain And Restore Your Ability To Move Better But How Do You Know When Its Time For Surgery

6 Best Exercises To Do Before Total Knee Replacement – Prehab

Knee replacement surgery is one of the most successful procedures in all of medicine, according to the American Academy of Orthopaedic Surgery . Its also very common: Over 790,000 knee replacements are performed each year in the United States. A complete knee replacement more correctly, a resurfacing places metal pieces to recreate the surface of the joint, with a plastic separator in between and possibly a plastic resurfacing of the inside of the kneecap .

Although youll need a little help afterward, you should be able to begin walking again either the same day or the day after surgery. And the procedure is overwhelmingly successful: The AAOS estimates that 90% of modern total knee replacements are still working more than 15 years after surgery.

How do you know if you need a knee replacement in the first place? Deciding when its time is a personal decision between you and your doctor, but there are some factors that make you a more likely candidate for surgery.

How Long Replacements Last

Most knee replacements last several decades, some longer. However, there are also times when a knee replacement needs to be redone after years or even just months. Understanding why a knee replacement has worn out is critical to performing a successful revision knee replacement.

The average knee replacement lasts more than two decades, but there are reports of implants lasting longer, and new materials and surgical techniques are hoped to provide even longer-lasting knee replacements. That said, there are times when knee replacements may last a very short time, even in otherwise healthy patients. A small percentage of patients end up needing their knee replacement revised within a few years of their initial surgery.

When To Get A Knee Replacement

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Do you have pain in your knees when you walk, hike, or sit down? Surgery is a last resort for many, but you can make your condition worse by putting off a knee replacement. Knee replacement surgery can help relieve pain and restore function in severely diseased knee joints. While the idea might be scary, knee replacements are extremely common. In fact, more than 1 in 10 Americans will have a knee replacement by the time theyre 80. So, how do you know when its time?

When to Consider Knee Replacement Surgery

In many cases, your doctor will recommend alternative treatments like physical therapy and exercise before suggesting surgery. If youre overweight, your doctor will recommend losing weight before considering a knee replacement, since weight loss can often reduce knee and other joint pain. If these alternative methods dont work, knee replacement may be recommended. Heres what you should think about when considering surgery:

How to Prepare for Recovery

If you and your doctor decide knee replacement surgery is the right decision, youll need to prepare for your recovery. You may need to use crutches or a walker for several weeks after your procedure. Make sure you have a ride home from the hospital and someone to help with everyday tasks, such as cooking, bathing, doing laundry, and running errands.

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Reasons Why A Revision Replacement Is Necessary

Revision replacements are performed for a number of reasons. Some of the more common include:

  • Loosening of the implant
  • Instability of the knee
  • Malalignment of the parts

Many people ultimately have a revision knee replacement because the problem is causing significant pain. While pain can be a problem in itself, a revision knee replacement surgery should not be performed without understanding why the pain is occurring. Performing this type of surgery for pain without an identified cause is unlikely to yield good results. Instead, the cause of the problem with the knee replacement needs to be precisely understood, and there needs to be a plan to address that problem with the implant. An operation without a clear plan to address the problem is unlikely to be helpful.

Could A Nonsurgical Option Be Right For You

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If youre having problems with knee pain and swelling due to osteoarthritis, there are a number of nonsurgical treatments you can try. Anti-inflammatory drugs such as ibuprofen, certain exercises to strengthen the muscles around the knee and injections offer relief for many people.

If these measures work for you, you dont need to have surgery. But if it gets to the point where youre staying home because it hurts too much to walk, or youre unable to do simple activities like climbing stairs, it may be time to seriously consider having knee replacement surgery.

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The Benefits Outweigh The Risks

Your knee replacement surgeon will also have to consider certain factors, such as your age, overall health, and activity level to determine the necessity of and your eligibility for the procedure.

While anyone of any age can undergo knee replacement surgery if their condition calls for it, the procedure is usually carried out on older adults, between 60 and 80 years of age. Since younger individuals are generally more active, they tend to require revision surgery sooner.

A knee replacement surgeon will thoroughly assess your individual circumstances and condition to see if the benefits do outweigh the risks.

Symptoms Of Failing Or Loose Knee Replacement Implant Are:

  • Mild to severe pain in the knee
  • Symptoms of Infection, including fever, chills, muscle ache, and others
  • Difficulty or restriction of movement
  • Swelling around the knee joint
  • Fluid build up around the knee
  • Thickening of the joint tissue
  • Instability of the joint
  • Feeling of warmth around the joint
  • Bone damage

It is important to contact your orthopedic surgeon or healthcare team of your experience or notice these signs.

A revision total knee replacement usually takes longer to perform in comparison to the primary joint replacement procedure. During the surgery, the worn out or damaged implant is first removed.

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In case there is a significant bone loss, then the surgeon may have to fill in the empty space with the bone grafts. The bone grafts used for this can be either autograft, taken from the patients own bone from another site of your body or an allograft, bone tissue is obtained from another person . For some people, additional parts such as metal wedges, wires or screws may also be used to support and strengthen the bone.

Finally, the surgeon inserts the specialized revision knee implants in the place where the original replacement implant was placed. This surgery is a complex procedure that should be performed by an experienced surgeon.

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Whats A Partial Knee Replacement

In the total replacement, the surgeon removes cartilage from both sides of the knee. You may hear your doctor or PT say the lateral and medial sides of the knee.

The medial side of your knee is on the same side as your big toe, and the lateral side of your knee is on the same side as your pinky toe.

In a partial knee replacement, its usually one side that needs to be replaced. Sometimes its the knee cap that needs to be replaced in a partial replacement.1

Recognizing The Signs Of A Blood Clot

Knee Exercises After Your Joint Replacement Surgery

Follow your orthopaedic surgeon’s instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. He or she may recommend that you continue taking the blood thinning medication you started in the hospital. Notify your doctor immediately if you develop any of the following warning signs.

Warning signs of blood clots. The warning signs of possible blood clots in your leg include:

  • Increasing pain in your calf
  • Tenderness or redness above or below your knee
  • New or increasing swelling in your calf, ankle, and foot

Warning signs of pulmonary embolism. The warning signs that a blood clot has traveled to your lung include:

  • Sudden shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing

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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 Type Of Anaesthetic Will I Need

There are two different types of anaesthetic for this operation:

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.

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Should You Have Both Knees Replaced At The Same Time

Many people with osteoarthritis have problems with both knees, but usually one knee is worse than the other. Most people have surgery on one knee at a time, though some patients want to have surgery on both knees at the same time. The plus side of this is that you only need one operation, but the downside is that its a harder, slower recovery.

There are strict criteria for having both knees operated on at the same time, including being in overall good health and being motivated to undergo a more difficult recovery.

What Are The Benefits Of Having Knee Surgery

Study shows value of knee replacement surgery, other ...

The aim of knee surgery is to relieve pain and decrease stiffness or deformity, and therefore help to improve your independence and quality of life. More than 90% of knee replacement surgeries last beyond 10 years. Patients who have knee replacement surgery experience less pain and greater mobility in their knee after the procedure.

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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)

Early On Focus On Range Of Motion

All exercise after knee replacement is important to strengthen the muscles and supporting structures of the knee. Strengthening the hip is important too.

However, the sooner you begin to see progress on your range of motion the better your recovery will be. Your therapist will have you doing range-of-motion exercises right off the bat.

You dont want scar tissue to build up. You want to avoid returning to your surgeon for manipulation under anesthesia or in extreme cases, surgery to remove scar tissue.

The range of motion exercises will hurt and cause discomfort but trust me the pain is worth the result. Dont get discouraged, take shortcuts or give up.

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What Is The Best Age For Knee Replacement Surgery

Posted in Joint Replacement

Many Americans suffer from knee pain that affects their daily lives. Knee pain is usually caused by osteoarthritis, rheumatoid arthritis, or damage from a traumatic accident. For some people, treating knee problems with joint replacement surgery is a viable option. This is especially true if other treatments have not provided sufficient relief.

Knee replacement can restore mobility and improve a patients quality of life. However, a research study done by Northwestern Medicine reports that most people wait too long to have the procedure done. Some patients are also cautioned against having the surgery too early. What is the best age for knee replacement surgery? That answer depends on multiple factors.

When Can I Go Home

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You will usually be in hospital for 3 to 5 days, depending on what progress you make and what type of knee replacement you have. Patients who have a half knee replacement usually have a shorter hospital stay.

If you are generally fit and well, the surgeon may suggest an enhanced recovery programme where you start walking on the day of the operation and are discharged within 1 to 3 days.

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Exercise #: Standing Side Leg Lifts

This exercise helps strengthen the inside and outside muscles of the legs, the abductors and the adductors. These muscles are critical for keeping the body and hips stabilized especially while standing on one leg.

  • Stand tall, feet about shoulder width apart and your knees slightly bent.
  • Stand to the side of a solid chair, desk, or countertop to hold for balance.
  • Flex the foot on the leg furthest from the chair, desk, or counter.
  • Lift the leg to the side as high as feels comfortable for you, making sure to keep the hips level and the torso straight, trying not to lean with the lift.
  • Bring the leg back and cross slightly over the standing leg.
  • Repeat the side leg lifts for a total of 15 times or repetitions.
  • Be sure to deliberately lift the leg instead of swinging it.

Who Is Offered Knee Replacement Surgery

A knee replacement is major surgery, so is normally only recommended if other treatments, such as physiotherapy or steroid injections, have not reduced pain or improved mobility.

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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When Can I Get Back To My Everyday Activities After Knee Arthroplasty

Your doctor will give you specific instructions. But many people can get back to their everyday activities three to six weeks after surgery.

Your healthcare provider will give you specific instructions about recovery. You will gradually increase activity, starting with a slow walking program. You will be encouraged to stand, climb stairs and perform other normal household activities as soon as possible.

Exercise #: Standing Leg Curls

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This exercise helps improve the range of motion of the knee so it can bend properly after surgery. It also helps to strengthen the back of the leg or the hamstring muscles which go from the hip to the knee.

  • Stand tall, feet about shoulder width apart and your knees slightly bent.
  • Make sure to hold onto a solid chair, desk, or countertop.
  • Keeping knees inline, curl one leg up behind you with a flexed foot, bringing the heel of the flexed foot as close to the hamstring as possible. Do this to a 3 count one and two and three.
  • Lower the foot slowly back to the floor with a 3 count one and two and three.
  • Repeat the leg curl up and down for a total of 15 times or repetitions.

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Preoperative Exercises For Knee Replacements

Note: Always talk to a medical professional before beginning a new exercise program. Your surgeon or physical therapist can recommend exercises prior to your knee replacement and help you decide which exercises are best for your abilities.

If an exercise causes an increase in your pain or discomfort, stop performing that exercise.

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?

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