Why Is The Hip Bone Dissolving After Hip Replacementthe New Research
The new study looked at bone density of the hip area after knee replacement. The rationale for performing this study was previous studies that had shown a higher rate of hip fracture after knee replacement surgery within the first year. Hence the research question was whether the hip fractures were coming from bone loss or something else.
Compared to control, the patients who had knee replacement lost more bone on that side in the head of the femur bone and around the hip in general. These patients also lost muscle mass. The authors postulated that perhaps this was due to poor outcomes and less activity. Having said that, another option may the toxicity of the metals in the knee replacement which are a big issue in many patients.
The upshot? Is the increased risk of hip fracture after knee replacement due to bone loss? Not sure anyone knows at this point, but I can say that its just one more reason to try to avoid knee replacement!
Chris Centeno, MD
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The Ligament Problem Is A Clue That For Some Patients Post Knee Replacement Pain May Be A Problem Of Overdoing It Even While In The Hospital Or Nursing Home
In a study from October 2018, doctors writing in the Journal of Pain Research, looking at why some people had excessive pain after knee replacement surgery asked if this was a problem of overdoing it in the hospital following the surgery? The research measured the results of making patients progressively walk more steps in the hospital or nursing home up to 10 days after the surgery.
These are surgeons and pain management specialists from leading hospitals and universities in Japan talking about patients soon after knee replacement during the surgery recovery.
- Poor pacing during physical activity is associated with severe pain in postoperative patients
- Over-activity results in a number of potential injuries to muscle fibers, nerves, bones, and ligaments. These injuries, as well as the repetitive experience of pain, will prolong pain and contribute to neurobiological mechanisms of peripheral and central sensitization.
So What Should You Do If You Have Painful Joints After Tka
Suffering from joint pain can be debilitating to your lifestyle and overall happiness. Seek medical advice if you are suffering from pain knee pain after a TKA procedure. There are many solutions to treating the cause of your pain or managing your pain symptoms. If you are experiencing knee pain after a TKA, talk to your doctor as soon as possible.
Personalized Orthopedics of the Palm Beaches has a wealth of knowledge and experience on joint pains and TKA procedures. If you are suffering from knee pain after a TKA, call 561-733-5888 today to make an appointment with one of our experts.
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Problem: Difficulty And Pain In Kneeling
Most people had difficulty kneeling because of pain or discomfort in the replaced knee. Many patients described how this limitation affected their daily lives, including housework, gardening, religious practices, leisure activities, and getting up after a fall. Patients often adapted to these limitations by finding alternatives to kneeling, assistance from others, or home adaptations. Many patients had accepted that they could not kneel, however some still expressed frustration. Few patients had consulted with healthcare professionals about kneeling difficulties, and unmet needs included the provision of information about kneeling and post-operative physiotherapy.
Reasons To Replace Your Hip Or Knee
You may want to consider hip or knee replacement if some of these things are true for you:
Pain and stiffness. It may be time for a new joint if it hurts so much that it’s hard to walk, climb stairs, get up from a chair, or do other activities.
The pain is also long-term, lasting at least 6 months, says Matthew Austin, MD, an orthopedic surgeon and spokesman for the American Academy of Orthopaedic Surgeons.
Affects your daily life. It’s not just pain itself that matters, but the impact it has on your regular routine, Austin says. Do your joint problems limit what you can do? Does it cause your mood to change?
Bone damage. X-rays and other imaging tests show that your osteoarthritis or other conditions are taking a toll on your joints.
Other treatments don’t help. Medication, injections, or devices like walkers aren’t giving you the relief you need.
Deformity. Your knee is severely swollen or your leg is bowed.
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Research: Doctors Are Looking For The Causes Of Pain After Knee Replacement And It Is Hard To Find
The confusion as to what may be the cause of chronic knee pain after knee replacement is a cause of great concern not only among doctors but obviously among patients. We often find patients to be confused between what is normal and what is not normal after knee replacement.
- Is some pain normal?
- Are the clunking sounds normal?
- Is the instability normal?
Q: I Had Knee Replacement Surgery Four Months Ago Why Do I Still Have Pain
A: Recovery from surgery can take several months, so its not unusual to still have soreness in the knee that was replaced. As the intensity of rehabilitation exercises increases, more strain is put on the muscles and joints that have not been used in a period of time. Stick with the routine of exercises that were prescribed by a physical therapist. Though bending and stretching the knee may hurt at first, re-training the body to move normally will help with recovery in the long run.
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In addition, postoperative swelling is often a major source of pain for patients. Pain in the knee following the operation can last from six months to as long as one year, but dont get discouraged. Once fully healed, knee replacement surgery will help provide pain relief and improved function long-term.
This article is adapted from Cleveland Clinic Arthritis Advisor.
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Can Hip And Knee Replacement Surgery Be Done At The Same Time
Q) Looking ahead it’s likely I’m going to need a second knee replacement and replacement of each of my hips. So, I wonder, has a knee and hip replacement ever been done at the same time? That would cut operations in half! Would it be possible, theoretically or practically?
Rosemary, Poole – 2017
A) In theory it’s possible to have both operations done at the same time , but there are a few things youll need to consider. Firstly, having two fairly large surgeries together will mean your recovery is likely to take longer, though it would probably still be shorter than total recovery time for having one surgery and full recovery followed by another.
Importantly, if you need both a hip and a knee replacement, and you’re worried about how youll cope with your rehabilitation, most surgeons will recommend having surgery on the hip first. Recovery after hip surgery doesn’t require as much rehab, so a painful knee won’t interfere too much with your recovery. If you do well after a hip replacement, you’re also more likely to cope successfully with the more intensive rehab required after knee surgery.
Another thing to bear in mind is that pain from the hip can spread to the knee, so replacing the hip joint may improve the pain in the knee or at least give a clearer idea of how much of the knee pain is coming from osteoarthritis in the knee.
This answer was provided by Dr Tom Margham in 2017, and was correct at the time of publication.
Why Is This Important
People with ongoing pain after knee replacement can become trapped in a futility loop. They do not seek help, despite believing they have a good reason to.
Improving the information given before knee replacement surgery could help. The authors recommend warning patients that they could experience ongoing pain. But patients need to be aware that while some pain in the healing period is normal, they should seek help if their pain persists.
It is also important that clinicians acknowledge and legitimise pain at follow-up appointments. This may encourage patients to return for care if their pain persists. Patients need information about how to access the healthcare services and treatments that could help them to manage their pain.
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Will Your Bones Even Allow For A Revision Knee Replacement
An August 2019 study in the Journal of Orthopaedic Surgery and Research offered this warning to surgeons concerning the problems of identifying whether a patients bones were strong and dense enough to withstand another knee replacement procedure.
Revision total knee arthroplasty is a demanding procedure, with a high complication and failure rate and a high rate of bone losses and poor bone quality. Different classifications for bone losses have been proposed, but they do not consider bone quality, which may affect implant fixation.
Look at the study findings:
- Fifty-one patients were included .
- The most frequent cause of failure was:
- aseptic loosening of the implant .
- 18.9% of the cases demonstrated poor bone quality.
What the researchers of this study were seeking to point out is that if revision knee replacement is required, a plan to address and repair the possibility of bone loss, bone weakening, a loss of bone density should be undertaken. This would significantly increase the success of the replacement.
Muscle Release For Lower Back And Hip Pain
Releasing muscle tension can help you resolve your lower back and hip pain, and if you are aware of it before you go into surgery, you could even prevent it altogether.
If you visit a physical therapist, they will likely be aware of the complications associated with a tight iliopsoas muscle. A physical therapist can release some muscle tension during physical therapy appointments by putting pressure on specific muscle connection areas with their hands.
However, that is only helpful if you can attend appointments on a regular basis.
Because I dont want you to have to wait for a physical therapist to help you every single time, I invented theHip Hook andHip Flexor Release Ball. These tools allow you to release the iliacus and psoas muscle tension youre experiencing any time you need from the comfort of home.
The Hip Hooks unique design gives you the ability to apply precise and angular pressure on the hard-to-reach iliacus muscle. The Hip Flexor Release Ball is the perfect size and density to target and help release the psoas muscle.
You can even learn more about realigning your body and treating unresolved pain in my book,Tight Hip Twisted Core.
As you expand your knowledge of how interconnected your joints and muscles truly are, you can easily prevent and treat lower back and hip pain as well as unresolved pain throughout your body.
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Incidence And Severity Of Ppsp After Tka And Tha
Table 2 shows the incidence of pain 46 months after THA or TKA. Of the 48 THA patients, 32 reported pain, and of the 44 TKA patients, 39 reported pain, indicating that TKA patients had a greater likelihood of developing PPSP . Table 2 also shows that, of the 32 patients reporting pain after THA, 18 perceived it on a daily basis, which did not differ significantly from the pain frequency patterns observed in the TKA group . Concerning PPSP intensity, both worst and average pain levels were significantly higher for TKA patients than for THA patients on the NRS. Figures 2 and and33 further illustrate the frequency of pain levels in the two pain groups, indicating clearly that for both worst and average pain intensity, the two groups showed distinct trends and distribution. Further, Table 3 shows that, for worst pain levels, while in the THA sample there were no reports of severe pain, with a significant majority of patients reporting no or mild pain , 56.8% of patients in the TKA sample complained of moderate to severe pain. Concerning average pain levels, Table 3 indicates that reports of severe pain ceased and the account of moderate pain levels also dropped sharply, from 27.1% to 6.3% in the THA sample and from 50% to 25% in the TKA sample. Accordingly, in terms of average pain, the majority of patients had mild levels of PPSP, both for THA and for TKA .
Comparison between THA and TKA on NRS of worst pain level 46 months after surgery .
Limitations Of The Study
This study has some limitations that should be considered when interpreting its findings. Regarding external validity, the generalizability of the results is limited by this being a single-site and single-country study, with small samples. Future epidemiologic studies with larger samples should be undertaken. Another issue is that the small samples, along with the discrepancy in gender proportions, ie, the low number of men with TKA , substantially reduced the tests statistical power for the correction of gender influence. Therefore, we chose not to correct for gender in the statistical analyses or in the interpretation of our results. Future studies should examine gender differences further and the effect of the interaction between surgical group and gender, specifically with regard to psychologic outcomes, such as anxiety and pain catastrophizing, for which gender differences are well documented.64,65
It is also important to underline that the lack of reporting of analgesic consumption stems from the fact that the study patients often had other joint comorbidities for which they were medicated, thus precluding us from rigorously recording analgesic use linked specifically to the research question.
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Knee Pain Complaints In Women Over 50 Is It Really Knee Osteoarthritis Or Is It Hip Pain Back Pain Weight
Here is an interesting 2018 study centered on women over the age of 50.
The researchers of this study investigated the factors associated with the level of knee pain in community-dwelling women aged 50 years or older. The radiographic grade of knee osteoarthritis, presence of low back pain, level of hip pain, Body Mass Index and presence of depressive symptoms were significant factors associated with the level of knee pain in the study group. For women without knee osteoarthritis, knee pain was found to increase according to increasing age, BMI, level of hip pain, and presence of low back pain. For women with knee osteoarthritis, knee pain was significantly associated with radiographic grade of knee osteoarthritis, BMI, level of hip pain, presence of low back pain, and presence of depressive symptoms.
The question is. Women with knee pain without MRI evidence of osteoarthritis and women with knee pain with clear evidence of osteoarthritis. In this study the doctors warned to check the back, the hip, depressive episodes, and weight to determine the true cause of pain. This could prevent a recommendation to surgery that was not needed, worse, the wrong joint gets operated on.
Metal Allergy Or Reaction
If your initial hip replacement was prior to May 2016, your surgeon may have implanted a metal-on-metal device . As these two pieces rub together during everyday activities, they can release microscopic metal particles into your body. This may lead to sensitivity or an allergic reaction in some patients. There are no FDA-approved metal-on-metal hip replacement components available today, but you may need a revision hip surgery if you had one done prior to 2016 and are experiencing symptoms of a problem.
Even if you did not get a metal-on-metal joint, you may still experience sensitivity to metal components that are used in hip and knee replacement joints. It is difficult to diagnose a metal allergy or reaction. However, talk to your orthopedic surgeon if you experience:
- large area of swelling,
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What Should I Expect During The First Six Weeks After Discharge
During the first six weeks after discharge, you should be making progress week by week. Most patients are eager to report their progress at follow-up visits and are ready to move to the next level in their recovery. Most patients can accomplish the following during the first six weeks after total joint replacement:
- Walk without help on a level surface with the use of walker, crutches or cane as appropriate.
- Climb stairs as tolerated.
- Get in and out of bed without help.
- Get in and out of a chair or car without help.
- Shower using a tub bench once staples are removed as long as there are no issues with the incision.
- Resume your activities of daily living including cooking, light chores, walking and going outside the home. You should certainly be awake and moving around most of the day.
- Some patients return to work before the first follow-up visit. This is approved on an individual basis and should be discussed with your surgeon.
Icing and elevation
After a joint replacement, swelling is expected. Swelling can cause increased pain and limit your range of motion, so taking steps to reduce the swelling is important. Continue using ice packs or some form of cold therapy to help reduce swelling.
Sexual activity after joint replacement
Many people worry about resuming sexual activity after a joint replacement.
Resuming your diet
If youre not eating well after surgery, contact your healthcare provider about nutritional supplements.
Harvard Medical Schools Findings Surrounding The Phenomena Of Continued Pain Following Total Knee Replacement
Here are some more quick facts surrounding the phenomena of continued pain following total knee replacement from researchers at Brigham and Womens Hospital, Harvard Medical School.
In this 2017 study published in the medical journal Osteoarthritis Cartilage, the doctors found:
- Approximately 20% of total knee replacement recipients have suboptimal pain relief. .
- Pre-operative widespread pain was associated with greater pain at 12-months and failure to reach a clinically meaningful difference in pain, pre and post replacement
- Patients with widespread pain along with the pain catastrophizing problems may help identify persons with suboptimal total knee replacement outcomes.
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