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Why Knee Replacement Is Required

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.

How Soon Will I Be Up And About

The staff will help you to get up and walk about as quickly as possible. If you have had minimally invasive surgery or are on an enhanced recovery programme, you may be able to walk on the same day as your operation. Generally, you will be helped to stand within 12-24 hours after your operation.

Walking with a frame or crutches is encouraged. Most people are able to walk independently with sticks after about a week but this can vary depending on the individual.

During your stay in hospital, a physiotherapist will teach you exercises to help strengthen your knee. You can usually begin these the day after your operation. It is important to follow the physiotherapist’s advice to avoid complications or dislocation of your new joint.

It is normal to experience initial discomfort while walking and exercising, and your legs and feet may be swollen.

You may be put on a passive motion machine to restore movement in your knee and leg. This support will slowly move your knee while you are in bed. It helps to decrease swelling by keeping your leg raised and helps improve your circulation.

How Long Will My New Joint Last

In recent years, improvements in medical equipment and surgical techniques have meant that many knee replacements last longer than they did in the past.

A new study looking at over 6,000 people who have had knee replacement shows:

  • More than 4 in 5 people who have total knee replacements can expect them to last for at least 25 years.
  • 7 in 10 people who have a unicompartmental knee replacement can expect it to last for at least 25 years.

Clearly this will vary between different people, and you still need to take care of your new knee.

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

Knee replacement surgery is one of the most successful procedures in all of medicine, according to the American Academy of Orthopaedic Surgeons . Its also very common: More than 750,000 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.

Will My Lifestyle Affect The Knee Surgery Compensation Amount I Receive

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Yes, your lifestyle will affect the compensation amount you receive for your knee surgery settlement. If you had a more active lifestyle before the surgery, then there is a higher chance that you will get a higher compensation amount. For example, a construction worker may have a better argument to recover more from a knee surgery settlement than a receptionist.

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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:

  • age,
  • 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.

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.

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A Realistic Assessment Of What We Can Do To Help With Your Pain After Knee Replacement

In our clinic, we try to provide information on helping people explore other treatment options before joint replacement. One of those options is simple dextrose Prolotherapy. This regenerative injection technique helps rebuild damaged ligaments and tendons.

When the patients have already had a joint replacement, we will do a physical examination of the knee to assess how we may be able to help.

  • Prolotherapy fixes soft tissue, it cannot fix hardware failure,
  • Prolotherapy works by stabilizes the knee by strengthening the natural muscle and bone attachments, ligaments, and tendons.

How Bad Does Your Knee Have To Be Before Replacement

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Surgery is a last resort for many patients. In most cases, doctors will try more conservative treatments first before recommending any type of joint surgery, including knee replacement. Conservative treatments mean treatments that dont use surgery. These include exercise, physical therapy, injections, medications, or non-surgical procedures.

Some doctors also recommend that patients lose weight before considering knee replacement surgery. Losing weight can often improve knee pain.

But if you have these symptoms, you may want to consider a more aggressive treatment: knee replacement surgery.

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Care After The Operation

Please give some thought as to how you will be looked after once you have had the operation, well in advance. Most people like to be independent, but you are going to need support with day-to-day activities for a while. If you have an able-bodied partner, this might fall to them, but otherwise you may need a friend or relative to come to stay with you for a while. Some people may arrange to stay in a care home until they have their mobility and independence back.

Increase Knee Flexion With Iastm

If traditional treatments like stretching havent been helpful in relieving your stiffness, a specialized form of massage may address your arthrofibrosis. IASTM, short for instrument-assisted soft tissue massage, uses metal tools to massage the areas around the knee and can break up the scar tissue that forms and impedes motion.

A 2016 study published in the Journal of Knee Surgery found good improvements in knee flexion among patients who underwent Astym therapy after developing a post-surgical stiff knee. Talk to your physical therapist about making it part of your rehab.

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Who Is A Candidate For Partial Knee Replacement

People with medial, or lateral, knee osteoarthritis can be considered for partial knee replacement. “Medial” refers to the inside compartment of the joint, which is the compartment nearest the opposite knee, while “lateral” refers to the outside compartment farthest from the opposite knee. Medial knee joint degeneration is the most common deformity of arthritis.

Other factors to consider:

  • You may want to consider a knee replacement if your knee pain persists despite your taking anti-inflammatory drugs and maintaining a healthy weight.
  • Your provider will ask you to identify the area of pain in your knee, then check your range of motion and the knee’s stability. An X-ray of the knee will determine your eligibility for partial knee replacement. However, your surgeon may not know for certain if you are a good candidate until the surgery has begun.
  • You must have an intact anterior cruciate ligament, a sufficient range of knee motion, damage to only one compartment and a stable knee. The angulation of the deformity is also considered.
  • In the past, a partial knee replacement was considered only in people 60 and over who were sedentary. Now younger, more active people are increasingly being considered.

How Long Should You Keep Your Leg Elevated After Knee Surgery

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Prop your leg on cushions or pillows so your knee is at least 12 inches above your heart for the first three to five days after surgery. Keep your leg elevated if your knee swells or throbs when you are up and about on crutches. Dont put pillows behind your knee because this limits motion of the knee.

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The Pros And Cons Of Minimally Invasive Knee Replacement Surgery

Both minimally invasive knee replacements and traditional knee replacements are performed to alleviate chronic knee pain due to arthritis, and both surgeries require the cutting of soft tissue and bone in order to implant prosthetic knee joint components. The difference is that a minimally invasive knee replacement uses a smaller skin incision and tends to require less cutting of other soft tissue, such as muscles, tendons and ligaments.

See Knee Pain and Arthritis

The expectation is that less invasive knee replacement techniques will allow for an easier post-surgical recovery in the short term and provide equal or better results in the long term. Whether this expectation is realistic is a matter of ongoing research. To date, experts have found minimally invasive knee replacement surgery has both advantages and disadvantages, and it is not appropriate for all knee replacement patients.

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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Protecting Your Knee Replacement

After surgery, make sure you also do the following:

  • Participate in regular light exercise programs to maintain proper strength and mobility of your new knee.
  • Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.
  • Make sure your dentist knows that you have a knee replacement. Talk with your orthopaedic surgeon about whether you need to take antibiotics prior to dental procedures.
  • See your orthopaedic surgeon periodically for a routine follow-up examination and x-rays. Your surgeon will talk with you about the frequency and timing of these visits.

When Is Knee Replacement Required

How To Know If You Need A Total Knee Replacement

Knee replacement is one of the most successful operations in medicine and has improved the lives of millions of patients. Patients often ask about the correct time to have a knee replacement. Knee replacement may be necessary once you have exhausted all options of conservatively managing knee arthritis or if your arthritis is at an extremely advanced stage which is not treatable by non-operative methods.

Conservative treatment for Knee Arthritis include Physical Therapy, Weight Loss, Steroid Injections, Anti-inflammatory Medications and other Nonoperative Treatments such as knee unloader braces, heel wedges placed in the shoe, and injections of hyaluronic acid

Knee replacement is overall a very safe procedure. However, there are some associated risks that patients should be aware of. The biggest risks that can occur after knee replacement are infection, incomplete pain relief and stiffness. These risks are all very rare, but it is important to know that they are possible. Knowing the risks, below are reasons to consider knee replacement.

Knee replacement is an extremely successful operation that has helped millions of patients. Knowing the risks, benefits, and options will help you to be included as part of the care team and will help you to get the most out of your knees.

About Dr Chirag Patel

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Will I Need Any Treatments After Knee Replacement

Your healthcare team will prescribe medications to help you manage pain after surgery, such as:

  • Acetaminophen.

To prevent blood clots and control swelling, your healthcare team might also recommend:

  • Blood thinners, such as aspirin or injectable Enoxaparin based on individual risk of blood clot formation.
  • Compression devices, usually used while hospitalized. These are mechanical devises which provide intermittent compression.
  • Special support hose.

Your team will ask you to move your foot and ankle around frequently to maintain blood flow at home. Theyll also show you special exercises to help strengthen your knee and restore motion. Exercises are very important to the success of your knee replacement. Initially, physical therapy will be in the home. Arrangements for this in home PT are made at the time of discharge from the hospital.

Is Partial Knee Replacement An Option

The knee is divided into three compartments:

  • the medial compartment
  • the lateral compartment
  • the patellofemoral compartment

If you have a problem in only one of the three compartments, you may be able to have what is called a partial knee replacement. Since only one area of the knee is resurfaced, recovery from partial knee replacement is faster. Because many patients have arthritis in more than one knee compartment, the majority of people who undergo knee replacement surgery about 90% need to have all three compartments resurfaced. This is called a total knee replacement, or total knee arthroplasty.

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Your Knee Has Become Deformed

If your arthritis is advanced, it can affect the way you walk, which can also lead to further problems elsewhere in your body.

As arthritis progresses, the knee may become bowed or knock-kneed, Heckmann says. If this type of deformity develops over time, a knee replacement may be indicated.

In addition, people with arthritis may also lose the ability to straighten their knee, according to Heckmann. If this occurs, you should seek an evaluation with an orthopaedic surgeon, as this loss of motion may be permanent, even after the knee has been replaced, he adds.

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What Is Revision Surgery

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Knee replacement surgery may seem intimidating, but it is proven to be successful. Nearly all patients report less pain and increased mobility after the procedure. The artificial prosthetics themselves are pretty hardy, lasting an average of 15 to 20 years.

But, as mentioned, we put our knees through a lot of wear and tear, especially when it has to bear excess weight or an active lifestyle. Knee replacements can break down. When this happens, patients need to get a corrective procedure or revision surgery. By nature, this is usually more complex than the first, due to scar tissue from the previous surgery and less bone to work with.

Patients who undergo revision surgery may notice less mobility and more stiffness, as knee replacements become less effective each time due to the accumulation of trauma and scar tissue. Complications may also require a patient to get revision surgery long before their replacement gives out. Although rare, contracting an infection from the first surgery is a typical reason for revision.

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How Will I Feel When I Get Home

Do not be surprised if you feel extremely tired at first. You have had a major operation and muscles and tissues surrounding your new knee will take time to heal. Follow the advice of the surgical team and call your GP if you have any particular worries or queries.

You may be eligible for home help and there may be aids that can help you. You may also want to arrange for someone to help you out for a week or so.

The exercises your physiotherapist gives you are an important part of your recovery. It is essential you continue with them once you are at home. Your rehabilitation will be monitored by a physiotherapist.

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