Knee Surgery

Gravidity, parity and knee breadth at midlife: a population-based cohort study

Study population

This study utilized a subsample of prospective, population-based Northern Finland Birth Cohort 1966 (NFBC1966)¹⁶. Initially, NFBC1966 comprised pregnant women living in Northern Finland (i.e. the provinces of Oulu and Lapland) whose expected delivery dates fell between Jan 1 and Dec 31, 1966. The cohort included 12,068 mothers and 12,231 children, with a coverage of 96% of all births during 1966 in Northern Finland. Prospective data collection began in the 16th gestational week, and the NFBC1966 participants have been followed ever since. Broad questionnaires and clinical examinations have been used to gather information on the participants’ health status and lifestyle habits.

At age of 46, a total of 5861 individuals responded to questionnaires and participated in clinical examinations. Of them, 1946 individuals residing in the Oulu region (100 km radius) underwent radiography of the knee joint. Of these, 1131 individuals were excluded due to (1) male sex, (2) missing reproductive or confounder data, (3) previous knee surgery, (4) bone pathologies in the radiographs (mostly osteoarthritic changes), or (5) technically inadequate radiographs. Thus, the final sample of this study comprised 815 women.

Knee measurements

Knee breadth measurements were taken from digital radiographs of the right knee joint (Fig. 1) by an author of the study (A.K.). A detailed description of the procedure has been given in a previous publication¹⁷. Radiographs were accessed and measured using neaView Radiology software version 2.31 (Neagen Oy, Oulu, Finland). Posteroanterior radiographs were utilized, with individuals positioned in fixed flexion view^18,19.

Figure 1

Knee measurements. FCML mediolateral breadth of femoral condyles, TPML mediolateral breadth of tibial plateau. Diameter of the calibration disc: 30 mm.

The following measurements were taken from each radiograph: (1) mediolateral breadth of the articular surface of the femoral condyles (FCML), and (2) mediolateral breadth of the articular surface of the tibial plateau (TPML). FCML was measured by drawing a line tangential to the inferiormost points of the femoral condyles; this line was transposed to the widest part between the femoral condyles. TPML was measured as close to the border of the tibial plateau as possible. Measurements were recorded to the nearest 0.1 mm. The initial measurements were converted into true sizes with the help of a metal calibration disc of 30 mm in diameter attached on the participant’s right leg. The technical error of measurement (TEM) and relative technical error of measurement (rTEM) were reported by Keisu et al.¹⁷, and the repeatability was high for all the measurements (TEM 0.1–0.5 mm, rTEM 0.1–0.6%).

Reproductive history

In the 46-year follow-up questionnaire, women were asked about the number of deliveries, ectopic pregnancies, miscarriages and abortions they had undergone during their lifetime. As described in a previous publication²⁰, gravidity was calculated as the overall number of pregnancies, and parity as the number of deliveries of each woman. Women with no deliveries were classed as ’nulliparous’, those with one delivery as ’primiparous’, and those with a history of several deliveries were classed as ‘multiparous’. Those with ≥ 5 deliveries were classed as ‘grand multiparous’.

Confounders

In the clinical examination at the age of 46, a study nurse systematically measured the height and weight of each individual. Body mass index (BMI) in kg/m² was calculated as weight divided by height squared.

Education, smoking history and leisure-time physical activity were elicited in the 46-year follow-up questionnaire. Education years, a proxy for socioeconomic status, was determined by asking: ‘What is your basic education? (1) Less than 9 years of elementary school, (2) elementary school, (3) matriculation examination’; and What is your vocational education? (1) None, (2) occupational course, (3) vocational school, (4) vocational college, (5) polytechnic, (6) university, (7) other, (8) unfinished course’. The responses were classed according to the Finnish education system as follows: < 9 years, 9–12 years, or > 12 years.

Smoking history was elicited using two questions: (1) ‘Have you ever smoked cigarettes (yes/no)?’ and (2) ‘Do you currently smoke (yes/no)?’. Individuals were classed as non-smokers, former smokers, or current smokers.

Leisure-time physical activity was elicited by asking: ‘How often do you participate in brisk physical activity/exercise [defined as causing at least some sweating and breathlessness] during your leisure time? (1) Daily, (2) 4–6 times a week, (3) 2–3 times a week, (4) Once a week, (5) 2–3 times a month, (6) Once a month or less often. The responses were regrouped as follows: < 1 times/week, 1–3 times/week, or ≥ 4 times/week.

Statistical analysis

SPSS software (IBM, Armonk, NY, USA) version 27, 64-bit edition was used for the statistical analyses. P values < 0.05 were considered statistically significant. Means with standard deviations (SDs), medians with interquartile ranges (IQRs) and percentages with frequencies were used as descriptive statistics. Characteristics of the sample were presented before and after stratification by parity.

The associations of gravidity and parity with knee breadth (i.e. FCML and TPML in mm) were analyzed using general linear models. Beta coefficients, 95% confidence intervals (CIs) and P values were documented from the output. Models were first constructed without adjustments (unadjusted models), and then confounder variables were added (adjusted models). Gravidity and parity were modelled as continuous variables (where beta coefficients are interpreted relative to one pregnancy/delivery), and by comparing groups with each other (e.g. multiparous vs. others, where beta coefficients represent mean difference between groups).

Ethical considerations

The study adhered to the principles of the Declaration of Helsinki, with voluntary participation and signed informed consent. Sensitive details were replaced by anonymous identification codes. The Ethics Committee of the Northern Ostrobothnia Hospital District approved the study.

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Originally Appeared Here

ROM Technologies: How Far Knee Recovery Technology Has Come

HARTFORD, CT, July 23, 2022 /24-7PressRelease/ — It is often said that a knee is simply not a knee post-surgery. As is the case with so many aspects of our lives and bodies that we take for granted. We scarcely realize how much pressure a joint like the knee must endure to keep us moving smoothly and pain-free. Of course, this is until something goes wrong and we need surgery to correct it.

While knee surgeries are sometimes the best option, they have come a long way. Improvements have been primarily due to the changes in medical knowledge and available technologies.

How ROM Technologies is Changing the Game

As stated prior, technology has done wonders to improve the results we experience from undergoing knee surgery. Much of this is due to changes in post-surgery knee recovery technology. ROMTech is a leading organization in pre-op and post-op knee surgery recovery.

Knee replacement is the most popular surgical option. In the past, this would leave recipients with stiff knees that would not help them move or function as efficiently as they desired. Today, the opposite is true.

Today, athletes can undergo knee replacement surgery and, with strategic rehabilitative work, find that they can work their way back to peak capacity. Thanks to leading medical technology organizations, having a knee rehabilitation resource helps ensure that patients can recover as quickly and efficiently as possible with smooth, pain free movement.

Knee replacement surgery no longer means that a sporting career has to end or that daily life has to be significantly hampered. Thanks to ROMTech’s work in producing high-quality joint replacement material, their work is not only limited to knees.

ROM Technologies PortableConnect actually used in both knee and hip patients rehabilitation as well. This makes sense, as a debilitatingly injured or arthritic hip can impact the knees negatively and vice versa. It makes sense that these key features of the lower extremities are considered in tandem.

How to Get Started Working with ROMTech

Since their PortableConnect device enables knee and hip recovery it is easy to see what their focus is on, improving quality of life. Sometimes people with knee and hip issues may be concerned with having to do a procedure.

However, the advancements in ROM Technologies help ensure that higher-quality replacements help reduce the likelihood of the same. As such, they encourage anyone who may need replacement surgery (irrespective of age or even profession) to have it done sooner rather than later.

—
Press release service and press release distribution provided by http://www.24-7pressrelease.com

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Originally Appeared Here

Report: Vikings TE Irv Smith Jr. to undergo knee surgery, miss start of season

Viking tight end Irv Smith Jr. spoke after Friday night’s preseason finale in Kansas City about a potentially “scary” lineup set to be unleashed for the Vikings offense. He’d played 11 of 12 snaps with the first-team offense in two series against the Chiefs — leading the way by catching both of his targets for 39 yards — before taking a seat in the 28-25 loss. There was no indication he wouldn’t be part of that Week 1 lineup on Sept. 12 in Cincinnati.

But Smith reportedly will miss “at least the start of the regular season,” according to NFL Media, as he’s expected to undergo knee surgery to fix a meniscus injury. The Vikings had no media access Sunday; coach Mike Zimmer is scheduled to give a news conference on Monday morning.

Smith, the 2019 second-round pick, was a strong candidate for a breakout season as he stepped into a starting role vacated by Kyle Rudolph this offseason. Further boosting expectations was Smith’s strong training camp in which he was a go-to target for quarterback Kirk Cousins and the play-action passing game.

Smith offered no indication after Friday’s game that anything was wrong with his health, walking away from the podium without issue after projecting optimism about a struggling offense that played without running back Dalvin Cook and receiver Justin Jefferson during a winless preseason.

“I think it’s going to be very scary, honestly,” Smith said of the Vikings offense. “We have a lot of talent on this offense. We’re just excited to get to it. It’s been a long camp. Now, we’re almost to that time.”

The Vikings offense will have to wait a little longer before it can be at full strength. Smith’s injury moves No. 2 tight end Tyler Conklin into a starting role. Conklin hasn’t played this preseason while dealing with a hamstring injury. The Vikings also have Brandon Dillon, rookie fifth-round pick Zach Davidson and undrafted rookie Shane Zylstra at the position.

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Bristol hospital backlog sees hip and knee patients sent home early after surgery

Hip and knee surgery patients are being sent home from Southmead Hospital early in a drive to get through a backlog of elective operations caused by the pandemic.

Patients who have had a hip or knee replacement and are deemed suitable for ‘hospital at home’ support are being discharged after two days, rather than the usual five days.

Councillors expressed concern about post-operative patients getting three fewer days of hospital care, but a hospital chief assured them the initiative was safe at a public meeting last month.

READ MORE:Coronavirus infection rates across 47 areas of Bristol still above UK average

Elective waiting lists grew during the coronavirus pandemic as NHS hospitals did not have the staff or facilities to carry out all booked procedures as well as provide treatment for Covid-19 and other patients.

By the end of April, 6,425 patients had been waiting for elective surgery for more than a year, and 41 had been waiting for more than two years, across Bristol, North Somerset and South Gloucestershire, a report to the meeting said.

The NHS Clinical Commissioning Group (CCG) for the region was subsequently chosen along with 11 other areas to participate in a government ‘accelerator’ pilot to speed up the delivery of elective operations.

It introduced the early discharge scheme at Southmead Hospital as part of a raft of pilot initiatives paid for with £8.5million of capital funding.

Kingswood councillor April Begley, who is a member of South Gloucestershire’s health scrutiny committee, said: “To take three days away from five is actually quite a lot.”

But Evelyn Barker, deputy chief executive at North Bristol NHS Trust, which runs Southmead Hospital, assured her the orthopaedic supported discharge scheme was well managed.

‘People aren’t just pushed out the door’

Ms Barker said hip and knee replacement patients are assessed for their suitability for early discharge, some are transferred to step-down beds in the community instead of being sent home, and those who are sent home are managed by a dedicated ‘hospital at home’ team of doctors, nurses and physiotherapists.

“People aren’t just pushed out the door home without any support,” she said.

Ms Barker, who is responsible for the accelerator pilot at the CCG, said she was hopeful it would reduce elective surgery waiting times over the coming months.

The initiatives are designed as far as possible not to put extra pressure on NHS staff who have been through the “worst year” in NHS history, she said.

They included ordering more hospital equipment and ‘modular theatres’, as well as extending some outpatient clinics by an hour a day.

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Efforts at Southmead suffered a blow last month when the hospital came under intense pressure from a rising number of Covid cases, emergency patients, and people suffering from the winter diarrhoea and vomiting bug norovirus, just as more and more staff were having to self-isolate amid the so-called ‘pingdemic’.

“We’ve absolutely had everything thrown at us that we could possibly think of,” Ms Barker told the health scrutiny committee on July 28.

She said Southmead had only one of three wards left for elective surgery patients, having lost at least one to emergency patients.

Three wards in the hospital were being used for norovirus patients.

Two wards were for Covid patients but this has since dropped to one, a spokesperson for the hospital trust said.

The spokesperson said: “Orthopaedic Supported Discharge is a scheme that is currently only being offered by North Bristol NHS Trust, but with a view to rolling it out elsewhere in the future.

“It is offered to appropriate patients who are screened in advance to check their suitability and ensure they meet key criteria, such as having someone at home with them. It only relates to knee and hip replacement surgery.”

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Originally Appeared Here

10 Things to Know About Knee Replacement Surgery

What are the “top ten things” I should know about knee replacement surgery?

The following points apply to knee replacement surgery, no matter what implants are used, or how skilled your surgeon is.

Knee surgery is not always the best option for knee pain or issues with walking.

Please keep in mind the following:

Minimally invasive or not, knee surgery is painful. AVOID surgery if you can.
Results from knee replacement depend critically on YOUR motivation, commitment, and participation.
Proper PREPARATION for knee replacement will improve your outcome.
Artificial knees can be NOISY; they sometimes pop, click, and clunk during movement.
SWELLING, ACHING, and HEAT continue for longer than most people expect.
Full recovery from knee replacement takes LONGER than most people think.
Physical, family, emotional, and spiritual SUPPORT will help recovery after knee replacement.
OLDER patients with knee arthritis will typically recover faster than younger patients; while this makes no sense, it is usually the case.
If you cannot EXERCISE before and after surgery, avoid knee replacement surgery.

About Knee Replacement

Knee Replacement FAQ

It’s important to understand the reasoning, procedure, and options behind a knee replacement. Here are some of the most frequent questions that patients ask.

Is knee arthroplasty different from knee replacement?

No. The terms can be used interchangeably. Total knee replacement is also called total knee arthroplasty. Similarly, a partial knee replacement is called uni-compartmental knee arthroplasty.

Is knee replacement surgery a fairly routine operation?

Yes. Hundreds of thousands of knees are replaced each year in the U.S., and world demand for knee replacements is increasing as people live longer and want more out of their lives.

Most orthopedic surgeons perform hundreds of knee replacements each year. While routine, knee replacement is still serious surgery. Each patient is unique, and each person’s anatomy demands careful attention to detail and precise steps during surgery.

Will a new knee joint be a perfect substitute for the real knee?

No, and you should be skeptical of any doctor or advertisement telling you otherwise. Those advertisements are designed to make a sale, rather than educate and enlighten consumers.

Normal human knee movement consists of gliding, rotation, sliding, and other complex movements. A synthetic joint can only approximate the intricacy and complexity of the knee joint that you were born with. No artificial knee joint, regardless of manufacturer’s advertising claims, or surgeon claims, has ever duplicated the complexity and intricate movements of the natural human knee.

The human knee joint has major ligaments and other soft tissue supports; these have fine nerve endings that send sensory, positional, and perceptual feedback to the brain from the knee. An artificial knee is simply metal and plastic. For severely diseased knees, modern total knee replacements provide excellent pain relief and function, but they are never a perfect substitute for the real thing.

What does an artificial knee feel like, if it does not feel natural?

Replacing your natural knee joint is a bit like replacing your natural teeth with dentures. Your own teeth are more than mechanical devices; they play a complex role in biting, chewing, hot-cold sensation, positional sense, vibration, and even taste.

Dentures are not natural or normal; they lack nerve endings and cannot feel vibration, heat, cold, touch, or any of the things we take for granted with our natural teeth. That is why dentures are useful only for patients whose own teeth are decayed or destroyed. Similarly, knee replacements are useful for patients with severe cartilage destruction, who have no other options, and who have thoroughly explored the possibilities.

How can I increase my chances of a successful knee replacement?

The success of knee surgery depends on your participation and how your body heals. Any operation on the human body has some uncertainty with respect to the outcome, despite the best of care.

Healing is a complex process, and each person heals differently. Knowledge and a strong partnership with your medical team leads to greater success, and makes it easier to work through any unexpected outcomes. The purpose of this website is to bridge the information gap and help you understand what questions to ask.

Can arthritis occur in a knee that is replaced?

No. Since cartilage is replaced by metal and plastic during knee replacement, there is no cartilage left in the knee to deteriorate. However, arthritis is a complex disease that frequently affects surrounding tissues, such as muscles, nerves, ligaments, and the synovial lining of the joint. This is one reason why despite a successful knee replacement, some pain, stiffness, and swelling may persist for many months.

In some patients, arthritis in other joints, such as the back and hip, can contribute to continuing symptoms after surgery. This is an important point to understand. Not all knee pain is from the knee; some may be coming from a diseased hip or spine, or other systemic illness like fibromyalgia or rheumatoid arthritis.

Stiff muscles, tendons, and ligaments can take many months to return to normal, even after healing from a knee replacement.

How long is the recovery after a total knee replacement?

Most patients are happy, mobile, and about 70 to 80 percent recovered by one month. Individual medical conditions such as diabetes, smoking, advanced age, obesity, neuropathy, heart and lung disease, Parkinson’s disease, and related variables can change recovery time drastically.

About 80 to 90 percent of the recovery is complete by six to eight weeks, but some aches and stiffness can persist for many months. The last 5 percent to 10 percent of soreness, achiness, and stiffness can take a year or two to subside completely.

For most patients, the most significant part of the recovery takes place during the first month. But keep in mind that patient variability is great; there is no value in comparing yourself with anyone else. Each person has a unique recovery.

Is recovery from knee surgery faster for younger patients?

No, and you should know about this paradox. Experience shows that the best recovery from knee replacement is in older patients, who have severe arthritis, and who have tried all reasonable conservative means of treating pain before surgery.

Younger patients, especially those of male gender and muscular physique, generally tend to have a noticeably slower recovery and higher level of pain from any knee surgery. This may reflect different expectations, different pain tolerances, body image, hypersensitivity of younger tissues, and other variables, but it is a fact that the younger patient should approach knee replacement surgery with added caution.

What is the best age for knee replacement surgery?

The optimal range is late 50s to late 70s. Most knee arthritis affects this age group, and a properly implanted total knee replacement should last the rest of life in such patients.

Should I get a second opinion before knee surgery?

Yes. If you have unanswered questions or doubts, additional opinions are always a good idea. A wealth of information exists on reputable websites. You can also learn a lot from orthopaedic implant companies as well as from friends, family, and others who have had knee surgery.

It is best to explore all your options and make your decision accordingly. Treat all information with a healthy dose of skepticism; any credible resource should be able to answer your questions to your satisfaction, no matter how authoritative or influential that resource holds itself to be.

A surgeon replaced my knee, and it did not work well. Can anything be done?

Usually, yes. Knee replacement surgery can be complicated by subtle infection, implant mal-positioning, and other unexpected outcomes that can leave patients unhappy. If this is the case, you should always seek a second opinion, even if a doctor has told you that nothing can be done. A variety of complex factors can compromise the results of knee replacements; fortunately, most such problems can be resolved.

Arthritis and the Knee Joint

What is a degenerative knee joint?

As cartilage gets rough, the friction in the joint increases. The result is an inflamed knee joint that swells and hurts. Arthritis and injury are usually responsible for degenerative changes in the knee. Pain, leg deformity, and disability can get severe enough so that patients seek help.

Why does cartilage get damaged?

Cartilage can be damaged by injuries, overuse, inflammatory conditions (like gout, rheumatoid arthritis, and others), and genetic causes. Obesity, poor joint alignment, age, and repetitive trauma to a joint can also damage cartilage. Diseased cartilage loses its smooth, friction-reducing surface, leading to progressive roughening of this biological bearing.

What causes the painful and annoying symptoms of arthritis?

When bone touches bone in the knee joint after loss of cartilage, the result is pain, grinding, swelling, and stiffness. The pain comes from inflammation in the tissues lining the knee joint; inflammation comes from abnormal movement and friction. This is why anti-inflammatory medicines such as aspirin and ibuprofen can often help arthritic pain, at least early in the disease. Swelling and fluid on the knee are adaptive mechanisms by which the body tries to deal with an inflamed and arthritic knee joint.

Is the wear of knee cartilage inevitable with old age?

Not particularly. Even though everything wears with time, the knee joint wears differently from person to person. Most people will never need knee surgery regardless of age. Others are at increased risk of developing arthritis.

While family history, racial origin, and genes may play a role in this, there are things you can do to manage an arthritic knee. Establishing a routine of light aerobic exercise, maintaining ideal body weight, and avoiding extreme sports that injure the knee are some steps that will help reduce the risk of wear in the knee.

After Knee Surgery

Recovering from Knee Surgery

When you’re considering knee surgery, you probably have many questions about post-surgery care. This informative article should address many of your concerns. Don’t hesitate to ask the members of your medical team for their advice and procedures.

What can I expect during the hospital stay?

You can expect several professionals to see you and help you with recovery. A physical therapist will help with knee exercises and walking with an assistive device, such as a walker. An occupational therapist will help you with everyday activities, such as dressing and bathing, while your knee is recovering. Your surgeon will see you often, as will a primary care doctor. Nursing staff will attend to your daily needs, ensuring that the doctor’s instructions are carried out and that you are comfortable. A nursing assistant will help with bathing and activities that you are unable to do yourself.

As you can imagine, the first night or two may be difficult; the hospital environment is new, the bed is not your own, and you will have multiple medications in your system. If you have trouble sleeping in the hospital, please ask the nurse for a sleeping pill. Expect to take a nap during the day, and anticipate several weeks before your normal sleeping patterns are restored, even after you go home.

How long will I be in the hospital?

Most patients are in the hospital for two to three days after a routine knee replacement; some need a longer duration of stay. A social worker will communicate with your insurance about the expected length of stay, and the duration approved by the insurance carrier. The social worker will help with discharge planning.

Preventing Blood Clots

What measures are taken to reduce the risk of blood clots?

Many physicians routinely use a blood-thinning medicine such as warfarin. This drug, or an alternative blood thinner, will be taken for about two weeks after surgery to lower the risk of a blood clot. The hospital pharmacist will monitor the blood-thinner dose, and will advise you if there is any change in the dosage.

After leaving the hospital, you will have a blood test twice a week, or more if necessary, to monitor the efficacy of the blood-thinner.

In addition, the exercises, foot pumps, lack of a tourniquet, efficient surgery, and early walking after surgery all serve to minimize the risk of blood clots. Most physicians use this type of multi-modal program to reduce the risk of blood clots forming.

What more should I know about blood clots?

Any surgery increases the risk of blood clot formation. Some patients are genetically predisposed to clot formation and are at a higher risk. If you have ever had clots in the past, please be sure to let your doctor know.

Clots can cause serious problems such as heart or vascular disease, or a stroke. A lung injury can occur if the clot migrates to your lungs from the leg. A large enough clot migrating to the heart or lungs can be fatal.

Anti-coagulation (blood-thinning) therapy is recommended after all knee replacement operations to reduce the likelihood of developing a clot. Even if a clot develops in the leg, if you are on a blood-thinner, the risk of the clot enlarging and migrating to the lungs is reduced. Exercises, spinal anesthetics, early mobilization, intermittent foot pumps, and blood-thinning medications are all aimed at reducing the risk of blood-clot formation after surgery.

What should I know about the blood-thinning medicine that I will be given?

At present, the most common blood thinner used after knee replacement is the drug warfarin. It is an inexpensive medication that requires adjustment on the dosage for each patient.

You will take warfarin at the same time each day. The dose will be based on a blood test that measures how fast your blood clots. The results are recorded as PT (prothrombin time) and INR (international normalized ratio); the pharmacist will look at these test results and figure out how much warfarin you should take. The goal of taking warfarin is to keep your INR between 1.8 and 2.5. If you miss a dose of warfarin, take it as soon as you remember, but do not double the next dose.

Many things, such as diet, other medications, physical activity and illness can affect warfarin dosing. Vitamins, over-the-counter remedies, herbs, nutrition supplements and other alternative treatments also affect warfarin, and should not be taken while you are on warfarin.

Are there risks to taking a blood-thinner?

Yes, and the obvious risk is bleeding. By thinning blood, we increase the risk of bleeding (something that can be managed), and decrease the risk of clot formation (which can be lethal). Thus, there is a trade-off in risks. The risk of bleeding is common to all blood thinners.

Drugs sometimes used instead of warfarin include heparin and aspirin. Some people may not be able to take warfarin; in that case it’s common to use a drug called enoxaparin. After about 10 days of warfarin, or enoxaparin, doctors typically switch patients to twice-daily aspirin; this combination is safe.

Side effects of warfarin and enoxaparin include dizziness, headache, weakness, cuts from shaving/injury that do not stop bleeding, nosebleeds, bleeding of the gums when brushing your teeth, vomiting blood, bruising or skin rashes, dark brown urine, red or black color to stools, unexpected vaginal bleeding, or unusual pain or swelling. If any such symptoms appear, we may have to switch to a different blood-thinner.

Warfarin interacts with many drugs, both prescription and over-the-counter. Special caution should be given to anti-inflammatory medications such as aspirin, ibuprofen-containing drugs; naproxen, ketoprofen, cimetidine, ranitidine; and food supplements that contain vitamin K.

Supplements, such as ginkgo biloba and danshen also interact with warfarin. Some herbal teas have tonka beans, melilot (sweet clover), or sweet woodruff in them, which contain vitamin K. In addition, foods containing fat substitutes such as olestra are supplemented with vitamin K.

Because so many dietary items affect warfarin, it is essential to monitor the action of this drug two or three times every week with blood draws that are done by the home health agency while you recover at home.

Preventing Infection

How do you prevent infections during knee replacement?

Scrubbing of the skin with an antiseptic, antibiotics given before surgery, surgeon experience, a team-approach designed to promote efficiency, and standardized protocols are some of the key steps in reducing the risk of infection. It is impossible to completely eliminate this risk, but it’s possible to get the risk down to nearly zero. It is very rare to have an infection after routine knee replacement.

Is there a long-term risk of infection in an artificial knee?

Yes, there is a lifetime risk of infection with any artificial implant in your body, whether a knee joint, heart valve, or other synthetic component. As long as you maintain good health and appropriate body weight, avoid smoking, maintain proper hygiene, keep diabetes under control, and promptly address even minor infections in your body, the risk of infecting an otherwise well-functioning knee implant is very low.

What if an infection does develop?

An early infection shows up as redness and pain around the healing incision. This can usually be treated with oral antibiotics alone, usually taken for five to 10 days. Very rarely, as a precaution, the knee joint has to be opened up and washed out to clean the tissues and effectively treat an early infection. This usually happens if the knee starts draining fluid after surgery, which is a rare occurrence.

A late infection that happens months or years after surgery is more serious, and will require additional surgery.

In these rare cases, the infected prosthesis is removed and a temporary antibiotic-loaded knee is implanted, to allow the patient to walk and function, while the infection resolves. After three or more months, a new knee joint is implanted. Six weeks of antibiotics and these two operations will effectively treat an established deep infection in the knee.

Fortunately, deep infections after knee replacement surgery are very rare, usually occurring in immune-compromised patients who have other serious medical problems.

Swelling

How long will I have swelling and warmth in the surgical site?

Swelling and warmth around the scar are common after a knee replacement operation. The ankle may also swell on the operated leg. This represents the normal process of healing and can last for several weeks to months, depending on factors such as circulation, body weight, diabetes, and other variables.

Obesity, diabetes, poor circulation, poor muscles, varicose veins, high activity, heart disease, and swelling before surgery will usually result in a longer period of swelling and heat in the operated leg. Elevating your leg at night and wearing compression stockings during the day will help.

Deep aches and swelling in the knee can persist for a long time because bone, a living tissue, continues to re-model and adapt around the metal implants. This increased metabolic activity can lead to lingering soreness and swelling after heavy activity, all of which will disappear with time.

Leaving the Hospital

What is the average length of hospital stay?

The length of hospital stay after knee replacement varies from just one day to five or more days. There is no standard formula; each person and each recovery is different. Typically, a routine knee replacement requires two to three days in the hospital; there is little to be gained by trying to accelerate this process. People need time to heal.

How is the discharge from the hospital handled?

During your hospital stay, a case manager will work with your doctor to plan your discharge, whether to your home, a skilled nursing facility, in-patient rehabilitation facility, or nursing home. A social worker may also visit, and work with the case manager to formulate a discharge plan.

What determines when I can go home after knee replacement?

You can go home when you are able to get into and out of bed; walk up to 75 feet with a cane, walker, or other assistive device; go up and down stairs; and get to the bathroom. Typically, you will have had a bowel movement before discharge, and will be able to take a shower. Your doctor is the one making the ultimate decision about the safety and timing of your discharge. You will need someone to drive you home from the hospital.

How will I manage at home?

After knee replacement surgery, you will need help at home from an adult family member or friend. If this is not possible, it may be necessary to stay at an inpatient rehabilitation facility. You will not be able to drive for the first couple of weeks.

A home health agency will check on you at home, about three times a week or more, to help with walking, exercise, incision checks, medications, and communication with the doctor. The home health agency will provide a nurse to do blood draws and follow-up care, a physical therapist to continue therapy, and possibly an occupational therapist. The nurse also communicates with your doctor to give regular progress updates.

While at home, if a concern arises, please contact your medical team. If there is a worry about the incision, taking a digital photo and sending it by email works very well.

When do I have to come back to see the doctor after knee surgery?

You will return for a visit about one month after your operation. If you have problems or questions before then, do not hesitate to call or e-mail your physician. Your home health nurse is also an excellent resource. Patients coming from far away can communicate by e-mail, send digital photos of their incisions and digital X-rays the same way; this works very well and saves a lot of driving and time.

Under what circumstances should I contact a doctor?

It is advisable to contact your surgeon’s office office if you have any of the following:

Temperature above 101 degrees
Drainage from your incision
Excessive redness around the incision
Increase in the incision pain
Increased leg swelling
Pain and swelling in the calf of the leg
Numbness or tingling down the back of the operative leg
Any other concern, even if it seems minor
Your family doctor may be your closest resource for advice if you develop a cold, flu, nausea, vomiting, diarrhea, or constipation. If you are unsure which doctor to call, call your surgeon.

If you cannot reach a doctor and feel that there is a problem, please go to the nearest emergency room. It is best to be vigilant and not take chances.

Common Sensations

Why do I hear a popping noise in the new knee?

Clicking, popping, and other noises in the knee alarm many patients. These are the harmless result of synthetic joint surfaces contacting each other and are common to all prosthetic knee components. The sounds may change over time, may disappear entirely, or may persist. The noises of an artificial knee joint will take some getting used to.

Why are my appetite, mood, food-taste, and sleep different after knee replacement?

Altered appetite, bowel habits, depression, and mood swings are common after any major elective surgery, including knee replacement. This is very important to know, understand, and anticipate. In some cases, medications might be necessary to control such symptoms.

All surgery elicits powerful psychosocial and physiological responses from the patient and vary from one person to another. These responses are normal, and we will help you get through them. It takes time for the body, mind, and soul to recover from any invasive operation.

Why is the outside of my knee numb?

This is normal after all knee surgery. The incision cuts small nerve fibers that run from inside to outside of the knee, so the skin to the outside of the cut always feels numb after knee surgery. Usually, this sensation will resolve over time and is not a major problem for patients. Most patients will not notice that the outside of the scar feels numb.

Is it normal for the muscles to spasm and tighten after surgery?

Yes. Sometimes unexpected spasms of the leg muscles occur after surgery, usually as the person is healing from the operation. These spasms will go away. If they are particularly troublesome, we can prescribe a muscle relaxant medicine, which can help.

Will my leg be longer after knee replacement?

Not noticeably, since it is not possible to lengthen or shorten a leg after knee replacement surgery. The reason is that blood vessels and nerves behind the knee present a practical limitation. Some patients say that the leg feels slightly longer. This comes from straightening out a crooked leg, which ends up feeling longer as a result. The sensation disappears as the patient gets used to having a normally aligned leg again.

Caring for your Incision

How long is the scar for knee replacement?

In most cases, a four- to five-inch incision is enough for knee replacement surgery. Your surgeon will use the shortest possible incision length. Incision length ultimately depends on each patient’s disease severity, anatomy, and amount of body fat.

Many orthopaedic implant companies have developed special instruments to assist in making shorter incisions, and provide training on their effective use. The general rule is to make the incision as short as possible, without compromising the accuracy, precision, or safety that is required for a successful long-term outcome. Since each patient is different, incision length can vary from person to person, even though the same type of knee replacement implants may be used.

Who will remove the staples from the incision?

For the first month, a home health nurse will visit you to check the incision, do blood work to monitor the blood thinner, and help you exercise and walk. That person should remove stitches no earlier than 21 days (three weeks) after surgery.

If there is any question about healing, it is safer to wait another week before removing stitches. Home health nurses can take a digital photo of the incision if there is a concern and send it to your doctor via email.

The preferred method to remove staples is to remove every other one, and apply adhesive-reinforced tape strips to ensure the skin stays together. If there is any concern about the skin edges coming apart, the rest of the staples can be left in for another week; delayed healing can occur in patients with a history of poor wound healing, cancer, diabetes, obesity, and other factors.

Please share this information with the home health person if there are any questions about staple removal. It is safe to shower anytime after staples are removed. Immersion of the incision in bath water, or in a pool should wait till the skin is fully healed.

Can I put any lotion on the scar?

While the staples are still in, it is best not to apply anything to the incision, and to keep the wound clean and dry. Once the staples are out, you can use vitamin E cream to massage and loosen up the scar. Most patients find this beneficial, and some feel that it makes the scar less visible. Massaging the knee area with an anti-inflammatory or cortisone cream can also help reduce skin inflammation and tenderness after knee surgery.

When can I shower after knee replacement?

You can shower as soon as you want after surgery. The incision will be covered with a plastic dressing, and the nursing staff will assist you. If the wound dressing gets wet, you can change it after the shower and use a towel to dry the skin around the incision. Showering reduces the bacterial load on your skin. Once the staples are out and the skin is dry, you can soak the knee in a bath also, but do not soak the incision area in a bath before the staples are removed.

Getting Moving

How long will I be off my feet after knee replacement?

You can put full weight on the replaced knee right after surgery. The therapist will get you up and walking the day after surgery. You will need the assistance of a walker or crutches, but putting weight on the knee and twisting is safe. Most patients are reasonably independent after four weeks, although individual recovery times will vary.

Will I need a walker, crutches, cane, or other assistive device?

Yes. You will likely require a walker for some time after knee surgery. If you have a walker, bring it with you to the hospital. If you do not have one, we can arrange for a walker while you are in the hospital.

Prior to surgery, you should pick up all throw rugs and secure extension/electrical cords at home, and make sure your furniture is arranged to allow you to use a walker safely, without the risk of falling. You can transition to a cane or crutches at any time you are comfortable.

I have pain and stiffness in the first few steps, then the knee feels OK. Is this normal several weeks, or even months after knee replacement?

Yes. Muscles, tendons, and ligaments take time to stretch and accommodate after surgery. The pain that is worse after sitting and goes away with walking is called start-up pain, and can persist for a long time. These symptoms will decrease as tissues heal. An anti-inflammatory medicine can help.

Will I have to learn how to walk again?

Considering that a prosthetic knee has no nerves and that the arc of movement after knee surgery will vary from before, many people feel like they must learn how to walk again. This is to be expected after knee replacement surgery. Take your time, and do not rush the process. There is no point comparing your recovery to anyone else, since recovery is very individual and depends on many patient-specific variables. At some point in your recovery, the new knee will begin feeling like a part of your body. Until then, it is true that you are, in a sense, learning to walk again.

How much therapy will I need?

You need a minimum of four weeks of therapy, usually at your home, with a visiting home health nurse. This person will see you about three times a week. Some patients need therapy after this four-week period, and others are already independent. If you need outpatient therapy, usually four to six weeks will suffice. Once you learn basic knee exercises, you will be able to do them at home.

Maintaining a regular program of exercise and mild aerobic activity long-term is an excellent idea, and you will maximize the benefit of your new knee.

Can I kneel after having a knee replaced?

Yes, although it may take several months before you can do it comfortably. The reason is that the kneecap experiences heavy loads during knee bending; loads that exceed your body weight. Soreness may keep you from kneeling after knee replacement surgery. You can safely kneel as soon as you are comfortable; you cannot damage the knee replacement by kneeling.

What happens if I do not get motion back in the knee quickly?

With minimally invasive surgery, lack of a tourniquet, and minimal muscle disruption, knee motion returns very quickly after replacement surgery. In very few cases, if the knee is not gaining mobility, it may be necessary to manipulate the knee joint under an anesthetic to “fast-forward” you in therapy, and break up early scar-formation in the knee joint. This is rarely necessary, and performed only on individuals who form heavy scar tissue.

Why does scar tissue form in the knee joint?

Scar formation is normal after all operations. After knee replacement, scar formation inside the joint is usually overcome by knee movement. Because of genetic factors and other variables, some patients will form scar very quickly inside the knee joint. Such patients may need additional or more aggressive therapy, and such patients will find that their recovery of knee mobility takes longer than others. This is normal, and again emphasizes that no two patients recover alike since patient anatomy and physiology vary from person to person.

How much bending will I get in the knee joint after replacement?

Implants bend safely to 150 degrees, which is about the physiologic limit of human knee anatomy. Existing scar tissue, contractures of the knee joint, severity of arthritis, pain tolerance, motivation for exercise, body size, and other variables profoundly affect how much mobility a person will get. For most patients, zero degrees of knee extension (bringing the knee out straight) and about 125 degrees of flexion (bending) are easily achieved; this is more than enough for almost all activities of daily living.

Do you use a machine to move the knee after surgery?

No benefit has been shown from the use of continuous passive motion (CPM) machines. Most surgeons use them now out of habit, or because some patients prefer them. If you would like a machine to move your knee after surgery, discuss it with your medical professional. Usually, outcomes from knee replacement are just as good without these machines. CPM machines are never a substitute for using your own muscles and motivation to regain mobility.

Should I exercise after knee replacement?

Yes. A regular program of light aerobic exercise is best, with weight training added to the exercise regimen. Exercise is beneficial from many standpoints, and will optimize the outcomes of your knee replacement. Recommended exercises include walking, swimming, light aerobics, golf, treadmill, stair-climbing, weight-training, and elliptical exercise equipment.

How soon will I be able to return to everyday activities?

Soon after surgery, you will begin to walk short distances in your hospital room and perform everyday activities. This early activity aids your recovery and helps your knee regain strength and movement. A nurse or therapist will assist you as necessary.

Returning to regular activity in terms of walking, exercising, and work vary greatly between patients; most patients return to their regular activities in six to 12 weeks.

How active can a person be after a total knee replacement?

You can be as active as you want and carry as much weight as you can tolerate. Heavy impact exercises, such as basketball, football, soccer, and tennis are probably best avoided, since they contribute to increased prosthesis wear. Low-impact aerobics, bicycling, treadmills, swimming, and similar exercises are fine. Climbing, hiking, and other outdoor activities can be performed as tolerated.

Strength and endurance will build up over time. Modern total knee implants are very durable and designed to take repetitive impact loading for many decades, even in active and heavy patients.

When can I drive after knee replacement surgery?

For the left leg and an automatic transmission in your car, drive whenever you can comfortably sit in a car and have control of the operated leg. For the right leg (and left in the case of driving a car with a clutch), it takes about two to four weeks before you regain the confidence and control in the leg to drive. Of course, you should not drive if you are taking narcotics that make you sleepy or reduce alertness. Avoid driving any time comfort or pain is an issue.

How much can I lift?

You can lift as much as you are comfortable doing. Start out with small weights, and build up your tolerance. As long as the knee does not hurt, lifting weights is fine.

Can I ride horses after knee replacement surgery?

Yes, once your recovery is such that you are independent, strong, and comfortable, you can ride horses, ATVs, and bicycles, with reasonable precautions that apply to each.

When can I go back to work after knee surgery?

The faster you get back to work, the better it is for you, psychologically and physically. We can accommodate your requests for time off work and your return to limited duties. Each individual and job situation is different. Your medical team will work with you to expedite your transition back to your job. Some people with desk jobs have returned to limited work in two weeks after knee replacement; others have preferred to take several months off.

Can I climb ladders?

Yes, climbing ladders is fine as long as the knee is fully healed and your strength has returned.

When can I resume sex?

You can resume sex at any time after knee surgery that you feel comfortable. Unless specifically instructed otherwise in very selected and unusual cases, there are no precautions to follow after knee replacement surgery.

When can I travel after surgery?

Whenever you feel comfortable, go ahead and travel by car or airplane. It is best to avoid the same seated position for over an hour, so try to get up and move around when possible. Otherwise, make sure to do ankle and calf exercises every hour to keep the blood pumping and avoid the possibility of blood clots forming. Prolonged sitting will also cause leg swelling, so it is best to change position during travel if possible.

When can I drink alcohol after surgery?

Moderate, social alcohol use can be resumed anytime that your appetite dictates. Avoid alcohol if your blood is too thin on the warfarin, and your warfarin dose is being held. Heavy alcohol use after any surgery is dangerous.

How long does it take for me to feel normal after a knee replacement?

While 80 to 90 percent of recovery is usually over by the first two months, the last 10 percent can linger. Even though patients can resume normal activities, the bone around the new implants will keep remodeling in response to the altered biomechanics. As a result, it can be up to two years or so before an artificial joint really feels like your own. It can take that long for the skeleton to accommodate the new knee, and feel normal.

Why is recovery after knee replacement said to be harder than after hip replacement?

One, the hip has more muscles covering it, and fewer nerves.

Two, the hip joint is relatively simple, consisting of one kind of movement (ball and socket).

Three, hip surgery can be done even less invasively than knee replacement using modern techniques.

Four, after a hip replacement, very little exercise is necessary for recovery, since there is little risk of the hip getting stiff. In contrast, the knee is a complex joint, relying on outside ligaments for support. These ligaments get stretched with every step. There is very little muscle cover around the knee, so that any bump is felt in the joint.

Finally, the knee tends to scar and stiffen quickly, and the joint must be moved actively to prevent this, and regain motion. For these reasons, recovery after hip replacement is typically a lot easier than recovery after knee replacement.

Helpful Tips

Tips on Walking

Proper walking is the best way to help your knee recover. At first, you will walk with a walker or crutches. Your surgeon or therapist will tell you how much weight to put on your leg; in most cases full weight is safe right away.

Stand comfortably and erect with your weight evenly balanced on your walker or crutches. Advance your walker or crutches a short distance; then reach forward with your operated leg with your knee straightened so the heel of your foot touches the floor first.

As you move forward, your knee and ankle will bend, and your entire foot will rest evenly on the floor. As you complete the step, your toe will lift off the floor and your knee and hip will bend so that you can reach forward for your next step. Remember, touch your heel first, then flatten your foot, then lift your toes off the floor.

Walk as rhythmically and smoothly as you can. Don’t hurry. Adjust the length of your step and speed as necessary to walk with an even pattern.

As your muscle strength and endurance improve, you may spend more time walking. You will gradually put more weight on your leg. You may use a cane in the hand opposite your surgery and eventually walk without an aid. Early on, it is best to moderate the exercise and avoid overdoing it.

When you can walk and stand for more than 10 minutes and your knee is strong enough so that you are not carrying any weight on your walker or crutches (often about two to three weeks after your surgery), you can begin using a single crutch or cane. Hold the cane or crutch in the hand opposite the side of your surgery. You should not limp or lean away from your operated knee.

Tips on Stairs

The ability to go up and down stairs requires strength and flexibility. At first, you will need a handrail for support and will be able to go only one step at a time. Always lead up the stairs with your good knee and down the stairs with your operated knee. Remember, “up with the good” and “down with the bad.” In other words, going up stairs, lead with the good (non-surgery) leg, and coming down stairs, put the bad (surgery) leg down first.

You may want to have someone help you until you have regained most of your strength and mobility. Stair climbing is an excellent strengthening and endurance activity.

Do not try to climb steps higher than the standard height (seven inches) and always use a handrail for balance. As you become stronger and more mobile, you can begin to climb stairs foot over foot.

Managing Pain and Discomfort

How much pain can I expect?

With modern surgery, pain can be controlled very well. Even though modern pain medicines are very effective, some aching and soreness in the knee may persist for many months. This is part of a normal recovery, as long as you notice steady improvement.

Each patient will recover differently; even two knees replaced in the same patient on the same date will recover differently. For example, effective pain control may be a problem for patients who take narcotics regularly before surgery. In these patients, pain relief can be hard to attain since the body desensitizes itself to narcotics.

Will there be persistent pain after surgery?

No, although pain perception varies greatly among patients and the time to full recovery is highly variable. The important thing to watch for is a steady decline in the level of discomfort; the knee should feel better month-to-month. If there is persistent pain, or increasing pain, then further inquiry is necessary. Remember, there will always be patients who go home in a day or two, and never seem to have any pain after knee replacement. There are others who recover far more slowly. The important thing to remember is that both types of recovery are entirely normal.

Should I apply ice or heat to the knee as it is healing?

After surgery, and for the first two weeks, ice is more effective in reducing swelling and pain. After complete healing of the skin and removal of staples, you can use a moist heat pack if it feels comfortable. Once healed, soaking the knee in a hot tub helps, too.

Whom should I call for pain pills?

Please contact your doctor’s office for pain medicines. State regulations allow some medicines to be phoned in; others require a written prescription. Please plan ahead, since narcotic prescriptions on weekends or Friday afternoons can be difficult to call in, mail in, or otherwise get filled.

How long should I take pain pills?

Most patients use the narcotics that are sent home with them for anywhere from one to three months. Over time, they taper off and begin anti-inflammatory medicines and other non-addictive medicines for pain by three months.

Narcotic drugs taken over a long time creates a tolerance that makes them less and less effective. That is why it is preferable to taper off narcotic drugs after three months, unless there are compelling reasons to continue use. This is a general observation; some patients will require narcotic medications for a longer period of time.

What if I need narcotics three months after surgery or if I have been taking them before surgery?

In such cases, the doctor who was filling the prescriptions prior to surgery may resume dispensing the medication. Very rarely, referral to a pain specialist is necessary for patients who are dependent on long-term narcotics. These medications are carefully monitored and tracked in the pharmacy databases, and specialized pain doctors are better trained and equipped to monitor their long-term use.

If you were taking narcotics regularly before surgery, pain control is usually more difficult and complicated since the body is desensitized to the pain control medicines we use after surgery. In such cases, let your doctor know what you are taking before surgery so that we can adjust pain medicines accordingly.

There are no hard rules. Your medical team is there to help you; they understand that every person is different and that pain is very individual.

Treating Knee Arthritis

Can exercise be helpful for knee arthritis?

Yes. Exercises to stretch and strengthen the quadriceps muscles and hamstrings are helpful in reducing the pain of arthritis. Stronger muscles and weight loss will decrease the mechanical loading of the knee joint, resulting in pain relief.

Walking, swimming, light aerobics, elliptical exercisers, and other related activities can be very useful. In some patients, a physical therapist can help design an exercise program to help an arthritic knee. Any exercise is far better than no exercise. Exercise will not make arthritis worse, and will not accelerate the wear and tear in the knee.

Does weight loss help with knee arthritis?

Yes. Excess body weight is multiplied across the knee joint. Thus, gaining 10 pounds of body weight can lead to a 30-pound load on the kneecap, making getting up, climbing stairs, and squatting very difficult.

Losing weight takes load off the cartilage, and decreases the burden on your knees. Weight loss also makes surgery safer. Generally speaking, weight loss and the maintenance of proper body weight can help reduce the pain of knee arthritis.

Does using a cane help with knee arthritis?

Yes, it does. Similarly, using a walker or other assistive device can help by off-loading the knee joint and reducing the tendency to limp. Most people would rather not use a cane, but using one will help with the pain of an arthritic knee.

Will a brace help with knee arthritis?

It depends. Over-the-counter knee braces can be very effective at controlling pain and giving you more confidence and balance in the knee. More expensive custom braces are rarely necessary. Wrapping the knee with an elastic bandage can also relieve arthritic pain.

What other non-surgical steps can I take to relieve pain of knee arthritis?

When possible, avoid stairs and concrete floors, lifting weight, deep bending, twisting activities such as golf, and repetitive impact such as jogging. These are all reasonable, non-surgical options that people use to relieve the pain of an arthritic knee until they are ready for surgery.

Will alternative therapies like supplements and acupuncture help?

Some patients find relief by using over-the-counter remedies like glucosamine, vitamins, oils, shark cartilage, herbal supplements, etc. Such remedies often lack scientific proof of their beneficial effects; be sure to read and understand the package label.

Chiropractor manipulations, acupuncture, massage, heat packs, prolotherapy, aqua-therapy, and related alternatives may also help. Explore and use these options if you feel they are of value. Of course, you should stop any therapy or manipulation that increases your pain.

One important note: If you are scheduled for surgery, stop all herbal, vitamin, and alternative medications at least 10 days before surgery, to avoid excess bleeding and interactions with anesthetics.

Do knee injections help?

Cortisone injections placed in the knee joint can provide relief; the duration of relief varies from patient to patient, often depending on how worn out the knee is. Most patients will get a month or so of relief after a cortisone injection; others may get longer-lasting relief.

Lubricant injections can be given weekly over three to five weeks; these replace the normal knee lubricants. Modern versions of these injections allow for one injection that is given every three to six months or so.

For arthritis that is not quite bone-on-bone yet, these injections can help, and allow patients to enjoy life without having the knee replaced.

Exciting new techniques are always being researched. For example, a new-generation of gold nanoparticles with low-grade radioactivity was used in research to come up with injections that can help with arthritic pain relief for a long time.

How long can I rely on medication as treatment for my arthritic knee?

It depends. Anti-inflammatory medications such as aspirin, ibuprofen, and others in this class of drugs are not addictive drugs. As long as your primary physician is aware and monitors your kidney function, these medications can be taken, within the safe dose range, for many years, even on a regular basis.

Alternative medicines such as glucosamine chondroitin might also help with knee pain. These medicines may not work for everyone, but they are worth a try; in some cases, they can help considerably.

Narcotic drugs are more risky and can create dependence. Also, long-term use of narcotics before surgery makes pain control after surgery more difficult. If your knee pain has progressed to the point where you require narcotic medication, it may be time to think about surgery.

Why not just replace my knee instead of trying non-surgical treatments?

Surgery should be the last option. No knee operation can ever restore the complexity and superior function of your own knee. Surgery also has risks. Experience shows that patients who wait and exhaust all other options before knee surgery have the best outcomes.

Those who rush into surgery without all the information are often unhappy afterward. That is why any responsible surgeon will work with you to try all non-surgical options first. Never rush to surgery, and never bypass other methods of obtaining pain relief.

Does arthroscopic surgery help in the treatment of knee arthritis?

For some patients, yes. Knee arthroscopy can help by providing several years of pain relief. Such cases usually involve early knee arthritis that has caused a cartilage tear.

Arthroscopy is an outpatient surgery where two or three holes are made in the knee for a camera and instruments that can remove arthritic debris, loose pieces, tears, and related pathology. Sometimes, injections and physical therapy are necessary after knee arthroscopy.

The key value of arthroscopy, in selected cases, is the ability of the surgeon to get a first-hand view inside the joint. This information is not usually available by other methods, and can be useful in planning treatment and understanding the prognosis.

If the cartilage destruction is severe, however, arthroscopic surgery is unlikely to help, and a knee replacement may be indicated.

Are there non-implant surgical options to treat arthritic knees?

In young patients with non-inflammatory arthritis of the knee joint that is not yet extensive and in whom leg deformity is significant, an osteotomy can be done to realign the leg.

This procedure involves cutting bone and realigning the axis of the leg, similar to wheel alignment in a car, to take off the wear from inside or outside the tires. Only a few patients are candidates for such joint-conserving procedures, and we can advise you if you are such a candidate.

When should knee replacement be considered?

The right time to consider knee replacement is when pain pills, exercise, weight loss, bracing, ice, heat, injections, and various alternative therapies no longer provide sufficient relief from the pain of an arthritic knee.

Knee replacement offers dramatic pain relief and increased motion. Some soreness and stiffness will persist for weeks to months in a few patients, but ultimately most people are glad they had surgery.

If pain, swelling, grinding, deformity of the leg, and decreased ability to function are severe enough to get your attention, and non-surgical options have not worked, it may be time to consider replacement surgery.

Diagnosing Knee Arthritis

Arthritis of the knee is a common underlying cause for knee replacement surgery. Here’s what you should know.

How is worn cartilage diagnosed?

Symptoms such as pain, swelling, stiffness, lack of movement, and grinding in the knee can suggest that knee cartilage is no longer smooth. X-rays are a common way of diagnosing diseased cartilage in the knee. The X-rays show the bones around the joint. The cartilage layer cannot be seen on X-rays, and shows up as a space between the femur and tibia bones.

In a healthy knee, this space is about a quarter of an inch thick. When joint space taken up by cartilage is destroyed by arthritis, X-rays will show joint-space narrowing. With significant cartilage loss, the bones may touch each other; doctors call this finding “bone-on-bone” on the X-rays.

Over time, cysts and bone spurs may form around the knee. Left untreated, the leg can get so deformed that it appears to be either bow-legged or knock-kneed.

Are there other ways to see the extent of damage to knee cartilage?

MRI scans are a special X-ray study that can diagnose diseased cartilage somewhat more accurately and at an earlier point than plain X-rays. Another method includes actually looking inside the knee during a procedure called “knee arthroscopy.” This involves the surgeon placing a small camera in the knee and inspecting the cartilage.