KNEE

Recovery from knee surgery can be full of ups and downs, but there are steps you can take to make the process as smooth as possible.

We find that patients who know what to expect and are proactive in their recovery tend to do better overall. With that in mind, here are six tips to follow in your recovery after knee surgery.

1. Get Plenty of Rest

Most people know that getting a good night’s sleep is essential for feeling rested and alert the next day, but few realize just how important it is for recovering from surgery. This doesn’t mean you have to stay in bed all day – although you should take it easy for the first few days – it does mean getting enough sleep at night and taking periodic naps during the day.

Good rest is crucial for healing because it gives your body the time it needs to repair the damage from surgery. When you’re well-rested, you’ll also have more energy for physical therapy and other essential activities for recovery. The recovery timelines for patients who get adequate rest are usually shorter than for those who don’t. So, make sure to get your ZZZs.

2. Eat a Nutritious Diet

As with sleep, eating a nutritious diet is vital for everyone but especially crucial for people recovering from surgery. A healthy diet will give your body the nutrients it needs to heal properly and fight infection. It’s also essential to avoid constipation, which can be a problem after surgery due to pain medication and inactivity.

To stay on top of your nutrition, eat plenty of fruits, vegetables, and whole grains. These foods are packed with vitamins, minerals, and fiber that will help keep your digestive system moving and your body healthy. It would help if you also drank plenty of water to stay hydrated.

3. Stay Active

It may seem counterintuitive, but staying active is vital for recovery after knee surgery. Of course, you shouldn’t overdo it – too much activity can delay healing – but getting some gentle exercise will help keep your joints mobile and prevent stiffness. Physical therapy is a great way to get the proper exercise for your needs.

Walking is another excellent way to stay active while recovering from knee surgery. Just be sure to start slowly and increase your distance gradually. If walking is painful or makes your incision feel uncomfortable, stop and rest until the pain subsides. As long as you listen to your body, staying active will speed up your recovery.

4. Follow Your Physical Therapy Regimen

Physical therapy is essential to recovering from knee surgery, but it’s important to follow your therapist’s recommendations. Depending on the surgery you had, you may need to start physical therapy a week after your procedure. This may seem like a lot, but getting the rehabilitation process started early is vital.

Your physical therapist will design a customized exercise program that gradually increases in intensity as you heal. Sticking to this program even when you feel like you can do more is essential. Pushing yourself too hard can delay healing and lead to setbacks. Trust your therapist and follow their guidelines for a successful recovery.

5. Use Pain Medication as Directed

Recovering knee surgery can be painful, but taking pain medication only as directed is essential. Taking too much medication can be dangerous and make it difficult to gauge your level of activity. It’s vital to listen to your body and rest when necessary, even if that means taking a little extra medication.

Of course, you shouldn’t suffer unnecessarily. Talk to your doctor or surgeon about adjusting your medication regimen if your pain is severe or persistent. It’s also important to let them know if you have any concerns about the side effects of your medication. In most cases, the benefits of pain relief outweigh the risks, but it’s always best to err on the side of caution.

6. Be Patient

Recovery from knee surgery takes time, so it’s essential to be patient and realistic about your expectations. Depending on the procedure, it may be several months before you’re back to your old self. And even then, you may have some lingering stiffness or pain. It’s important to listen to your body and take things slowly to avoid setbacks.

If you’re having trouble staying positive, talk to your doctor or surgeon about ways to cope with the frustration of a long recovery. In the meantime, focus on following your rehabilitation program and taking care of yourself. The better you take care of yourself now, the sooner you’ll be back to your old self.

Following these tips will help you have a successful recovery after knee surgery. However, every patient is different, so talk to your surgeon about what you should expect during your recovery process. Just remember to listen to your body and take things one day at a time – before you know it, you’ll be back on your feet again.

Newswise — Hackensack University Medical Center physicians are now offering ioverao, a handheld device that is applied in the doctor’s office before knee replacement surgery to relieve postoperative knee pain, as well as to reduce the chronic pain of knee osteoarthritis. This cryotherapy treatment has been shown to decrease patients’ use of opioids and restore mobility by reducing stiffness and discomfort.

Knee pain due to osteoarthritis is a very common complaint among adults in the United States. It is a leading cause of disability that impairs quality of life and hinders mobility. Osteoarthritis of the knee is also the number one reason for total knee replacement. “We are continually seeking effective nonsurgical alternatives to opioids to reduce pain in people with chronic knee arthritis and to relieve postoperative pain in those who have had total knee replacement surgery,” explained Gary Panagiotakis, D.O., who specializes in Physical Medicine and Rehabilitation and in Pain Medicine at Hackensack University Medical Center.

The ioverao system is an innovative “cryoneurolysis” approach to blocking pain that relies on the body’s natural response to cold. Here’s how it works:

1. The physician assesses a patient’s pain before the procedure and uses physical examination and ultrasound to identify the nerves responsible for the patient’s knee pain.
2. The nerves are marked and the doctor injects a local anesthetic into the areas to be treated.
3. The ioverao system is a portable handheld device that delivers precise, controlled doses of very cold temperatures to the targeted nerves through a small probe with three tiny needles at its tip. The physician applies the device along each nerve until the nerve is blocked. 
4. The ioverao treatment temporarily stops the nerve from sending pain signals to the brain without damaging surrounding tissue. 
5. Pain relief is immediate and lasts until the nerve regenerates. One treatment with the iovera° system can last 90 days.
6. The treatment areas are cleaned and bandaged, and the patient goes home the same day.

A clinical study showed that patients who received ioverao treatment before total knee replacement surgery requested 45% fewer opioid prescriptions 12 weeks after the operation. They also had less pain two weeks after surgery. Patients with chronic osteoarthritis who received ioverao treatment experienced less stiffness 30 days after the treatment and reported improved physical function at the 90-day mark.

“Traditionally, opioid pain medications have been the first line of defense against knee pain due to osteoarthritis, both before and immediately after surgery, despite causing side effects that can detract from a patient’s recovery,” noted Yair Kissin, M.D., an orthopedic surgeon at Hackensack University Medical Center who specializes in knee replacement. “The iovera° system has provided us with a new approach to enhance the recovery of our patients and improve patient comfort without opioids.”

“Hackensack University Medical Center is committed to ensuring that our patients have access to the latest approaches to relieve pain while reducing the dependence on opioids,” added Michael A. Kelly, M.D., chairman of Orthopedic Surgery. “We are proud to have the ioverao system in our arsenal of tools and look forward to expanding its applications to further enhance the exceptional care we provide to our patients with acute and chronic knee pain.”

About iovera°

The iovera° system is used to destroy tissue during surgical procedures by applying freezing cold. It can also be used to produce lesions in peripheral nervous tissue by the application of cold to the selected site for the blocking of pain. It is also indicated for the relief of pain and symptoms associated with osteoarthritis of the knee for up to 90 days. The iovera° system is not indicated for treatment of central nervous system tissue. It is important to note that iovera° does not treat the underlying cause of pain. Timely remediation is necessary to address and treat the cause of pain. iovera° has been studied in clinical trials of patients prior to total knee arthroplasty and to treat the pain and symptoms of knee osteoarthritis. Additional information is available at www.iovera.com.

ABOUT HACKENSACK UNIVERSITY MEDICAL CENTER

Hackensack University Medical Center, a 781-bed nonprofit teaching and research hospital, was Bergen County’s first hospital founded in 1888. It was also the first hospital in New Jersey and second in the nation to become a Magnet®-recognized hospital for nursing excellence, receiving its sixth consecutive designation from the American Nurses Credentialing Center. The academic flagship of the Hackensack Meridian Health network, Hackensack University Medical Center is Nationally-Ranked by U.S. News & World Report 2022-2023 in four specialties, more than any other hospital in New Jersey. The hospital is home to the state’s only nationally-ranked Urology and Neurology & Neurosurgery programs, as well as the best Cardiology & Heart Surgery program. It also offers patients nationally-ranked Orthopedic care and one of the state’s premier Cancer Centers (John Theurer Cancer Center at Hackensack University Medical Center). Hackensack University Medical Center also ranked as High-Performing in conditions such as Acute Kidney Failure, Heart Attack (AMI), Heart Failure, Pneumonia, chronic obstructive pulmonary disease (COPD), Diabetes and Stroke. As well as High Performing in procedures like Aortic Valve Surgery, Heart Bypass Surgery (CABG), Colon Cancer Surgery, Lung Cancer Surgery, Prostate Cancer Surgery, Hip Replacement and Knee Replacement. This award-winning care is provided on a campus that is home to facilities such as the Heart & Vascular Hospital; and the Sarkis and Siran Gabrellian Women’s and Children’s Pavilion, which houses the Donna A. Sanzari Women’s Hospital and the Joseph M. Sanzari Children’s Hospital, ranked #1 in the state and top 20 in the Mid-Atlantic Region in the U.S. News & World Report’s 2022-23 Best Children’s Hospital Report. Additionally, the children’s nephrology program ranks in the top 50 in the United States. Hackensack University Medical Center is also home to the Deirdre Imus Environmental Health Center and is listed on the Green Guide’s list of Top 10 Green Hospitals in the U.S. Our comprehensive clinical research portfolio includes studies focused on precision medicine, translational medicine, immunotherapy, cell therapy, and vaccine development. The hospital has embarked on the largest healthcare expansion project ever approved by the state: Construction of the Helena Theurer Pavilion, a 530,000-sq.-ft., nine-story building, which began in 2019. A $714.2 million endeavor, the pavilion is one the largest healthcare capital projects in New Jersey and will house 24 state-of-the-art operating rooms with intraoperative MRI capability, 50 ICU beds, and 175 medical/surgical beds including a 50 room Musculoskeletal Institute. 

  ###

MicroPort Navibot has recieved FDA 510(k) approval of its first robot-assisted platform for orthopedic use, MicroPort Orthopedics said Aug. 8.

The Skywalker system will initially be used for total knee replacements and is compatible with the Evolution medial-pivot total knee system, according to a MicroPort Orthopedics news release. It has preoperative planning capabilities and assists surgeons with implant alignment during surgery.

MicroPort Navibot, based in Foxborough, Mass., plans to develop other orthopedic applications, according to the news release.

For 12 years, Shashi Joshi found it difficult to even stand due to severe pain

An Indian expat underwent a successful robot-assisted complex knee replacement surgery, walking just three hours later.

For the past 12 years, 63-year-old Shashi Joshi had been battling severe pain in both her knees due to osteoarthritis for more than a decade. It made her daily routines difficult, from walking to even standing.

“We have tried all sorts of conventional treatment from injections to pain killers, etc., in various hospitals in the UAE and abroad. But the pain and difficulty in walking persisted,” said Joshi.

The pain soon became unbearable and Joshi consulted Dr Azam Badr Khan, specialist orthopedic surgeon at Prime Hospital in Garhoud.

“Joshi had been suffering from knee pain and deformity for more than 15 years, and her left knee was more badly affected,” said Dr Khan.

“She was under medication, supplements, physiotherapy, and even intra-articular inside knee injections of hyaluronic acid and steroids.”

Joshi asked Dr Khan “to come up with a derived plan” for her knees, and she was subjected to pain management and medication for nearly two months.

On July 28, Joshi underwent robot-assisted knee replacement surgery.

“We removed the worn-off part in the knee joint by shaving the lower end of the thigh bone, called the femur, and the upper end of leg bone, called the tibia, and replaced it with a titanium and cobalt chrome sophisticated metal and inserted polyethylene to act as a spacer,” said Dr Khan.

Dr Khan added that the robot-assisted knee replacement concept was the same as the traditional knee replacement but with nearly no chance of human error.

“Sensors are attached along the knee where the robot controls the surgery. It guides the surgeon on the exact tissues and area to peel off.”

“The robotic surgery helps in precision, perfect alignment, and ligament balancing as the implant is precisely fused to negate negligible human error.”

Dr Khan also explained that the surgery is first carried out on a screen and then performed on the actual knee after it precisely calculates where the implant is to be fixed.

“Robots in total knee replacement is all about precision which comes from the integration of physics, maths & thoughts. Precision leads to better alignment and hence better mobility with faster recovery and long-lasting knee replacement,” Dr Khan explained.

ALSO READ:

Joshi could walk in just three hours soon after the surgery.

“I am on my regular exercises and physiotherapy sessions, and I do experience pain a bit, but that is part of the process,” said Joshi.

Joshi was under observation for five days and was discharged on August 3.

“I am thankful to the surgeon and hospital staff, and I am waiting to get back to ease in my daily routine,” added Joshi.

arthroscopic knee surgery It is a non-invasive surgical procedure, in which a small camera is used to look inside the knee and be able to see the joint as a whole.

During arthroscopic knee surgery, pain can be controlled in three ways:local anesthesia

The knee may be numbed with anesthetic medication and the patient may also be given medication to calm nerves and anxiety, although the patient will remain awake.

spinal anesthesia

It is injected into a vertebral space in the spine. Although the patient will be awake, he will not be able to feel anything from the waist down.

general anesthesia or regional anesthesia

The patient will be taken to the operating room for medicines, serum and anesthesia, the patient will be in a deep sleep and will not feel any pain.

General anesthesia within it also penetrates the regional nerve block (blockade of the femoral or adductor canal). This is another type of regional anesthesia. Anesthetic is injected around the nerve in the groin. You will be asleep during the operation. This type of anesthesia will block pain, so less general anesthesia is needed.

arthroscopic surgery in procedure

A cuff-like device may be placed around the thigh to help control bleeding during the procedure.

The surgeon will make 2 or 3 small incisions around the knee and salt will be inserted into the knee to enlarge it. A narrow tube with a small camera on the end will be inserted through one of the incisions.

The camera is connected to a video monitor that allows the surgeon to see the inside of the patient’s knee.

The surgeon may place other small surgical instruments into the knee through other incisions. He will then repair or correct your knee problem.

At the end of the surgery, the knee will drain the saline solution. The surgeon will close the incisions with sutures and cover them with a dressing.

Candidates for Arthroscopic Knee Surgery

Arthroscopy may be recommended in the following cases:

The meniscus is the cartilage that protects the space between the bones of the knee. Surgery is done to fix or remove it.

• An anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) is damaged or torn.

• Torn or damaged collateral ligament.

• Inflammation or damage to the lining of the joint. This lining is called the synovial membrane.

• Patella that is out of position.

• Tiny pieces of torn cartilage in the knee joint.

• Baker’s cyst removal. This is a swelling behind the knee that fills with fluid. Sometimes this happens when there is swelling and pain due to other causes such as arthritis.

• Some fractures in the knee bones.

risk

are related to anesthesia and surgery

• Allergic reaction to drugs
• respiratory system problems
• is bleeding
• infection

Additional risks of this surgery may include:

• bleeding within the knee joint
• Damage to the cartilage, menisci or ligaments in the knee
• blood clot in leg
• injury to a blood vessel or nerve
• knee joint infection
• knee stiffness

Preparation before knee arthroscopy

• You should not drink or eat anything for 6 to 12 hours before the procedure.

• The medicines prescribed by your doctor should be taken with a small sip of water.

• Usually you should wear a bandage over your knee dressing.

• Most people can go home the same day as the surgery.

• Your doctor will give you exercises to do, which you can start after your surgery. You may also be referred to a physical therapist.

arthroscopy results

Full recovery after knee arthroscopy will depend on the type of problem the doctor faced.

For example, problems such as a torn meniscus, torn cartilage, Baker’s cyst, and synovial membrane problems can often be easily corrected. Many people remain active after these surgeries.

In most cases, recovery is quick with simple procedures. However, you may need crutches for some time after some types of surgery.

Your doctor will also prescribe pain relievers to take during recovery.

Postoperative scarring is a complication of arthroscopic knee surgery that causes a lack of terminal extension and tissue sliding defects. We present video evidence of tissue sliding before and after ultrasound-guided hydrorelease in a 53-year-old man. The patient presented with pain in the scarred area following arthroscopic knee surgery. His active and passive extension was -5° with restricted patellar mobility. Dynamic ultrasonography revealed scar tissue sliding defects. For ultrasound-guided hydrorelease, a needle (22G, 60 mm) was aimed at a site within 10 mm depth of the hypoechoic change in the scar area below the patella, and saline solution (10 mL) mixed with 1% lidocaine (10 mL) and 10 mg prednisolone was injected. Immediately after injection, the patient’s extension was 0° with no pain or limitation of patellar mobility, and dynamic ultrasonography showed tissue sliding improved. Video evidence from dynamic ultrasonography clarifies the direction of the inadequate slide and the indication for and efficacy of ultrasound-guided hydrorelease. This case highlights the benefits of video evidence from dynamic ultrasonography before and after ultrasound-guided hydrorelease.

Introduction

Case Presentation

Discussion

Conclusions

As part of our commitment to staying at the forefront of technology and innovation while continuing to serve our community the Bone & Joint Care Center is the first in Berks County to offer iovera° treatment for qualifying patients. The iovera° system is FDA-cleared to provide immediate and long-lasting relief of chronic and acute knee pain without the use of opioids. The iovera° treatment can be performed prior to knee surgery to help reduce pain after surgery or to treat chronic knee pain due to osteoarthritis. The iovera° procedure provides relief right at the site of pain so it doesn’t affect the entire body like NSAIDs, opioids/narcotics, traditional cortisone or gel injections.

“Traditionally, opioid pain medications have been a first line of defense against knee pain, both before and immediately after surgery, despite causing side effects that can detract from a patient’s recovery experience,” said Kenneth McAlpine, Jr., MD, at Bone & Joint Care Center. “The iovera° cold therapy system will allow us to reach for a new standard of enhanced recovery and patient care in our practice and we couldn’t be more thrilled with the extent of positive outcomes it will provide for our patients.”

With the iovera° system, our physicians are able to deliver precise, controlled doses of cold through a portable, handheld device. Studies show that pain relief with the iovera° treatment is immediate and can last up to 90 days. During the simple outpatient procedure, iovera° safely and effectively allows patients with knee pain to leave their physician’s office experiencing less pain than they had when they arrived. Studies show that patients who receive iovera° treatment prior to knee replacement surgery benefit from reduced post-operative pain, leading to accelerated recovery time and reduced reliance on pain medication. Studies also show that knee replacement patients who received iovera° treatment requested 45% fewer opioid prescriptions at 12 weeks after knee replacement surgery.

For more on the iovera° procedure, as well as detailed safety and potential complication information, visit boneandjointreading.com/iovera.

If your goal is to postpone knee replacement surgery as long as possible, there are a number of things you can do to help manage your pain and stay active (via HealthPartners).

As counterintuitive as it may seem, exercising and moving your joints, in spite of the pain, can actually stimulate the flow of fluid around your knees, strengthen the muscles that support your knees, reduce stiffness, and increase flexibility. Stick to low-impact activities such as walking, swimming, strength training, and cycling. Any exercise that strengthens your core, hips, and legs, without damaging your knees any further, should help manage your pain.

Working with a physical therapist to get a personalized exercise plan you can do at home can also have long-term benefits — especially if you’re consistent about doing the exercises on your own. And if you’re even a little overweight, consider losing a few pounds. According to HealthPartners, even losing one pound eliminates four pounds of pressure on your knees, which is pretty impressive.

Cortisone shots and other injections that include hyaluronic acid (HA) help lubricate the inside of the knee and may provide short-term relief — up to about three months — from arthritis pain, says Johns Hopkins Medicine.

As for medications, steer clear of opioids if at all possible; they’re addictive, and aren’t proven to help long-term knee pain. And check with your doctor even before using over-the-counter drugs like ibuprofen and naproxen because they can have side effects.