Knee Replacement

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The knee is a hinge-like joint made up of various muscles, ligaments, cartilage, and tendons. A knee replacement (also known as knee arthroplasty) is where portions of the bones that form the knee joint are removed and replaced with artificial implants. It is performed primarily to relieve knee pain and stiffness caused by osteoarthritis.

Most patients who get this surgery have advanced knee arthritis, in which the knee cartilage is worn away and the surface of the knee becomes pitted, eroded, and uneven. This causes pain, stiffness, instability, and a change in body alignment. Knee replacement surgery can also help some people who have a weakened knee joint caused by an injury or other condition.

Causes & Symptoms

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Although there are several conditions that may lead to the need for knee replacement, arthritis is the most common reason, as described below:

 

Osteoarthritis

This occurs when cartilage on the gliding surface of the knee begins wearing away, causing pain and stiffness. When the cartilage wears away completely, the bones rub directly against each other causing decreased mobility and chronic pain. Osteoarthritis is common in patients 50 and older but is also prevalent in those with a family history of arthritis or those with lifestyles that stress the joints, such as athletes and laborers.

 

Rheumatoid Arthritis

This is an autoimmune disease in which the body’s immune system begins to attack the synovial membrane causing it to become inflamed and overproduce synovial fluid, Most importantly, the process also causes damage and wear to the articular cartilage.

 

Traumatic Arthritis

This results from a more serious knee injury, such as a fracture, ligament damage, or meniscus tear. The impact of the accident also causes mini trauma to the articular cartilage which over time, develops into osteoarthritis, causing knee pain and stiffness.

It’s not always easy to know when knee replacement surgery is necessary – here are some signs that can lead to the surgical treatment of a knee replacement:

 

Pain

There can be a number of causes of this type of pain, and if it is accompanied by certain symptoms like sudden and severe swelling, a trip to the emergency room may be required. Otherwise, if a sufferer is noticing chronic pain in the knee while performing any type of physical activity that is not relieved by rest, weight loss, medication, and physiotherapy.

 

Movement limitation

In addition to pain, you may experience “movement” in the knee area which feels as though something within the knee is rubbing, catching on, or causing the knee to freeze up. These symptoms are affecting how you move in general and may be affecting the entire leg. Certain problems include weakness, limping, and numbness radiating down the entire leg into the foot.

 

Quality of life

Another sign of a failing knee is increasing issues with completing normal activities. This includes pain, stiffness, or instability in walking, lifting up out of chairs, climbing stairs, or squatting or kneeling, and then attempting to get back into an upright position.

 

Alternative treatments no longer functioning

Surgery is often considered a last alternative, even by surgeons. Before considering a knee replacement, patients often are asked to try a variety of therapies, ranging from exercise to medication to alternative medicines, like acupuncture.

 

Change in appearance

Such changes include swelling in the knee area or a physical displacement or “bowed” appearance of the knee itself. Both situations require immediate examination and, in the cause of a knee bowing, intervention to avoid impact to the entire leg.

Who has a Knee Replacement?

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Contrary to what many patients may believe, age is not necessarily a major risk factor in knee arthroplasty. Juvenile arthritis can cause pain and disability to the point where a knee replacement may be recommended in children and teens. However, most patients are adults between the ages of 50-80 who suffer from osteoarthritis. In fact, this type of arthritis is age-related.

Other certain risk factors that can lead any patient to undergo a knee replacement are:

 

  • Those who have frequent morning joint stiffness

 

  • Development abnormalities

 

  • Genetics

 

  • Obesity

How does it affect you? How serious is it?

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All surgeries require incisions (cuts that allow surgeons to open an area of the body and make repairs). Therefore, this means there is a chance of infection but with a low percentage likelihood of it happening. When infections do arise, they’re considered serious. That is why it’s very important to follow the care instructions given to you by your doctor, including keeping your wound clean and dry and taking any prescribed antibiotics.

Complications of knee replacement surgeries include:

 

  • Persistent knee pain – Some patients tend to continue to have persistent knee pain after surgery. When this happens, your doctor will work with you to create a treatment plan, which may include additional physiotherapy, cognitive behavioral therapy, or medicines to help you recover regularly.

 

  • Long-term knee stiffness – Long-term stiffness is typically caused by excessive scar tissue. Oftentimes, lack of use or exercise can cause scar tissue to build up in the soft tissue around the joint. That’s one of the reasons physiotherapy following surgery is highly recommended.

 

  • Nerve or blood vessel damage – During surgery, there’s a slight chance that the nerves, veins, or tissue around your knee can be damaged. Damaged nerves or blood vessels can cause numbness, pain, or lower blood flow around the knee. Normally, any damage will heal on its own over time. In some cases, a procedure may be recommended to help fix the issue.

 

  • Implant failure – Knee implants are built to be long-lasting. However, there is a small chance that the implant will fail. Implant failure is when the replacement joint isn’t able to work properly. Typically, persistent pain and stiffness can be signs of an implant failure.

 

  • Blood clots – Because a knee replacement affects the way blood flows around your knee, it can increase your risk of developing blood clots. In rare cases, blood clots can cause serious complications including a pulmonary embolism (a blood clot inside your lungs).

Recommended Treatment & Rehabilitation

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An orthopedic surgeon can diagnose your knee condition with a thorough examination. You will be asked to describe your medical history, your pain, your current level of function, and any known injuries that may be contributing to your knee problems. Your doctor will then perform physical tests to check your knee for range of motion, alignment, and strength; for example, you may be asked to walk and bend your knee. X-rays or MRIs may be required to determine the extent of any bone damage, tissue damage, or irregularities in your knee.

At the end of your visit, your orthopedist will present you with treatment options and discuss with you whether knee replacement surgery is an advisable option for improving your pain and ability to function.

In the early phases of a knee replacement surgery, knee replacement requires anesthesia. You might also be given a nerve block around your knee to numb it. The numbness wears off gradually after the procedure. Your knee will be in a bent position to expose all surfaces of the joint. After making an incision about 6-10 inches long, your surgeon will move your kneecap aside and cut away the damaged joint surfaces. After preparing the joint surfaces, the surgeon attaches the pieces of the artificial joint. Before closing the incision, he / she bends and rotates your knee, testing it to ensure proper function. This entire surgery may last about two hours.

The goal of the first 2 weeks of recovery is to manage pain, decrease swelling, heal the incision, restore normal walking, and initiate exercise. A physiotherapist will be able to design the following programs and work with you to help recover after a knee replacement:

 

  • Range-of-motion exercises – Swelling and pain can make you move your knee less. Your physiotherapist can teach you safe and effective exercises to restore movement to your knee so that you can perform your daily activities the usual way.

 

  • Strengthening exercises – Weakness of the muscles of the thigh and lower leg could require you to continue to use a cane when walking, even after you no longer need a walker or crutches. Your physiotherapist can determine which strengthening exercises are a good fit for you.

 

  • Balance training – When you are able to put your full weight on your knee without pain, your physiotherapist may add agility exercises and activities using a balance board that challenges your balance and knee control. Your program will be based on the physiotherapist’s examination of your knee, on your goals, and on your activity level and general health.

 

  • Functional training – When you can walk freely without pain, your physiotherapist may begin to add activities that you were doing before your knee pain started to limit you. These might include community-based actions, such as crossing a busy street or getting on and off an escalator.

 

Regular exercise to restore strength and mobility to your knee and a gradual return to everyday activities are important for your full recovery after a knee replacement. Here are some exercise examples after a knee replacement has been done:

 

Thigh squeezes

Lie on your back, then, tighten the muscles in the front of your thigh by pushing the back of your knee down toward the floor or bed. Hold for 5 seconds and then release before repeating with 3 sets of 5-20 repetitions.

 

Straight leg raises

Lie on your back and bend your uninjured knee so your foot is flat on the floor. Tighten your injured thigh and lift your straight leg to the height of your opposite knee. Lastly, hold for 2 seconds at the top and slowly lower back to the starting position. Repeat this exercise with 3 sets of 5-20 repetitions.

 

Knee bending

Sit in a stable chair and bend your knee back as far as possible. Then hold it for 5 seconds and then return it to the resting position. Repeat this stretch with 3 sets of 5-20 repetitions.

 

Clamshells

Lie on your side with the recovered knee pointed toward the ceiling. Next, keeping your heels together, open and close your legs like a clamshell. Repeat this with 3 sets of 5-20 repetitions.

Alternative & Homeopathic Treatment

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Many homeopathic and natural remedies are available to recover much sooner after your knee replacement surgery. Some of these treatments include:

 

  • Avoid foods with vitamin K – Vitamin K enhances blood clotting. This can be useful for preventing bleeding, but keeping vitamin K amounts consistent after knee replacement surgery is important. Particularly because there is a higher risk of blood clots and deep vein thrombosis.

 

  • Vitamin C and zinc – Your doctor may suggest that you supplement your diet with vitamin C and zinc. These two substances may help maintain your immune system. A healthy immune system is crucial while your wound is healing. There is some evidence that vitamin C may help prevent inflammation and joint damage in a natural knee and for those with a knee replacement.

 

  • Knee bracing – After your surgery, your doctor may give you a knee brace. It is recommended to wear it as much as you possibly can to help keep your knee straight and prevent any unnecessary strain.

 

  • Blood thinners – Your doctor will tell you if, and when, you can restart your medicines. He / she will also give you instructions about taking any new medicines. Your doctor may give you blood-thinning medicines to prevent blood clots. If you take a blood thinner, be sure to get instructions about how to take your medicine safely.

 

  • Ice application – For pain and swelling, put ice or a cold pack on the area for 10-20 minutes at a time. Additionally, you can put a thin cloth between the ice and your skin for a recovery boost.