Arthroplasty, or total knee replacement surgery, is a major surgical procedure and to ensure proper healing it is important to follow the directions given by your orthopedic surgeon. The knee bears a great deal of weight and a well designed physical therapy plan should be followed after knee surgery to ensure restoration of movement and mobility to the knee joint.

Very basically, arthroplasty involves replacement of the knee joint cartilage with a prosthesis made up of special metals and plastics and involves a hospital stay of 3 to 7 days after the knee replacement surgery. Most hospitals will not discharge a patient who has had replacement knee surgery unless they can walk with the aid of crutches. Knee rehabilitation therapy commences almost immediately after the surgery and can continue for several months. This is a crucial key to good recovery.

Since it can take up to 3 weeks after surgery before the repaired knee joint can be expected to bear any weight, it may be necessary for patients to receive in-home assistance. If in-home care is not available then there are rehabilitation centers that can provide that service. This would mean staying at the center for 2 or 3 weeks after the operation. During this time the leg should be kept elevated as much as possible and use ice packs to help minimise swelling.

Since we are all different with different health, fitness and motivation levels and the complexity of knee surgery varies with each operation, the recovery procedure and recovery time can vary. The following are guidelines only and can vary from case to case.

For the first three to four weeks after the knee replacement, walking with aid of crutches or a walker is necessary.

After that period the use of a cane is recommended for two to three weeks.

Usually, after around 8 weeks, most people can walk unaided.

It generally takes from 6 to 12 months for the knee joint to heal completely. This time frame is dependent on the knee exercises and rehabilitation program being followed and on the knee not being damaged by trying to pursue some activities too soon.

The level of mobility of the knee following the surgery varies from person to person, however, most people should be able to bend the repaired knee joint to 90 degrees with two to three weeks after their knee replacement surgery. Eventually, many will get over 110 degrees of motion in the repaired knee.

It should be possible to return to jobs that are sedentary by 6 weeks after surgery. More physical jobs should be looked at on an individual basis in conjunction with your health care professional.

After about 12 weeks, most people are back to their normal activities and the pain experienced before the knee replacement has usually disappeared by this time.

It is important to remember that the components used in the knee joint prosthesis are not able to heal if the knee is damaged and so common sense must prevail when considering undertaking leisure, sporting and employment activities to lessen the risk of injury. Here is a list of recommended activities, activities that are allowed in moderation and ones that should be avoided altogether.

Recommended activities

* Swimming and water aerobics

* Cross-country skiing

* Golf

* Dancing

* Cycling

*Using training machines like cross trainers and exercise bikes

* Desk work

Permitted: Allowable in moderation:

* Hiking

* Sports like gentle tennis or gentle downhill skiing

* Jobs that do not require heavy lifting (driving, walking, standing etc).

These activities should be avoided at all costs:

* Jogging or running

* Impact exercises

* Contact sports and those sports that put a lot of stress son the knee through pivoting or twisting e.g. basketball, squash, football etc.

* Heavy labor and lifting.

With the advances made in total knee replacement surgery procedures and prosthetics, almost full use of the knee can be expected for many years.

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Total knee replacement surgery (also called arthroplasty) can be life changing for someone suffering from knee trauma but it is a major operation and so recovery can take quite a while. Recovery from this type of knee surgery could also mean suffering with quite a bit of pain and some loss of function of the knee joint. However, this knee operation can be a major player in helping restore quality of life.

Prior to knee surgery, the knee has usually suffered from some degenerative changes which, in turn, may have caused the muscles that help support the knee to lose some of their strength and to not function exactly as they should. After a knee replacement operation, exercise is a critical part of the healing process but because of the pain and loss of function of the knee as well as the weakened muscles, it can be difficult to stick with an exercise regimen.

Over the past few years a lot of progress has been made in developing knee prostheses that are extremely durable and long lasting. Even so, these synthetic knee joints are not as robust as the actual knee joint and are subject to being damaged by activities like running, jumping and twisting and other “high impact” physical movements.

Your orthopedic surgeon will guide you in the exercise routine that you should commence after knee replacement surgery. He will also advise when to start exercising. Major knee exercises generally should not commence until your knee can bear your full weight, swelling and pain at the front of the knee has subsided and you have good knee motion, usually being able to bend you knee through 90 degrees. This could be as long as three months after the surgery. As soon as possible after the knee surgery, patients are expected to do simple knee straightening and bending exercises, sometimes with the aid of a special machine. The exercises will progress from light exercises initially and slowly increase in intensity as time and the healing process progresses.

The aim of the knee exercises is not only to ensure the knee can be bent and straightened but also to build up the muscles around the knee that help support it and to develop balance.

Two of the best knee rehabilitation exercises are bike riding (on an exercise bike) and swimming. These not only provide excellent therapy to assist in the healing of the knee joint but also are excellent cardiovascular exercises that also help in weight control. Maintaining a healthy weight level will speed up recovery time as less pressure is applied to the knee joint.

• BIKE RIDING – Use an exercise bike. When sitting on the seat, the foot should just rest on the pedal and the leg should be straight. This will prevent over-bending the knee which could cause damage. Start on a low resistance setting and slowly increase the resistance and the time.

• SWIMMING – This is one of the favored exercises because it is not weight bearing and can provide a total body workout. Again, start slowly and, if necessary, use a float to support the legs. Avoid leg actions like in the breast stroke which can put excessive strain on the knee joint. Slowly work up to a normal kicking action.

As the strength of the muscles around the knee and the mobility of the knee joint increases, you should experience less pain and discomfort and be able to slowly get back to your normal daily routine.
Knee rehabilitation exercises post total knee replacement surgery are one of the best ways to reduce recovery time and ensure that the new knee will give you many years of pain-free use.

Knee Rehabilitation Exercises

Whether you are rehabilitating your knee form after surgery or after an injury, progression of exercises should be slow and pain free.

Knee Rehabilitation After Knee Surgery

A general rehabilitation program in a patient with total knee arthroplasty (TKA). Day of surgery

Technorati Tags: arthroscopic knee surgery, Arthroscopy, knee joint replacement surgery, knee rehabilitation exercises, knee strengthening exercises, orthopedic knee surgery, surgery, total knee replacement surgery

KNEE REPLACEMENT SURGERY IMPLANT FIXATION METHODS

There are four ligaments that will ensure the knee joint works correctly. Their job is to assist hold the bones in place. When the knee is sound then they are very effective. However, when a knee joint deteriorates, say due to joint disease, damage and scarring can develop to these ligaments. The objective of knee replacement surgery is to replace some or all of these ligaments and also the surfaces of the knee joint by synthetic components or prostheses. These prostheses need help to stay in place and two types of implant fixation techniques can be used – cemented or cementless.  With both methods knee rehabilitation exercises to help speed up recovery are important.

CEMENTLESS FIXATION METHOD

Cementless fixation was first unveiled in the 1980′s and entails making use of implants whose surfaces are attractive to new bone growth so that they would attach to the bone without using any kind of cement or adhesive. In other words the new bone grows into the specially coated surface of the implant. Cementless implants do require using screws to aid the stability of the implant until the new bone grows sufficiently to provide adequate support. Because it is essential to wait for the new bone to grow into the implant and because of the use of the supporting screws, recovery time is more lengthy than if using a cemented fixation technique. Even though this procedure has proved as effective as cemented fixation in many cases, it has not solved the problems a result of bone reduction and wear in the implant (see below).

CEMENTED FIXATION METHOD

The most common method these days is cemented fixation in which a polymethylmethacrylate cement, a special fast curing bone cement, is used to hold them in place. Knee replacements performed using this method have had excellent outcomes with an expected life of 15 to 20 years. In the other method, cementless fixation, the actual bone is encouraged to actually grow into the surface of the implant.  Bone reduction and wear of the implant is also an issue with this method.  Nonetheless, despite these issues, which are rare but not unknown, cemented fixation has turned out to be to be a most reliable technique in total knee replacement in most cases including in young patients who have an energetic lifestyle and where joint disease was relatively advanced.

ISSUES

How long a knee replacement lasts and how well it functions are determined by the overall health and weight of the recipient as well as the amount of use the knee joint gets and the stresses placed on it by this use. Weight management is very important in reducing wear and in lessening the risk of other conditions.

When orthopedic knee replacement surgery is carried out, the harder bone at the top of the tibia or shinbone is removed. The softer more porous bone that is left must absorb the stresses that your knee joint is put under, which under normal use can be considerable. If these stresses are greater than this bone is capable of absorbing then the metal alloy components of the prosthesis can loosen. Over a period of time, these kinds of excessive loads may well cause the prosthesis to sink into the softer bone tissue or loosen its adhesion to the bone.

Loosening of the prosthesis and sometimes bone reduction can be a result of the polyethylene layer between the metal components wearing unevenly. This may be caused by an uneven gait where by the knee is subjected to uneven loads leading one side of the knee implant to push into the bone whilst the other side lifts off from the bone. This uneven wear may also cause tiny particles of the polyethylene layer to rub off. This “debris” may cause the body to set off a biological reaction that could cause further movement of the knee implant. Bone loss may also be a direct result this. What happens then is that the surrounding cells absorb these minute particles. The body’s immune system senses this and attempts to eliminate them by triggering an inflammatory response. This response may also cause osteolysis, a condition where the cells essentially take away some of the bone from around the prosthesis. As wear increases so does the bone loss and the weakened bone causes the implant to loosen more.

CONCLUSION

It seems that both methods are successful in total knee replacement surgery. Having said that, the use of cementless implants has only been relatively recent and so long term comparisons of the two methods are unavailable but in the short term, it would seem that the success rates are comparable.

Technorati Tags: implant fixation techniques, joint disease, knee replacement surgery, orthopedic knee surgery, total knee replacement surgery

Orthopedic terminology – when you visit your orthopedic physician, you will hear some new and confusing terminology.   Words like patella, fibula, medial, ACL and many more are common in the orthopedic surgeon’s vocabulary.  But what do they mean in layman’s terms?   They certainly can be very confusing.

Your orthopedic surgeon should explain these terms to you but even then they can still be quite confusing.  Below is a list of common terms and their meanings that are often used by .

ANTERIOR – at the front of the body.

Anterior Cruciate Ligament – usually abbreviated to ACL is the ligament that connects the femur to the tibia.  Responsible for a large proportion of knee injuries.

ARTICULAR CARTILAGE – the covering of the moving inside surfaces of the knee.
ARTHROSCOPY – minimally invasive surgery routinely used in knee surgery to repair the knee or remove debris from the knee joint.

BONE SPURS  or Osteophytes – abnormal projections of bone most commonly caused by excessive stress on the ends of the bones.

CARTILAGE – the covering of the bones in a joint that allows the joint to move and also cushions the bone.

FEMUR - the thigh bone.

FIBULA – the outer bone in the leg between the ankle and the knee.

HAMSTRINGS – the muscles at the back of the thighs.

LIGAMENTS – the tissue that connects one bone to another.

MENISCUS – the cartilage that gives further cushioning to the knee joint.

MENISECTOMY – arthroscopic surgery to remove part of the meniscus.

OSTEOPHYTES – see bone spurs.

PATELLA – the kneecap, the flat bone at the front of the knee.

PATELLO FEMORAL JOINT – the joint under the kneecap.

PATELLA LIGAMENT – the ligament that secures the patella (knee cap) over the front of the knee joint.

POSTERIOR CRUCIATE LIGAMENT – usually abbreviated to PCL and is found behind the Cruciate ligament.

QUADRICEPS – the muscles located at the front of thighs.

SYNOVIAL MEMBRANE – the membrane that produces a lubricant (synovial fluid) to help knee move smoothly.

TIBIA – The shin bone.

These are the most common terms that your orthopaedic surgeon or the surgeon’s assistant may use but there are many more. 

Although orthopedic terminology can be confusing, the knowledge of a few of the more common terms will help in your understanding of the complex knee joint and impending orthopedic knee surgery.

Major knee surgery set for Leafs’ Van Ryn

CBC.ca Major knee surgery set for Leafs ‘ Van Ryn SportingNews.com Defenseman Mike Van Ryn will have major knee surgery in late October

Adam Vinatieri Has Knee Surgery

Colts kicker Adam Vinatieri was forced to undergo surgery on his right knee to remove some cartilage. Early Wednesday, the Colts announced the surgery. 

Knee Surgery Common Among Young Patients

Chronic pain management and support group dealing with Fibromyalgia, degenerative joint disease and other neurological disorders. 

Extensive Knee Surgery Ahead For Mike Van Ryn

Defenceman Mike Van Ryn is expected to announce that he has decided to undergo extensive knee surgery which could potentially spell the end of the 30-year old’s NHL career. continued.

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Arthroscopic knee surgery is becoming a more and more popular knee treatment method.  Here is information on using arthroscopy to regenerate knee cartilage.

Knee microfracture surgery or knee cartilage regeneration is a method used to repair damaged cartilage.  This method of orthopedic knee surgery can be used in some instances instead of necessitating a full or partial knee replacement surgery.   It can also be used to relieve the pain associated from knee cartilage injuries, knee arthritis in its early stage, lesions on the knee cap and degenerative chondral lesions of the knee.

Simply put, it is cartilage that helps to cushion the bones in the joints.

This type of knee surgery is minimally invasive with only one small incision being made to the affected knee.  this small incision, usually only a quarter of an inch long is made and an arthroscope is inserted into the knee joint.  This apparatus allows the surgeon to see inside the joint using a micro camera and to work directly on the problem.  It is another type of arthroscopic knee surgery. 

Using an awl, a tool a bit like an ice-pick, the orthopedic specialist drills a series of tiny holes or "microfractures" directly into the bone surrounding the problem cartilage.  These tiny fractures causes the body to make new cartilage to replace the defective cartilage by causing bone marrow to seep from the microfractures that creates a blood clot.  This blood clot releases cells that rebuild cartilage.

Once the procedure has been completed knee surgery recovery is relatively fast with most patients being able to participate in sports and other strenuous and intense pastimes in around four months.
 
Physical therapy of the knee commences immediately the surgery is completed, usually in the recovery room, where a continuous passive motion machine is used to gently flex and extend the leg.  This CPM machine is used for periods up to 8 hours per day for a few weeks after surgery.  It is sometimes used while the patient is sleeping.  This sort of knee therapy is thought to sped up the cartilage regeneration process.

 
For the first six to eight weeks the knee joint should not be subject to any load bearing and so crutches are needed to assist with mobility.

Like any surgery there are risks like excessive bleeding and infection.  With proper care these are minimal.
Using microfracture surgery causes new cartilage to develop.  However, this new cartilage is not as durable as the original cartilage and has been known to break down after a few years.   The patient can also be left with increased stiffness in the knee joint.

Combining of arthroscopic knee surgery and microfracture knee surgery is becoming a recognised method of rebuilding cartilage.

Kerry Northey

Panthers look to Allen’s return from microfracture knee surgery.

The 29-year-old played only two games last season before he had to go for microfracture surgery on a knee, which caused him to miss the rest of the 2008-09 campaign. 

Microfracture Knee Surgery

Cartilage damage can lead to chronic knee pain. Athletes with this problem can benefit by microfracture surgery.  

Micro Fracture Surgery Versus Stem Cells

A physician compares the results of micro fracture for a knee cartilage lesion to stem cell injection. … It’s a brilliant advance over arthroscopic debridement (surgeries where cartilage is simply “cleaned up” by cutting it out). I think that in the future we may see stem cells placed in the joint after micro fracture surgery to aid healing and we’ll also see many non-surgical, stem cell based, injection options like the Regenexx procedure. 

Gregg’s Micro Fracture Surgery

It marked Gregg’s first regular-season game back on the field after missing last season when he underwent microfracture knee surgery. "It’s good to be back," Gregg said. "I was down and out. 

Did Cofield Have Microfracture Knee Surgery?

In the wake of New York Giants defensive lineman Fred Robbins’ disclosure that he had microfracture knee surgery before later removing the information from his blog.

Robbins needed microfracture surgery

He had microfracture knee surgery, which is a much more serious procedure than the scope that Cofield had. Robbins revealed the nature of his surgery on his own website. 

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Because  arthroscopic knee surgery is far less invasive than traditional knee orthopedic surgery, arthroscopic surgery recovery time is usually much quicker.  Even so, it is very important that you still follow the instructions of your arthroscopic surgeon to ensure that complications do not occur.

Signs of complications can include the following symptoms:

Fever or chills
Unexpected swelling in the knee
Ongoing redness or warmth around your knee
An increase in knee joint pain or pain in your calf muscle.

If you experience any of these symptoms you should call your orthopedic Dr as soon as possible.

Here are some things you should do and expect following your knee orthopedic surgery.

For the first few days following surgery keeping your knee elevated will help to reduce any swelling.  Using ice packs on your knee will also help with swelling and pain.

Generally the dressing that was applied following the knee operation can be removed after a day or so.  When you remove the bandage ensure to keep the area dry and clean.  When showering avoid getting water directly onto the wound.  

Usually within a few days after the knee surgery you will be expected to see your knee surgeon so he can check your progress and instruct you on your knee physiotherapy.

After your knee surgery you should be able to walk unassisted.  However, you may be advised to use crutches or a cane for a short period of time.  You will find that you will slowly be able to put more weight on the affected limb as any pain reduces and the knee becomes stronger.  You can usually drive after about 7 days.

Exercise is very important to regain mobility and strengthen the knee.  You may be directed to use a physiotherapist who can map out an exercise regimen specifically for you.

Your arthroscopic surgeon may recommend a course of antibiotics following the surgery to prevent any infection.  In addition he may also prescribe some medication for knee pain relief.

Although rare, knee arthroscopy does sometimes lead to complications.  These can include infection, an accumulation of blood around the knee and blood clots.  As I mentioned, these are infrequent an are usually minor.  They are easily treated.

Fortunately, with this type of orthopedic knee surgery, the pros far outweigh the cons.  Any complications arenegligible and the benefits obtained in mobility and pain reduction are well worth a few days of discomfort.

Knee Pain Relief: Arthroscopic Knee Surgery & Knee Braces

The arthroscope (one of the surgical tools used in the surgery) is inserted into the knee joint through a small incision that your physician will make.  As a result of being less invasive, this procedure can reduce recovery time and can increase the success rate of the procedure. 

News that Seahawks’ Jones will require another knee surgery.

News that Jones will require another knee surgery, this one arthroscopic, leaves the team with only two proven tackles for the immediate future.

Speeding Up Your Recovery After Knee Arthroscopy

Recovery from knee arthroscopy is fairly quick, especially when compared with recovery from open knee surgery.

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Because arthroscopic knee surgery is classed as minimal invasive surgery, recovery times are much shorter than from traditional open knee surgery.  However, this does not mean it is without post operative risks so it is imperative that you follow your orthopaedic surgeons instructions when you get home.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       

Arthroscopic Surgery Recovery – Points to remember

Keeping your leg elevated as much as possible and applying ice as recommended will help reduce swelling and relieve any pain.

Antibiotics may be prescribed to help reduce the risk of infection after orthopedic knee surgery and also pain medication to help relieve any pain or discomfort.

Your knee will covered by a dressing when you leave hospital.  This can usually be removed 24 hours after the arthroscopy (if in doubt check with your orthopedic dr).  Keep the incisions dry and clean.  Avoid soaking them in water (as in a bath) and spraying water directly on to them.

Usually you will be able to walk unassisted after your arthroscopy.  However your surgeon may recommend using a walker, a cane or crutches for a short period.  Slowly, as any discomfort lessens and your knee regains its strength, you will be able to put more weight on your legs.  After about a week you should be OK to drive.

Exercises to Strengthen Your Knee

It is important to strengthen your knee and the muscles around your knee to ensure your knee regains full movement.  Your orthopedic surgeon will be able to give you more information on knee pain exercises and may recommend you use a physical therapist to help with your exercise regimen.  Exercises should continue for several weeks after surgery.

Generally, you will be expected to visit your orthopedic surgeon a few days after your surgery so your progress can be checked and reviewed.  It is here that you will usually be given your post arthroscopy treatment plan.

Complications are minimal with this type of orthopedic knee surgery.  Potential complications are blood clots, infection and accumulation of blood in the knee.  As I mentioned, these are infrequent and usually minor in nature but, should a complication arise, it is readily treatable.

If you use your common sense and follow any instructions given to you, knee arthroscopy surgery is a very effective treatment for many knee injuries.

Arthroscopic Knee Surgery

Arthroscopic Knee Surgery & The Benefits A Knee Brace Can Provide. Do you want to know what arthroscopic surgery entails? 

Arthroscopy

In a restorative technique a reparative tissue is generated by surgery. There are a number of techniques involved and some can be done through key hole incisions (arthroscopic surgery).

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This article is about  Orthoscopic Knee Surgery and also outlines other types of orthopaedic knee surgery.

The most common reasons for knee surgery are arthritis and injury. Osteoarthritis is a degenerative disease that slowly wears away cartilage. Rheumatoid arthritis is inflammation of the knee, causing damage to the cartilage.

Arthritis can develop in people of all ages but is more commonly found in the older segment of the population. Injury can occur following a blow to the knee and is commonly a result of sports related injuries. This type of injury is often found in younger people who are involved in activities with a lot of stress to the knee, sudden shifting of positions, or potential for the knee to be hit. There are several types of surgery to repair damage done to the knee.

Synovectomy is the process where the lining of the knee is replaced. This surgery often helps reduce progression of knee problems and can delay the need for more invasive surgery. This type of surgery shows success only if the problems were diagnosed early and the damage is not severe. Prolonged diagnosis or advanced injury will not likely be conducive to this type of surgery.

An osteotomy is a procedure is where the bones are cut and realigned to redistribute weight. If this type of surgery is performed, it may reduce the necessity for a knee replacement. In order for it to be successful, though; early detection is crucial. Even in more advanced cases, this surgery can prolong the need for knee replacement by up to ten years.

Menisectomy is where pieces of cartilage are removed to help promote a pain free experience. This procedure is an arthroscopic process resulting in less recovery time and lowered post operative pain. In approximately sixty percent of patients, this procedure can provide maximum relief for up to five years. It has a high success rate.

Total knee replacement surgery is the most radical type of surgery of the knee. It is usually a last resort and will occur only with progressive advancement of damage or in cases of severe distress. This procedure is still in its early stages of development but advances are made continually. This type of surgery is proven to be highly effective and can provide permanent relief from pain and stiffness.

Damage to the knee can cause pain and stiffness. This may hamper a person’s ability to walk or perform routine exercises comfortably. Surgery is a viable option for reducing the effects of knee arthritis or injury. Most physicians recommend utilizing the least invasive form of surgery possible. This will provide relief and delay the necessity for more radical surgery.

By: Gray Rollins -

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UCLA’s Morgan Recovering From Knee Surgery

UCLA’s Morgan recovering from knee surgery. The Associated Press. 3:35 p.m. April 16, 2009. LOS ANGELES — UCLA center J’mison Morgan has undergone arthroscopic knee surgery. 

Arthroscopic Surgery for Knee Osteoarthritis?

Arthroscopic surgery for knee osteoarthritis? Just say no: for most patients with osteoarthritis of the knee, arthroscopic surgery offers little benefit.

Lugo to Have Arthroscopic Surgery on Knee Tuesday

Julio Lugo will likely have arthroscopic surgery on his sore right knee Tuesday to determine the extent of the damage there, and could be back on the field in less than a month if all goes well. 

Arthroscopic Knee Surgery Does Not Bring Expected Benefits

And recent research published in the New England Journal of Medicine has revealed that arthroscopic knee surgery, which is the most commonly performed orthopedic surgery in the United States, may not bring any desired benefits.

Knee surgery

Arthroscopic knee surgery was developed to treat torn cartilege and ligaments, and it works beautifully for these acute injuries. 

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