Archive for the ‘Surgery’ Category
Amputation Following Knee Replacement – Topic of Discussion
2012 Pac Rim Meeting - A Pacific Forum for Physical Rehab
The United States Chapter of the International Society of Prosthetics and Orthotics held its bi-annual meeting in Honolulu this week. Dr. Frank Gottschalk presented a half hour lecture titled, “Amputation Following Failed Infected Knee Arthroplasty”. Dr. Gottschalk stressed the fact that total knee arthroplasty is a safe and common procedure, and explained that only less than 1% of patients succumb to infections. However he believes that this problem could become more prevalent by 2030.
Dr. Gottschalk quoted statistics that there are approximately 500,000 knee replacements performed in the United States each year. That number will swell to 3.5 million annual surgeries by 2030. His research indicates that there are specific risk factors that lead to infections post surgery. Diabetes, morbid obesity, smoking, rheumatoid arthritis, steroids, and revision surgeries are the primary culprits. Knee replacement surgeries for these osteoarthritis patients are usually a last resort.
The infections are of the staph, MRSA, and Gram Negative varieties. Approximately 90% of the patients who succumb to infection post knee replacement surgery are treated successfully, but some conditions will deteriorate to the point where a limb will have to be amputated. Dr. Gottschalk informed the audience of prosthetists about what types of patients will be successful candidates for prosthetic restoration. He stressed that when a patient is motivated they can have the potential to accomplish anything.
His statistics show that younger patients who lose limbs following an infected knee replacement will have a good chance of becoming active community ambulators. Dr. Gottschalk explained that elderly and morbidly obese patients will often times not be candidates for artificial legs and will most likely be confined to wheelchairs. He concluded by saying that the more surgery a patient is exposed to, the more scar tissue will develop. Scar tissue decreases functionality. So it is in the patient’s best interest to keep the revisions to a minimum.
Frank Gottschalk, M.D. is a professor at the Department of Orthopaedic Surgery at the University of Texas Southwestern Medical Center at Dallas. Dr. Gottschalk serves on the Board of United States Member Society, International Society of Prosthetics & Orthotics.
Knee Replacement
Black patients are more likely than white patients to have their knees replaced in hospitals with high risks of post-operative complications or mortality; reports a new study published in the journal of Clinical Orthopedics and Related Research.
Total Joint Replacements are performed in patients with knee osteoarthritis of all races. Earlier science has suggested that black patients are more likely to get their knees replaced in medical centers or hospitals that perform a low number of joint replacement surgeries as compared to white patients who tend to have their joints replaced in hospitals that perform significantly more of these types of surgeries.
The study examined the records of Medicare patients who had their knees replaced between July 1st, 2002 and June 30th, 2005. The study concluded that, “Among elderly Medicare beneficiaries undergoing TKA, African American patients were more likely than Caucasian patients to be admitted to hospitals with higher risk-adjusted postoperative rates of complications or mortality”.
Total Knee Rehab
The rehabilitation process following knee replacement will vary. Expect to stay in the hospital from one to seven days following your surgery. The length of stay will depend on your strength and your at-home support.
Protected weight-bearing with a walker or crutches is required until the quadriceps has healed and recovered. Continuous Passive Motion machines are often prescribed to enhance range of motion. Daily physical therapy will be required to restore motion, function, and strength.
It will take about six weeks for you to walk with a cane, and full recovery should be expected after three months. Many patients kick themselves for waiting so long to have their knees replaced. After years of suffering with osteoarthritis it is a pleasure to be able to walk without pain.
uni-knee
Partial knee replacement or unicompartmental arthroplasty (UKA) is intended for patients who have significant wear and tear to only one of the three compartments comprising their knees; unicompartmental osteoarthritis. The advantages of a partial knee replacement as compared to a total knee replacement is that the incision is smaller, the post-surgery rehabilitation is easier, better range-of-motion after surgery, the hospital stay is shorter, less blood is lost during the procedure, lower risk of infection, lower risk of blood clots, and revisions are easier if surgical complications present.
knee-replacement
Knee arthroplasty or knee replacement surgery replaces the anatomy of an osteoarthritic knee with prosthetic components. Generally the weight-beaing surfaces of the joint are replaced to relieve pain and improve function.
Knee replacements can be partial or total. The surgeries are major, requiring intense physical rehabilitation and considerable post-operative pain. Recovery time can take weeks and the use of a cane or crutches is usually required.
The results are usually impressive. A person who suffers for years with osteoarthritis in many instances will be able to walk pain-free and enjoy a full range-of-motion.
arthroscopy
In a recent policy article, health insurance giant Aetna considers arthroscopic debridement and lavage for osteoarthritis of the knee experimental and investigational because its effectiveness has not been established.
The only people Aetna considers arthroscopic debridement and lavage medically necessary are for those with mild to moderate osteoarthritis who have loose bodies or meniscal tears in their knees.
This means Aetna is reading the literature. They based their policy on 40 different references from medical journals and scholarly articles. Arthroscopic debridement and lavage is not an effective treatment option for many people with knee osteoarthritis.
Total Knee Replacement
When you run out of treatment options for your knee osteoarthritis the time may come for you to have your knee replaced. This surgery involves removing your knee and replacing it with prosthetic components. The bottom of your femur, your knee cap, and the top of your tibia will all be cut out.
Some reasons for having your knee replaced are listed below:
- Severe knee pain while walking or standing
- Knee pain while resting either or day or night
- Chronic knee swelling
- Knee deformity
- Knee stiffness
- Failure to obtain pain relief from other treatment options
- Inability to take medications
High Tibial Osteotomy
A high tibial osteotomy (HTO) is a surgical procedure used to treat knee osteoarthritis. During the surgery a wedge-shaped bone is removed from the lower-leg. This changes the angle of the knee joint and relieves pain.
You will be treated with intravenous medications immediately following surgery. This will help reduce the chance of getting an infection from the hospital, help reduce the risk of blood clots, and help with the pain. Expect to be in the hospital up to one week on the high side.
Once you get home crutches, a cane, or a walker will be required for about one month. You will be able to put some weight on your leg, but how much and when will be up to your doctor. Physical therapy will also be prescribed and required.
Most HTO’s are successful. Make sure to ask your doctor for a detailed recovery plan so you will know exactly how long you will be off your feet. Patients who have a high tibial osteotomy will experience swelling for 3 to six months.
Knee Arthroscopy
Arthroscopy is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage to the interior of a joint is performed using an arthroscope, a small camera. The “scope” is inserted into the joint through a small incision.
The advantage of arthroscopy over traditional open surgery is that the joint does not have to be completely opened. Instead, two small incisions are made – one for the arthroscope and one for the surgical instruments to be used in the knee cavity to fully remove the knee cap.
Though arthroscopic surgery is widely recommended by the orthopedic community to treat knee osteoarthritis, the usefulness of the surgery is doubtful. A study on arthroscopic surgery for osteoarthritis of the knee was published in the New England Journal of Medicine in 2002. In this three-group study, 180 military veterans with osteoarthritis of the knee were randomly assigned to receive arthroscopic debridement with lavage, just arthroscopic lavage, or a sham surgery, which made superficial incisions to the skin while pretending to do the surgery. The study reported, “At no point did either of the intervention groups report less pain or better function than the placebo group. Because there is no confirmed usefulness for these surgeries, many agencies are reconsidering paying for a surgery which seems to create risks with no benefit.”
Knee Exercise
Pre-operative exercise programs help patients with osteoarthritis of the knee after they have their knees replaced. People who undergo “pre-habilitation” experience better leg function and faster recovery times.
So even if you decide to have total knee replacement surgery you still have to exercise!
71 patients were divided into two groups at the University of Louisville. One group underwent an exercise program before surgery. The exercises was developed to improve knee and leg strength, through light walking and step exercises. Standard preoperative care was provided to the other group of patients.
The group that exercised before they had their knees replaced experienced less pain during functional tests and increased extension strength. The findings published in the Journal of Strength and Conditioning suggests exercise before surgery results in quicker recovery.