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Archive for the ‘Knee Replacement’ Category

Prosthetics like the preservation implant protect more healthy bone.  Not all procedures are equally invasive, and surgeries like the MAKOplasty may improve function and accelerate recovery.

The most severe cases of knee osteoarthritis are treated with a total knee replacement.  This highly invasive surgery involves removing large portions of bone in order to attach metallic prosthetic substitutes.  The surgery is highly traumatic and requires a lengthy recovery.  This makes a total knee replacement a difficult option for older or infirm patients because slow healing may make full recovery difficult or impossible.  Total knee replacements are also problematic for very young and very healthy people because the implants typically last only 5-10 years.  When the original prosthetic implant is replaced, even more bone must be removed to anchor the new, larger implant.  This means that a 50 year old man with severe knee osteoarthritis who has a total knee replacement can expect more highly traumatic surgeries every 5-10 years for the rest of his life.   As he ages and his healing slows down, the recoveries for each surgery will be longer as well.

Fortunately, a total knee replacement is not the only surgical option, even for the most severe patients.  Osteoarthritis affecting only one side of the knee has been effectively treated with partial knee replacements for many years.  Robotic technology has vast surgical applications, and has recently been employed in a new procedure called a MAKOplasty.  The MAKOplasty uses robotic arms to trim away only the damaged bone, and to create and implant a unique prosthetic that complements the healthy tissue.  This means that healthy, well vascularized bone is not removed, and so there is much less trauma and a faster recovery.

This procedure may not be appropriate for everyone but the MAKOplasty and other partial replacements could be a more conservative surgical treatment.  If your doctor recommends joint replacement surgery, ask about your options.  You may not need a total joint replacement to get the best results.



Total knee replacements are invasive surgeries that leave long scars accross the knee. They involve removing damaged bone and replacing it with a prosthetic.

Osteoarthritis of the knee is very common in people age 65 and older.  As the US population ages, more and more people are diagnosed with osteoarthritis.   Since it can produce extreme knee pain that worsens over time, many people are desperate for a miracle treatment.  While there are many medications, braces, and therapies for osteoarthritis of the knee, many people are turning to surgery for help.

According to a recent New York Times article, total knee replacement surgery rose more than 800 percent from 1979 to 2002.  With improving technology, this is  a wonderful treatment for many people.  But some people are not so lucky.  For as much as 30 percent of the population, knee pain is not reduced after surgery.  So almost 1 in 3 people may be undergoing knee surgery with no benefit.  Considering that all surgeries are potentially life-threatening, this is a terrifying statistic.

This does not mean that knee surgery is bad or ineffective, but it may not be right for everyone.  Before looking for a surgical solution, try non-invasive arthritic knee treatments first.  Why take the risk if you don’t have to?



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

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

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

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-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.



Total Knee Replacement

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


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

knee arthrodesis

knee arthrodesis

Recommendation XXV

In patients with knee osteoarthritis joint fusion can be considered when joint replacement has failed.  This is a salvage procedure.

Joint fusion or knee arthrodesis is usually indicated when a total knee replacement becomes infected and is not reconstructable.  Outcome evidence is based primarily on uncontrolled cohort studies.  Patients can expect a stable knee, relatively pain free knee following joint fusion but will experience problems with function.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 69%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162


Unicompartmental Knee Replacement

Unicompartmental Knee Replacement

There are three compartments that comprise the knee joint:  one in the front of the knee (patellofemoral compartment), one on the outside (lateral compartment) and one on the inside (medial compartment).  Patient with osteoarthritis that affects only one of the three compartments, may be a candidate for a unicompartment knee replacement.  Unicompartment knee replacement is when only the diseased compartment is replaced with titanium and plastic components.

The advantages to a patient that receives a partial knee replacement compared to a total knee replacement is that the recovery time is quicker, there is less blood loss, the knee may bend easier, and there is less pain after surgery.  And since less bone, ligaments, and cartilage are cut out most patients say that a unicompartmental knee replacement feels more like their real knee as compared to a total knee replacement.

There are two major disadvantages of a unicompartmental knee replacement compared to a total knee replacement.  The first is that the pain relief is less predictable.  The knee is a complicated joint – doctors don’t always get it right.  Also and more importantly there is a strong potential for additional surgery.  If the healthy parts of a patient’s knee continue to deteriorate after the unicompartmental knee replacement, then a total knee replacement may still be necessary.

The primary goals of knee replacement surgery, whether it be a total or a unicompartmental replacement are a decrease in pain and an increase in function.  Why not consider a surgical alternative?  Bio-Mechanical knee braces (also called unloader knee braces or off-loading knee braces) are designed to relieve pain and increase function in patients with unicompartmental osteoarthritis.  The perfect candidates for a unicompartmental knee replacement are also the perfect candidates for unloader knee braces!

An arthritis knee brace is meant to buy time and post-pone surgery.  Science published in the Journal of Bone and Joint Surgery proves bio-mechanical knee braces increase function and decrease pain in patients suffering with knee osteoarthritis.