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Total knee
The document discusses treatment options for knee pain, including non-surgical and surgical options. Non-surgical options include medications, injections, lifestyle changes, and physical therapy. Surgical options range from minimally invasive procedures like arthroscopy to full knee replacement, depending on the severity of arthritis and other factors. Recovery from knee surgery involves regaining mobility and strength through physical therapy over several months.
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Total knee
- 1. Treatment Options forKnee Pain
- 2. Made up ofthree bones: Femur (thigh bone) Tibia (lower leg bone) Patella (kneecap) Anatomy of the Knee Source: www.AllAboutArthritis.com , 2003
- 3. Knee Joint Healthyknee joint Arthritic knee joint
- 4. Causes of KneePain Osteoarthritis (wear and tear) Rheumatoid arthritis Post-traumatic arthritis caused by: Fractures Ligament injuries Meniscus tears Source: www.AllAboutArthritis.com , 2003
- 5. Symptoms of KneeArthritis Pain During activity At rest or sleeping Swelling and tightness Bone spurs Grinding sound during movement Stiffness and decreased range of motion Source: www.AllAboutArthritis.com , 2003
- 6. Diagnosing Knee ArthritisPhysical examination Medical history review X-Rays Blood tests Source: www.AllAboutArthritis.com , 2003
- 7. How Can MyLife Change with Treatment? A return to mobility Regaining a sense of your former lifestyle Reduce or eliminate pain
- 8. Non-Surgical Treatment Optionsfor Knee Pain: Over-the-Counter Medications Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Usually first drug used to treat arthritis Can reduce pain, swelling and redness Relief can take several months Examples: ibuprofen ( Advil ® , Motrin ® ) naproxen ( Aleve ® ) Aspirin Reduce joint pain and inflammation Form of NSAIDs Source: www.AllAboutArthritis.com , 2003
- 9. Non-Surgical Treatment Optionsfor Knee Pain: Over-the-Counter Medications Acetaminophen Reduces pain Lowers fever Does not reduce inflammation of arthritis Examples: Tylenol ® Datril ® Extra Strength Tempra ® Source: www.AllAboutArthritis.com , 2003
- 10. Non-Surgical Treatment Optionsfor Knee Pain: Prescription Medications NSAIDS Most popular type for osteoarthritis treatment Includes ibuprofen ( Motrin ® ), naproxen sodium ( Anaprox ® ) , oxaprozin (Daypro ® ) , sulindac (Clinoril ® ) , etc. Analgesics Provide pain relief, but do not reduce inflammation Includes Acetaminophen with codeine (Tylenol ® with Codeine), Oxycodone (OxyContin ® , Roxicodone ® ), Hydrocodone with acetaminophen (Vicodin ® , Dolacet ® ), etc. Source: www.AllAboutArthritis.com , 2003
- 11. Non-Surgical Treatment Optionsfor Knee Pain: Prescription Medications Biological Response Modifiers Treat rheumatoid arthritis; may postpone injury to the joints Includes: Infliximab ( Remicade ® ), Etanercept (Enbrel ® ) Glucocorticoids or Corticosteroids Treat rheumatoid arthritis; fight inflammation Includes: cortisone, hydrocortisone (Cortef ® , Hydrocortone ® ), Prednisolone (Prelone ® ) DMARDS Treat rheumatoid arthritis; slow joint destruction Includes: methotrexate, injectable gold, penicillamine (Depen ® ), Azathioprine (Imuran ® ), etc. Source: www. AllAboutArthritis .com , 2003
- 12. Non-Surgical Treatment Optionsfor Knee Pain: Injection Therapy Cortisone Injections Helps reduce swelling and discomfort from arthritis. Temporary pain relief. Small risk of infection. Hyaluronic Acid (HA) Injections Restores lubrication and fluid in the joint. Creates a shock absorber between the bones. Source: www.AllAboutArthritis.com , 2003
- 13. Non-Surgical Treatment Optionsfor Knee Pain Lifestyle Changes Extra weight Exercise important to control weight Know what foods to eat Orthotics Assistive devices (Cane, etc) Walking Bathrooms Climbing Dressing Source: www.AllAboutArthritis.com , 2003
- 14. Knee Surgical TreatmentOptions Arthroscopy Synovectomy Tibial osteotomy Total knee replacement Uni-compartmental replacement Source: www.AllAboutArthritis.com , 2003
- 15. Arthroscopy Removes damagedsoft tissue. Less invasive surgery, possibly leading to shorter recovery times. Sustained pain relief varies in advanced osteoarthritis patients. Source: www.aaos.org , 2003
- 16. Arthroscopic Surgery Smallcamera inserted to see inside the joint. Small instruments remove any debris and smooth cartilage surfaces. Source: www.aaos.org , 2003
- 17. Arthroscopic Surgery, continuedBenefits Outpatient surgery Less invasive May reduce recovery time Disadvantages Pain relief may be temporary Source: www.AAOS.org , 2003
- 18. Synovectomy Early stagesof rheumatoid arthritis. Removes inflamed tissue lining. Potentially saves joint from further damage. Source: www.AllAboutArthritis.com , 2003
- 19. Synovectomy Surgery Smallincision is made. Arthroscope is used to inspect the joint. Diseased synovium is removed. Physical therapy usually required. Source: www.AllAboutArthritis.com , 2003
- 20. Synovectomy, continued BenefitsAlleviates rheumatoid arthritis pain in the joint Joint may be saved from further damage. Synovium could grow back over time Disadvantages Not a permanent solution Source: www.AllAboutArthritis.com , 2003
- 21. Tibial Osteotomy Treatsa varus or bowlegged deformity Candidates have: Pain Knee cartilage damage primarily in one section. Improperly healed broken knee. Source: www.AllAboutArthritis.com , 2003
- 22. Tibial Osteotomy SurgeryIncision is made on both the front and side of the knee. Wedge-shaped piece of bone is removed. Edge of cut bone is stapled and held by plates and screws. Source: www.AllAboutArthritis.com , 2003
- 23. Tibial Osteotomy BenefitsRestore knee function Reduce osteoarthritis pain May even stimulate growth of new cartilage Disadvantages Results may be temporary Cosmetic difference between knees Source: www.aaos.org , 2003
- 24. When is KneeReplacement Surgery Right for You? Experience significant pain. Knee function and mobility decreases.
- 25. Uni-compartmental Knee ReplacementMinimally invasive surgery Removes damaged articular cartilage in single area of the knee Replaces damaged component with prosthesis Goal is quick: Return to normal activities. Pain relief Source: www.jointreplacement.com , 2003
- 26. Benefits of aUni-compartmental Knee Replacement Resolves arthritis pain Maintains two-thirds of the natural knee Minimally invasive procedure Proven procedure Source: www.jointreplacement.com , 2003
- 27. After Uni-Compartmental Knee Surgery Before leaving the hospital, you must be able to: Get in and out of bed. Walk with crutches or a walker. Do exercises that bend and straighten the leg. May be back to regular activity within four to six weeks. Source: www.jointreplacement.com , 2003
- 28. Total Knee ReplacementTotal knee is affected by arthritis. Reduce knee pain Improve the motion 323,448 total knee replacements in 2001 1 1. Solucient, Inc. 2001. Source: www.preservation-uni.com , 2003
- 29. Femoral- replaces arthriticportion of thigh bone Tibial- replaces arthritic portion of shin bone Tibial insert- replaces cartilage and acts as shock absorber Patella- replaces knee cap Total Knee Replacement Components Source: www.jointreplacement.com , 2003
- 30. Total Knee Replacement:Cemented or Cementless Cemented implant is held in place by a type of epoxy cement that attaches the metal to the bone. Uncemented implant has a fine mesh of holes on surface allowing tissue to grow into. Source: www.aaos.org , 2003
- 31. Total Knee ReplacementTwo major types of total knee replacement systems: Fixed Bearing- does not allow full range of motion Rotating Platform Bearing- closely simulates the action of the normal knee joint Source: www.jointreplacement.com , 2003
- 32. Potential Benefits of Fixed Bearing Total Knee Replacement Provides pain relief. Restores the motion of your knee. Improves quality of life. Good results in appropriate patients. Source: www.jointreplacement.com , 2003
- 33. Potential Benefits of Rotating Platform Total Knee Replacement Provides pain relief. Restores the motion of your knee. Rotation similar to a normal knee. Reduces potential of early wear and loosening. Improves quality of life. Source: www.jointreplacement.com , 2003
- 34. Surgical Procedure Patientis anesthetized. Incision is made. Arthritic surface at the end of the thigh bone or femur is removed. Bone is prepared for a new covering. Femoral component is attached. Source: www.Jointreplacement.com , 2003
- 35. Surgical Procedure Arthriticsurface on top of the shin bone is removed. A metal tray (tibial tray) is placed on top of remaining bone. Tibial insert locked into tray. Incision is closed. Source: www.Jointreplacement.com , 2003
- 36. Preparing for Joint Replacement Surgery Ease anxiety by mentally preparing with: Breathing exercises Meditation Talking with friends and family Learn more about knee replacement surgery: Brochures Handouts Websites Videos Source: www.Jointreplacement.com , 2003
- 37. The Night BeforeSurgery Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.). Do not consume any food or liquid after midnight. Make sure you have everything you’ll need at the hospital. Ask any questions you may have before surgery. Source: www.Jointreplacement.com , 2003
- 38. After Surgery Movementof knee determined by doctor. Physical therapy is very important to regain mobility and strength. Source: www.Jointreplacement.com , 2003
- 39. A Caregiver’s RoleProvide support and show patience Help with needs that the patient can not do, like: Bathing Cooking Dressing Daily chores (running errands, driving to appointments, etc.) Source: www.Jointreplacement.com , 2003
- 40. Hospital Discharge Youwill be released from the hospital as soon as you can: Get in and out of bed safely. Walk up to 75 feet with your crutches or walker. Get up and down flight of stairs. Access the bathroom. Demonstrate good muscle contraction of the upper thigh muscle. Hospital stay usually lasts 3 to 4 days. May continue physical therapy at a rehabilitation center or at home. Source: www.Jointreplacement.com , 2003
- 41. Recovery in theFirst Week Continued use of your walker or crutches is required. With a cemented procedure, increase weight on sore leg as comfortable. With a cementless procedure, place only the toes down until a follow-up x-ray. Source: www.Jointreplacement.com , 2003
- 42. Recovery in theFirst Month Sutures or staples usually taken out 10-14 days after surgery. Do not shower or bathe until the sutures or staples are removed. Motion exercises should be progressing. Source: www.aaos.org , 2003
- 43. Recovery After SixWeeks Swelling normal for first three to six months Elevate leg slightly and apply ice. Driving 1 to 2 weeks- Left knee replaced and automatic transmission. 6 to 8 weeks- Right knee replaced. Return to work in 6 to 8 weeks depending on type of work. Source: www. aaos .org , 2003
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Editor's Notes
- #3 Source “ Anatomy of the Knee ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes A painful knee can severely affect your ability to lead a full active life. Over the last twenty five years, major advancements in artificial knee replacement have greatly improved the outcome of the surgery. Artificial knee replacement surgery is becoming more and more common. The knee is made up of three bones: the femur (thigh bone), the tibia (lower leg bone) and the patella (kneecap).
- #5 Source “ Causes of Arthritis of the Knee ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes There are many conditions that can result in degeneration of the knee joint. Osteoarthritis is the most common reason that patients need to undergo knee replacement surgery. This condition is commonly referred to as "wear and tear arthritis." Osteoarthritis can occur with no previous history of injury to the knee joint - the knee simply "wears out." Abnormalities of knee joint function resulting from fractures of the knee, torn cartilage and torn ligaments can lead to degeneration many years after the injury. The mechanical abnormality leads to excessive wear and tear - just like the out-of-balance tire that wears out too soon on your car.
- #6 Source “ Symptoms of Arthritis of the Knee ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes The symptoms of a degenerative knee joint usually begin as pain while bearing weight on the affected knee. The degeneration can lead to a reduction in the range of motion of the affected knee as the knee bends less than normal and may lose the ability to completely straighten out. Bone spurs will usually develop and can be seen on an x-ray. Finally, as the condition becomes worse, the pain may be present all the time and may even keep you awake at night.
- #7 Source “ Diagnosis of Arthritis of the Knee ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes The diagnosis of a degenerative knee starts with a complete history and physical examination by your doctor. He will ask about any other medical conditions and surgical conditions. X-rays will be required to determine the extent of the degenerative process and may suggest a cause for the degeneration. Other tests may be required if there is reason to believe that other conditions are contributing to the degenerative process. Blood tests may be required to rule out systemic arthritis (such as rheumatoid arthritis) or infection in the knee.
- #9 Source “ Over-the-Counter Medicines can Reduce Joint Pain ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes Over-the-counter (OTC) arthritis medicines can be a very important part of your comprehensive arthritis treatment plan. Over-the-counter arthritis medicines are used to reduce the swelling, redness, joint pain and inflammation. At this time, there is no known cure for arthritis. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs are usually the first drug to be used to treat arthritis. These drugs reduce inflammation, but are not steroids like cortisone, consequently the name nonsteriodal anti-inflammatory. NSAIDs can reduce joint pain, swelling, tenderness and redness. NSAIDs may take several months for relief of symptoms to be noticed. Currently, the only NSAIDs that are over-the-counter are ibuprofen (Advil®, Motrin®, and others), naproxen (Aleve®), and aspirin. Aspirin: Aspirin has been used since eighteenth century England to treat arthritis. It can reduce joint pain and inflammation in arthritis sufferers. Aspirin is a form of NSAID.
- #10 Source “ Over-the-Counter Medicines can Reduce Joint Pain ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes Over-the-counter (OTC) arthritis medicines can be a very important part of your comprehensive arthritis treatment plan. Over-the-counter arthritis medicines are used to reduce the swelling, redness, joint pain and inflammation. At this time, there is no known cure for arthritis. Acetaminophen – Tylenol®, Datril® Extra Strength, Tempra®, and others: Acetaminophen is a painkiller and lowers fever. However, it is not an anti-inflammatory drug so it does not decrease or reduce inflammation of arthritis.
- #11 Source “ Prescription Medications to Reduce Arthritis”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes NSAIDs are the most popular type of prescription drug for the treatment of osteoarthritis. Some of the NSAIDs your doctor may prescribe may include one of the following: Ibuprofen (Prescription: Motrin®; Non-prescription: Motrin IB, Advil®, Nuprin®) Naproxen (Naprosyn®, Naprelan®) Naproxen sodium (Prescription: Anaprox®; Non-prescription: Aleve®) Oxaprozin (Daypro®) Sulindac (Clinoril®) Analgesics Unlike NSAIDs, analgesics do not fight inflammation, but instead are used to provide arthritis pain relief. Acetaminophen is the most commonly used analgesic and is available without prescription. Other types of analgesics that require a prescription include: Acetaminophen with codeine (Fioricet®, Phenaphen® with Codeine, Tylenol® with Codeine) Oxycodone (OxyContin®, Roxicodone®) Hydrocodone with acetaminophen (Vicodin®, Dolacet®) Propoxyphene hydrochloride (PP-Cap®, Darvon®) Tramadol (Ultram®)
- #12 Source “ Prescription Medications to Reduce Arthritis”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes Biological Response Modifiers Once given as part of a second-line treatment strategy for rheumatoid arthritis, biological response modifiers are now being used earlier in treatment. These drugs may postpone structural injury in the joints of rheumatoid arthritis patients. Unlike traditional drugs, these biologic agents target the specific area of the immune system that is a factor in the progression of the disease. Etanercept (Enbrel®) Infliximab ( Remicade® ) Glucocorticoids or Corticosteroids For over 50 years, glucocorticoids have been used to treat rheumatoid arthritis and other types of arthritis. Glucocorticoids are hormones that fight inflammation and are similar to the naturally occurring hormones in our body. These drugs are available in many forms including pills and injections. Because there are serious side effects to high dosages and long term usage, doctors are now using lower doses to treat inflammation and joint damage. Cortisone Hydrocortisone (Cortef®, Hydrocortone®) Methylprednisolone (Medrol®) Prednisolone (Prelone®) Prednisone (Deltasone®, Orasone®, Prednicen-M®, Sterapred®) Triamcinolone (Aristocort®) DMARDs Over time, DMARDs slow joint destruction in people with rheumatoid arthritis. The effects of DMARDs are generally slow and can take several months to make a difference. Experts are now prescribing DMARDs earlier in the treatment of rheumatoid arthritis and are often using a combination of two or three drugs. Methotrexate is one of the most widely used DMARDs on the market and has been used for over twenty years. Approximately half of all people with rheumatoid arthritis are taking methotrexate®. Other DMARDs include: Injectable gold Penicillamine (Depen®) Azathioprine (Imuran®) Chloroquine Hydroxychloroquine (Plaquenil®) Sulfasalazine (Azulfidine®) Side Effects Every drug has possible side effects. Be sure to talk with your doctor about possible side effects before taking a new medication. If you notice a side effect, contact your doctor immediately to discuss whether or not you should continue to take that medication. Your doctor may change your medication or reduce the amount of the drug you are taking. Only your doctor will be able to advise you on the best possible course of treatment.
- #13 Source “ Injections to Treat Knee Pain Caused by Arthritis”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes Corticosteroids, also known as glucocorticoids, refer to a group of naturally occurring human hormones. These hormones, commonly referred to as “cortisone”, can be artificially produced in the laboratory and purified for injection into inflamed or arthritic joints, due to rheumatoid arthritis, osteoarthritis, or trauma. For knee arthritis, cortisone injections into the joint can often help reduce the inflammation for two to three months. Hyaluronic acid (HA) injections are designed to replenish the acid in your knee joint. These injections were recently approved for use in the United States. Used for years in Canada and Europe, this jelly-like medication reduces knee pain by deadening nerve endings in the knees. It also acts like natural cartilage by creating a shock absorber between the bones and easing the pain associated with weight bearing and joint movement. Hyaluronic acid is injected directly into the knee with a needle. It can produce relief for varying periods, but can be beneficial for at least three months.
- #14 Source “ Knee Arthritis: Assistive Devices to Help Patients with Arthritis Pain ” . DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com “ Weight Control Can Help You in Managing Arthritis Pain ” . DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes While there is no evidence that being overweight causes your arthritis pain and arthritis symptoms, being above your ideal weight can aggravate the problem. Extra pounds add stress to your already painful joints. Weight control isn’t easy, but it is essential to managing arthritis pain. Exercise not only helps control arthritis symptoms, it will help you control your weight. In fact, exercise and diet are equally important in the process of weight control. To be healthy, the key is to eat a variety of foods and to avoid too much fat, cholesterol, sugar and sodium. Some people with arthritis pain eat processed foods that are high in fat and salt because it may be easier than cooking a healthy meal. If you have problems cooking, speak to your occupational therapist about how you can perform cooking tasks more easily. It may be as simple as buying new knives and cookware and setting up your kitchen to be more people-friendly. If you do dine out, perhaps you could order only a salad and an appetizer instead of an entrée. Or, share an entrée with a friend.
- #15 Source “ Arthritis and Your Joints: Knee ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com
- #16 Source “ Arthroscopy ”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://www.aaos.org Notes Although arthroscopic surgery has received a lot of public attention because it is used to treat well-known athletes, it is an extremely valuable tool for all orthopaedic patients and is generally easier on the patient than "open" surgery. Most patients have their arthroscopic surgery as outpatients and are home several hours after the surgery.
- #17 Source “ Arthroscopy ”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://www.aaos.org Notes A small incision (about the size of a buttonhole) will be made to insert the arthroscope. Several other incisions may be made to see other parts of the joint or insert other instruments. When indicated, corrective surgery is performed with specially-designed instruments that are inserted into the joint through accessory incisions. Initially, arthroscopy was simply a diagnostic tool for planning standard open surgery. With development of better instrumentation and surgical techniques, many conditions can be treated arthroscopically.
- #18 Source “ Arthroscopy ”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://orthoinfo.aaos.org Notes Arthroscopy (ar-THROS-ka-pea) is an outpatient surgical procedure used by orthopaedic surgeons to diagnose and treat problems inside a joint. The surgeon makes small incisions, less than half an inch long, and inserts a pencil-sized instrument called an arthroscope. The arthroscope contains a small lens, a miniature camera and a lighting system. This projects three-dimensional images of the joint on a television monitor, enabling the surgeon to look directly inside the joint and identify the trouble. Tiny probes, forceps, knives and shavers can then be used to correct many problems at the same time.
- #19 Source “ Synovectomy: a Surgery for Rheumatoid Arthritis Pain ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes One of the surgical procedures available for rheumatoid arthritis is a synovectomy. Mostly used in the early stages of rheumatoid arthritis, a synovectomy removes inflamed lining tissue (synovium) from inside the affected joint. Most commonly, this procedure is used on knees, but it can be used on other joints such as the shoulder, wrist and elbow. One of the benefits of this surgery is that it can alleviate rheumatoid arthritis pain in the joints by removing diseased tissue. The joint itself may also be saved from further damage. The synovium could grow back over time. However, this isn’t a permanent solution in most cases. Be sure to discuss with your doctor the benefits and disadvantages of this surgery in your particular case.
- #20 Source “ Synovectomy: a Surgery for Rheumatoid Arthritis Pain ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes You will be given either a local or general anesthetic depending on your situation and your doctor’s advice. In many cases, you may be able to go home the same day or you may stay in the hospital for one to two days. The surgeon will enter the joint through a small incision with an arthroscope, a narrow tube with a light at the end of it that is connected to a television. The arthroscope allows the doctor to see inside the joint to remove the diseased tissue. The surgeon’s team may pump a sterile saline solution into the joint in order to clean it. Air may also be pumped in to expand the joint space, allowing the surgeon to see easily inside of the joint.
- #21 Source “ Synovectomy: a Surgery for Rheumatoid Arthritis Pain ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes If medication, exercise and physical therapy fail to greatly alleviate rheumatoid arthritis pain, you and your doctor may start to consider surgery. One of the surgical procedures available for rheumatoid arthritis is a synovectomy. Mostly used in the early stages of rheumatoid arthritis, a synovectomy removes inflamed lining tissue (synovium) from inside the affected joint. Most commonly, this procedure is used on knees, but it can be used on other joints such as the shoulder, wrist and elbow. One of the benefits of this surgery is that it can alleviate rheumatoid arthritis pain in the joints by removing diseased tissue. The joint itself may also be saved from further damage. The synovium could grow back over time. However, this isn’t a permanent solution in most cases. Be sure to discuss with your doctor the benefits and disadvantages of this surgery in your particular case.
- #22 Source “ Tibial Osteotomy”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes What Are the Benefits? Tibial osteotomies treat a varus, or bowlegged, deformity at the knee. This deformity may result from past trauma or surgery, congenital deformity and/or the progression of a degenerative disease, such as osteoarthritis. Candidates for tibial osteotomies are in pain and may eventually require a knee replacement. Source “ Osteotomy”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://www.aaos.org Osteotomy An osteotomy may be recommended if damage to your knee cartilage is primarily in one section (compartment) of the knee. The inside (medial) compartment, where the inner knob of the thighbone (femoral condyle) meets the top of the shinbone (tibia), is most commonly involved. An osteotomy also may be recommended if a broken knee does not heal properly.
- #23 Source “ Tibial Osteotomy”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes How Is a Tibial Osteotomy Performed? A tibial osteotomy usually involves cutting a wedge-shaped portion of bone from the tibia to correct the alignment of the knee. The surgeon will make a small incision on the front of the knee and/or another one on the side of the knee. The shinbone is exposed and a wedge shaped piece of the bone is removed just below the knee. The leg is moved in a way that allows the gap in the bone to be closed in a hinge-like manner. The edges of the cut bone are then stapled or held together with plates and screws. The osteotomy site should heal just like a fracture.
- #24 Source “ Osteotomy”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://www.aaos.org Notes This procedure involves reshaping the bones to improve knee alignment. The surgeon repositions the joint to move the mechanical axis of weightbearing for the limb away from the damaged area. This shifts weightbearing stresses from the damaged section to a healthier part of the knee. An osteotomy can restore knee function and diminish osteoarthritis pain. It may even stimulate the growth of new cartilage. Although an osteotomy can decrease pain and improve function, the results often deteriorate over the long term. Many people who have an osteotomy will eventually need a total knee replacement (arthroplasty). As with all surgeries, there is a slight possibility of infection, complications from the anesthesia or other surgical complications such as blood clots, nerve damage and circulation problems. There will be a cosmetic difference between the surgically-treated knee and the untreated knee
- #26 Source “ Partial Knee Replacement: A Less-invasive Option for Treating Knee Arthritis”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com Notes When you wear out only one side of your knee joint, your surgeon may be able to replace just the damaged side of your joint. Your doctor may call this surgical procedure a minimally invasive knee replacement or partial knee replacement. The goal of a partial knee replacement is to allow you to return to more normal daily activities with pain relief as quickly as possible.
- #27 Source “ Partial Knee Replacement: A Less Invasive Option for Treating Knee Arthritis”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com Notes There can be some advantages to a partial knee replacement for the qualified patient. Replacing only part of your knee can now be accomplished with a smaller incision. A smaller incision makes pain control easier and often reduces recovery time following surgery. Most patients stay in the hospital only one or two days following this surgery. Rehabilitation to resume independent activities usually occurs much quicker after a partial knee replacement as compared with a total knee replacement.
- #28 Source “ Partial Knee Replacement: A Less Invasive Option for Treating Knee Arthritis”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com Notes After a partial knee replacement, there are certain things you must be able to do before going home from the hospital. You should be able to get in and out of bed, walk with crutches or a walker, and do exercises that bend and straighten your new knee. A physical therapist will teach you how to manage all of these activities. While each patient recovers at his or her own speed, some patients may be back to regular activity within four to six weeks.
- #29 *Solucient, Inc. 2001 Source “ Surgical and Reconstructive Treatment Options for Knee Arthritis ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www..com Notes Total (tri-compartmental) knee replacement is a replacement surgery that resurfaces the entire knee joint, providing pain relief and restoration of motion. Since the implants cover more of the bone ends replacing all of the articular cartilage in the knee, total knee replacement requires a larger incision and the removal of more bone. Total knee replacement usually requires a three to five day hospital stay and full recovery can take several months. This treatment option is for a patient who has a knee that has deteriorated in more than one compartment of the knee, or who has a condition that precludes them from uni-compartmental knee replacement.
- #30 Source “ Components for Knee Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com Notes The most common knee implant consists of a femoral (thigh) component, a tibial (shin) and bearing components; and a patella (kneecap): The femoral, or thighbone, component is made of metal (chromium-cobalt) and covers the lower end of the thighbone. It may be cemented to the bone or, for some implants, inserted without cement so that the patient's tissues grow into the porous coating of the device. The tibia, or shin bone, component is often called a "tray" and is typically made of metal (titanium or chromium-cobalt), and a plastic cushion, or bearing. The patella, or knee cap, component is made of either plastic (polyethylene), or of a combination of plastic and metal. Again, this component may be fixed with or without cement.
- #31 Source “ Cement vs. Cementless Knee Replacements”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://www.aaos.org. Notes Cemented fixation relies on a stable interface between the prosthesis and the cement as well as a solid mechanical bond between the cement and the bone. Today’s metal alloy components rarely break, but they can occasionally come loose from the bone. Cementless designs have a surface topography that is conducive to attracting new bone growth. Most are textured or coated so that the new bone actually grows into the surface of the implant. They may also use screws or pegs to stabilize the implant until bone ingrowth occurs.
- #32 Source “ LCS® Complete™ Mobile Bearing Knee System More Natural Movement from Knee Replacement Surgery ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com
- #33 Source “ LCS® Complete™ Mobile Bearing Knee System More Natural Movement from Knee Replacement Surgery ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com Notes The difference lies in the design of the tibial component. In a fixed-knee prosthesis, the tibial component is topped with a flat metal piece that securely holds the polyethylene insert. When the knee moves, the femoral component glides across the polyethylene. Because the bumpy condyles at the end of the femur are not perfectly round, differing amounts of stress are put on the insert as the knee moves.
- #34 Source “ LCS® Complete™ Mobile Bearing Knee System More Natural Movement from Knee Replacement Surgery ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com Notes In a mobile-bearing knee prosthesis, the polyethylene insert can rotate, which gives the knee implant a more natural contact between the femoral component and the polyethylene. Because the polyethylene can rotate with the femoral component, the contact between the two can be more evenly distributed, reducing stress on the implant. While the majority of knees implanted have traditionally been fixed-bearing, the mobile-bearing total knee replacement is quickly gaining surgeon acceptance.
- #35 Source “ Knee Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com Notes The steps involved in replacing the knee begin with making an incision on the front of the knee to allow access to the knee joint. Shaping the Distal Femoral Bone: Once the knee joint is entered, a special cutting jig is placed on the end of the femur. This jig is used to make sure that the bone is cut in the proper alignment to the leg's original angles, even if the arthritis has made you bowlegged or knock-kneed. The jig is used to cut several pieces of bone from the distal femur so that the artificial knee can replace the worn surfaces with a metal surface. Preparing the Tibial Bone : Attention is then turned toward the lower bone, the tibia. The top of the tibia is cut using another jig that ensures the alignment is satisfactory.
- #36 Source “ Knee Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com Notes Placing the Tibial Components : The metal tray that will hold the polyethylene spacer is attached to the top of the tibia. The metal tray is either cemented into place, or may be held with screws if the component is uncemented. The screws are primarily used to hold the tibial tray in place until the bone grows into the porous coating. (The screws remain in place and are not removed.) The plastic spacer is then attached to the metal tray of the tibial component. If this component wears out while the rest of the artificial knee is sound, it can be replaced.
- #37 Source “ Preparing Your Mind Before Joint Replacement Surgery ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com Notes Several kinds of relaxation techniques may be helpful for joint replacement surgery patients. These include: Breathing exercises—Using awareness and conscious control over breathing to bring about relaxation. Meditation—Relaxing the body and calming the mind by focusing on a repeated word or sound. Patient Education Before Joint Replacement Surgery Another helpful tool is simply learning more about what to expect before and after joint replacement surgery. The relative emphasis you should put on practicing relaxation techniques versus educating yourself about joint replacement surgery depends on your individual personality and needs. Some people tend to react to stress emotionally. They might become very anxious, fearful, or nervous, or they might have unexpected panic attacks. Others might feel tense, have trouble concentrating, or develop unexplained physical symptoms, such as a pounding heart, chest pain, an upset stomach, or constant tiredness. Such people might benefit from learning new ways to relax before their surgery. On the other hand, certain joint replacement patients may tend to intellectualize this event. This type of patient is always looking for information on the Web, in books and magazines, and on television, they really want to know all the nitty-gritty details about their upcoming surgery. This type of patient feels reassured by focusing much of their energy into gathering information.
- #38 Source “ The Night Before Joint Replacement Surgery ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com Notes Be sure to take all of your normal medications unless the doctor has instructed you not to take certain medications. Medications such as "blood thinners" (coumadin, aspirin, ibuprofen and the other anti- inflammatory medications) may cause a greater blood loss. Your doctor has probably already had you stop taking these medications. Ask to make sure! You can eat about anything you wish the night before surgery. You can eat solid food until midnight. After midnight, you should not eat or drink anything unless your doctor has told you otherwise. This means nothing - not coffee, not water, not ice chips. Make sure you have everything you'll need at the hospital, that all of your questions are answered and that you have your advanced directives available if you wish.
- #39 Source “ Total Knee Replacement Surgery Rehabilitation Program ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com Notes Recovery and rehabilitation are an important aspect of your total knee replacement surgery. You will work with your surgeon and physical therapist to develop a program best suited to your situation. You must take an active and responsible role in the rehabilitation.
- #40 Source “ Caregiver’s Roles and Responsibilities ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com Notes This volunteer must be resilient, as duties for this position as the caregiver to a joint replacement patient include (but are not limited to): Helping patient stand, sit, lie down, and move from room to room and place to place; Providing help with bathing/grooming, dressing, feeding, and using the bathroom; Doing (or arranging for) the shopping, cleaning, cooking, laundry and errand-running; Administering medications, changing dressings, keeping track of assistive devices (cane, walker, crutches, etc); Communicating with the healthcare team about any changes or concerns; Managing finances, including paying regular household bills and handling the patient’s insurance paperwork.
- #41 Source “ Following Knee Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com Notes While You Are in the Hospital Treatment will proceed on a one to two time per day basis. You'll be on your way home when you can demonstrate a safe ability to get in and out of bed, walk up to 75 feet with your crutches or walker, get up and down flight of stairs and access the bathroom. It is also important that you regain a good muscle contraction of the upper thigh muscle (quadriceps) and that you gain improved knee range of motion. After You Leave the Hospital Home Health Needs: Once discharged from the hospital, your therapist will likely see you for in-home treatment. This is to ensure you are safe in and about the home. You should be seen for at least one visit for the safety check and to review your exercise program.
- #42 Source “ Following Knee Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com Notes Outpatient progression: Your therapist may choose one or more modalities such as heat, ice, or electrical stimulation to help reduce persistent swelling or pain. Continue to use your walker or crutches. If you had a cemented procedure, you'll advance the weight you place through your sore leg as much as you feel comfortable. If yours was a noncemented procedure, place only the toes down until you've had a follow-up x-ray and your doctor or therapist directs you to advance the amount of weight through your leg (usually by the 5th or 6th week postoperatively). Range of motion exercises and techniques will be used to help you regain full bending and straightening of the knee.
- #43 Source “ Following Knee Replacement Surgery”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://www.aaos.org Notes Resuming normal activities: Once you get home, you should continue to stay active. The key is to remember not to overdo it! While you can expect some good days and some bad days, you should notice a gradual improvement and a gradual increase in your endurance over the next 6 to 12 months. The following guidelines are generally applicable, but the final answer on each of these issues should come from your doctor. Physical therapy exercises: Continue to do the exercises prescribed for at least two months after surgery. Riding a stationary bicycle can help maintain muscle tone and keep your knee flexible. Try to achieve the maximum degree of bending and extension possible. Do not shower or bathe until the sutures or staples are removed, usually a week to 10 days after surgery. Keep the wound clean and dry.
- #44 Source “ Following Knee Replacement Surgery”. American Academy of Orthopaedic Surgeons. 2 April, 2003. http://www.aaos.org Notes Return to work: Depending on the type of activities you perform, it may be 6 to 8 weeks before you return to work. Driving: If your left knee was replaced and you have an automatic transmission, you may be able to begin driving in a week or so, provided you are no longer taking narcotic pain medication. If your right knee was replaced, avoid driving for 6 to 8 weeks. Remember that your reflexes may not be as sharp as before your surgery. Swelling is normal for the first three to six months after surgery. Elevate your leg slightly and apply ice.