Knee Replacement

Rehab Exercises after Total Knee Replacement

Once you return home after a total knee replacement (TKR), you will need to perform certain exercises to prevent complications, improve motion of the knee, and build strength. Most people have weak leg muscles before surgery because they were not used much due to knee problems. Now that surgery has corrected this knee problem, you will need to have a regular exercise regimen.

Exercise Program

A regular exercise program is used to strengthen weak leg muscles. Your success with rehabilitation relies on your willingness to follow the exercise program developed by your physical therapist. You should perform these exercises 2-3 times each day after surgery. Each exercise must be done 10 times, starting out, and you gradually increase the repetitions by 5 times each week until you reach 20 repetitions. Your schedule will be:

  • Week 1 – 10 repetitions
  • Week 2 – 15 repetitions
  • Week 3 – 20 repetitionsheel-slides

Ankle Pumps and Circles

  • Bend both ankles up, pulling toes toward you.
  • Bend both ankles down, pointing toes away from you.
  • Rotate each foot clockwise and then counterclockwise while keeping toes pointed to the ceiling.

Heel Slides (Knee and Hip Flexion)

  • Bend the hip and knee by sliding the heel up toward buttocks while keeping the heel on the bed.
  • Slide heel back down again while keeping kneecap pointed at the ceiling.
  • Repeat with opposite leg.

Thigh Squeezes (Quadriceps Sets)

  • Tighten muscles at the front of the thigh by pushing the back of your knee down on the bed.
  • Hold for 5 seconds, then relax.
  • Repeat with opposite leg.

Leg Slides (Abduction/Adduction)

  • Slide leg out to the side while keeping kneecap pointed toward ceiling.
  • Slide leg back to the starting position.
  • Repeat with opposite leg.

Lying Kicks (Short Arc Quadriceps)

  • Lie on back with a rolled blanket under your knee.
  • Straighten knee and hold for 5 seconds.
  • Lower leg down slowly and relax.
  • Keep back of knee in contact with blanket.
  • Repeat with opposite leg.

Straight Leg Raises

  • b7a636bc5a5da7a0eafbb497fb8cac4eBend leg with foot flat on the bed.
  • Raise opposite leg up 12 inches with knee straight.
  • Hold for 5 seconds.
  • Slowly lower leg and relax.
  • Repeat with other leg.

Knee Bending (Sitting Knee Flexion)

  • Sit on a chair.
  • Bend knee back as much as you can and hold for 10 seconds.
  • Return to starting position and relax.
  • Repeat with other leg.

Sitting Kicks (Long Arc Quads)

  • Sit on a chair.
  • Lift foot and straighten knee as much as possible.
  • Keep knee level as if you are holding a tray on your lap.
  • Hold for 5 seconds.
  • Lower leg down slowly and relax.
  • Repeat with other leg.

Prolonged Knee Stretch

  • Sit on a chair.
  • Bend knee back as much as possible.
  • Scoot your body forward to increase the stretch.
  • Hold for 30-60 seconds.

Knee Straightening Stretch

  • Sit on a chair with your heel up on a footstool or chair in front of you.
  • Hold this for 30-60 seconds.
  • Repeat with other leg.

Knee Dangling/Swinging

  • Sit on a high chair or bed so that feet don’t touch floor.IMG_5017
  • Bend knees and swing surgical leg back and forth.
  • Do this for 2-3 minutes.

Heel Digs (Hamstring Sets)

  • Bend surgical knee.
  • Tighten muscle at back of thigh by digging heel into the bed.
  • Hold for 5 seconds.
  • Repeat with other leg.

Buttock Squeezes (Gluteal Sets)

  • Tighten buttock muscles by squeezing.
  • Hold for 5 seconds and relax.

OSPIblogbanner(3)

Rehab After a Total Knee Replacement

Total Knee Replacement Rehabilitation

Having a total knee replacement surgery is usually the best option for patients with severe knee arthritis. At present, more than 4.5 million people in the U.S. are living with at least one total knee replacement, and around 1.5 million people with a replaced knee are 50-70 years of age. During the last couple of decades, total knee replacement increased by 84% in the U.S. population, with the current rate 22 per 10,000 persons. The most important part the knee replacement process is rehabilitation.

The greatest demand for total knee replacement is not coming from the elderly demographics. Rather, it is younger people who have weight issues. There is a strong relationship between knee osteoarthritis and having a high body mass index. More people ages 18 to 64 years are having severe knee pain and loss of mobility related to being overweight.

General Considerations

  • Patients are weight-bearing as tolerated with a walker, crutches, or cane until they can walk without assistance.
  • Early emphasis is on developing full extension equal to the opposite leg soon as possible.
  • No active or passive flexion motion greater than 90 degrees until stitches are removed.
  • Early exercise will focus on recruitment of proper quadriceps set.
  • Keep incision site clean and dry.b7a636bc5a5da7a0eafbb497fb8cac4e
  • Avoid submerging in a pool, tub, or sauna until wounds are healed.
  • Avoid jumping, twisting, pivoting, or rigorous activities.

Week 1

  • You will return to see the Arizona orthopedic surgeon to change the dressing and review health status.
  • Icing, leg elevation, and swelling control are implemented. Swelling control can be achieved using a compression wrap and circumferential massage.
  • Soft tissue treatments and gentle mobilization are implemented by physical therapist.
  • Exercises include gluteal sets, gait training, and balance/proprioception maneuvers. Straight leg raise exercises with quad sets are began, and passive/active range of motion exercises are started.
  • Goals of therapy are to increase range of motion < 90 degrees, and to decrease swelling and pain.

Weeks 2-4

  • You will return to the Gilbert orthopedic surgeon’s office to have staples/stitches removed and for a check-up.canstockphoto7424057
  • The therapist will continue with soft tissue treatments and gentle mobilization, avoiding flexion or patella contracture.
  • Exercises are continued, including progress flexion range of motion, functional exercises, gait training, and balance/proprioception maneuvers.
  • Aerobic exercise is began as tolerated (cycling, swimming).
  • Goals include decreasing swelling and edema and range of motion < 10 degrees extension to 100 degrees.

Weeks 4-6

  • You will follow-up with the orthopedic surgeon.
  • Gentle mobilization and soft tissue treatments continue.
  • Exercises continue, such as functional exercises (weight machines and walking outside), balance/proprioception maneuvers, and swimming after incisions are closed.
  • Goals include walking without a limp and range of motion < 5 degrees extension to 110 degrees.

Weeks 6-8

  • Continue soft tissue treatments, joint mobilizations, and patellar glides to increase range of motion.
  • Add lateral training exercises, and incorporate single leg exercises as tolerated.
  • Goals include patient walking without limp, and range of motion 0-115 degrees.

Weeks 8-12

  • Continue joint mobilizations, soft tissue treatments, and patellar glides to increase range of motion.
  • Begin activity specific training, such as gardening, sports, and household chores.
  • Low impact activities after week 11.
  • Patients are weaned into a home and gym program with emphasis on their particular sport/activities.
  • Goals include return to functional activities and range of motion within functional limits.

OSPIblogbanner(3)

Resources

Health Research Funding (2016). 23 Amazing Total Knee Replacement Statistics. Retrieved from: http://healthresearchfunding.org/23-amazing-total-knee-replacement-statistics/

Intermediate and Long-Term Quality of Life after Knee Replacement

Osteoarthritis (OA) is one of the main causes of functional disability and chronic pain in older people. OA is related to environmental factors, aging, lifestyle changes, and genetic predisposition. When the knee is affected canstockphoto10845760by arthritis, many people undergo knee replacement procedures.

The goal of total knee replacement is to improve overall quality of life and return patients to a higher level of functioning than before surgery. Most people will heal well without problems if they follow their rehabilitation program. Some activities are permitted and others are not:

  • Permitted: Swimming, golf, dancing, water aerobics, cross-country skiing, cycling, hiking, light labor (involves standing and walking), and sedentary occupations.
  • Not permitted: Jogging, running, impact exercises, contact sports, sports that require pivoting and twisting, and heavy labor.

Post-Operative Exercise

golf swingPost-operative exercise may be detrimental to the success in recovery after a total knee arthroplasty (TKA). You will begin to receive physical therapy in the hospital, and will continue at home, outpatient, or in a skilled nursing facility. A home exercise program is provided before hospital discharge.

Weeks 1-2: Anticipate discharge from the hospital after 3-5 days. Continue using walker with instructions from the therapist. At this time, you will start walking 300 feet, begin to straighten the knee, dress independently, and perform simple homemaking tasks. Home exercises will be advanced with your therapist.

Weeks 2-4: During this time, you will gradually increase independence. The home exercise program involves progressive ambulation using the cane, resuming driving if you had a left knee replacement, independent showering, and walking around ¼ mile.

Weeks 4-6: During this time, your physical therapist will have you bending the knee to 90 degrees, using a cane as needed, walking up stairs, and straightening the knee completely.

Weeks 6-12: You will continue home exercises. During this time, you will progress to walking one mile, climb stairs, and resume usual activities, such as swimming and bowling.

Clinical Studies

Many clinical studies regarding total knee replacement have studied quality of life after surgery. Considered a highly successful operation, technical outcomes from total knee replacement are excellent. In a recent study evaluating intermediate and long-term quality of life following surgery, researchers conducted a large review of studies. They found that both intermediate and long-term post-operative quality of life were superior to the pre-Hiking2operative level in analyses.

In the review of clinical reports, researchers found that most patients were satisfied with the knee replacement surgery and reported substantial improvement in daily functional activities. In addition, the benefits were related to health-related quality of life as well as disease-specific quality of life. Four validated measurement tools were used to assess quality of life: the Western Ontario and McMaster’s Universities Osteoarthritis Index, the Knee Society Score, the Center for Epidemiological Studies Depression Scale, and the visual analogue scale for pain.

Another study evaluated self-reported outcomes in the first year after total knee replacement and attempted to determine which factors influenced patient quality of life. The results showed that after 6 weeks, all patients reported significant improvement for all measured parameters in relation to quality of life.

To examine health-related quality of life after total knee arthroplasty, researchers in a Singapore hospital interviewed patients. Data were collected from almost 5,000 patients. The patients who had total knee replacement all had improved pain scores. In addition, two years after surgery, the majority of patients showed improved physical functioning scores.

OSPIblogbanner(3)

Resources

Ko Y, Narayanasamy S, Wee HL, et al. (2011). Health-related quality of life after total knee replacement or unicompartmental knee arthroplasty in an urban asian population. Value Health, 14(2), 322-328.

Papakostidou I, Dailiana ZH, Papalychroniou T, et al. (2012). Factors affecting the quality of life after total knee arthroplasties: a prospective study. BMC Musculoskel Dis, 13, 116.

Shan L, Shan B, Suzuki A, et al. (2015). Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Am, 97(2), 156-168.

How Does a Knee Get Replaced?

How do they Replace a Knee?

Knee replacement surgery is performed due to chronic knee pain and loss of mobility. According to the Center for Disease Control and Prevention (CDC), in 2010 alone, almost 700,000 total knee replacements were performed on adults age 45 years and older. Total knee replacement (TKR) has nearly doubled in prevalence over the last couple of decades, especially for women (a 99% increase).

Steps in a Total Knee ReplacementKnee pain 3

Step 1: Administering anesthesia – Knee replacement surgery is usually performed with you under general anesthesia. The doctor will discuss this with you before the surgery. You will be given medications through an intravenous (IV) catheter, and an intubation tube will be placed in your airway.

Step 2: Prepping the knee – After all excessive hair over the knee is clipped or shaved, the skin over the knee is cleaned with an antiseptic solution.

Step 3: Making incision – The orthopedic surgeon will make a 4- to 6-inch incision in the knee area.

Step 4: Removing damaged surfaces – The damaged knee joint and surface will be removed. This involves specialized instruments used to remove cartilage and bone pieces from the joint.

Step 5: Insert prostheses – The artificial components are made of plastic and metal. Most artificial knee components are cemented into the joint. The prosthesis attaches to the bone using a special cement. The components include a tibial component (resurface top of tibia or shin bone), a femoral component (resurfaces end of femur or thighbone), and a patella component (resurfaces the patella or kneecap).

Step 6: Checking motion and implants – After the implants are in place, the surgeon checks range of motion and prostheses stability.

Step 7: Closing incision – The incision is closed using surgical staples or sutures. Depending on the situation, a tiny catheter with drain may be placed in the incision to remove fluid. A sterile, dry bandage dressing is applied over the knee.

How Long does a Total Knee Replacement Last?

A common reply to this question is that a total joint replacement typically lasts 15-20 years. Most current data suggest that both knee and hip replacements have an annual failure rate of around 0.5%. This means that if you have a total knee replacement today, you have a 95% chance of it lasting 10 years, and an 85% chance that it will last 20 years.

canstockphoto10845760

Types of Implants

The orthopedic implant industry has continued to develop innovative technologies to improve the outcomes of total knee replacement. However, many studies show that there is no clear advantage of any of these designs in relation to improving clinical outcomes. Some designs are:

  • Gender specific – This refers to a modified implant design that accounts for the anatomic difference between women’s and men’s knees. Most companies have some modifications in these designs to allows for sizing options so the prosthesis will fit accurately in relation to the patient’s anatomy.
  • Rotating platform – This refers to a plastic component that independently rotates on a metal tray. The plastic bearing will lock into the tray, and was designed to reduce wear on the bearing. In addition, this device can reduce the rate of loosening of metal components and better replicate the normal knee function and movement.
  • Computer technology – There are studies that have evaluated the emerging technologies in knee replacement surgery along with the success of the procedure using computer technology. Computer, robot, and custom cutting guides are used for accuracy in implant placement, as well as a more efficient surgery.

Resources

Center for Disease Control and Prevention (2015). Hospitalization for Total Knee Replacement Among Inpatients Aged 45 and Over: United States, 2000–2010. Retrieved from: http://www.cdc.gov/nchs/data/databries/db210.htm

Current Concepts Regarding Customized Knee Replacement

                  Osteoarthritis is a degenerative joint disease that can affect any joint and is most commonly found among older people. The mechanism of how the disease develops is not fully understood. Currently, there is no known cure for osteoarthritis and research has focused on the knee arthritisprevention and treatment of symptoms for this condition. Osteoarthritis is more frequently found in joints of the lower limb. Risk factors of osteoarthritis include history of injury, increasing age and obesity. Conservative treatment for osteoarthritis includes the use of oral medication to provide pain relief, physical therapy and as a last resort, a surgical procedure known as total knee arthroplasty (TKA). TKA involves the replacement of the entire knee joint and rehabilitation is required after surgery for patients to be able to return to their routine activities.

                  TKA is a highly successful surgical procedure but failures can occur, mostly due to infection and loosening of implants (parts). Poor positioning of the components can contribute to loosening as it creates areas of stress. Some patients such as those who are younger and those with other health conditions may sometimes require a revised TKA. Studies have also shown that the demand for TKA will increase as much as 673% from 2005 to 2030 with a total of 3.48million procedures being required. This necessitates the need to improve the outcomes of TKA especially for younger patients.

                  In a traditional knee replacement surgery (TKA), the surgeon uses a standard implant from a range of different standardized sizes. The necessary adjustments are then made so that it fits the patient during the surgery. Since the standard implants are not designed specifically for each individual patient, it may result in an implant overhang (where the implant is bigger and hangs over the bone) or underhang (implant is too small leaving parts of the bone exposed and uncovered). It iFit-Designcan also result in an implant that does not align exactly. Studies have shown that compromises such as the overhang, underhang and slight misalignment can cause pain after surgery.

                  In customized knee replacement surgery, partial and total knee implants are designed and tailored specifically for each individual patient. This new technology is utilized to create customized implants that are specifically fit to each patient’s natural knee shape and curves. This enables the potential for the patient to feel like they have a more natural knee. Other benefits include optimal bone preservation. The goal of customized knee surgery is to restore the patient’s knee as close as possible to their pre-diseased state.

                  A computed tomography (CT) scan or magnetic resonance imaging (MRI) scan is taken of the patient’s knee and the data is processed in a computer assisted design (CAD) system. The implants are then designed and manufactured specifically for that patient. With customized knee replacement surgery, hospitals benefit due to the improved efficiency of surgery while patients benefit with a shorter surgery and recovery time with improved knee alignment due to a better fitting implant.

OSPI offers the best knee replacement doctors in Arizona who perform customized joint replacement. In addition, the procedures may be performed as an outpatient when indicated. Most insurance is accepted, call us today!

knee replacement

 

References:

Customized Knee Replacement in Arizona

The knee is a complex, mobile joint. Knee joints are the largest joints of the body, and they differ in shape and size from other joints. A customized knee replacement uses specially designed implants that are made to fit the unique knee of the patient. Traditional knee replacement requires the surgeon to attempt to match prostheses to fit the knee.

How many knee replacements are performed each year?

In the United States, around 4.7 million people have a total knee replacement. Prevalence increases with age, with around 8% canstockphoto11809008have a history of total knee replacement. Women are more likely to have this operation than men (3 million: 1.7 million).

Why are customized knee implants important?

Once the Arizona knee surgeon selects the implant, the technique requires precision structuring so the implant fits snugly with your individual bone structure. An improper implant fit could result in residual issues that may cause problems after surgery.

Customized knee replacements are an innovative approach to correctly knee problems. The need for a precision implant fit has driven this new trend. Manufacturers now offer customized and personalized implants that are appropriate for gender and the individual knee. In a 2010 study, customized implants were found to reduce sizing problems during surgery, and also, found to replicate the curvature of the patient’s knee, giving a more natural feel to the replacement.

How are customized knee prostheses made?

Customized knee implants are created from CT and MRI scan data obtained from the patient. This assures the implant iFit-Designmatches the natural curves and shape of the knee. Knee implant manufacturers use specific technology to change the images of the knee into a 3D model, which is used to make an implant that matches the patient’s knee. Using scan data, the manufacturer can customize the implant using computer-assisted surgical instrumentation utilized by the surgeon during the procedure.

Why are women’s implants different than men’s?

Called gender-specific knee replacement, women are more petite and require special sized implants. A regular, traditional implant is designed for men, which means the implant for a woman could overhang on the bone at the sides. This could cause soft tissue interference or mid-flexion instability. For some patients, over-sized implants may cause pain and discomfort long after healing is complete. For this reason, new implants are used to accommodate the knee, which is smaller top-rightin women from side-to-side and from front-to-back. This reduces implant misfit and persistent knee pain.

Why do the differences between men and women make knee replacement difficult?

Researchers have found many differences between women’s knees and men’s. The gender-specific implants are based on research that shows:

  • Women’s knees have a thinner profile at the front.
  • Women’s knees have a distinct shape that accommodates the different angle between the knee and hip.
  • Women’s knees have a different contour.

Some researchers believe the differences in knee shape and size have less to do with gender and more to do with genetics. Certain ethnic influences tend to determine knee joint sizes.

Orthopedic and Sports Performance Institute offers customized knee replacements that have an amazing fit with exceptional outcomes. The total knee replacement surgeons in Arizona work with patients from all over the Valley including Gilbert, Mesa, Chandler, Queen Creek and Maricopa AZ.

Most insurance is accepted, call today to meet with the top knee specialists in AZ!

Resources

Bourne, et al; Patient Satisfaction after Total Knee Arthroplasty. Who is Satisfied and Who is Not? Clinical Orthopedics and Related Research; 2010, 468: 57-63.

Mahoney, et al; Overhang of the Femoral Component in Total Knee Arthroplasty: Risk Factors and Clinical Consequences. The Journal of Bone and Joint Surgery; 2010, 92: 1115-1121

 

Minimally Invasive Total Knee Replacement vs. Traditional Total Knee Replacement

Total knee replacement has been a successful procedure for the treatment of end-stage, severe knee arthritis. According to clinical studies, long-term results for functional improvement and pain relief are excellent using total knee replacement. However, the traditional approach to knee replacement requires a large incision and a long recovery period. Many patients suffer from permanent quadriceps weakness after knee replacement.

Benefits

The mini-incision technique, also called minimally invasive total knee replacement, is an alternative to total knee arthroplasty canstockphoto11809008(TKA). The minimally invasive procedure is a true quadriceps-sparing surgery. The proposed benefits of the mini-incision procedure include:

  • Gain of early knee flexion (bending)
  • Decreased pain and need for analgesics
  • Improved quadriceps function
  • Decreased blood loss
  • Shortened length of hospital stay
  • Cosmetically better smaller incision
  • Early recovery
  • Rapid rehabilitation

To evaluate the short-term clinical and functional outcome of minimally invasive surgery TKA compared to traditional total knee replacement, researchers evaluated 80 knees. They found that patients in the minimally invasive TKA group had significant decrease in post-operative pain, hospital stay, and blood loss. The study showed that the mini-incision technique offered many benefits.

In another study comparing the two procedures, researchers compared 50 total knee arthroplasties performed with the traditional method with 50 that were performed using the mini-incision technique. The found that overall, the minimally invasive canstockphoto10845760surgery took significantly longer to perform. The traditional approach was found to be easier for the surgeon, and a substantial learning curve may be required for the surgeon to perform minimally invasive knee replacement.

Incision Size

With traditional knee replacement, an incision of 6-8 inches is required. The patient’s size and the extent of joint damage will also determine the length of an incision. The doctor must have a large incision to fully visualize the joint, the implants, and the disease tissue.

With the minimally invasive technique, the incision is only 4 inches long, which is half the length of a traditional TKA incision. Surgeons perform surgery using special instruments that are designed to move around muscle and soft tissue rather than cut through it. A smaller incision is more aesthetically pleasing to the patient.

Recovery

Recovery after total knee replacement from traditional techniques takes around 6-8 weeks, depending on age, health status, and previous knee injury. Each person’s recovery time will vary, but most patients drive after 3 weeks, garden after 4-6 weeks, canstockphoto1903417and golf after 8 weeks. The surgeon will determine what activities you can participate in and which ones you must avoid.

After a minimally invasive knee replacement, recovery takes half as long than traditional surgery. While every patient is different, most people are driving after 2 weeks, gardening after 4 weeks, and golfing after 6 weeks. Regardless of which procedure you have, certain high-impact activities are not permitted, as they place extreme pressure on the new knee joint.

Considerations

The minimally invasive approach is may not be an option for an overweight or obese person, as well as for very muscular people, those who require a complex replacement, and people with severe knee deformity or instability. The mini-incision procedure requires specialized instruments and is more technically challenging to the surgeon. According to some studies, the risks of complications is higher with the minimally invasive TKA, which can be detrimental for the final outcome of surgery.

While the minimally invasive total knee replacement is a good alternative in the hands of an experienced orthopedic surgeon, you should work with your surgeon to decide which procedure is best for you. Choose an Arizona total knee replacement surgeon who is experienced if you wish to have the mini-incision procedure, and work with your doctor to lose weight before surgery.

Study Background:

Minimally invasive surgery has gained popularity over the past several years. Early results have shown better functional outcome with early recovery and rapid rehabilitation.

Aim:

Evaluation of the short-term clinical and functional outcome of minimally invasive surgery total knee arthroplasty (MIS-TKA) compared with the traditional total knee arthroplasty (TKA).

Materials and Methods:

During 2009, all cases scheduled for primary TKA through the modified mini-mid-vastus approach (MIS group) were studied. This group included 40 knees and was compared to a cohort control group of similar number of patients (40 knees) that underwent the procedure through the standard conventional technique (standard group).

Results:

Patients in the MIS group showed significant decrease in postoperative pain, blood loss in first 24 hours, and in hospital stay. Furthermore, they achieved motion considerably faster than the standard group with earlier return of quadriceps function and greater early flexion.

Conclusion:

This study proved that MIS-TPA has the ability to couple the benefits of less invasive surgical approach.

 

Resources

Dabboussi N, Sakr M, Girard J, & Fakih R. (2012). Minimally Invasive Total Knee Arthroplasty: A Comparative Study to the Standard Approach. N Am J Med Sci, 4(2), 81-85.

King J, Stamper DL, Schaad DC, & Leopold SS (2007). Minimally invasive total knee arthroplasty compared with traditional total knee arthroplasty. Assessment of the learning curve and the postoperative recuperative period. J Bone Joint Surg Am, 89(7), 1497-1503.

Preparing for a Total Knee Replacement in Arizona

Preparing for a total knee replacement begins weeks to months before the actual surgery date. Good physical health is important for a successful operation. Getting the upper body strong will improve your ability to use crutches or a walker, and performing leg-strengthening exercises will improve ability to walk on your new knee. In addition, you should follow the Arizona knee replacement doctor’s orders explicitly before undergoing a total knee replacement.

Meeting with the Gilbert Orthopedic Surgeon

To prepare for the total knee replacement, you will meet with the AZ orthopedic knee surgeon. The doctor will ask you Knee pain 3questions about your past medical history, inquire about your current knee problems, and perform a physical examination. In conjunction with an internal medicine evaluation, you may have x-rays, laboratory tests, and an electrocardiogram (heart rhythm test). If you are a smoker, many doctors require that you refrain from smoking for 6 weeks before surgery.

The orthopedic surgeon will discuss your current medications and allergies. Certain agents that thin the blood must be held for several days before surgery. In case you require blood transfusions during surgery or right after, you may want to store your own blood at the hospital’s blood bank. In addition, you should see your dentist to evaluate for infected teeth or gums, which could cause problems with the new knee.

Meeting with the Physical Therapist

Before you undergo surgery, you may see the physical therapist and start an exercise program. The therapist will work with you 2-3 times each week to perform strengthening and flexibility exercises. The work out helps prepare your muscles and soft tissue structures for surgery and recovery.

The physical therapist may either come to your home to assess your recovery environment or simply discuss it with you. If you have stairs, problems with hallways, and other issues, the therapist may recommend that you recover for the first couple of weeks in a skilled nursing facility. This will depend on your unique situation and health conditions.

canstockphoto10845760Preparing your Home and Assistance after Surgery

When you are preparing for surgery, you should begin thinking about recovery after surgery. You will go home from the hospital 2-5 days after the total knee replacement. Since you cannot drive, you should arrange to have a ride home. In addition, you will need someone to help you at home for a few days (getting meals, dressing, follow-up appointments, etc.)

Right Before Surgery

The morning of your surgery, you can brush your teeth and take necessary medications with a small sip of water. You are not to eat solid food within 8 hours before your surgery, and should not drink or eat after midnight. We recommend that you shower the morning of your surgery using an antibacterial soap.

When you arrive at the hospital, you will register at the surgical center. A nurse will have you change into a procedure gown. After discussing the procedure, you must sign a consent form. The nurse will attach monitoring devices to assess blood pressure, pulse, and oxygen level. In addition, an intravenous (IV) catheter is placed in your arm.

Orthopedic and Sports Performance Institute offers the top knee replacement surgeons in Arizona. Often times outpatient knee replacement is performed, and most insurance is accepted at the practice. Call us today to discuss your options with our Gilbert and Chandler knee specialists!

Life after a Total Knee Replacement

Pain and suffering from severe degenerative joint disease of the knee can compromise a person’s ability to maintain gainful employment, as well as perform usual activities of daily living. A total knee replacement (TKR) is a successful procedure for keeping people active and working. Returning patients to a higher level of functioning is the goal of knee arthroplasty, along with eliminating the chronic knee pain.

Returning to Work after Surgery

Around 98% of total knee replacement patients who were working before their surgery are able to return to work after surgery. Knee pain 3In addition, 90% of these patients are able to resume their previous position. A total knee replacement, also called total knee arthroplasty (TKA), is one of the most widely performed procedures in the world, and it is used to relieve pain and restore function in patients with advanced knee arthritis.

According to an independent survey center that interviewed more than 660 TKR patients 1-5 years after surgery, patients resume normal activities after the procedure. Their finding revealed that around 75% of patients were employed before surgery, and almost all of these people returned to work after the procedure. Men were more likely to have worked during the 3 months before surgery than women (83% vs. 70%), but of those patients, the rates of work return after surgery were similar.

A recent study out of Sweden evaluated joint replacement patients through self-reported assessments and physician evaluation. The researchers found that at 5- and 10-years post-surgery, most patients reported an active lifestyle. Surgery durably and substantially improves physical activity levels for men and women of all age categories.

Quality of Life Studies

canstockphoto11809008In a review of studies regarding quality of life among people who underwent total knee replacement surgery, and the various associated factors that impact recovery, researchers found several factors that were associated negatively with an active lifestyle. These factors were obesity, comorbidities, advanced age, persistence of pain, and lengthy wait for surgery.

Another study evaluated the self-reported outcomes after a total knee replacement to determine factors that influenced quality of life at 6 weeks, 3 months, 6 months, and one year post-surgery. Of the patients, 162 females and 40 males had a mean age of 69 years. At 6 weeks post-surgery, physical function was satisfactory. However, significant improvement was noted at 3 months postoperatively. Patients had decreased VAS pain scores, as well.

This quality of life study has proved that patients can return to previous level of functioning and enjoy an improved functional status. Researchers found that at one year post-operative, most patients reported that they had a significant improvement in quality of life. The researchers concluded that quality of life after TKR was noticeably different, with patients experiencing significant improvement for all parameters measured.

Longevity of the New Knee

It is difficult to predict how long the total knee implant/prosthesis will last, as lifespan depends on several factors. For a few patients, surgical complications occur which affects the longevity of the new knee. However, the majority of new knees last for 20 years, giving patients pain relief and improved function.

Surgeons, researchers, and prosthesis manufacturers all continue to work to improve the long-term outcomes of total knee replacement. The life of an implant depends on the use and wear. In addition, uses of new high performance material had shown to decrease wear by as much as 60%.

Orthopedic and Sports Performance Institute offers top knee replacement surgeons in Arizona. The procedures are often able to be performed on an outpatient basis, with most insurance being accepted. Call the top orthopedic surgeons in Gilbert and Chandler today!

Resources

American Academy of Orthopedic Surgeons. (2013). 98 percent of total knee replacement patients return to life, work following surgery. ScienceDaily. Retrieved from: www.sciencedaily.com/releases/2013/03/130321082857.htm

Da Silva RR, Santos AA, de Sampaio CJJ, & Magos MA (2014). Quality of life after total knee arthroplasty: systematic review. Rev Bras Ortop, 49(5), 520-527.

Papakostidou I, Dailiana ZH, Papapolychroniou T, et al. (2012). Factors affecting the

quality of life after total knee arthroplasties: a prospective study. BMC Musculoskelet Disord, 13, 116.

Recovery after Partial Knee Replacement

After a partial knee replacement, you are monitored in the recovery room for a few hours. After you wake from general anesthesia, you are moved to a hospital room. Most patients stay 2-4 days in the hospital after knee replacement.

Hospital Recovery

  • Deep breathing – To avoid lung and airway congestion, you should take several deep breaths every hour. This moves mucus from the airways and expands the lungs.Knee pain 3
  • Compression stockings – You will wear elastic or plastic compression devices to prevent formation of blood clots in your legs. This is done to improve circulation and prevent clot formation.
  • Physical therapy – Soon after you move to your hospital room, you will meet with the physical therapist. Physical therapy is used to prevent complications, improve mobility, and strengthen knee muscles. You will work with the therapist 1-2 times each day.
  • Continuous passive motion (CPM) – A CPM machine bends the knee in normal range of motion on a continuous level. This is used to keep the knee from getting stiff and prevent blood clots.
  • Physical activity – A nurse will help you move to and from the bathroom, and the physical therapist works with you on walking using a cane or walker. Physical activity is encouraged immediately after surgery.

Recovery at Home

Once you go home, you must continue with your recovery. This involves:

  • Preparation – Before going home, you must arrange to have someone drive you. In addition, you may want to have help around the house for a few days. Have some gauze, tape, and ice packs available, and stock up on frozen meals and canned foods. You need to have a raised toilet seat, a shower Unicompartmental knee replacementchair, and handrails on stairways before you go home.
  • Incision care – You will have sutures or staples along your incision at the front aspect of the knee. These are usually removed within 10-14 days. You may have bandages on the knee as well. You must keep the area clean and dry, and avoid soaking in a tub or pool until wounds are healed.
  • Physical activities – You are not permitted to drive for 3-6 weeks, so arrange to have someone drive you home and help at home for a few days. You are encouraged to move about your home using an assistive device. Avoid falling by removing all loose rugs and cords from walkways.
  • Physical therapy – A therapist will come to your home daily after your knee replacement. You must work with the professional to walk, climb stairs, and perform activities. The therapy is used to strengthen leg muscles and improve range of knee motion.

Same Day Discharge

It is possible that the Gilbert orthopedic surgeon discharges you on the same day of surgery. This depends on your existing health conditions, current health status, and surgeon’s choice. In a pilot study used to investigate discharging patients within the day of surgery, researchers evaluated patients undergoing knee replacement. Of the study participants, all had a partial knee replacement through a short incision, and no dislocation of the patella was involved. All patients were in the accelerated recovery program.

Follow-up assessments were performed at 1, 2, and 6 weeks after surgery. The average pain score for the first couple of weeks was a 2 on a 1-10 scale. In addition, knee flexion was 125 degrees for all patients at 6 weeks, and all patients could walk independently at the 6-week follow-up appointment. Researchers found that the fast-track recovery protocol was safe and effective for people undergoing partial knee replacement.

OSPI in Gilbert AZ offers the top knee specialists in AZ. They offer both total and partial knee replacements, often allowing patients to go home the same day! This allows for rapid recovery, with less downtime than if traditional methods were used. Call today!

Resources

Bard DJ, Murry DW, Rees JL, et al. (2002). Accelerated recovery for unicompartmental knee replacement–a feasibility study. Knee, 9(3), 221-224.

 

JOIN OUR E-MAIL LIST!