Knee

Healthy Knee

The healthy knee is a complex hinge joint consisting of bones and healthy cartilage. The three bones that form the knee are the thighbone (femur), shinbone (tibia), and kneecap (patella). The femur and tibia are held together by ligaments, which are strong bands of tissue that stabilize the joint.

The end of your femur can be compared to a rocking chair. It has two distinct surfaces called compartments, which rest on the tibia. The third compartment is found behind the patella. All three compartments are covered with a tough lubricating tissue called cartilage.

Cartilage acts like a natural shock absorber, preventing bone on bone contact and providing a smooth, pain-free surface for the bones to glide against. The knee also contains synovial membranes, which produce synovial fluid to help lubricate and nourish the cartilage.

The knee is the largest joint in your body and it is susceptible to injury. Because the knee is a complex joint, made up of many parts, there are numerous things that can go wrong. Knee pain and damage is commonly caused by arthritis or injuries to the joint.

Topics below cover two common areas of knee problems.

  • Arthritis
  • Injuries

Arthritic Knee

Arthritis is a term that is defined as inflammation of the joint and used to describe over 100 different conditions that can affect the human body. Arthritis affects millions of Americans each year with symptoms including pain, stiffness, swelling, and loss of motion in affected joints.

The most common form of arthritis that generally affects the knee is osteoarthritis.

Osteoarthritis, the most common form of arthritis, results in the wearing out of the cartilage that protects the bones in the joints. Once cartilage is damaged or destroyed, cartilage cannot repair or replace itself like many other body tissues. Knee cartilage can be compared to the tread of an automobile tire, very durable but susceptible to wear over time. As we age, the tread surface slowly erodes until the underlying bone is exposed. This exposed bone can be painful when the joint moves and bears weight.

Often the cause of arthritis is unknown, but may develop as a result of injury to the joint, excess body weight, or years of wear and tear on the joint cartilage. There is no known cure. The best that doctors can do for patients is to restore motion and reduce pain.

Common symptoms of osteoarthritis of the knee
  • Severe knee pain that limits everyday activity
  • Knee pain at night causing sleeplessness
  • Progressive deformity of the leg (bowing of leg inward or outward)
  • Chronic swelling of the knee with morning stiffness
  • Catching or locking of knee
  • Decreased activity
  • Impaired lifestyle
  • Grinding pain during movement

Knee Injuries

There are many different types of knee injuries; however, there are a few that are more common than others. Common types of knee injuries include: anterior cruciate ligament (ACL) tears, posterior cruciate ligament (PCL) tears, Medial (MCL) & Lateral (LCL) Collateral Ligament tears, meniscus tears, and cartilage damage.

Many of these injuries can occur from long-term overuse, such as repetitive lifting, pushing, pulling and throwing. For this reason, athletes and skilled workers are particularly prone to knee injuries.

ACL (Anterior Cruciate Ligament) Tear

The ACL (Anterior Cruciate Ligament) Tear can be injured if the knee is twisted, bent side to side, or hyper-extended during physical activity. The ACL is one of the four main ligaments in the knee. The ligament connects the thigh bone to the shin bone, keeps the knee from hyper-extending, prevents anterior dislocation at the tibia, and stabilizes to help prevent unnatural movement in the joint. Contact sports involving rapid twisting movements may place harsh force on the knee, which can lead to injury.

Symptoms can include swelling of the knee immediately after injury or within 24 hours, may cause a loud popping or cracking sound at the time of the injury, and create the feeling of the knee “giving way.”

PCL (Posterior Cruciate Ligament) Tear

PCL (Posterior Cruciate Ligament) Tear is most commonly injured by direct force to the front of the knee, when it is bent. The PCL can also be injured by a direct blow to the outside of the knee joint, such as those that occur during soccer or football.
Symptoms vary depending on the instability in the knee. Patients usually see swelling in the back on the knee and bruising 24 to 36 hours after the injury, pain, excessive swelling and chronic instability.

MCL & LCL Tears


The MCL (Medial Collateral Ligament)
connects the femur and tibia on the inner side of the leg and resists forces acting on the outer side of the knee.

The LCL (Medial Collateral Ligament)
connects the femur and tibia on the outside of the leg and resists forces acting on the inner side of the knee.

The two ligaments create support and stability for the knee. The MCL is more often injured than the LCL as injuries are often caused by a blow to the outer side of the knee, usually seen in contact sports, that stretches/tears the ligaments on the inner side of the knee.

Symptoms of MCL and LCL tears often include pain, stiffness, swelling and tenderness along the inner or outer side of the knee.

A Meniscus Tear usually occurs when the knee is rotating while it is bearing weight. This type of injury often occurs in field sports such as soccer and football.

Symptoms include mild to severe pain, swelling is common at the time of injury, but can develop much later, can cause a popping sound, or the knee may lock, or feel weak.

Cartilage Damage may not heal quickly or at all because cartilage does not have a blood supply to help repair damage. Cartilage acts like a natural shock absorber, preventing both bone on bone contact and providing a smooth, pain-free surface for the bones to glide against. One of the most common and serious types of damage is to the articular cartilage that is between joints.

Symptoms of this articular cartilage damage include swelling, joint pain, stiffness, decreased range of movement and joints that lock or catch.

Diagnosing Knee Pain

Your surgeon will evaluate your health history, perform a physical examination, and take x-rays to diagnose your knee pain.

  • Medical history
  • Symptoms
  • Health
  • Activity
  • Examine affected joint
  • Range of motion tests
  • Joint-line tenderness
  • Joint deformities
  • X-rays

An x-ray will help your surgeon diagnose your knee pain. On an x-ray, a healthy knee joint appears as if there is a space between the bones in the joint. Although you cannot see the cartilage on an x-ray, in the healthy knee, the cartilage is working to cushion and smooth the movement of the thighbone (femur) against the tibia (shinbone). On the x-ray of a knee with osteoarthritis, there is bone on bone contact because the cartilage between the femur and tibia has been worn away.

When non-surgical treatments such as diet, exercise, medications, supplements, walking aids, and physical therapy fail, your orthopedic surgeon may recommend total knee replacement.

You should discuss your condition and treatment options with your surgeon.

The treatment options covered here relate to osteoarthritis, although many of them may be helpful for patients with other arthritic conditions. Please ask your physician before starting any treatment.

  • Exercise
  • Physical Therapy
  • Modify Your Activities
  • Weight Control
  • Self-Help/Assistive Devices
  • Heat and Cold Treatments
  • Nutritional Supplements
  • Over-The-Counter Medications
  • Injections
  • Bionicare

Exercise

Moderate doctor-prescribed exercise is an integral part of treating arthritis. Joints that are not regularly exercised can become tight and painful. Activities such as walking, swimming or gardening can assist in keeping your bones strong and your joints limber, which may help relieve stiffness. Low-impact exercise will not wear out your joints. Although exercise may sometimes cause discomfort, proper exercise will help nourish the cartilage, strengthen the muscles, and prolong the life of your joints.

Aquatic Therapy

Aquatic therapy is an excellent form of exercise to help manage arthritis pain. Water’s buoyancy helps protect your joints from impact injury. Water also resists movement, which is helpful for strengthening. Hydrostatic pressure can also assist with reducing the swelling in joints and edema in the legs.

Walking

Walking is an excellent form of endurance exercise for almost anyone, including those with arthritis. Be sure to have a good pair of walking shoes to help cushion impact. Check with your physician to obtain any exercise precautions or guidelines. You should be able to speak clearly without feeling out of breath when you are walking. Always warm up and cool down by walking slowly.

How much exercise is too much?

If you note increased joint swelling, decreased joint motion, unusual or persistent fatigue or continuous pain, you may be exercising too much. You should expect some muscle soreness, especially if you are just beginning an exercise program or have changed exercises. Joint pain should not last more than several hours after exercise.

For an in-depth guide on starting and maintaining a walking program, reference Walk With Ease by the Arthritis Foundation.

How do I stay consistent with exercise?
  • Seek help from a health care professional to assist you in setting up an individualized program.
  • Make a plan! Write it down! Set goals!
  • Exercise at the same time each day so it becomes part of your routine.
  • Find an exercise buddy.
  • Look for an appropriate exercise class.
  • Stay in the habit of doing some exercise each day.
  • Vary your exercise routine and rotate your exercises.
  • Evaluate your progress and enjoy your success.

Physical Therapy

A physical therapist may demonstrate a variety of low-impact exercises designed to increase the strength and mobility of your knee joint. However, you should only perform the exercises that are ordered by your surgeon.

Modify Your Activities

Proper body mechanics can lead to less strain on your joints. The following activity modification guidelines may be helpful:

  • Practice good posture by standing up straight.
  • Avoid stooping while standing.
  • Avoid sitting in low chairs to reduce stress on your knees when sitting and standing.
  • Avoid impact-loading activities (e.g., running, jumping, etc.).
  • Reduce climbing activities (e.g., stairs, hills, etc.).
  • Avoid any activity that causes prolonged discomfort.

Weight Control

Being overweight puts weight-bearing joints under extra pressure and stress. Because the joints are eccentric (not in the centerline of your body), the force across the joint is three times greater than a person’s body weight when that person balances on one leg. For example, a 150-pound person places up to 450 pounds of pressure on the joint. The good news is for every single pound lost; subtract three pounds of force off the knee. The bad news is for every one pound gained; add three pounds of force to the knee. Extra pressure on your joints can make arthritic symptoms worse, leading to pain and stiffness.

A well-balanced diet coupled with regular doctor prescribed low-impact exercise can help reduce excess body weight, decrease pressure on the joints and increase joint strength. Many claims have been made concerning diet as a cause of arthritis but none have been proven to date. If you have been diagnosed with gouty arthritis, some dietary restrictions are indicated. Maintaining your ideal body weight will help keep your joints healthy. If you are overweight, ask your doctor to advise you on a weight-loss program to fit your needs.

Self-Help/Assistive Devices

Simple everyday tasks may be hard to accomplish with arthritis. Utilizing self-help/assistive devices can help. Ask your physician or physical therapist about the following self-help devices.

Assistive Devices

If you are walking with a limp, consider an assistive device such as a cane, a crutch or a walker. Ask your physician or occupational therapist about different types of assistive devices and which type is best for you.

Canes

It is important to use canes properly since you can actually stress other joints with an abnormal gait (walking) pattern. Canes should be used in the opposite hand of the affected joint; for example, hold a cane in your right hand if your problem is with your left leg.

Walkers or Crutches

If you are unsteady with a cane or cannot grip it properly; you may be able to use either one or two crutches or a walker. This will provide support and balance.

Self-Help Tools

The self-help devices listed below can help minimize pain, discomfort, stress, and can assist you in accomplishing tasks. Ask your physician or physical therapist about these self-help devices:

  • Orthotics to improve foot alignment
  • Braces for knee support
  • Abdominal supports to reduce stress on the back
  • Long-handled reachers or grabbers to help you pick things up without bending
  • Sock sliders to help you put on socks

Heat and Cold Treatments

Heat or cold treatments may be used to decrease pain and increase flexibility. Heat or cold treatments may be combined with the exercises prescribed by your physical therapist.

HeatCold
Use prior to activity
Increases blood flow
Improves motion
Decreases joint ache
Helps relax muscles
Use after exercise
Decreases blood flow
Decreases swelling
Better for pain
Reduces inflammation

You may want to purchase a gel pack that can be kept cold in your freezer or heated in a microwave.

Nutritional Supplements

Recently, nutritional supplements have become popular with arthritis patients. Glucosamine and Chondroitin have been the most widely used. Consult your physician before beginning treatment.

Glucosamine

Glucosamine is a building block of cartilage and may be found as a hydrochloride or sulfate. It may be useful in strengthening and repairing cartilage. Studies have shown it to be effective in reducing pain, especially painful arthritis of the hands. Glucosamine is not a cure and has not been shown to rebuild cartilage.

Chondroitin Sulfate

Chondroitin Sulfate is commonly taken in conjunction with Glucosamine. It is found in cartilage and acts somewhat like a sponge for the fluid found in cartilage, which makes the cartilage more elastic and spongy. Chondroitin may help prevent the breakdown of cartilage as well.

Vitamins C and D

Some studies have indicated that patients low in Vitamins C and D may have a higher incidence of arthritis. Arthritis patients should take vitamins regularly, or as prescribed by a medical professional.

Calcium

Some people confuse osteoporosis with osteoarthritis. Osteoporosis is a thinning of the bone, not the joint. High amounts of Calcium is not the cause of osteoporosis but calcium may accumulate in bone spurs around arthritic joints in response to increased pressure on the joint.

Talk to your physician before taking any medications.

Over-The-Counter Medications

Many medications are available to help treat arthritis and can function as a pain-reliever and as an anti-inflammatory to help relieve joint swelling and pain. These medications can lead to improvement in everyday function and quality of life. Always consult your physician before beginning treatment.

Tylenol®

The non-narcotic analgesic Tylenol® is generally effective in relieving minor pain and discomfort. The Academy of Rheumatology has suggested this as the first-line arthritis treatment. Tylenol®, however, does not reduce the inflammation caused by arthritis. Ask your physician about dosing and safety.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) can be purchased over-the-counter with some common forms being Aspirin, Motrin®, Advil®, and Aleve®. NSAIDs are usually indicated for mild to moderate arthritis pain and may be effective where Tylenol® is not. They are very effective in reducing inflammation caused by arthritis. However, they can also increase your chance for gastric (stomach) ulcers and can alter your blood by affecting your platelets. Therefore, patients with stomach problems, bleeding problems or on blood thinners should not take these medications. Always check with your physician before starting NSAIDs.

Patients with chronic pain may need to take medication daily. However, many may only need to take it when necessary or when they anticipate a strenuous activity that is likely to lead to pain. This may not be true for patients with inflammatory forms of arthritis such as rheumatoid arthritis or lupus.

Topical Creams

Many topical creams on the market can reduce pain from arthritis. The American College of Rheumatology does recommend Capsaicin as part of a treatment plan. Capsaicin is thought to help block the release of the body’s painkillers while also blocking a chemical that transmits pain signals. Check with your physician before applying any topical creams.

Talk to your physician before taking any medications.

Injections

Cortisone

Cortisone, which is injected directly into joints, may be used to help relieve both swelling and pain. Cortisone is a naturally occurring hormone produced by the adrenal gland. It helps regulate inflammation and when injected into a joint it can relieve or reduce both swelling and pain. Relief usually occurs within a day or two of the injection. Patients do not need to change activities following injections. Many patients elect to receive cortisone injections prior to big events when they will be more active.

Cortisone may play a role in weakening tendons or cartilage if used too often. Therefore, most physicians limit its use to a few times per year depending on the circumstances.

Always consult your physician before participating in any treatment option.

Hyaluronates

Hyaluronate injections have been approved for arthritis of the knee. They may help relieve osteoarthritis pain and restore joint function. Hyaluronate is a naturally occurring substance in joint fluid that provides lubrication and cushioning to the joint. As osteoarthritis continues to develop, the joint fluid becomes thinner, with less hyaluronate and thus loses its ability to properly lubricate and cushion the joint cartilage.

Several synthetic forms of hyaluronate have been developed to use in the knee joint. In order to be effective, anywhere from 3 to 5 injections must be given weekly. The effectiveness is usually not noticed for at least a month. Patients do not need to significantly reduce activity following injection. Various studies have indicated maximum effectiveness at anywhere between 50-70%. Studies have shown that the more severe the arthritis, the less effective the injections. However, when effective, the relief may last for 6 to12 months. Synthetic hyaluronate is made from rooster combs. Therefore, anyone who is allergic to feathers, chickens or egg products should not receive an injection.

Always consult your physician before participating in any treatment option.

Bionicare

Bionicare is a new, non-invasive therapy (FDA approved) for the treatment of osteoarthritis of the knee and rheumatoid arthritis of the hand. A wrap is placed on the affected site and attached to a small battery-powered transmitter for six to eight hours every day. The transmitter sends an electrical signal to the hyaline cartilage cells in your joint. This signal has been shown in animals to stimulate the cells to regenerate the cartilage and reduce the inflammatory enzymes that cause pain and stiffness in joints. Although cartilage growth has not yet been proven in humans, Bionicare has been shown to reduce pain and associated symptoms as well as produce overall improvement. A long-term study has shown that treatment with Bionicare can delay the need for total joint arthroplasty in a majority of patients treated for an average of one year.1

Bionicare is based on technology that has been well established over the past 30 years in stimulating bone cells to produce bone. There have been no adverse effects associated with Bionicare, except for a few patients who developed a rash from the gel.

Positive results probably require treatment for 6 months or more. Although it is possible to walk around wearing the wrap during the day, most patients apply the wrap at night.

1 BioMechanics, April 2005; M. Mont, D. Hungerford, J. Caldwell et al.1

When non-surgical treatments fail to provide adequate relief from the symptoms of arthritis, your orthopedic surgeon may recommend joint replacement. The technique of joint replacement uses implants typically made from polyethylene (plastic) and metal alloy to replace the damaged sections of bone and cartilage in the joint. The purpose of the procedure is to restore function and mobility and to provide relief from joint pain.

You must decide if your discomfort, pain or stiffness, and overall loss of quality of life justify undergoing surgery

In patients with only limited knee arthritis, surgeons may elect to perform a unicompartmental (partial) knee replacement. Unlike total knee replacement involving removal of all the knee joint surfaces, a partial knee replacement replaces only one side of the knee joint, preserving the undamaged cartilage.

Knee osteoarthritis usually occurs first in the medial (inside) compartment as this side of the knee bears most of the weight. In knees that are otherwise healthy, this approach allows the outer compartment and all ligaments to remain intact. By retaining all of the undamaged parts, the joint may bend better and function more naturally.

This conservative procedure makes the technique less invasive than traditional knee replacement surgery. This technique requires a smaller incision (3 to 4 inches), less bone removal with minimal trauma to surrounding soft tissue, which can allow you to recover more quickly and with less pain.

The implant can also help prolong or avoid the need for future total knee replacement. However, if you should need total knee replacement in the future, partial knee replacement allows your surgeon the ability to perform the procedure with a less invasive approach.

Benefits of Partial Knee Replacement

  • Eliminate or reduce pain
  • Less scar tissue
  • Less removal of tissue and bone
  • Quicker mobility
  • Shorter hospital stay
  • Smaller incision
  • More like normal knee
  • Shorter recovery period
  • Improve quality of life
  • Return to normal activity
  • Low-impact sports and activities

Partial knee replacement is one option available to you and your surgeon. Only your orthopedic surgeon can determine if you are a candidate for this implant or if another type of implant would better suit your unique situation.

Complications

While uncommon, complications can occur during and after surgery. Some complications include infection, blood clots, implant breakage, malalignment, and premature wear. Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as the patient’s post-surgical activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon.

Preparing for Surgery

Patients should begin preoperative strengthening exercises to help them prepare for surgery and their recovery. Patients may be given a comprehensive nutrition plan to help ensure optimum health before surgery.

There are many things that your surgeon may do to minimize the potential for complications. Your surgeon may have you see a medical physician before surgery to obtain tests. You may also need to have your dental work up to date and may be shown how to prepare your home to avoid falls.

After Surgery

After surgery, most patients walk on their surgical leg the same day and can be discharged within 24 – 48 hours. It is important to start moving your new knee as soon as possible after surgery to promote blood flow, to regain knee motion, and to facilitate the recovery process.

Before you leave the hospital, your therapist will show you a variety of exercises designed to help you regain mobility and strength in your knee. You should be able to perform these exercises on your own at home. You will be shown how to safely climb and descend stairs, how to get into and out of a seated position, and how to care for your knee once you return home.

At home, it is important to continue with your exercises as your physician has instructed. It is a good idea to enlist the help of friends or family to help you once you do return home.

Recovery

Recovery after partial knee replacement takes approximately half as long as traditional total knee replacement. Every person’s recovery time will vary, but most people should be able to drive after 2 weeks, garden after 3 to 4 weeks, and golf about 6 to 8 weeks after surgery. Your surgeon will tell you when you can return to these activities and will also tell you which activities to avoid.

You will typically not be allowed to participate in high-impact activities or contact sports. These types of activities place extreme pressure on the knee joint, which could lead to complications.

After Surgery Total Knee Replacement

Total knee replacement surgery, also called arthroplasty, is an option for many suffering with pain from dysplasia or osteoarthritis, a disease that involves the breakdown of cartilage in one or more joints. This causes bones in the affected area to grind against each other, causing severe pain and limited joint mobility.

The first total knee replacement surgery was performed more than 30 years ago, and since then, millions of people have received knee replacements. Total knee replacement involves removing the diseased bone and cartilage and resurfacing it with orthopedic implants re-creating the smooth gliding surfaces that were once intact.

During the surgery, the joint is exposed by an incision made down the center or off to the side of the knee. The damaged sections of bone are removed to make room for the replacement components. The replacement implants include a metal alloy on the end of the femur (thighbone) and polyethylene (plastic) on the tibia (shinbone) and patella (kneecap). The implants create a new, smoothly functioning joint that prevents painful bone-on-bone contact.

Total knee replacement is one option available to you and your surgeon. Only your orthopedic surgeon can determine if you are a candidate for this implant or if another type of implant would better suit your unique situation.\

Benefits of Total Knee Replacement

  • Eliminate or reduce pain
  • Enhance movement and mobility
  • Improve quality of life
  • Return to normal activity
  • Low-impact sports and activities

Complications

While uncommon, complications can occur during and after surgery. Some complications include infection, blood clots, implant breakage, malalignment, and premature wear. Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as the patient’s post-surgical activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon.

Preparing for Surgery

Patients should begin preoperative strengthening exercises to help them prepare for surgery and their recovery. Patients may be given a comprehensive nutrition plan to help ensure optimum health before surgery.There are many things that your surgeon may do to minimize the potential for complications. Your surgeon may have you see a medical physician before surgery to obtain tests. You may also need to have your dental work up to date and may be shown how to prepare your home to avoid falls.

After Surgery

After surgery, you probably will be hospitalized for 5 to 7 days. During this time, you will receive pain medication and begin physical therapy. It is important to start moving your new knee as soon as possible after surgery to promote blood flow, to regain knee motion, and to facilitate the recovery process. You should be out of bed and walking with crutches or a walker within 24 hours of your surgery.Before you leave the hospital, your therapist will show you a variety of exercises designed to help you regain mobility and strength in your knee. You should be able to perform these exercises on your own at home. You will be shown how to safely climb and descend stairs, how to get into and out of a seated position, and how to care for your knee once you return home.At home, it is important to continue with your exercises as your physician has instructed. It is a good idea to enlist the help of friends or family to help you once you do return home.

Recovery

Every person’s recovery time will vary, but most people should be able to walk without support and drive 3 to 6 weeks after surgery. Your surgeon will tell you when you can return to these activities and will also tell you which activities to avoid.You will typically not be allowed to participate in high-impact activities or contact sports. These types of activities place extreme pressure on the knee joint, which could lead to complications.

The field of orthopedics is constantly researching new techniques to help make joint replacement surgery less painful and to help patients recover more quickly. One of the most talked about orthopedic advancements is minimally invasive joint replacement, also called mini-incision joint replacement.

A traditional total knee replacement requires an incision between 6 to 8 inches long. The patient’s size and the extent of the joint’s damage can sometimes determine the length of the incision. The incision allows the surgeon to fully visualize the joint, the diseased tissue, and the implants.

Minimally invasive total knee replacement may be performed through an approximately 4 inch incision, half the length of a typical knee replacement incision. Surgeons can perform surgery through such a short incision because they use instruments specifically designed to move around soft tissue, rather than cut through it.

It is important to remember that minimally invasive joint replacement is a technique, not an implant. The technique allows your surgeon to lengthen the incision should it become necessary during surgery. Your surgeon will select the implant that they feel will best treat your specific condition.

Benefits of Minimally Invasive Total Knee Replacement

  • Shorter hospital stay
  • Quicker mobilization
  • Accelerated recovery process
  • Healthy tissues and muscles are preserved
  • Reduced blood loss
  • Less scar tissue

Today’s implants offer exceptional outcomes, but traditional surgical techniques require a long and involved physical recovery. Surgeons understand that patients desire to heal quickly so they can return to a more active and enjoyable lifestyle.

Complications

While uncommon, complications can occur during and after surgery. Some complications include infection, blood clots, implant breakage, malalignment, and premature wear. Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as the patient’s post-surgical activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon.

Preparing for Surgery

Patients should begin preoperative strengthening exercises to help them prepare for surgery and their recovery. Patients may be given a comprehensive nutrition plan to help ensure optimum health before surgery.

There are many things that your surgeon may do to minimize the potential for complications. Your surgeon may have you see a medical physician before surgery to obtain tests. You may also need to have your dental work up to date and may be shown how to prepare your home to avoid falls.

After Surgery

Surgeons may implement a unique pain program during surgery that is designed to dramatically reduce a patient’s postoperative pain. Reducing patient’s postoperative pain is critical to helping them begin their postoperative rehabilitation and to helping them make a rapid recovery.

After surgery, you probably will be hospitalized for 2 to 3 days. During this time, you will receive pain medication and begin physical therapy. It is important to start moving your new knee as soon as possible after surgery to promote blood flow, to regain knee motion, and to facilitate the recovery process. You should be out of bed and walking with crutches or a walker within 24 hours of your surgery.

Before you leave the hospital, your therapist will show you a variety of exercises designed to help you regain mobility and strength in your knee. You should be able to perform these exercises on your own at home. You will be shown how to safely climb and descend stairs, how to get into and out of a seated position, and how to care for your knee once you return home.

At home, it is important to continue with your exercises as your physician has instructed. It is a good idea to enlist the help of friends or family to help you once you do return home.

Recovery

Recovery after minimally invasive knee replacement takes approximately half as long as traditional total knee replacement. Every person’s recovery time will vary, but most people should be able to drive after 2 weeks, garden after 3 to 4 weeks, and golf about 6 to 8 weeks after surgery. Your surgeon will tell you when you can return to these activities and will also tell you which activities to avoid.

You will typically not be allowed to participate in high-impact activities or contact sports. These types of activities place extreme pressure on the knee joint, which could lead to complications.

Planning ahead and preparing for your knee surgery can help ensure a smooth surgery and an easier recovery.

The following recommendations can help you with this process.

  • Preparing For Knee Surgery
  • Caring For Your New Knee Implant
  • Caregivers Guide

Preparing For Knee Surgery

When you and your orthopedic surgeon decide that joint replacement surgery is the best option to relieve pain and restore motion, you will begin the normal preparation for surgery. You should notify your surgeon about any of the medications you are presently taking because some medications must be stopped before surgery. All surgeries carry certain risks and possible complications. Before surgery, your surgeon will explain the possible complications. Your orthopedic surgeon may ask you to see your primary care physician to make sure that you do not have any health conditions that may complicate your surgery.

You may be asked to donate blood before your surgery. There are several options regarding blood donation and surgery, and all of these options should be explained to you.

Surgery also requires anesthesia. There may be some options regarding anesthesia and they will be explained to you. Your options will be based on your health history, the medications you presently take, and the results of your physical examination.

Your surgeon may also recommend that you start a strengthening program before surgery. The prescribed exercises are designed to help add strength and flexibility. Strengthening your muscles before surgery can assist your postoperative recovery.

After surgery your surgeon will give you a specific recovery plan that you should carefully follow. Do not attempt exercises that are not prescribed by your surgeon, and do not attempt to alter your recovery schedule. It takes time for your joint to heal properly.

Planning ahead for your return home

  • Launder all of your dirty clothing before your surgery. Have loose, comfortable clothing set aside for your recovery time.
  • Prepare single-serving meals before your surgery. These meals can be heated quickly in a microwave and there is less to clean up.
  • Be sure to remove loose rugs and other trip hazards such as electrical cords and magazine racks from walking paths to avoid accidents or falls. If necessary, widen furniture paths to accommodate a walker or cane.
  • Place regularly used items such as remote controls, medications, and reading materials in easy-to-reach locations.
  • Un-tuck bedding to allow for easier access in and out of your bed. If your bedroom is on a second floor, it may be helpful to temporarily relocate your sleeping arrangements to the first floor. This will avoid having to climb stairs when you are not feeling your best.
  • Having some assistance after total joint replacement can also be very beneficial. Contact family members or friends ahead of time so they may make the necessary arrangements to assist in your recovery.

Caring For Your New Knee Implant

During your first few weeks at home, it is important that you move properly. You should avoid crossing your legs while sitting or standing, and do not allow your knees to come higher than your hips. Also, avoid sitting in low sofas or chairs.

It is important to have some assistance when going up and down stairs. When climbing stairs, always use the railing and lead with your non-surgical leg, one step at a time. When going down stairs hold onto the railing and lead with your surgical leg, again, one step at a time.

Continue the prescribed exercises during your entire recovery period, and talk to your doctor about developing an exercise program after you fully recover. Golfing, swimming, walking, and bicycling are excellent sources of low-impact exercise if your surgeon feels that these activities are appropriate for your individual condition.

Follow your surgeon’s check-up plan. It is common to visit with your surgeon at three, six, and nine months after surgery and annually thereafter.

Caregivers Guide

As a caregiver, your role is important for helping your friend or loved one recover from joint replacement surgery. When at home, there are a variety of things you need to know for the patient’s safety, recovery, and comfort. This information will help you with some of the many questions and concerns as you prepare to care for your joint replacement patient.

  • Home Safety and Avoiding Falls
  • Body Changes
  • Blood Thinners
  • Stockings
  • Incision Care
  • Controlling Discomfort
  • Recognizing & Preventing Potential Complications
  • Pulmonary Embolus

Home Safety and Avoiding Falls

  • Pick up throw rugs and tack down loose carpeting. Cover slippery surfaces with carpets that are firmly anchored to the floor or that have non-skid backs.
  • Place regularly used items such as remote controls, medications, and reading materials, in easy-to-reach locations.
  • Widen furniture paths to accommodate a walker or cane.
  • Place frequently used cooking supplies and utensils where they can be reached without too much bending or stretching.
  • Be aware of all floor hazards such as pets, small objects, or uneven surfaces.
  • Provide good lighting throughout. Install nightlights in the bathrooms, bedrooms, and hallways.
  • Keep extension cords and telephone cords out of pathways. Do NOT run wires under rugs, this is a fire hazard.
  • Do not let the patient lift heavy objects for the first three months and then only with your surgeons permission.
  • Un-tuck bedding to allow for easier access into and out of the patients bed.

Body Changes

  • The patient’s appetite may be poor. Make sure they drink plenty of fluids to keep them from getting dehydrated. Their desire for solid food should return.
  • Joint replacement patients may have difficulty sleeping, which is normal. Do not let the patient sleep or nap too much during the day.
  • The patient’s energy level will be decreased for the first month.
  • Pain medications that contain narcotics promote constipation. Follow the surgeon’s recommendations for using stool softeners or laxatives such as milk of magnesia
    if necessary.

Blood Thinners

Blood thinners may be given to help avoid blood clots in the patient’s legs. Always follow the surgeon’s recommendations regarding blood thinners.

Stockings

  • The patient may be asked to wear special stockings. These stockings are used to help compress the veins in their legs. This helps to keep swelling down and reduces the chance for blood clots.
  • If swelling in the operative leg is bothersome, help the patient elevate the leg for short periods throughout the day. It is best when the patient lies down and raises the leg above heart level.
  • Make sure the patient wears the stockings continuously, removing for one to two hours twice a day.
  • Notify the physician if the patient notices increased pain or swelling in either leg.

Incision Care

  • Keep the incision dry.
  • Keep the incision covered with a light dry dressing until the staples are removed, usually 10-14 days.
  • Patient should request showering/bathing instructions from surgeon.
  • Notify the surgeon if there is increased drainage, redness, pain, odor, or heat around the incision.
  • Take the patient’s temperature if he or she feels warm or sick. Call the surgeon if it exceeds 100.5ºF.

Changing the Dressing (ONLY IF DIRECTED BY SURGEON)

  1. Wash hands.
  2. Open all dressing materials (ABD pads, 4×4 if needed, Betadine® swab if indicated).
  3. Remove stocking and old dressing.
  4. Inspect incision for the following:
    a. increased redness
    b. increase in clear drainage
    c. yellow/green drainage
    d. odor
    e. surrounding skin is hot to touch
  5. If Betadine® is ordered, take one Betadine® swab and paint the incision from top to bottom. Then turn the swab over and paint the incision from bottom to top. Use remaining swab to paint the drain site.
  6. Pick up ABD pad by one corner and lay over incision. Be careful not to touch the inside of the dressing that will lie over the incision.
  7. Place one ABD pad lengthwise and place the other ABD crosswise to form a “T” (to cover drain site).
  8. Tape dressing in place.

Controlling Discomfort

  • Pain medicine should be taken at least 30 minutes before physical therapy.
  • Encourage patient to gradually wean him or herself from prescription pain medication. Follow the surgeon’s recommendations for taking over-the-counter medication in place of prescription pain medication.
  • Have patient change position every 45 minutes throughout the day.
  • Use ice for pain control. Applying ice to the affected joint will decrease discomfort, but do not use for more than 20 minutes at a time each hour. Use ice before and after the patient exercises according to their prescribed program. A bag of frozen peas wrapped in a kitchen towel makes an ideal ice pack. Mark the bag of peas and return them to the freezer (to be used as an ice pack later).

Recognizing & Preventing Potential Complications

Signs of Infection
  • Increased swelling and redness at incision site
  • Change in color, odor of drainage
  • Increased pain in surgical joint
  • Fever greater than 100.5º F
Blood Clots in Legs

Surgery may cause the blood to slow and coagulate in the veins of the patient’s legs, creating a blood clot. This is why patients take blood thinners after surgery. If a clot occurs despite these measures, the patient may need to be admitted to the hospital to receive intravenous blood thinners. Prompt treatment usually prevents the more serious complication of pulmonary embolus.

Signs of blood clots in leg
  • Swelling in thigh, calf or ankle that does not go down with elevation.
  • Pain, heat and tenderness in calf, back of knee or groin area. NOTE: Blood clots can form in either leg.
Prevention of blood clots
  • Foot and ankle pumps
  • Walking
  • Compression stockings
  • Blood thinners such as Coumadin® or Heparin

Pulmonary Embolus

This is an emergency, if suspected CALL 911 immediatelyAn unrecognized blood clot could break away from the vein and travel to the lungs.

Signs of a pulmonary embolus
  • Sudden chest pain
  • Difficult and/or rapid breathing
  • Shortness of breath
  • Sweating
  • Confusion
Prevention of pulmonary embolus
  • Heparin or warfarin therapy. Taking Anticoagulants such as heparin and warfarin decreases your chances of pulmonary embolus.
  • Graduated compression stockings. Compression stockings offer a safe, simple and inexpensive way to keep blood from stagnating after general surgery. They steadily squeeze your legs, helping to increase your blood flow efficiency as long as the stockings are not overly tightened
  • Pneumatic compression. Pneumatic compression can dramatically reduce the risk of blood clots, especially in people who have had joint replacement surgery.
  • Physical activity. Becoming active as soon after surgery as possible can help prevent pulmonary embolism and speed up recovery process.

Physical Therapy and Exercise for the Knee

You may be prescribed a number of physical therapy exercises. Physical therapy is simply an exercise program that gently stretches and strengthens specific muscles and joints. The exercises you may perform are gentle, range of motion (stretching) exercises designed to restore movement and strength to your joint and to promote blood flow for healing. It is important to stay proactive in your physical therapy since it can have a direct impact on the total outcome of your surgery. Remember to stay diligent and don’t give up. Ask for help if you need it. Friends, family members, and even neighbors can be helpful during your recovery, especially if you ask for their assistance before your surgery. Physical therapy, which usually lasts between 4 and 6 weeks, is a very important role in the recovery process. A physical therapist may demonstrate a variety of low-impact exercises designed to increase the strength and mobility of your knee joint. However, you should only perform the exercises that are ordered by your surgeon.

The following are examples of exercises that your surgeon may prescribe.

ONLY PERFORM THE EXERCISES PRESCRIBED BY YOUR DOCTOR
  1. Knee Flexion: Seated Stretch
  2. Knee Extension: Seated Stretch
  3. Knee Extension: Passive
  4. Knee Extension: Straight Leg
  5. Straight Leg Raise
  6. Sitting Knee Extensions
  7. Ankle Pump
  8. Quadriceps/Gluteal Exercise

1. Knee Flexion: Seated Stretch

The knee flexion/ seated stretch is performed while seated in a chair. Gently slide your surgical leg behind you while keeping your foot flat against the ground. Move forward in your chair and hold the stretch for 10-15 seconds. Repeat the recommended number of times.
ALL EXERCISES SHOULD BE PERFORMED AS INSTRUCTED BY YOUR SURGEON, AFTER PROPER DEMONSTRATION BY A PHYSICAL THERAPIST.

2. Knee Extension: Seated Stretch

The knee extension/seated stretch is performed while seated at the edge of a chair. Gently slide your surgical leg forward and push down on the knee to straighten your leg. Hold for 10-15 seconds then pull your leg back. Repeat the recommended number of times.
ALL EXERCISES SHOULD BE PERFORMED AS INSTRUCTED BY YOUR SURGEON, AFTER PROPER DEMONSTRATION BY A PHYSICAL THERAPIST.

3. Knee Extension: Passive

Prop foot of operated leg up on chair. Place towel roll under ankle and ice pack over knee. Put 5-10 lbs. of weight on top of knee (a 5-10 lb. bag of rice works well). Do this for the recommended amount of time.

ALL EXERCISES SHOULD BE PERFORMED AS INSTRUCTED BY YOUR SURGEON, AFTER PROPER DEMONSTRATION BY A PHYSICAL THERAPIST.

4. Knee Extension: Straight Leg

Lie on back, place towel roll under thigh. Lift foot, straightening knee. Do not raise thigh off roll. Repeat the recommended number of times.

ALL EXERCISES SHOULD BE PERFORMED AS INSTRUCTED BY YOUR SURGEON, AFTER PROPER DEMONSTRATION BY A PHYSICAL THERAPIST.

5. Straight Leg Raise

The straight leg raise is performed in a reclined position, using your forearms to support your upper body. While keeping your leg straight, lift your leg twelve to twenty inches, hold for a count of ten, and slowly lower your leg back to the floor. Relax. Repeat the recommended number of times.

ALL EXERCISES SHOULD BE PERFORMED AS INSTRUCTED BY YOUR SURGEON, AFTER PROPER DEMONSTRATION BY A PHYSICAL THERAPIST.

6. Sitting Knee Extensions

Sit with your back against the chair. Straighten knee. Repeat the recommended number of times.

ALL EXERCISES SHOULD BE PERFORMED AS INSTRUCTED BY YOUR SURGEON, AFTER PROPER DEMONSTRATION BY A PHYSICAL THERAPIST.

7. Ankle Pump

The ankle pump is performed by slowly moving your foot back and forth as far as possible. Repeat the recommended number of times.

ALL EXERCISES SHOULD BE PERFORMED AS INSTRUCTED BY YOUR SURGEON, AFTER PROPER DEMONSTRATION BY A PHYSICAL THERAPIST.

8. Quadriceps/Gluteal Exercise

The quadriceps/gluteal exercise is performed while lying on your back. Tighten the tops of your legs while squeezing your buttocks and hold for a count of ten. Do not hold your breath. Repeat the recommended number of times.

ALL EXERCISES SHOULD BE PERFORMED AS INSTRUCTED BY YOUR SURGEON, AFTER PROPER DEMONSTRATION BY A PHYSICAL THERAPIST.

What is arthritis?

Arthritis is a term that is defined as inflammation of a joint and used to describe over 100 different conditions that can affect the human body. Arthritis affects millions of Americans each year with symptoms including pain, stiffness, swelling, and loss of motion in affected joints.

Why does my knee hurt?

The bones in a joint are covered with a tough, lubricating tissue called cartilage to help provide smooth, pain-free motion to the joint. As the layer of cartilage wears away, bone begins to rub against bone, causing the irritation, swelling, stiffness, and discomfort commonly associated with arthritis.

What are the benefits of joint replacement?

The purpose of a joint replacement is to help restore pain-free or near pain-free movement to a joint. Activities that could not be performed before surgery, such as climbing stairs, walking acceptable distances, or driving, may be resumed as directed by your surgeon after total joint replacement surgery. Your orthopedic surgeon may have several patients who would be willing to speak with you about their experiences before and after total joint replacement surgery. Ask your orthopedic surgeon about this beneficial resource.

What is the difference between a partial knee replacement and a total knee replacement?

Only part of the joint surface is replaced during a partial knee replacement. A total knee replacement involves resurfacing the entire knee.

How long does the typical knee implant last?

A total joint implant’s longevity will vary from patient to patient. All implants have a limited life expectancy depending on an individual’s age, weight, activity level, and medical condition. It is important to remember that an implant is a medical device that is subject to wear, which may lead to mechanical failure. Following all of your surgeon’s recommendations after surgery may enhance longevity, there is no guarantee that your particular implant will last for any specific length of time.

Do implants fail and can they be replaced?

Since implants are mechanical devices, they are subject to conditions that can lead to mechanical failure. The most common reason for implant failure in knee replacements is implant loosening or implant wear that leads to loosening. Implant wear particles can react with the bone, causing thinning of the bone that can lead to implant loosening. In most cases, failed implants can be revised successfully to provide good results.

What are my non-surgical options before considering joint replacement?

  • Assistive devices such as a support brace, a cane, or a walker may provide relief when joint pain does not affect everyday activity.
  • Exercise or physical therapy can strengthen the muscles around the affected joint(s), possibly providing relief from pain while improving mobility and function.
  • Medical management including nonsteroidal anti-inflammatory medications or steroid injections may assist in reducing painful joint inflammation and restoring function.

When should I have joint replacement surgery?

Your surgeon will evaluate your health history, perform a physical examination, and take x-rays to decide if you are a candidate for this surgery. You must then decide if your discomfort, pain or stiffness, and overall loss of quality of life justify undergoing surgery. Generally, there is no harm in waiting to have surgery if conservative, non-surgical treatments are effective.

Is total knee replacement only for people with osteoarthritis?

There are several indications for total knee replacement including rheumatoid arthritis, arthritis resulting from previous injury to the bones in the joint, corrections of various bone deformities, or direct trauma to the joint.

Is age a consideration for joint replacement?

Age is not a problem if you are in reasonably good health and have the desire to continue living a productive, active life. You may ask to see your personal physician for an opinion about your general health and readiness for surgery.

What can I expect from the surgical procedure?

  • Surgical incision on the front of the knee, alongside the kneecap.
  • Length of surgery will be approximately 1 1/2 to 2 hours. Preoperative care and time spent in the recovery room can add an additional 2 to 3 hours before you are back in your hospital room.
  • Rehabilitation and walking may begin the day after surgery.
  • Hospital stay is normally 3 to 7 days.

How long and where will my incision be?

Traditional total knee replacements require an incision between six and eight inches long. Minimally invasive total knee replacement is designed to shorten the traditional incision, lessen trauma to soft tissues, and reduce recovery time.

The scar will be straight down the side of your knee, unless you have previous scars, in which case your surgeon may use an existing scar. It is common for patients to notice some numbness around their scar.

Will I notice anything different about my new knee?

Yes, you may have some numbness on the outside of the scar. The area around the scar may feel warm. Kneeling may be uncomfortable for a year or more. You may also notice some clicking when you move your knee as a result of the artificial surfaces coming together.

Are there risks from surgery?

While uncommon, complications can occur during and after surgery. Some complications include infection, blood clots, implant breakage, malalignment, and premature wear. Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as the patient’s post-surgical activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon.

There are many things that your surgeon may do to minimize the potential for complications. Your surgeon may have you see a medical physician before surgery to obtain tests. You may also need to have your dental work up to date and may be shown how to prepare your home to avoid falls.

How can I prepare for surgery?

Proper preparation and a great attitude are the best ways to accomplish a rapid recovery from joint replacement. With the help of a physical therapist, get yourself as physically fit as you can before surgery. Proper nutrition and optimal medical condition can help avoid complications. See your physician prior to surgery to ensure your blood pressure, heart, and lungs are in good shape. Be prepared to continue with your exercise program after surgery.

What type of rehabilitation can one expect following surgery?

Exercise is necessary for proper healing. Depending on the orthopedic surgeons prescribed recovery outline, physical therapy may begin between 24 and 48 hours after surgery. Formal physical therapy may begin in the hospital and continue as directed by the surgeon. Patients should always follow the recovery schedule prescribed by their surgeon.

What activity range can be expected after this surgical procedure?

Diligent physical therapy, proper diet, and a willingness to follow all of the surgeon’s recommendations will promote a more complete recovery after surgery. Most patients should be able to walk unassisted and drive about 4 to 6 weeks after surgery. After a thorough evaluation by the physician, activities such as golfing, bicycling, and swimming may be resumed.

How long until I can walk and resume my regular activities after surgery?

Walking with support typically begins the day after surgery. Walking support may be continued for 2 to 6 weeks. The hospital can arrange for these devices as needed.

Most patients can climb stairs after 3 days and are discharged to home at that time. With less invasive surgical techniques, some patients can climb stairs sooner and be discharged to home after 1 or 2 days. Dancing, golfing and other low-impact activities may be permissible between 6 to 12 weeks. Returning to your daily activities will depend somewhat on your individual circumstances. Consult with your surgeon or therapist for advice on acceptable activities.

Are there any restrictions on exercise or movement with my new knee?

Yes, you will be restricted from performing high-impact activities such as running, tennis, and basketball. You will also be restricted from performing contact sports and downhill skiing. Positions which require you to bend or put weight on your knee should be used with caution.

Are regular visits with your surgeon required after surgery?

The surgeon will set a follow-up schedule for the first year after surgery to evaluate your progress. Usually these follow-ups occur three, six and nine months after the surgery. Annual visits may be required thereafter. Complications can occur with implants, so seeing the surgeon when you notice a change in symptoms can assist in evaluating any changes that may occur with your new joint.

All patient education materials are provided by OrthoPatientEd.com and have been reviewed by our Advisory Board of leading Orthopedic Surgeons to ensure accuracy. All materials are provided for informational purposes only and are not intended to be a substitute for medical advice from your orthopedic surgeon. Any medical decisions should be made after consulting a qualified physician.
This site includes links to other web sites. OrthoPatientEd.com takes no responsibility for the content or information contained in the linked sites.

Scroll Up