FAQ Category: Knee

It all depends on how important a quick recovery is to you…and how much it’s worth in terms of risk. There’s a chance that the implant won’t last as long as the standard joint replacement. This risk of early failure is usually accompanied by persistent pain.

On the other hand, most patients who have the mini-approach are back to their normal activities after only one to four weeks’ time. This would certainly fit in with your travel plans.

Studies done so far show no reason to think you shouldn’t go ahead with this plan. So long as you know the potential problems, you’ll know the worst that could happen. Bon voyage!

Some sort of external support is a good idea right after surgery. It will help you keep your balance and prevent a bad fall. A “younger” looking supportive device may be possible. When the nurse or therapist comes back, ask if you could use crutches or two canes instead.

Crutches are a possible option if you are in good health, not overweight, and strong enough with good balance. Crutches offer slightly more support than canes do. You might be able to progress from walker to crutches to cane(s).

Your pain level is also an important factor. Pain can cause the leg to go out from underneath you. Again, the goal is to restore function. Avoiding further injury is part of that plan.

Patellar fracture and patellectomy (removal of the kneecap) are fairly rare events. Since there aren’t very many cases reported, information about results is limited.

Doctors from the Mayo Clinic recently reported on eight cases of patellectomy after total knee replacement. Their patients were in a leg cast for six to eight weeks. After the cast was taken off, the patients started putting weight on the leg and began range of motion exercises.

Half the patients reported pain relief from this operation. Three people still had mild pain. One person had severe pain. Although the patellectomy gave them pain relief, motion and function were very poor even months to years later.

The kneecap (patella) has a very important job to do. It helps the knee joint move and work normally. The quadriceps muscle, the large muscle on the front of the thigh, comes down, crosses the patella and attaches to the lower leg bone. The patella acts as a pulley system to help you use the quadriceps muscle to straighten your knee. This is called the extensor mechanism.

Taking the patella out changes how the extensor mechanism works. Change in the forces around the knee from extensor lag can cause an unstable joint. There’s also a loss of protection of the bones in the knee joint.

Lastly, the appearance of your leg will change. This may not matter to you when you are in so much pain. Once the patella is gone you can’t get it back so it’s a fairly important decision.

Some doctors prefer patients try a conservative approach. This means pain management while the bone heals. Taking the patella out is more of a final treatment option.

Postoperative problems can occur. Sometimes very low blood pressure, nausea, and pain hold people back from progressing quickly. Problems of this sort can keep a patient from being able to walk around or use the toilet.

Immobility can lead to other problems like blood clots. Dehydration can cause dizziness, weakness, and even falls.

So if you have a good outcome and have good pain control, your chances of going home are very good. Don’t be afraid to stay overnight if problems arise. It’s great to say, “I was in and out the same day” but not if it means going back to the hospital on an emergency basis after being discharged.

There has been some concern that the plastic component parts won’t hold up under the wear and tear of today’s active seniors (and younger patients).

Metal implants have always shown superior strength in laboratory studies. There’s less stress on the bone where the metal comes in contact with bone.

Earlier use of the all-poly design was reported to loosen easily (compared to metal) or collapse into the bone.

Researchers are taking a second look at the all-poly model these days because metal backed implants have a downside. There’s quite a bit of wear on the “backside” where the implant rests on the bone. Severe breakdown of the bone can occur.

The results of a recent study using the all-poly tibial component in younger adults (less than 60 years old) had a low overall failure rate (1.8 percent). The study was considered “intermediate” as the patients were followed from two to 11 years. Long-term studies (20 years or more) are still needed.

For now it looks like the all-poly is a safe bet for the first 10 years at least.

Good question…and one that is highly debated in the literature. After decades of using the metal-backed implants surgeons are trying the new all-poly (molded plastic) implants.

They say the metal backed implants can get worn unevenly causing the bone to deteriorate. The implant can loosen, too. On the other hand there’s concern that the polypropylene type won’t hold up under daily use by active adults.

Researchers at the Lenox Hill Hospital in New York City report results of the all-poly implant for a group of active, younger (less than 60 years old) adults. A majority of the patients said that walking distance was unlimited. A smaller number reported walking limited to 10 blocks or less.

Many of these active adults were also involved in swimming, tennis, and golf.

Orthopedic surgeons aren’t certified in any of the individual surgical techniques that they do. When new methods come out, each surgeon must get the training and practice needed before operating on patients.

Right now researchers suggest the new minimally-invasive (MI) method of joint replacement should only be done by some surgeons. They should have a high-volume arthroplasty practice. This means they do a lot of joint replacements.

The best results reported have come from high-volume total joint centers. Not all patients are selected for this procedure. Surgeons who choose patients carefully tend to have better results. Some might say it’s more important that the patients are “certified” than the surgeons.

Your best bet is to find a center that focuses just on joint replacement. Ask how many minimally-invasive knee replacements the surgeon has done before making your final choice.

Many people are able to go home with either a cane or using nothing. We can’t say for sure about you, but here are some things to think about. Do you use a walker or crutches now before the operation? If yes, then you’re more likely to need one afterwards…at least for a little while.

How strong is your other leg? Can it support you without the off-loading assistance provided by a walker or crutches? many people have arthritis in both knees. They have the worst knee replaced first but this puts a lot of extra load on the other knee until the leg operated on gets stronger.

You may find it easy to navigate your apartment but need to use an assist when outside or walking in the community. The long-term goal is to walk unassisted and pain free.

First you’ll have to find a surgeon and clinic trained in minimally invasive surgery (MIS). MIS for knee joint replacement is fairly new. Not all orthopedic surgeons are using this method. In some places an overnight stay (or longer) is still required.

Each surgeon will have his or her own patient criteria. Many will not accept patients for this type of surgery who have had a heart attack in the last 12 months. Being on blood thinners to prevent blood clots may also exclude you from eligibility.

Some surgeons won’t accept patients for MIS who are overweight or obese. Others require someone to be in the home for the first few days after the operation.

If you’re in good health with no history of heart disease, diabetes, cancer, or blood clots, then you have a good chance of being an acceptable candidate for MIS.

Doctors think there are several reasons for this. First, the cysts have thick walls with twisted, deep roots. The body can’t dissolve or absorb this tissue. There’s also a valve
between the cyst and the joint. This opening allows fluid to move from the joint into the cyst.

Often other damage in the knee adds to the problem. A new study by two doctors in South Korea report better results for cyst removal using arthroscopy. A special tool with a tiny TV camera is inserted into the cyst. The fluid is taken out. Then the cyst wall is removed with a motorized shaver. Any other damage in the joint is repaired at the same time. They’ve had 100 percent success in treating cysts this way.

It sounds like you may have had a Baker’s cyst also known as a popliteal cyst. A cyst like this can be persistent and cause painful knee swelling and loss of motion. Some doctors advise having the fluid removed again. But if you have to do this
more than three times, then removing the cyst is an option.

Doctors can use a special tool called an arthroscope to go inside the knee joint. The fluid is removed and the wall of the cyst is cut out. The doctor also takes out the valve that allows fluid to move from the joint into the cyst.

A recent study from South Korea reports this treatment method is 100 percent successful. In a group of 14 patients with recurrent cysts, none of the cysts came back after removal, even after a year.

It depends on how the operation is done. Sometimes the doctor has to cut into the knee and open up the area. This method takes longer to heal. It’s also possible to go inside the joint using a special tool called an arthroscope.

There’s a tiny TV camera on the end of the scope. This allows the doctor to look inside the joint and make any repairs without an incision. The patient is left with just one or two puncture wounds. The cyst can be removed, and the patient is usually pain free and
back to regular activities in one or two days.

Ask your doctor ahead of time about your options. You may want to postpone surgery until after the show. If you do have the cyst removed, give yourself plenty of warm-up time for the knee before each show.

It may depend on the type of inserts you are trying. Some of the more rigid orthotics take a little longer to adjust to. Some patients start by wearing them for a few hours at a time and build up over a few weeks to full-time wear.

If they are custom made, you may need some minor adjustments during the early period of wear. It’s a good idea to get the fit just right before resuming all activities. Likewise, runners need to ease back into their training schedule over a few days to weeks.

With patellofemoral syndrome, pain occurs behind the kneecap with certain activities. It’s always a good idea to avoid repetitive deep knee bends and squatting. These activities often make the pain worse. Once you’ve had the orthotics for a month to six weeks, you’ll have a better idea how much more you can do without flaring up the knee symptoms.

It sounds like your surgeon used an arthroscope to enter the joint. This long, slender tool pokes through the skin and tissue right into the knee joint. A tiny TV camera on the
end allows the physician to see inside the joint.

There’s a special part of the arthroscope called a cannula. The cannula can be a rigid or flexible tube. It’s used to drain fluid or guide other instruments into the joint.

New tools have been made for arthroscopic surgery. There are forceps, shavers, measuring rods, and even tiny drills that can pass through the cannula. Once inside, the doctor uses special foot pedals and hand held devices to guide the camera and operate the tools. Frayed tissue can be shaved smooth. Torn cartilage can be sewn or glued back down. Bone chips can be removed and so on.

Sometimes X-rays just aren’t enough to show everything. Other imaging studies such as magnetic resonance imaging (MRI) may be better, depending on the tissue injured and its
location. Even with more advanced imaging, tissue damage can stay hidden by torn cartilage flapped over it.

In that case, an arthroscopic exam is needed. The doctor uses a special tool inserted into the joint. With a tiny TV camera on the end, the arthroscope projects a complete view inside the joint up on a screen. By entering the joint from different sides, the
doctor can see areas hard to see or reach.

Don’t wait to ask your doctor about the next step for you. Continued symptoms a year later are not normal. It may take awhile, but someone should be able to get to the bottom of the problem.

You may have to ask your doctors to know for sure. Without all the details, we can only make an educated guess.

Most areas inside the knee joint can be reached with an arthroscope. This depends on where the doctor inserts the tool from outside the joint. The damage to your knee may be too hard to reach even with an arthroscope. In cases like this, the doctors can do surgery the “old-fashioned” way by opening the joint up.

Or they may be able to combine the use of the arthroscope with a small incision. This is called a mini-open procedure. As surgical instruments become more and more
specialized, companies are making newer and better tools for use in arthroscopy.

Recently, a group of doctors in Italy reported on just such a case. A 25-year old man was involved in a car accident that left a hole in the knee. A piece of cartilage deep enough to include attached bone was ripped away from the joint. Cartilage was harvested from the
joint, grown in a lab, and reinserted into the hole. A special glue was used to hold the graft in place.

The entire operation was done arthroscopically. The authors report they couldn’t do this type of operation without instruments made just for the procedure. It’s probably only a
matter of time before all joint operations are done this way.

An exercise program is always part of the rehab plan after total knee replacements (TKRs). A physical therapist will work with you to get your motion and strength back. An
exercise program is a good idea before the operation. However, most patients are in too much pain to carry it out on a regular basis.

A recent study from the Biomechanics and Movement Science Program in Delaware added electrical stimulation to the rehab program. They found exercise and neuromuscular electrical stimulation (NMES) together gave an even better result. Quadriceps muscle
function improved quickly in the first three weeks of treatment. Patients were followed for six months and still showed good results.

Ask your therapist about using NMES for you. Mention the article by physical therapist, Dr. Jennifer Stevens on NMES after TKR. It’s in the January 2004 issue of the Journal of Orthopaedic & Sports Medicine.

You probably need some more information before making your final decision. Contact someone involved with the study and find out exactly what’s being done. They may be doing
a study using electrical stimulation, which doesn’t necessarily involve shock treatment.

Electrodes or patches are placed over muscles and the muscles are forced to contract. This is one way to help strengthen muscles weak from pain and disuse. Most researchers explain everything on the first day. You still have the option to bow out before
starting.

When using electrical stimulation, the therapist usually lets you feel a small dose first. There’s a tingling sensation. As the current is turned up, the muscle fibers start to twitch. With enough stimulation, the entire muscle contracts. It’s an odd sensation,
but it’s usually not painful or dangerous.

Research shows electrical stimulation applied along with exercise can help restore muscle strength after a knee replacement. Sounds like you have a chance to get help while also
helping others.

Your doctor may be able to estimate how long a wait you have in store for you. By looking at your son’s height compared to other family members and examining the bone growth plates, it’s possible to get an idea if it’s a matter of months or years.

It is best to wait to have an ACL repair until the bone growth is complete. There are some other treatment options. Doctors at the University of Texas describe “physes-sparing” ACL repairs. The physis is the growth plate at the end of the bone. An ACL repair usually drills holes through bone that may still be growing in children and some teens. Any disruption of the physis can cause permanent damage.

The physes-sparing operation passes a graft through the joint without drilling a hole in the bone. There are some problems and difficulties with this procedure. Most doctors prefer to wait until the bone has stopped growing to repair the damaged ligament.

Once you know how long you might have to wait (remember, it’s just an educated guess), then speak with the football coach about the situation. Find out what your options are before planning treatment.