FAQ Category: Knee

Total knee replacement (TKR) often gives patients good pain relief. With less pain they can walk better and farther. Function improves and they can start doing things they haven’t done in years (like stair climbing or even dancing).

But studies show there are other problems that aren’t solved with a joint replacement. In fact, the surgery may make things worse. For example, loss of quadriceps muscle strength (the large muscle along the front of the knee) makes balance more difficult.

Patients who have both knees replaced are more likely to trip and fall. This is especially true if and when they have to get around objects or obstacles. A program of balance training and exercises to improve joint position sense may be to good place to start.

But first, make sure there isn’t a medical reason for your father’s loss of balance. Have him see his doctor for a check-up. If there are no medical problems, then give rehab a try.

Patellar tendonitis is an inflammation of the tendon just below the kneecap. Most patients report pain and swelling with this problem. It’s often caused by overuse of the tendon from jumping or other repeated activities like walking or running.

Sometimes people have this kind of tendonitis as a result of alignment problems from the hips down to the feet. This could be from wide hips, knock-knees, fallen arches, or other abnormal posture.

If the problem is coming from the foot or ankle, a shoe insert to correct the alignment might help. If the problem is caused by a muscle imbalance, then a specific exercise program may be advised. In the case of overuse, rest and ice are used most successfully. Surgery is only considered when all forms of conservative care have been tried without success.

Studies show that patellar tendonitis can last from weeks to months to years. This is especially true for athletes who practice and train hours each day. Treatment will be guided by your physician, and will depend on the cause of your tendonitis and your particular circumstances.

You may be describing a condition called jumper’s knee. This is an inflammation of the patellar tendon just below the kneecap. The most common activity that causes jumper’s knee is repeated jumping or running.

Greater weight and height are factors that can make this condition worse with overuse. The force generated through the knee puts an increased load on the tendon. Sports like volleyball and basketball have the highest rate of jumper’s knee.

This type of inflammation and discomfort can last weeks to months. Recover may depend on the severity of the condition. Treatment is important to keep the inflammation from getting worse and causing long-term damage. It’s best not to overuse or over train during treatment.

A sports doctor, physical therapist, or athletic trainer can help you determine the cause of your symptom(s) and set up an appropriate treatment program.

There are many different kinds of straps, supports, and braces for use with knee problems. Wearing a band across the patellar tendon can support the tendon. This is called an infrapatellar strap or brace. Giving the tendon support may keep it from getting overused and inflamed.

Other similar bands may be used to guide the kneecap (patella) as it moves up and down in its groove. The strap helps spread the pressure on the patella over a wider area. It lifts the patella enough to relieve painful pressure.

Some knee braces offer dual support above and below the kneecap. The idea is to apply pressure on the tendon above and below the patella. Force from the quadriceps muscle large muscle over the front of the thigh) on the patellar tendon is less. The pressure is less because the alignment of the femur (thigh bone) and tibia (shin bone) is better.

These types of bands and supports still allow full motion and function, which makes them popular for use during practice and while competing. Wearing such a device may help you. Ask your coach, trainer, or therapist for advice on your situation before buying any device of this type.

There are always risks with any surgery and older age does factor into those risks. Researchers say the most important risk factor is health. Older adults in good health have a very low risk of death after knee replacement.

To put this into numbers, a large study from Canada reported death in 1.5 percent of adults over 80 years old having a total hip replacement. This figure was even less (1.09 percent) after total hip replacement.

It’s true that the number of older adults (80 years old and older) who die from complications of hip or knee replacement is higher than in younger adults (less than 80 years old). The main difference is the presence of other diseases. Heart disease, low or high blood pressure, diabetes, and cancer are just a few examples of conditions that put an older adult at greater risk of death after total hip or knee replacement.

Talk to your mother’s doctor about your concerns. Knowing the status of her general health may help ease your mind.

Morphine is a controlled narcotic used for pain relief. It has its place in medical treatment, and is very useful in controlling pain for the first 24 to 48 hours after surgery.

Pain relief after knee replacement is very important. With greater pain control the patient is able to regain motion and function quickly. Studies show the use of morphine after orthopedic surgery for knee replacement is very low normally.

Other pain measures are used as well. Oral pain relievers can be given. A cold
compression cuff around the joint during the first 48 hours helps control painful
swelling.

Doctors and nurses are usually very willing to discuss patient care with family members. A release of information form must be signed first by the patient.

The “half” knee replacement you describe sounds like a unicompartmental knee replacement (UKR). Sometimes only one side of the joint needs to be replaced. A special implant has been made so the whole joint isn’t disrupted.

Even with a partial replacement there is still a certain amount of inflammation and swelling that goes with it. It usually takes about six weeks for a surgically-induced trauma of this type to heal. This means the inflammatory response is resolved and the tissues return to normal.

Most patients find that although they are just getting back to their pre-operative range of motion (ROM), their function is much better. Knee ROM will continue to improve over the next six weeks.

You may be describing a device used to apply compression with cold to control swelling, pain, and bleeding into the joint. The pump exchanges warm water for cold.

Intermittent pressure (cycling on and off) helps mimic the muscle action to keep the blood circulating and to keep fluid from pooling or collecting.

The cuff is easy to put on right in the operating room. No time is lost controlling pain and swelling. The device is designed to allow some motion while wearing the cuff. It’s easy to put on and take off for full motion.

Many patients wear the Cryocuff for the first 48 hours after surgery for best results.

Today’s technology has brought us new temperature measuring systems. These tools allow scientists to measure and graph temperatures inside the knee joint. This is helpful because keeping a cool joint can help prevent painful swelling after surgery.

A recent study from Spain measured the temperature inside the knee joint. Measurements were taken during and after arthroscopic surgery. A temperature probe in the joint fluid took the joint temperature every 30 seconds during the operation.

They found the temperature inside the joint was lowered by four degrees after using a saline solution to flush the joint out. The saline solution was kept at room temperature. Other studies also show that the normal temperature inside the knee joint is lower than normal body temperature.

Normal core body temperature is between 97 and 99 degrees F for most people. Internal knee temperature is between 90 and 95 degrees. The difference is most likely due to a fact lack of blood supply to the cartilage in the normal knee.

Surgery of this type is done by arthroscope. An arthroscope is a long, thin tool that is inserted through the skin and into the joint. Once the scope is inside the joint, other tools can be passed through the tube or cannula of the scope.

A temperature probe can be passed through the scope into the joint. The surgeon must avoid touching the tip of the probe to the synovial membrane or cartilage. The sensor must sit free in the joint fluid to get an accurate reading. It only takes a few seconds
to get the temperature.

Studies show that putting ice on the skin over the knee starts to cool the joint in the first five minutes. The cold decreases the blood flow and slows down the metabolism of the bone and muscle.

The maximum benefit from an ice pack has been measured at 20 minutes. After that the body will send more blood to the area to try and warm it up. It’s usually advised to stop cold treatments after 20 minutes to avoid nerve damage and to prevent the increase in blood flow to the area.

Other studies using cold for up to one hour don’t show any damage from the long cooling period. With the development of new temperature systems in the last few years, we may be able to find out more about the effects of long-term cooling.

Many studies have been done following the results of a lateral retinacular release (LRR). In this operation the fibrous tissue called the retinaculum is cut alongside the kneecap. Sometimes the surgeon will also cut the capsule surrounding the joint and the attached synovial tissue.

The results may vary depending on the cause of the problem. Results are best in patients with a tight retinaculum but a stable knee. Long-term results remain the same in this group. Patients with a dislocating patella may end up dislocating again years later.

Studies of a lateral retinacular release (LRR) may show different results for different patients for two reasons. The first is just in how the studies are done. First, it’s hard to compare results from one study to the next if patient histories, physical findings, and results of imaging studies aren’t reported.

Second, the LRR may not work for all cases of knee pain. A recent study showed the LRR was more successful in patients with knee pain but a stable patella. This means the patella doesn’t sublux or dislocate. Patients with an unstable patella or cartilage damage down to the bone have worse results.

You may be a good candidate for LRR if you have knee pain but a stable kneecap. Your results will improve if you follow a good rehab program after surgery.

From a mechanical point of view, the lateral retinacular release (LRR) can’t always correct the cause of patellar instability. This is especially true if the problem is a defect in the anatomy. The bone underneath the kneecap may be misshapen or the ligament may be deficient. Cutting the retinaculum won’t change that.

In some cases a lateral release can make a patient worse. If the retinaculum on the other side of the knee (medial) isn’t strong enough, releasing the lateral side can make the excessive patellar motion even greater. This may be what happened to you.

A rehab program may be needed. Strengthening the quadriceps muscle that controls the kneecap can be helpful. A physical therapist can examine the four parts of the quadriceps muscle. If any one section is pulling unevenly it could be contributing to the problem. Proper alignment may depend on muscular strength and coordination.

With good communication you may be able to clear up any confusion over your condition. Let your doctor know your concerns and clearly rate your pain for him. Ask your doctor for treatment options to choose from. Find out the pros and cons of each one.

Don’t be too hard on your doc. Studies show that physicians often underrate patient’s pain levels and assume they have more function than they really do. They base their ratings on other patients who have had the same thing. Patients compare symptoms from before to after injury or from one side to the other. No one can be inside your body but you. Doctors count on patients to inform them of symptoms and function.

One thing doctors do well and that’s predicting how much pain and function patients will have after surgery. They have the advantage here since they see many patients from before to after surgery and know what to expect.

Shared decision making is becoming more important for some patients. Baby boomers (adults who were born between 1946 and 1964) are a big part of this change. They like to know what to expect ahead of time. They want to be part of the process from start to end. They want to make informed decisions for themselves.

Studies show that patients actually do better in the long-run if there’s good patient-physician communication. They may not get the results the surgeon expected but they are more satisfied when they know what to expect.

Doctors are paying more attention to what patients want, too. They realize that the patient’s goals may not be the same as their own. Giving patients what they want and need is part of the new consumer-based approach to health care.

Getting knee motion back after surgery is called mechanical recovery. Being able to perform your daily activities or get back to sports is referred to as functional recovery. What you are noticing is the lag between mechanical and functional recovery.

Such a difference is fairly common. There are many possible reasons for this. Regaining motion is just one part of recovery. There’s also muscle strength and joint position sense (proprioception) to consider. Your rehab program will include exercises to help with motion, strength, and proprioception.

Your doctor and your therapist should be able to give you some idea of what to expect over the next weeks to months. They will likely base their predictions on your age, condition before surgery, and compliance with rehab. They also have the advantage of seeing the results of many patients who have come and gone before you.

You didn’t say your mother’s age but age may be a factor. Older women are at increased risk for this problem. There’s an increased number of these fractures in women who are postmenopausal. Osteoporosis (decreased bone density) in this age group is another important factor.

Without its normal resiliency, the simplest, everyday stress can cause damage to the bone. Anyone who has arthritis is also at increased risk. Often, the osteoporosis added to any slight knee deformity can be enough to cause this problem.

Other factors include alcohol use, Crohn’s (intestinal) disease, and the use of steroids for arthritis. Low calcium absorption, vitamin D deficiency, and hormonal changes are also factors.

Insufficiency fracture is a small subset of a larger group of fractures called
stress fractures. Insufficiency fractures are caused by the effect of normal stress
on weakened bone. Osteoporosis is the most common cause of bone loss leading to
insufficiency fractures.

Loss of bone density from osteoporosis decreases the bone’s ability to “give” slightly
and resist everyday loads. The loss of this “elasticity” seems to affect the spine, tibia
and fibular (lower leg bones) and calcaneus (heel) most often.

These fractures seem to be on the rise in older adults, especially postmenopausal women.

In this age group with a history of alcohol use as described, an X-ray would certainly be a good place to start. If nothing unusual shows up, an MRI, CT scan, or even a bone scan may be needed.

Doctors are finding more and more cases of a condition called insufficiency fractures in this age group. Postmenopausal women seem to be at greatest risk, probably because of osteoporosis. The weakened bone just can’t stand up to normal, everyday stresses. Early diagnosis and treatment are important to avoid a full fracture.