FAQ Category: Knee

The tibial plateau is the top of the lower leg bone called the tibia. This plateau forms the bottom half of the knee joint. A fracture at this site does increase the risk of problems with a joint implant.

The fracture changes the way the leg carries the weight. This can cause uneven wear on the joint and an imbalance in the muscles. The doctor must put the implant in with these changes in mind.

If there were previous operations, there can be scar tissue formed around the knee joint. This may put the joint at risk for infection and poor wound healing.

Joint stiffness and loss of motion and function can occur. Sometimes, even with careful planning and use of advanced skills, the implant doesn’t last. In this case, a second operation may be needed.

The tibia is the lower leg bone between the ankle and the knee. The tibial plateau is at the top of the tibia. It’s the surface where the upper leg bone rests on the tibia. In other words, the tibial plateau is the bottom surface of the knee joint.

A fracture in this area can be treated with or without surgery. This depends on how severe it is and whether or not there is another injury with it. A torn ligament or a second fracture may also require surgery.

Over the years, studies have shown that tibial plateau fractures result in arthritis. A total knee replacement (TKR) may be needed. The final outcome isn’t as good for patients receiving a TKR without a previous fracture. The operation can be very complex.

Results are good when the doctor is aware of these problems and plans carefully.

The tibial plateau is at the top of the lower leg bone (the tibia). It’s the surface where the thighbone attaches to the lower leg bone to form the knee joint.

The risk of problems is greater when surgery is done. There can be poor wound healing, infection, blood clots, and dislocation of the kneecap. If the break is deep enough, it can affect the joint. Arthritis can develop early, requiring a knee joint replacement. Often, more than one operation is needed.

Treatment without surgery suggests a less serious problem with a better outcome. The stiffness could lead to joint fusion over time. Most likely, with exercise and a rehab program, your range of motion will be restored fully.

There are two main tendon grafts to choose from when reconstructing the anterior cruciate ligament (ACL). The surgeon may use the hamstring on the other side or the patellar tendon from either side.

There are pros and cons to each choice. Using graft tissue from both sides may cause some temporary discomfort for you. Your age, weight, overall health, and activity level will help guide this decision.

It’s also possible to use donor graft from another person. There can be problems with this choice. Your body may reject the graft. It’s usually best to use your own tissue. You and your surgeon should discuss the best choice for you.

This is entirely up to you and your surgeon. Some people have both knees replaced at the same time. Others wait anywhere from three weeks to three years or longer.

Your decision may be based on some personal factors. For example if you have both knees done at the same time, is there someone who can help you at home for a few weeks after the operation? This is very important.

How is your overall health? Can you withstand two replacements at the same time or two major operations in the same month? Same year?

Is one knee much worse than the other or are they pretty much the same in terms of pain, stiffness, and loss of motion? Some patients choose to have the worst knee done first. They depend on the “better” knee during rehab. When the first knee replacement can support them, then they have the second knee done.

Talk to your doctor about his or her suggestions for you.

Researchers who study the gait patterns of total knee patients say that some changes are just habits from before the operation. For example, pain and stiffness before your surgery may have caused you to step lightly.

You may have tried to soften the impact when the foot hit the ground. The result is you spend less time standing on that leg. This shortens your stride length. It may even look like you are limping.

Another possibility for your gait changes may be due to muscle weakness. The surgeon often cuts through muscle to put the implant in place. Any weakness or imbalance in the muscles of the leg may cause abnormal gait patterns.

The same is true for any loss of motion. The way you walk will change if you do not have full knee extension. And you’ll need at least 110 degrees of knee flexion for a smooth transition from toe off back to heel strike.

Finally studies show that joints damaged by arthritis and altered by surgery may lose some of their proprioceptive abilities. Proprioception is the sense of joint position. Normal gait may not return until proprioception is restored.

See a physical therapist for a gait analysis. You may just need some additional exercises or activities to do at home to regain your normal walking pattern.

In most cases…yes. Combined injuries can be complex. One damaged ligament can affect the healing of others. Joint instability can be worse with two deficient ligaments.

Fortunately, the medial collateral ligament (MCL) tends to heal quickly and even restores some stability to the joint. A torn anterior cruciate ligament (ACL) is less likely to heal with enough strength to restore joint function.

Your past experience with rehab is to your advantage. As they say, “you know the drill.” Since you know what to expect you’ll have a better idea when the rehab program can be progressed. Working with a knowledgeable physical therapist should help keep you on track.

With so much damage to the joint, it’s best not to push yourself past what the healing tissue can handle. For the best result, follow your doctor’s and your therapist’s guidelines.

Home-based rehab programs have been shown to work for some patients. Patients can get better even without a lot of equipment. Those who have exercise equipment at home, in a physical therapy (PT) department, or at a fitness center can do extra exercises beyond the basic rehab program.

Patients should only do exercises given to them by their doctor or PT. Exercises given by on-site fitness trainers must be approved by the doctor or therapist. It’s best to have a therapist review how you do your exercises. Even small errors in exercising can make a difference. Follow-up at regular intervals during rehab and recovery are advised.

A few studies have been done showing how rehab can be done at home. Most researchers advised patients to have some supervision by a physical therapist. They reported a need for quality education before and after the operation.

Patients at home need good handouts with detailed instructions about the exercises. Patients must be motivated to do their own program for it to work.

Not all patient types have been studied. Most studies have included athletes. A recent study from Canada only included athletes with chronic ACL tears. Anyone with a recent injury wasn’t included.

Talk to your surgeon about your options. There may be a way to work out a program with some supervision that cuts down the number of trips you make. It’s important to follow some kind of rehab program to prevent joint problems later.

Studies show that the medical collateral ligament (MCL) heals faster and better than other ligaments. The anterior cruciate ligament (ACL) doesn’t heal well on its own.

In fact animal studies have shown the MCL can be cut in half and still heal without surgery or immobilization. There’s even enough strength in the healed ligament to restore joint stability.

The joint can be restored to normal without surgery only when the MCL is the only ligament damaged. If the knee has a torn meniscus or torn ACL along with an injured MCL, then surgery is needed.

A home program is better than no rehab at all. It’s highly recommended that you do some kind of rehab after an ACL repair. Problems can occur if patients don’t follow through on the exercises needed to regain motion and strength.

A recent study in Canada showed that the patients on a home-based ACL rehab program actually had better results than supervised patients. Patients who are motivated and used to exercising can rehab successfully after ACL repair. A limited number of sessions with the physical therapist is still advised.

Most of the work done to analyze gait and walking patterns is done in special laboratories. The equipment is fairly specific and very expensive.

Researchers often get money through research grants to do this kind of work. It also takes quite a bit of time to conduct before and after studies of this type. Again, money becomes an issue, as insurance companies don’t usually pay for this extra service.

Even if the average therapist can’t use tools of this kind, the results of the research done in labs are still helpful. Results can help therapists find out what areas need to be included in the rehab program. For example, should exercises focus on cadence (steps per minute), range of motion, or step length?

The lower leg is made up of two bones: the tibia (main bone) and the fibula (smaller bone along the outside). The place where these two bones meet is called the tibiofibular joint.

There are strong ligaments that hold this joint together. It’s possible that you have a fracture. It could also be a tear of the soft tissues around this joint. An X-ray is needed to know for sure.

The doctor will also examine your leg and test the tibiofibular joint as well as the knee joint. It’s easy to confuse a knee joint injury for a tibiofibular joint injury.

Don’t jump to any hasty conclusions. Take the safe approach and call your doctor immediately. A simple X-ray may answer your question quickly and allay your fears.

In below the knee amputations, problems can occur at the tibiofibular joint. This is where the two bones in the lower leg (tibia and fibula) meet just below the knee joint.

If you normally have loose ligaments, you may be at risk for dislocation of this joint. The amputation is also a risk factor for problems in this area.

The majority of patients who have knee replacement surgery would do it again if faced with the same decision. As with any operation, the early days after surgery can be difficult.

No doubt, you’ve been living with a certain level and type of knee pain for a long time. It’s uncomfortable, but you’ve learned to live with it. After your knee surgery, that kind of joint pain will be gone. Getting used to a new kind of pain from the incision and swelling will make it seem like it’s worse than when you started.

Your doctor is aware of the discomfort and will work with you to control pain levels. A physical therapist will show you how to manage pain through movement and body awareness.

Most likely, you won’t regret your decision. You’ll probably have much greater freedom from pain. Increased motion and strength will allow you to do things you haven’t done for some time.

Scientists refer to this as ‘inhibition.’ The muscle along the front of your thigh is the quadriceps. The surgery disrupts this muscle and keeps it from contracting with full force. In other words, the voluntary contraction is inhibited. Pain and swelling in the joint probably add to the problem.

A new study supports the use of electrical stimulation and biofeedback to get back the full power of the muscle. You may need a more complete rehab program with a physical therapist to regain this muscle function. It will prolong the life of your implant and reduce your risk of falls.

Actually, doctors report the chances of a blood clot after a total knee replacement (TKR) are very high. The medical term for this is deep venous thrombosis (DVT). One study reported DVT occurs in at least 50 per cent of all patients.

There’s a lot of trauma that occurs to the blood vessels of the leg during this operation. The doctor must cut through soft tissue and blood vessels to get down to the bone and joint. A tourniquet is used above the knee and this adds to the problem.

Taking the old joint out and putting a new joint in requires a lot of force. The leg is twisted and turned, pushed and pounded. Since the risk of DVT is so high, prevention is started before the operation even begins.

Blood clots or deep venous thrombosis (DVT) are very common after hip or knee surgery, especially after joint replacements. Finding them isn’t always easy. Ultrasound studies may not show any sign of clotting when in fact there is some. One out of every 20 patients will have a blood clot in the opposite leg.

It’s not standard practice to monitor both legs after surgery. If the patient has risk factors for DVT, then more tests may be done. Preventing DVT is the main goal. Drugs, activity, and leg pumps work well to accomplish this. The treatment affects both legs at the same time.

Some patients have increased local bleeding and leg swelling after knee joint replacement. This condition interferes with normal motion and is referred to as a soggy knee.

Treatment with drugs and physical therapy help take care of these problems. Getting knee motion back as early as possible is very important. Sometimes, a soggy knee condition can be avoided with the use of aspirin right after the operation.

Aspirin has five ‘A’s that go with it. It is an analgesic for pain, an antiinflammatory to prevent swelling, and an antipyretic to reduce fever. It’s also an anticoagulant or blood thinner. This helps prevent blood clots. The final ‘A’ is for acidic which can cause stomach problems. The first four ‘A’s work together to help reduce the chances of developing a soggy knee after surgery.

Treatment before an operation is to help the patient understand the surgery and its expected results. Measurements of joint range of motion and muscle strength will be taken. This will help the therapist track your progress after the operation.

Often, preoperative therapy can improve motion and strength. Exercise can increase blood circulation to the area and even help you walk better. All these things will help you get motion and function back quickly after surgery. The program will also help prevent loss of balance and falls.

The therapist will tell you what to expect after surgery. Preventing blood clots and dealing with pain are also part of the preoperative plan.