Physical Therapy

Depending on the time of your surgery, you may
begin your physical therapy on the same day. Your
knee rehabilitation program is ordered by your
surgeon and done under his supervision and/or
control. Isometric exercises (tightening muscles
without moving the joint) will begin while you are
still in bed. You will be instructed to do these
exercises a number of times per day. You will be
encouraged by the physical therapist to move your
ankle and other joints so you will remain strong.
These exercises will help you regain strength and
mobility. The therapist will teach you the safest
methods for getting in and out of bed or a chair, and
on and off the toilet. You will be taught the do’s and
don’ts of joint replacement recovery.
The day after surgery, you will probably begin
walking and exercising your knee joint. The exercises
will probably be done twice daily. Initially, the
physical therapist will assist you in getting out of
bed and standing at the bedside with a walker. For
your entire hospital stay, you will walk with a walker
or crutches under the supervision of a therapist.
Your walking distance will gradually increase.
When you are strong enough, you will be able to
walk without the support of the immobilizer.

You will probably begin range of motion exercises on
your first postoperative day. Through progressive
daily exercises, you may achieve about a 90-degree
bend in the knee joint by the time you leave the hospital.
Bending your knee during the exercises may be
painful. Pain medication taken before therapy will
make the exercises more comfortable. Ice packs, hot
packs and other treatments may be used to assist
you in bending your knee.
The therapist will check your progress daily and
will keep your surgeon informed.

Progress

The usual hospital stay for knee replacement
surgery is three to five days. Depending on your
progress, you will probably gain independence
within one week after surgery. To accommodate
sitting, there will be an elevated chair and toilet
available for your use. An elevated toilet seat will
also be ordered for you to take home. At home,
you will need a firm chair with arms.
The therapist will teach you how to dress, get out
of bed without help and use a walker or crutches.
You will continue strengthening exercises in
preparation for your return home.
It is important for you to comply with your
surgeon’s directions and follow proper positioning
techniques throughout your rehabilitation. Since
you will no longer be in the hospital, arrangements
will be made for someone to remove the sutures or
skin clips about 10 days after surgery. It is not
uncommon to still experience some pain. The full
recovery period normally lasts three to six months.

Before and After Knee Surgery: What to Expect

Before Surgery

You may be asked to see your family physician or an internal medicine doctor for a more thorough medical evaluation. To prepare yourself for surgery, you may be asked to do a number of things. You may be asked to lose weight if you are overweight. If you smoke, it is important for you to stop two weeks prior to surgery. If you take estrogen (i.e., Premarin), your surgeon will probably advise you to stop one month prior to surgery. Your doctor may want you to donate your own blood ahead of time for a possible transfusion during surgery. It is essential that your surgeon be aware of any medications or supplements you are taking. Bring a list of
all medications and dosages. If you are taking aspirin or certain arthritis medications, inform your surgeon; you may need to stop taking these two weeks before surgery. If you are taking aspirin under the direction of a physician for vascular or cardiac reasons, your doctor may advise you to continue taking it as directed.

Your Surgery

Usually patients are admitted to the hospital the morning of surgery. You cannot eat or drink
anything after midnight the day of surgery.

The Recovery Room

You will awaken after your surgery in the Post-Anesthesia Recovery Room. You will remain there until you have recovered from the anesthesia, are breathing well, and your blood pressure and pulse are stable. If you experience pain, medication will be available.

What To Expect After Surgery

You may have a tube or drain coming through the surgical dressing that is attached to a drainage
apparatus. This system provides gentle, continuous suction to remove any blood that accumulates in the surgical area. The drain will probably be removed several days after surgery. The dressing will also be changed and a smaller one applied. An “immobilizer” (a cloth support with stays) will fit around this dressing and will hold the leg straight. An alternative to the operated leg being immobilized after surgery is the use of a “Continuous Passive Motion” (CPM) machine. Your leg is held softly in a cradle. The knee is then gently and slowly bent and straightened. Your leg will be supported and elevated on one or two pillows to help your circulation and stretch the muscles behind your leg. You will be asked to move your ankle to promote circulation and prevent stiffness in your ankle joint. The immobilizer may be used the first 48 hours after surgery, and then removed. The CPM machine may be used the next
48 hours or longer, if needed, even after you leave the hospital. The nurse will assist you in turning on your side, if you wish. You may adjust the head of the bed to any level you desire. The knee adjustment on the bed should not be used. Your knee should remain straight unless you are performing knee exercises.
An IV may remain in your arm for several days to administer antibiotics or other medications you may need. This helps prevent infection and gives you proper nourishment until you are eating and drinking comfortably. You will begin regular fluid and food intake under the direction and advice of your surgeon.
To prevent problems in your lungs, you may receive an incentive spirometer after surgery to
encourage you to cough and breathe deeply. This is used every hour while you are awake.
It is normal to feel pain and discomfort after surgery. Inform the nurse of your pain and
medication will be ordered by your physician.

Its Time To Evaluate Your Knee

Your Knee Evaluation

An orthopaedic surgeon specializes in problemsaffecting bones and joints. Your knee evaluation will begin with a detailed questionnaire. Your medical history is very important in determining whether surgery is necessary and medically safe. It helps the surgeon understand your pain, limitations in activity and the progression of your knee problem. After your history information is reviewed, a physical exam is performed. The range of motion of your knee is measured, your legs are evaluated for variances such as bowlegs or knock-knees, and your muscle strength is analyzed. The surgeon will observe how you walk, sit, bend and move. X-rays will be taken of your knee joint. Bring any previous knee X-rays with you to help your surgeon plan the surgery and evaluate the fit of your new knee prosthesis. If the X-rays show severe joint damage and no other means of treatment has provided relief, total knee replacement may be recommended.
A small amount of fluid may be taken from your knee joint to check for infection.
After your initial orthopaedic evaluation, the surgeon will discuss all possible alternatives to surgery.

Rotating Platform Knee Technology

One of the truly exciting developments in knee replacement is the rotating platform technology. To understand its significance, the design of the standard total knee must be considered.
Knee joint implants work as a system and consist of the femoral, tibial and patellar components. The femoral component is the uppermost part of the knee system and is made of a strong, polished metal called cobalt chrome. It covers the end of the thighbone, the femur. The patellar component replaces the back of the kneecap. The tibial component covers the top end of the tibia or shinbone.
In a fixed knee prosthesis, the tibial component is designed to securely hold the polyethylene insert or spacer. When the knee is in motion and the femoral component glides across the polyethylene insert, different degrees of stress are placed on the insert. Over time, this movement can lead to wear of the plastic insert and in some cases, after years of
wear, it must be replaced.
The difference between the rotating platform knee implant and the more traditional fixed
bearing implant is mainly in the design of the tibial component. The rotating platform knee’s unique design spreads the weight of the body over the largest area possible while allowing the polyethylene insert to rotate in the tibial tray. These design characteristics reduce stress or force on any one area of the knee implant. This reduction in stress may potentially lead to
extended implant longevity. The rotating platform knee more closely mimics the motion of a natural knee, allowing it to slightly twist and turn, move back and forth as well as flex and extend. Because many of the components of the rotating platform knee are identical to fixed knee implants, the same surgical procedures can be used for implanting the device. Additionally, the current preoperative and postoperative routines for the patient are also the same.
The majority of total knees implanted in this country are the clinically successful fixed bearing.

The right design for you depends on your age, health status and the condition of your knee.

Knee Replacement Surgery

When conservative methods of treatment (i.e.,
pain medications, injections, etc.) fail to provide
adequate relief, total knee replacement is considered.
If your X-rays show destruction of the joint, you
and your orthopaedic surgeon will decide if the
degree of pain, deterioration and loss of movement
is severe enough that you may be a candidate to
undergo the operation.
Today, your orthopaedic surgeon can replace your
problem knee, thanks to the development of total
knee implants. Total joint replacement aids in pain
relief and enables patients to perform activities that
may have been limited due to knee pain.
Modern total knee replacement is the result of a
40-year evolution of improved materials, designs
and refined surgical techniques. This year, about
400,000 total knee replacements will be performed
in the United States.
Restoring

Rotating Platform in Knee Raplacement Surgery

When Knee Problems Arise
When pain, stiffness, knee swelling and limitation of motion in your knee keep you from your daily activities, you may need to seek help from an orthopaedic surgeon.
The most frequent source of debilitating knee pain is arthritis. It is estimated that 40 million people in the United States have some form of arthritis. That’s one in every seven people, one in every three families. Of the more than 100 types of arthritis, the following three are the most common causes of joint damage. Osteoarthritis is a disease that involves the breakdown of tissues that allow joints to move smoothly. The layers of cartilage and synovium become damaged and wear away, leaving the underlying bones unprotected from rubbing against
each other. It occurs primarily in people over 60. Rheumatoid arthritis is a systemic
disease because it may attack any or all joints in the body. It affects women more often than men and can strike young and old alike. With rheumatoid arthritis, the body’s immune system produces a chemical that attacks and destroys the synovial lining covering the joint capsule, the protective cartilage and the joint surface, causing pain, swelling, joint damage and loss of mobility. Trauma-related arthritis, which results when the joint is injured, is the third most common form of arthritis. It also causes joint damage, pain and loss of mobility.

The Knee Joint
The knee is the largest joint in the body. It is commonly referred to as a “hinge” joint because
it allows the knee to flex and extend. While hinges can only bend and straighten, the knee
has the additional ability to rotate (turn) and translate (glide). The knee joint consists of the
tibia (shinbone), the femur (thighbone) and the patella (kneecap). Each bone end is covered with a layer of smooth, shiny cartilage that cushions and protects while allowing near frictionless movement. Cartilage, which contains no nerve endings or blood supply, receives nutrients from the fluid contained within the joint. (If damaged, the cartilage is not capable of repairing itself.)
Surrounding the knee structure is the synovial lining, which produces synovial fluid, a moisturizing lubricant. Tough fibers, called ligaments, link the bones of the knee joint and hold them in place—adding stability and elasticity for movement. Muscles and tendons also play an important role in keeping the knee joint stable and mobile.

Thanks to DePuy Orthopedics, a Johnson & Johnson Co., for their patient education information.

Next Blog will cover Knee Replacement Surgery

Anterior Hip Replacement Approach

The following is an overview of an article that you may find helpful if your considering having a hip replacement and you've heard of the new Anterior Approach.

Anterior Approach
Article Summary
Spondylitis Plus Winter 2006/07
(A magazine of the Spondylitis Association of America (SAA))

New Surgical Procedure Offers Hope
for A.S. (ankylosing spondylitis)
Patients Facing Hip Replacement

An Interview with Dr. Joel Matta

What is the article about?
This article contains numerous quotes from Dr. Matta as well as an anterior approach patient, Tom West (former president of SAA), that highlight the benefits of the anterior approach, in general, and specifically for patients suffering from AS.

Anterior approach from the patient's perspective
Tom West had his left hip replaced in 1992 through a traditional posterior approach. He was told at that time that he would have to have his right hip replaced within 10 years.
By 2006, the pain became too much to bear, and Tom was once again facing hip replacement surgery. That’s when he found out about Dr. Matta.

• “I found the anterior approach when I was checking into surgeons, and Dr. Matta’s name came up several times, and then my wife’s cousin from Texas knew of someone that had flown to California from Texas for this special surgery.”
• “The difference is phenomenal.
• “First of all, it was the pain differences between the two procedures that convinced me—and the recovery time was amazing. Plus there were no restrictions on my weight bearing or crossing my legs or sitting or standing. With me I’m a branch manager for a stock brokerage firm, and to be laid up for two months would have been a disaster.”
• He adds that he did have the usual swelling and bruising after that surgery...It’s still major surgery.
  

Anterior approach from Dr. Matta’s perspective

• Dr. Matta tells Spondylitis Plus that he saw an anterior hip replacement surgery performed in Paris in 1981 by French orthopaedic surgeon Emile Letournel.
  
• According to Matta, “With the help of a special operating table, Dr. Letournel accessed the hip through a frontal incision without cutting through the large muscles.”
• What are the advantages for AS patients? “First of all with AS patients seeking hip replacement surgery, I think there is a higher possibility of dislocation” Matta says, “...but with the anterior approach, there is a higher resistance to dislocation because of posterior soft-tissue preservation and more precise placement of the acetabular prosthesis.”
• Furthermore, Matta adds, “The fused spine of an AS patient is an extra problem relating to hip replacement that requires special consideration. The normal adaptive changes in positioning that the pelvis makes during standing, sitting, and walking [which would normally assist the patient in preventing dislocation] does not occur in the fused AS population.”
• “Another problem with AS patients...is an increased sensitivity to any leg length discrepancy...But the anterior hip replacement addresses both of these potential problems and yields a good outcome.”
• Dr. Matta further shares that he believes the maintenance of the posterior muscles and hip capsule as well as more accurate cup positioning help with dislocation prevention. While the features of the orthopaedic table and on-going X-ray checks help with accurate leg length.
  

Click here to view www.spondylitis.org