What Causes A Stiff Knee After Tka And How Can It Be Prevented
Dr. Jesse Otero answers ICJRs questions about the most common causes of knee stiffness after total knee arthroplasty, what to do if a patient presents with stiffness, and when to consider a revision procedure.
ICJR: What is the definition of a stiff knee after total knee arthroplasty?
Jesse E. Otero, MD, PhD: The goals of TKA are to relieve pain and restore function in patients with moderate to advanced osteoarthritis who have exhausted conservative treatments but still have knee pain that interferes with their activities of daily living. In most patients minds, the ideal result of TKA would be a knee that moves and feels the way it did in a more youthful time.
Before discussing stiffness after TKA, it is essential to first review normal native knee motion in relation to the activities patients routinely perform. Laubenthal et al presented a quantitative analysis of knee motion required to achieve normal activities of daily living. In this classic article, the authors used an electro-goniometer to show that on average:
- 83° of flexion is required for climbing stairs
- 93° of flexion is required for sitting
- 106° of flexion is required for tying a shoe
- 117° of flexion is required for squatting to lift an object
The widely accepted target after TKA, based on this study, is 120° of knee flexion. In objective terms, therefore, knees that fail to achieve 120° of flexion after surgery are commonly considered to be stiff.
ICJR: What are the most common causes of knee stiffness?
Find Chronic Knee Pain Treatment Near You
Theres no need to suffer through chronic knee pain, especially when the Orthopedic Institute of Pennsylvanias physicians are here to help. While surgery may end up being the best option, it is never the first one we suggest. We opt instead to work with each patient to find non-invasive ways to treat chronic pain.
With numerous locations across Pennsylvania, were dedicated to helping you live a pain-free life. To request an appointment at one of our locations, simply fill out the form online or call 717-761-5530.
How Long Does It Take For Soft Tissue To Heal After Hip Replacement
In general, most surgeons prefer that you avoid certain positions of the hip that can increase your risk of dislocation of the hip for about 6 weeks following surgery. After 6 weeks the soft tissues involved in the surgery have healed and restrictions are often lifted allowing more vigorous activity.
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Initial Swelling And Pain Management After Knee Replacement
Most patients have moderate to severe swelling for the first few days after knee surgery. Some patients may also experience this degree of inflammation for several weeks. However, this should ease down within the third to sixth month from the day of the procedure.
You can help your knee recover from the swelling faster with the use of ice therapy. Icing can help reduce inflammation, so long as done immediately after an injury. In the case of knee surgeries, you may have to extend the cold treatment for as long as you have swelling.
Aside from cold therapy, its also best to elevate the leg wherein youve had knee surgery. This will help prevent too much blood from flowing to the surgical site. The reduced blood flow, in turn, can help reduce swelling.
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When Its Time For Knee Replacement Surgery
Knee arthritis can get worse in spite of treatment. If youve tried these methods and are still dealing with pain, it might be time to discuss knee replacement with an experienced orthopaedic surgeon. Total knee replacement is a major procedure, but it can offer better quality of life and improved mobility that last for many years.
A total knee replacement is more of a resurfacing of the bones in the knee: the end of the femur , the top of the tibia and the inward facing surface of the patella, or kneecap. The surgeon removes the bony surfaces and replaces them with metal and plastic implants. The plastic serves the same purpose as the cartilage, helping the implants glide against each other smoothly.
There are constant innovations in the field of knee replacement. For instance, more surgeons are using regional anesthesia for the procedure, which can mean a shorter hospital stay compared with when general anesthesia is used. New multimodal pain approaches, surgical techniques and physical therapy after these surgeries are all improving a patients knee replacement experience.
Hip and Knee Replacement at Johns Hopkins
The Johns Hopkins Hip and Knee Replacement program features a team of orthopaedic specialists highly skilled in joint replacement procedures. Our team will guide you through every step, from presurgical education to postsurgical care and physical therapy. Our goal is to return you to your desired level of activity as soon as possible.
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About The 2nd Edition
The 2nd edition of the PFPS tutorial was launched on July 28, 2014, after months of collaboration with Tony Ingram, a Physical Therapist who did his Masters thesis on anterior knee pain. Tony was officially a co-author for a while, but retreated to focus on pursuing a PhD and a career in science.
Like all my books, this one was updated many times over the years, but changes were too small and spread out to constitute an edition: that had to wait for this, by far the largest ever major change to the book. It has several new sections, a lot of new science, and a strong new emphasis on the evidence-based value of exercise reversing my grumpy anti-exercise position. Its also much less exclusively about a single theory of knee pain than it was.
A new position on exercise
Exercise for patellofemoral pain syndrome is a good example of a treatment that works, but probably doesnt work how most people think it works. I was anti-exercise before because the evidence just wasnt there for it yet, and too many professionals fancied that they were prescribing exercise to change biomechanical parameters that correlated poorly with the condition. Such prescriptions tended to be overzealous: too much exercise, too soon for patients suffering from what is fundamentally an overuse condition.
Not just one guys theory any more
I didnt buy your book so I could get one guys theory about how patellofemoral pain syndrome works.
Prp And Stem Cell Injections
Platelet-rich plasma injections are created using your own blood centrifuged to concentrate platelets in the plasma while getting rid of white and red blood cells.
The concentrated PRP is injected into your joint to attract growth factors to the area and speed healing. Stem cells perform a similar task, boosting the regenerative power of your system and relieving pain in the process.
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Change Your Running Technique To Cure Runners Knee
Consider changing the way that you run. This isnt straightforward, but if your symptoms are related to your running form, this may be something you need to change.
Many runners will benefit from increasing their step rate . You can find more information about this here: Gait Re-training for Runners Knee Patellofemoral Pain & Running Form
I hope this quick guide helps you in your recovery, and gives you a realistic idea of how long it will take to recover from runners knee.
If you have any questions, feel free to let me know in the comments below
Dr. Brad Neal
Youre Ignoring Depression Which Can Worsen Pain
Depression, sleep problems, and osteoarthritis pain appear to be linked, according to a study published in March 2015 in the journal Arthritis Care & Research that assessed sleep, pain, and depression symptoms in 288 adults over the course of a year. The anxiety, stress, and worry that can go along with someone whos depressed may minimize their ability to cope with osteoarthritis, Johnson says. If you think you may be depressed, seek treatment immediately.
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How Long Does Pain Last After Knee Replacement Surgery What To Expect
Knee pain can appear in many forms. Arthritis, an injury, and gradual wear and tear as you age can all have an effect on your activities and comfort level. If youre unable to walk or climb a stairs because of your pain , knee replacement surgery may be the best way to get your life back. While the benefits of the procedure may significantly outweigh temporary discomfort, its important to have realistic expectations regarding your recovery timeline and knee replacement pain after surgery.
Tips For Managing Chronic Pain
Get effective chronic pain management strategies for arthritis with valuable tips and personal stories.
Many people who have arthritis or a related disease may be living with chronic pain. Pain is chronic when it lasts three to six months or longer, but arthritis pain can last a lifetime. It may be constant, or it may come and go. Chronic pain can make it hard to perform daily activities like cleaning the house, dressing, or looking after your kids. However, there are ways to effectively manage chronic arthritis pain. Follow these tips to help you feel better and learn from people who have experienced chronic pain from arthritis.
01. Take Your Medications
Prescription and over-the-counter drugs recommended by your doctor can help control inflammation and pain. If you have side effects that keep you from taking your medications, or if you have trouble affording their cost, speak to your doctor. There may be other options.
02. Manage Your Weight
Excess weight can cause more pressure on the weight-bearing joints and increase pain. Plus, adipose tissue sends out chemical signals that increase inflammation. Being overweight is bad for your overall health, as it increases your chances for heart disease, diabetes and even some cancers. Make sure you have a balanced diet with plenty of vegetables, fresh fruit, whole grains and lean protein, such as beans, poultry, and fish. Stay away from processed foods, red meat, and sugary drinks.
03. Stay Active
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Knee Pain Will Not Go Away Here Are 5 Reasons Why
Whenever you feel pain in a particular part of your body, its really your bodys way of saying that youve either injured yourself , you are overdoing it in some activity or another, or something else is going on and you need to start paying attention. Knee pain is no exception. In some cases, the pain can go away or at least diminish once your bodys natural healing process kicks in but more often than not, it wont unless you take some sort of action. Want to know why your knee pain wont go away? Keep reading.
You Might Need A Change In Activity
Knee pain is a clear signal that something is not right with the knee joint or the structures that support it or depend on it. The good news is, by having Dr. Nickson evaluate your knee pain early on, he can recommend changes that can alleviate your symptoms and help reduce the risk of further injury.
Depending on whats causing your pain, your age, your overall health, and other factors, he might suggest using specific warm-up exercises, undergoing physical therapy, reducing your playing time, or other ways to play smart and protect your knees. He also might recommend knee treatments, like corticosteroid injections, to give your knees additional support and care.
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When The Scar Heals
- Push & Pull: Imagine that you have divided the scar into sections 2 finger widths apart. Place 2 fingers in the left most section and move it in all directions of a clock . Where ever the scar feels stuck hold this position for 60 seconds. You will feel a strong pulling or light burning. Then move to the next section until you have massaged the whole length of the scar. When the top layers of skin move more freely try to press a little deeper to get to a deeper layer of the scar.
- Skin Rolling: Pinch the skin on either side of the scar, lifting the skin up. Start at either end and move forward and backward, rolling and raising the skin as you move. A free scar bulges upward, a stuck scar will dimple.
- Stroking along the Scar:Massage the scar tissue by working it with a rubbing motion along the grain. You can move your fingers apart along the length of the scar as if you are trying to make the scar longer.
- Plucking: Put your index finger on one side and thumb on the other side of the scar. Try and lift scar up, separating it from the underlying tissues. If the skin slips out of your hands, you may not be ready for this stage.
The sensation you feel when you massage your scar is one of strong pulling or light burning, NOT sharp pain. Sharp pain is as if you cut your fingers with a knife. Scar massage should NOT feel like that.
Massaging scar tissue has many benefits. Here are of the main reasons to regularly scar massage :
Q Ack Whats With That Surprise Price Tag
A. I know it can make a poor impression, but I have to make a living and this is the best way Ive found to keep the lights on here.
Paying in your own currency is always cheaper! My prices are set slightly lower than current exchange rates, but most cards charge extra for conversion.
Example: as a Canadian, if I pay $19.95 USD, my credit card converts it at a high rate and charges me $26.58 CAD. But if I select Canadian dollars here, I pay only $24.95 CAD.
Why so different? If you pay in United States dollars , your credit card will convert the USD price to your cards native currency, but the card companies often charge too much for conversion its a way for them to make a little extra money, of course. So I offer my customers prices converted at slightly better than the current rate.
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Reasons Not To Play Through Knee Pain
Knee pain is a common medical problem for Americans of all ages. If youre an athlete pro, student, or casual painful knees are even more common.
Most athletes are dedicated to their sports, which makes it all the more tempting to play through their pain, hoping that with a bit of time, the symptoms will go away on their own.
But deciding to play through knee pain can have some serious consequences. In this post, Dominique Nickson, MD, and the Next Step Orthopedicsteam explain three reasons its not a good idea to play through the pain.
The Stiff Knee: A Frustrating Post Tka Challenge
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Douglas W. Jackson, MD, poses 4 Questions to Alejandro González Della Valle, MD, about knee stiffness occurring after total knee arthroplasty.
One of the most frustrating surgical sequelae for both the patient and surgeon is the development of a stiff knee following surgery. While, this may occur unexpectedly after almost any knee procedure, it is not an infrequent problem after a total knee replacement. For this interview, I have asked Alejandro González Della Valle, MD, to share his insight and approach to this problem.
Douglas W. Jackson, MDChief Medical Editor
Douglas W. Jackson, MD: What is the prevalence of stiffness following total knee replacement?
Alejandro González Della Valle, MD: It is between 5% and 7% and in my opinion it is the most prevalent early local complication of total knee replacement surgery, surpassing the combined prevalence of infection, thromboembolism and early mechanical failure. Pariente et al. recently reviewed 5,714 TKRs performed in 4,106 patients between 1997 and 2003. Manipulation under anesthesia was required in 399 cases . Similarly, Yercan et al. recently reported that among 1,188 consecutive TKR patients, 63 developed stiffness. Of the 56 patients available for analysis, 46 patients required manipulation and 10 required revision surgery for stiffness.
Jackson: What is the definition of stiffness?
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Ial And Total Knee Replacement Surgery
More severe knee pain may require surgical treatment, either arthroscopic or some type of replacement.
But even if you need a total knee replacement, advances in technology have made it possible for many people to recover with a full range of motion only a couple of months after the Signature total knee replacement. Patients undergoing an Oxford partial knee replacement are treated as an outpatient and do not spend one night in the hospital. Partial replacement patients typically recover very quickly.
For more information, read our dedicated page about recovery timelines for partial and total knee replacements.
What Is Arthritis Of The Knee
Arthritis is a disease that causes pain, swelling and stiffness in your joints. It can affect the largest and strongest joints in your body. Its common in knees. Arthritis of the knee can be a serious, debilitating disease.
Although there is no cure for knee arthritis, there are steps you can take that might ease your symptoms and potentially slow the progression of your disease.
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What To Do If Your Knee Pain Is Not Getting Better
May 8, 2020
Knee pain is a relatively common occurrence, which is why people often treat it as if it were no big deal. You can develop knee pain from playing sports or from exercising, and you will likely assume it will go away on its own.
After all, if the knee pain is the result of a minor sports injury or overuse, you can easily treat it using the R.I.C.E. method rest, ice, compression, and elevation of the knee area. You can also take low-dose, over-the-counter medication such as ibuprofen or naproxen to ease the pain and reduce any swelling while youre recovering.