Providing Better After Care For Patients
We’re funding research which aims to provide a standardised approach and assessment for virtual clinic follow-up of total joint replacement patients and subsequent management of patients identified as ‘at risk’ by this approach. This study would enable us to deliver better and more streamlined after care for patients.
The National Joint Registry
The National Joint Registry collects details of knee replacements done in England, Wales, Northern Ireland and the Isle of Man. Although it’s voluntary, it’s worth registering. This enables the NJR to monitor knee replacements, so you can be identified if any problems emerge in the future.
The registry also gives you the chance to participate in a patient feedback survey.
It’s confidential and you have a right under the Data Protection Act to see what details are kept about you.
The Knee Won’t Bend Like Before
In general, a well performed knee replacement should bend as much as the knee did before the replacememt. In cases where the knee bend is poor before surgery, special techniques during surgery should allow the amount of bend to be improved, sometimes very significantly, but again your surgeon needs to be skilled in dealing with such problems.
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A Realistic Assessment Of What We Can Do To Help With Your Pain After Knee Replacement
In our clinic, we try to provide information on helping people explore other treatment options before joint replacement. One of those options is simple dextrose Prolotherapy. This regenerative injection technique helps rebuild damaged ligaments and tendons.
When the patients have already had a joint replacement, we will do a physical examination of the knee to assess how we may be able to help.
- Prolotherapy fixes soft tissue, it cannot fix hardware failure,
- Prolotherapy works by stabilizes the knee by strengthening the natural muscle and bone attachments, ligaments, and tendons.
Are There Any Reasons Why I Cant Have A Knee Replacement
Unfortunately, some people may not be able to have a knee replacement even though their arthritis is very bad. This may be because:
- your thigh muscles are very weak and may not be able to support your new knee joint
- there are deep or long-lasting open sores in the skin below your knee, increasing your risk of infection.
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How Painful Is A Knee Replacement
Pain will fluctuate based on time, medication, activity, and more.
On a 0 to 10 scale with 0 being no pain and 10 being described as pain makes me pass out the first 24 to 48-hours after surgery are often described as a 7/10.
7/10 Pain is Cant be ignored for any length of time, but you can still go to work and participate in social activities.
The pain will often vary between 3/10 Annoying enough to be distracting at the low end up to an 8/10 Physical activity severely limited. You can read and converse with effort. Nausea and dizziness set in as factors of pain.
Looking After Your Knee Replacement
Your new knee will continue to improve for as much as two years after your operation as the scar tissue heals and you exercise your muscles. You’ll need to look after yourself and pay attention to any of the following problems:
Stiffness Sometimes the knee can become very stiff in the weeks after the operation for no obvious reason. Try placing your foot on the first or second step of the stairs, hold on to the banister and lean into your knee. This should help to improve movement and flexibility in your knee. Its very important to continue with the exercises you were working on in the hospital.If the stiffness doesnt improve after about six weeks your surgeon may need to move or manipulate your knee. This will be done under anaesthetic.
Pain Pain caused by bruising from the operation is normal in the first two months, and you’ll probably still need to take painkillers at six weeks to help you sleep through the night. You may still have some pain for as long as six months. If you still have pain after this, speak to your physiotherapist or GP.
Infection You should speak to your GP or hospital if you notice any signs of infection, for example:
- breakdown of the wound with oozing/pus or sores
- increased pain
- redness and the affected area feeling warmer than usual or smelling unpleasant.
You should also look after your feet see a doctor or podiatrist if you notice any problems such as ingrown toenails that could become infected.
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Patients May Need Subsequent Surgeries To Maximize The Benefits Of Joint Replacement
Many patients with hip and knee arthritis have the condition in more than one of their hip or knee joints, said the studys lead author Dr. Gillian Hawker. So its not surprising that replacing a single joint doesnt alleviate all their pain and disability patients may need subsequent surgeries to maximize the benefits of joint replacement.
The study, published in the journal Arthritis & Rheumatism , followed a group of patients with osteoarthritis and inflammatory arthritis. Only half reported a meaningful improvement in their overall hip and knee pain and disability one to two years after surgery. Whats more, researchers found the patients who had the worse knee or hip pain to begin with but fewer general health problems and no arthritis outside of the replaced joint were more likely to report benefits.
According to the study authors, nearly 83 percent of study participants had at least two troublesome hips and or knees.
- In general, an estimated 25 percent of patients who undergo a single joint replacement will have another joint replacement usually the other hip or knee within two years.
What Is Normal Joint Recovery Pain
Every person and every joint is different. Its important that you carefully monitor your pain throughout your road to recovery. As an overly simplistic rule of thumb, you should experience less pain as the days, weeks and months after your surgery climb. The more time between you and surgery day, the less pain you should feel. As you read on, you will see there is one exception to this rule for those recovering from a knee replacement.
95.5% of Total Hip Replacements patients reported having less pain 1 year after surgery than they did before surgery. 86.4% of Total Knee Replacements reported having less pain a year later.
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Knee Replacement Complications In Former Athletes
In a recent paper, doctors from NYU Langone Medical Center, Hospital for Joint Diseases suggest that total knee arthroplasty is often the best answer for end-stage, post-traumatic osteoarthritis after intra-articular and periarticular osteoarthritic fractures the knee.
However, total knee replacement in the setting of post-traumatic osteoarthritis is often considered more technically demanding surgery and the surgical outcomes are typically worse for these patients. The goal of the NYU paper was to create a new classification label for post-traumatic osteoarthritis patients and improve medical documentation and improve patient care.
- The researchers looked at post-traumatic osteoarthritis patients who suffered from osteoarthritis as a result of high demand or athletic activity. These were on average were younger and healthier than the primary total knee replacement population .
- The healthier post-traumatic total knee replacement group had the following complications:
- higher rates of superficial surgical site infections,
- bleeding requiring transfusion,
- increased length of hospital stay,
- and 30-day hospital readmission.
In a similar study, doctors at Duke University also recognized that Total Knee Arthroplasty as an important treatment for post-traumatic arthritis. However, these researchers also found complications that should not be expected in a mostly healthy patient population.
- knee wound complications
- need for revision surgery.
Is It Normal To Still Suffer Knee Pain Months After A Total Knee Replacement Surgery
Immediate post-surgical pain is expected, but were talking months here.
Knee replacement patients are given powerful narcotics to numb the post-surgical pain.
However, for how long after knee replacement surgery is it still normal to feel pain?
My father had knee replacement surgery in March of 2009, and afterward, the pain in the surgical joint never disappeared.
Of course, the pre-surgical pain of osteoarthritis went away. But now, he was left with a newpain, and the joint didnt feel right.
The pain wasnt just in the knee it was in the area above it, and was most pronounced every time he stood up from a chair or climbed stairs. Many times, hed say, It just doesnt feel right. I know something is wrong.
A few times he speculated that it was infected. Signs of infection would include swelling, redness and fever, of which my father had none.
He even wondered if the surgeon had made a mistake with the knee replacement procedure, even though the same surgeon performed the procedure on my fathers other knee about a year prior to the second operation.
My father adhered to all the prescribed post-knee replacement surgery exercises, which included physical therapy and stretching.
He regularly went to the gym to do leg presses, leg extensions and seated leg curls. He had been doing these leg exercises long before even the first surgery.
The surgeon told him he was absolutely NOT to do any leg extensions.
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Why Does A Knee Replacement Hurt More Than A Hip
This year, twice as many Americans will undergo knee replacements over hip replacements. For this large group, chances are they will experience more pain than their hip replacement counterparts. The reason being is complex, but is likely because the knee joint is a much more confined space and postoperative swelling increases stiffness and pain. In addition, a total knee replacement involves more bone and cartilage being removed and more artificial components being introduced.
In recovery, knees require a period of intense therapy to ensure adequate flexibility for everyday movements. Simply walking does not suffice, but a structured physical therapy program prescribed by your surgeon should be followed with daily exercise. Dr. Mehran adds, The hip is naturally a more mobile joint, and thus it is easier to regain range of motion post operatively. We naturally stretch the hip through sitting and standing.
The rehabilitation of the knee joint is slower and varies for each person. However, most patients report feeling good around the 3 month mark.
How Long Should You Keep Your Leg Elevated After Knee Surgery
Prop your leg on cushions or pillows so your knee is at least 12 inches above your heart for the first three to five days after surgery. Keep your leg elevated if your knee swells or throbs when you are up and about on crutches. Don’t put pillows behind your knee because this limits motion of the knee.
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Increase Knee Flexion With Iastm
If traditional treatments like stretching haven’t been helpful in relieving your stiffness, a specialized form of massage may address your arthrofibrosis. IASTM, short for “instrument-assisted soft tissue massage,” uses metal tools to massage the areas around the knee and can break up the scar tissue that forms and impedes motion.
A 2016 study published in the Journal of Knee Surgery found good improvements in knee flexion among patients who underwent Astym therapy after developing a post-surgical stiff knee. Talk to your physical therapist about making it part of your rehab.
Research Continued: After The Surgery The Researchers Found Patients Had To Alter Their Recovery And Post
It is important to know that the purpose of this research was to assign a set of values to these patient problems in order to be able to come up with a formula that would better help the patient with their expectations before and after the surgery. The researchers had to conclude in the end that:
Our systematic review highlights a lack of evidence about the effectiveness of prediction and management strategies for chronic postsurgical pain after total knee replacement.
In the end, there is no way currently to predict who will benefit and who will get worse from knee replacement surgery and patients should be counseled that there is no guarantee that knee replacement will work for them.
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What Can I Do To Help Ease The Pain
Once the knee replacement surgery is completed, its imperative that the patient gets up and walking on the new knee as soon as possible to prevent blood clots. Putting pressure on the newly operated joint, as well as bending the knee will cause initial pain but will fade as the healing continues. Fortunately, knee replacement surgery technology and pain management have come a long way since the first days of the procedure, so today knee replacement surgeries involve less pain and patients are able to heal faster than ever before.
Knee Replacement Pain A Year And Beyond
The goal of knee replacement surgery is to help you get back to the activities you love. Your doctor will encourage you to stay fit through activities like swimming, cycling, and even golf. This type of exercise will help you stay limber and pain-free.
On the contrary, there are certain activities that could negatively affect the prosthetic joint materials in place. Even normal use will begin to wear out the implants, but excessive weight or activity can cause your knee replacement to loosen and become painful. You may need to avoid running, jogging, high-impact exercises, and contact sports for the rest of your life following surgery.
The good news is that studies show more than 90% of total knee replacements are still functioning properly 15 years after surgery. Staying healthy and following the advice of your doctor will help you achieve these long-term benefits.
While its possible for pain to persist for a year and beyond, it shouldnt be debilitating. Scar tissue can continue to heal, as well as the muscles in your knee, but if youre suffering from ongoing pain after a year, always talk to your doctor.
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A Lot Of Physiotherapy Is Needed Afterwards
Physiotherapy is certainly needed afterwards, usually 6-8 sessions, but well performed surgery makes the physiotherapists job much easier as movement is regained quickly and strengthening of muscles occurs more quickly.
It is important that your surgeon also partners with you in your rehabilitation and recovery. This should involve reviewing your progress and identifying what is amiss if things are going more slowly than usual to help you get back on track. Liaison with your physiotherapist as necessary is also important.
When movement is not regained as quickly as necessary it is sometimes necessary to manipulate the knee under a brief anaesthetic. This should not be needed very often. As a guide, Mr Sood manipulates on average one of his knee replacements a year . High rates of manipulation are more common with knee replacements that are performed by non-specialised Orthopaedic surgeons.
Whos At Risk Of Arthrofibrosis
There are several different risk factors for developing a stiff knee after surgery. Individuals with decreased range of motion prior to surgery have a greater risk of arthrofibrosis after their operation.
African Americans and patients who are under the age of 45 are also about twice as likely to need surgery to correct their stiffness . Smokers are at a greater risk too.
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Possible Benefits Of Total Knee Replacement Surgery
Regardless of whether a traditional total knee replacement or a minimally-invasive partial knee replacement is performed the goals and possible benefits are the same: relief of pain and restoration of function.
The large majority of total knee replacement patients experience substantial or complete relief of pain once they have recovered from the procedure. The large majority walk without a limp and most dont require a cane, even if they used one before the surgery. It is quite likely that you know someone with a knee replacement who walks so well that you dont know he even had surgery!
Frequently the stiffness from arthritis is also relieved by the surgery. Very often the distance one can walk will improve as well because of diminished pain and stiffness. The enjoyment of reasonable recreational activities such as golf, dancing, traveling, and swimming almost always improves following total knee replacement.
Genicular Nerve Block With Radiofrequency Ablation
Instead of more invasive surgical options, many patients turn to a genicular nerve block to treat and diagnose persistent knee pain. A genicular nerve block uses anesthetic injected into one or more of the genicular nerves to interrupt pain signals being sent to the brain.
Unfortunately, a genicular nerve blocks effects only last eight to 24 hours. Doctors use genicular nerve blocks to test the effectiveness of the procedure on a persons knee pain. Many patients who experience relief with genicular nerve blocks will then get radiofrequency ablation. When combined, these two procedures can offer pain relief that lasts anywhere from six months to a year.
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Preparation For Total Knee Replacement Surgery
Patients undergoing total knee replacement surgery usually will undergo a pre-operative surgical risk assessment. When necessary, further evaluation will be performed by an internal medicine physician who specializes in pre-operative evaluation and risk-factor modification. Some patients will also be evaluated by an anesthesiologist in advance of the surgery.
Routine blood tests are performed on all pre-operative patients. Chest X-rays and electrocardiograms are obtained in patients who meet certain age and health criteria as well.
Surgeons will often spend time with the patient in advance of the surgery, making certain that all the patient’s questions and concerns, as well as those of the family, are answered.
The surgeon’s office should provide a reasonable estimate of:
- the surgeon’s fee
- the degree to which these should be covered by the patient’s insurance.
Total Knee Replacement Surgical Team
The total knee requires an experienced orthopedic surgeon and the resources of a large medical center. Some patients have complex medical needs and around surgery often require immediate access to multiple medical and surgical specialties and in-house medical, physical therapy, and social support services.
Finding an experienced surgeon to perform your total knee replacement
Some questions to consider asking your knee surgeon:
- Are you board certified in orthopedic surgery?
- Have you done a fellowship in joint replacement surgery?
- How many knee replacements do you do each year?