How much work will I miss having a partial knee replacement?

April 20th — admin

I’m trying to save up enough vacation time to have a knee replacement done. I’m opting for the unicompartmental design to help speed up recovery. How much time should I expect to be out of work for this operation?

You didn’t mention your age but since you are still working, we will assume you are younger than the average adult having a knee replacement. The peak age range for patients having total knee replacement (TKR) is 75 to 84 years old. Many patients having the unicompartmental knee arthroplasty (UKA) are younger than that.

Time in the operating room for a UKA is about an hour shorter than for a TKR. Recovery time is less for UKA, both in the immediate post-operative period and for rehab afterwards.

A recent study of outcomes suggests that patients experience about five weeks of disutility after a UKA. Disutility is defined as less than perfect health. This time period may vary depending on the age of the patient and general condition or fitness before the operation. Any complications such as infection or implant loosening can alter this estimate.

The demands of your job may make a difference as to how soon you can return to work. For example, manual laborers may need more time to rehab and build up enough strength for the required tasks compared to someone with a sedentary job at a desk. You may be able to return to your job before attaining perfect health.

Check with your surgeon for a more accurate idea. He or she may have some additional information to offer based on the type of implant being used and clinical examination of your condition.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Should an older adult get a partial or complete knee replacement?

April 18th — admin

Please help me out. We are trying to advise my father about knee replacement surgery. He’s 78-years old and not very active. The doctor has advised just replacing the side of the joint that’s worn out. At his age, wouldn’t it make more sense to replace the whole joint and be done with it?

Replacing one compartment of the knee joint is called a unicompartmental knee arthroplasty (UKA). Most often it’s the inside (medial) half of the joint that wears down first and becomes arthritic.

There are several pros and cons to this operation. Operative and recovery time are less. The cost is less, too. But there are some concerns, too. Studies show the UKA doesn’t last as long as the TKR. Other studies show function is improved more with the UKA compared with the TKR.

There may be an increased need for revision if the one-sided implant comes loose or the other compartment wears out. Then the patient would need a total knee replacement (TKR) after all. Overall, the UKA has become more popular as surgical implants and techniques improve.

A recent analysis of the cost versus benefit of UKA and TKR for low-demand patients confirmed the usefulness of the UKA. Low-demand means the person is fairly inactive and unlikely to put much stress on the new implant. Your father may fall into this category.

If the UKA gets him back on his feet sooner he may become more active. Many older adults find that pain relief from the implant makes their daily activities so much easier. They weren’t looking for a game of tennis or to take up jogging again, anyway. Many elderly patients die of unrelated causes before the UKA ever wears out or needs revision.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Which ACL surgical repair is best?

April 16th — admin

I am planning to have a torn ACL repaired surgically in my left knee. The surgeon has given me the option of a patellar-tendon or hamstring-tendon graft. From everything I’ve read, it looks like the hamstring graft is the better choice. Are there any disadvantages to this technique?

Many studies have been done to compare these two methods of anterior cruciate ligament (ACL) repair. The hamstring tendon repair has gained in popularity with surgeons because it is easy to harvest. Usually the semitendinosus (ST) portion of the hamstrings is the donor tendon.

With patellar-tendon grafts, there can be pain and loss of function when kneeling.There are fewer problems at the donor site after the operation when the ST tendon is used. A recent study highlighted one disadvantage to the ST donor site.

Loss of strength during deep knee flexion has been reported when using the ST tendon instead of the patellar tendon. Measurements of strength with the knee bent to 45- and 90-degrees showed a loss of torque (force) at 90 degrees (full squat position).

The strength deficit was only shown in patients whose ST tendon reattached above the knee joint or who did not have tendon regeneration seen on MRI. Most patients had full regeneration and full recovery.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Can I avoid surgery if my knee joint is wearing.

April 12th — admin

I have X-rays to show the inner edge of my knee joint is wearing out faster than the outer edge. My doctor tells me they can replace just one side of the knee now. Is there anything else that can be done first that doesn’t involve surgery?

Unicompartmental knee arthroplasty (UKA) has become very popular for patients with one-sided joint changes. Many people have medial joint changes. Such changes occur because of increased angles between the hip, knee, and ankle. Excessive angles can shift the weight toward the inner edge of the knee. Over time, the increased load wears down the joint on one side faster than the other.

If joint changes are caught early enough, you may be able to benefit from a simple shoe insole to off-load the joint. A plastic, silicon, leather, or rubber cup or wedge can be slipped inside the shoe. Some of these devices are designed to be placed under the shoe’s own insole. Others rest on top of the shoe’s insole and fit around your heel.

Lateral wedge insoles have been shown to help in cases of mild (grade one or two) osteoarthritis (OA). Ask your doctor if you are a good candidate for this kind of noninvasive treatment.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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When is a total knee replacement patient ready to come home?

April 10th — admin

My mother had a total knee replacement and was transferred from the hospital to a transitional unit. Then she went to a skilled nursing facility. Now she is in an assisted living unit. How can we tell when she is really ready to go home? Of course, she says she’s ready to go now!

You shouldn’t have to make this decision alone. The team of health care professionals working with her can give you advice and counsel. The physical therapists (PT) will be measuring her strength, coordination, balance, and motion. These are the skills needed for everyday activities of walking, climbing stairs, and getting around safely.

The occupational therapist (OT) will know when she is ready to resume her daily activities of daily independently in her own home setting. Usually the PT and/or the OT make a home visit and assess her needs based on her living situation. If there is no PT or OT, then a nurse or social worker may be the one to do this.

For example, is her home on one level? Or does she have to manage stairs to get in and out of the house? Are there grab bars in the bathroom to help her manage toileting and bathing? Is the laundry room accessible? What other adaptive aids or equipment are needed for her to bathe, cook, clean, and manage her daily tasks?

The PT can give your mother several tests of physical function to help guide this decision. For example, the Timed Up & Go Test (TUGT) measures how fast a person can get up from a chair, walk three meters, turn and return to sit in the chair. Or patients are given the Six-Minute Walk Test. They walk as far as they can safely in six-minutes.

There are standard measures of how fast a person should be able to do these tasks to show they can live safely by themselves. Your mother’s score will be compared to those standards to give you both an idea of how well she is doing.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Would a knee replacement help my tightened muscles?

April 6th — admin

I’m 77-years old and have pretty bad knee arthritis. I can’t straighten my left knee all the way anymore. It means I have to walk with a limp all the time. Would a knee replacement help get my motion back if the loss of motion is caused by muscle tightness?

When a surgeon replaces a joint, the condition of the soft tissues around the joint is always evaluated carefully. Muscles, ligaments, and joint capsule may all be contributing to the problem and can be corrected.

The surgeon will carefully take steps to restore full motion during the operation. Removing any and all bone spurs called osteophytes is important. Osteophytes can act as a bony block to the joint, preventing it from moving all the way. These bone spurs can also keep the soft tissues from moving smoothly and freely with the same result.

If removing the osteophytes still doesn’t restore your motion while in the operating room, then the surgeon can remove some of the bone at the bottom of the femur (thighbone). If this doesn’t gain the needed motion, then one of several other steps can be taken.

First, the joint capsule may be cut or released. Then the gastrocnemius (calf muscle) may be released. Finally, a hamstring tenotomy can be performed. A tenotomy is the surgical cutting or division of a tendon.

Most often these last steps aren’t needed. Just removing the osteophytes and balancing the soft tissues around the knee is enough to restore your motion. It may take awhile, but with rehab you should be able to resume walking normally after your knee replacement.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Would a knee brace help with my arthritis?

April 4th — admin

I’ve gradually started losing knee motion from arthritis. The X-rays show degenerative changes in and around the joint. Would it help to wear some kind of brace or splint at night to hold that knee straight?

Loss of knee extension is called a knee flexion contracture. It means your knee is stuck in a position of flexion and can’t straighten all the way. Without full knee extension, your ability to walk is affected. Not only does it take more energy to walk without full extension, but it slows you down!

Most surgeons would advise a total knee replacement. Preoperative casting or stretch-bracing have been suggested to reduce the knee flexion contracture. The idea is to restore as much motion as possible to make the surgery easier.

There are very few studies to investigate this idea. It’s likely the time it would take to gain a few degrees of motion wouldn’t be worth the extra pain and loss of daily function. Extension can be much more easily restored during surgery.

The surgeon will take the necessary steps to balance the soft tissues and remove any bone spurs affecting motion. Joint motion is checked and rechecked during the operation. Minor adjustments are made in bone structure, joint capsule, and tendon length until full motion is available.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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How does taping the kneecap relieve pain from PFPS?

April 2nd — admin

Our 16-year old daughter has had constant knee pain from a problem called PFPS. She is seeing a physical therapist who wants to try taping the kneecap. How does this help the problem?

Patellofemoral pain syndrome (PFPS) is a fairly common condition. Girls are affected more often than boys. With the increased participation in sports, PFPS has become a bigger problem than it once was. Pain with knee motion makes it more difficult to stay active in sports.

The patella sits over the knee joint and moves up and down along a track or groove in the femur (leg bone). PFPS causes pain because of the way the patella (kneecap) tracks within the femoral groove as the knee moves.

The quadriceps muscle helps control the patella so it stays within this groove. If part of the quadriceps is weak for any reason, a muscle imbalance can occur. When this happens, the pull of the quadriceps muscle may cause the patella to move more to one side than the other. This in turn causes more pressure on the cartilage on one side than the other. In time, this pressure can damage the articular cartilage.

Taping the patella helps it stay in the groove and move up and down over the knee as it should. Many patients get immediate pain relief with this treatment technique. Taping is usually accompanied by a muscle stretching and strengthening program.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Can taping knees affect pain in sports activities?

March 29th — admin

I have been working as a parent volunteer for our girls’ softball team. The coach has been doing some taping of the girls’ knees who have pain during squatting. I notice it seems to help some girls right away. Others don’t really seem to benefit. Why is that?

Taping has been used by many coaches, trainers, and therapists working with athletes who have ankle, knee, or shoulder pain. Taping usually stabilizes a joint and holds it in place. This takes pressure off the joint and nearby structures. It forces the muscles to respond more normally.

Studies definitely show a wide range of responses to taping. It would be very helpful if it were known who could benefit from taping rather than spending time trying out taping on a trial-and-error basis.

Pain during squatting may be caused by a problem called patellofemoral pain syndrome (PFPS). A recent study from Australia found two patient characteristics that may help predict which athletes with PFPS can benefit from knee taping.

The first is the patellar tilt test. The examiner glides the patella toward the outside of the knee, and then tries to lift the outer border of the patella up. In the normal knee, the patella should stay flat and should not lift up. Too much lift means the patella is very mobile and unstable.

The second is the angle of the tibia (lower leg bone). Bowing of the leg past five degrees seems to contribute to the problem of PFPS. Patients with these two positive tests often get immediate pain relief with taping.

The girls on your team who don’t get any pain relief from this type of taping may have some other problem that needs to be identified. Some other form of treatment may work better for them.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Does knee repair always require rigorous rehab?

March 27th — admin

I’m planning to have an operation called microfracture to repair an old football injury to my right knee. I’ve been told to expect a rigorous rehab program. I’m not much of an exerciser anymore now that I’m not playing ball. Can I get by without this part?

Microfracture is a method of treating defects in knee cartilage that go clear to the bone. The surgeon drills tiny holes through the cartilage into the bone. This allows the blood from inside the bone to seep into the cartilage layer. Blood clots are formed and start a healing process.

Studies show that results after microfracture are best when the patient follows a four- to six-week postoperative program. The rehab includes protected weight bearing on that leg and continuous passive motion (CPM).

With CPM, your leg is strapped into a machine that slowly bends and straightens your knee. You can expect to spend six to eight hours (or more) each day on CPM. Based on the results of studies done so far, some surgeons consider patients at too great a risk for failure if they don’t want to follow the expected post-op rehab program.

This program is not strenuous, just time consuming. Talk to your surgeon about your concerns and let him or her know your thoughts on the subject. More information about what to expect on a daily basis may help you in your decision-making process.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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