Naples Orthopedic Surgeon - Dr. Robert J. Zehr » knee pain

Do you need resurfacing before knee joint replacement?

admin — Wed, 21 Jul 2010 14:10:59 +0000

What is selective resurfacing? I know it has something to do with knee joint replacements.

The knee joint consists of three parts: the knee cap (patella), the femur (thigh bone), and the tibia (lower leg bone). A knee joint replacement is done when arthritic changes cause pain, swelling, and loss of knee function.

Arthritic changes occur inside the knee joint as well as behind the patella. The patella may need to be resurfaced for a successful joint replacement. This means a metal or plastic backing is added to the patella. This helps it ride smoothly over the other parts of the implant when the knee moves.

Not every patient needs patellar resurfacing. Doctors decide whether or not to do this when they look at the back of the patella during the operation. The doctor looks at the shape of the patella and the condition of the cartilage when making this decision.

Selective resurfacing refers to the fact that not all patients have the patella resurfaced, only those who need it based on the surgeon’s exam.

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 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.

Source of knee pain best discovered by MRI

admin — Mon, 21 Jun 2010 11:42:36 +0000

I am only 48 years old, but I have severe knee pain from years of running marathons and participating in triathlons. The first doctor I saw took an X-ray and said there’s some narrowing of the joint space, but nothing to worry about. Would an MRI (magnetic resonance imaging) show anything else the X-ray didn’t show?

For years doctors have used X-rays to help diagnose osteoarthritis (OA). Recently, researchers have started to call this practice into question. An X-ray reading of the joint may not be valid in predicting pain and function. In other words, the joint looks fine but the pain is very limiting all the same.

More and more doctors are using MRIs to find OA. MRIs can image cartilage and soft tissues. The more the doctor knows about the soft tissues involved, the more direct and specific treatment can be.

Ask your doctor about having an MRI. You may be a good candidate.

Is a nerve block safe for total knee replacement surgery?

admin — Wed, 16 Jun 2010 18:27:39 +0000

I’m going to have a total knee replacement next week. The doctor asked me if I want a nerve block before the operation to help stop the pain after the operation. What are the chances of ending up with permanent nerve damage from this?

It’s possible but not likely. Studies show permanent nerve damage after nerve blocks is very low. In fact when nerve damage occurs, most patients recover completely within three months’ time. Minor long-term problems can occur such as mild muscle weakness or a small patch of numbness.

Ask your doctor what his or her experience has been using nerve blocks. Find out what other problems can occur and how often this happens. Consider the benefits of a preoperative nerve block: less pain and less use of morphine or other painkillers after the operation.

Studies show a single-injection femoral nerve block is a simple and safe way to reduce pain after total knee replacement.

Can knee meniscus be transplanted?

admin — Tue, 08 Jun 2010 10:37:55 +0000

I’ve heard it’s possible to get a new meniscus if your own cartilage is torn beyond repair. Is this true?

Meniscal transplantation is in the works. It’s not done by all surgeons but it’s being studied by some. There are many questions left to answer before using this operation on a routine basis.

For example how much meniscus is really needed? What’s the best way to prepare donated tissue? How should it be put into the knee? How long does it last? What problems come up soon after the operation compared to years later?

Right now this method of meniscal “repair” is used in young patients who have already had the entire meniscus taken out. Pain and joint degeneration are the basic criteria for this treatment method. There’s about a 60 percent success rate. This means about 40 percent (four out of 10) of patients have a failed transplantation.

Could knee pain be arthritis?

admin — Fri, 30 Apr 2010 11:33:00 +0000

Whenever we get close to the ski season I start gearing up my exercise program. I notice the last two years I’ve had knee pain when squatting or practicing my wall sits. So far it doesn’t bother me when I ski. What could be causing this pain?

There are several possible causes of knee pain in these positions. Early arthritic changes with thinning of the joint surface is the first that comes to mind. This is more likely in the middle-aged to older adult groups.

Patellofemoral pain syndrome (pain involving the kneecap) is probably the most common in younger people. Muscle weakness or imbalance and postural changes cause the kneecap to slide up and down over the knee slightly off center. Compression and irritation of the soft tissues leads to pain.

If you are planning to continue your skiing activities, it might be a good idea to have this checked out. A specific exercise program may help alleviate the pain and prevent
injury.

Athletes’ knee injuries more likely in afternoon

admin — Mon, 19 Apr 2010 12:41:16 +0000

Is there any truth to the idea that ski injuries are more likely in the afternoon than in the morning? I would have thought injuries occur in the morning before skiers are warmed up.

Studies do indeed show the greatest chances of injury to skiers occur in the afternoon. It’s also true that injuries to football players are higher in the third quarter of a game. Coincidence?

Researchers don’t think so. They say general fatigue in athletes may be the key factor in these injuries. Fatigue leads to a decline in knee proprioception. Proprioception is the joint’s sense of position. Fatigue and then decreased proprioception can result in ligament injuries.

Change in neuromuscular control may be a factor, too. This is the link between messages to the nerve telling the muscle what to do and when to do it. Special exercise to improve motor control may help reduce these “third quarter” injuries.

Knee injuries more common in women. Is a sixth sense to blame?

admin — Thu, 15 Apr 2010 15:33:36 +0000

I hear knee injuries are more common in women than men. If that’s true, why are most knee studies just on men?

It’s true studies show female athletes are four to six times more likely to injure the knee. One factor may be the difference in proprioception between men and women. Joint proprioception is the ability to sense joint position.

Fatigue of the leg or overall body fatigue may affect proprioception. Men seem to be affected by this more than women. This factor may help explain injuries in men. Some other mechanism of injury may be important for women.

Researchers get a better picture of results by studying just men or just women instead of a mixed group. Both kinds of studies are underway.

Pace of rehab after total knee replacement varies

admin — Thu, 01 Apr 2010 12:45:52 +0000

I had a total knee replacement six weeks ago. I’m a young (65-years old), active athletic-type. I’d really like to push my rehab ahead and get more aggressive. Is this possible?

Most patients have a fair amount of pain, swelling, and stiffness the first eight weeks. They aren’t always able to advance their rehab program. The first two weeks are usually focused on warm-ups, specific exercises to strengthen the muscles, followed by a cool-down exercise period.

From two to six weeks more time is spent on functional skills like walking and stair climbing. Exercises get harder and last longer starting at five minutes and moving up to 20 minutes. By the end of six weeks the knee joint is ready to handle more demanding activity and exercise.

You’ll want to check with your doctor about how far and how fast you can go now. Having a physical therapist to supervise your home program is often a good idea.

Can McConnell taping help my knee pain?

admin — Mon, 29 Mar 2010 16:05:10 +0000

What is McConnell taping? I heard it might help my knee pain. Where do I get this tape?

Jenny McConnell is a physical therapist from Australia. She came up with a treatment plan using taping and exercise for a condition called patellofemoral pain syndrome (PFPS). It’s been used for the last 20 years with good results.

The taping is designed to pull the patella (kneecap) over the middle of the knee. This helps the patella track or glide up and down properly.

McConnell taping is done by trained physical therapists and athletic trainers. They use a special kind of tape that holds in place while the leg moves. Once the therapist or trainer decides the right taping method to use for your problem, you can learn how to apply it to yourself.

Losee maneuver can detect ACL injury

admin — Wed, 24 Mar 2010 11:38:56 +0000

What is the “Losee maneuver?” I’ve heard it can be used to detect a torn anterior cruciate ligament.

Dr. Ron Losee from Ennis, Montana, was the first to describe a test for ACL instability. It was called the Losee maneuver for many years. Now it’s sometimes referred to as the “pivot-shift” test.

When the test is done, the patient is asked, “Is this how your knee feels when it gives out?” The doctor doesn’t always feel a change in the knee during the test, so the patient’s report is important.

A positive pivot-shift may be a sign that surgery is needed to repair the torn ligament. There is a device that measures laxity between the two knees (a KT-2000). The results of one test usually aren’t enough to tell which patients need an operation. Tests like the pivot-shift, along with several others, are still important.