Is it possible to predict who will and who won’t have a good result from a total knee replacement?

January 13th — admin

My father-in-law is going to have a total knee replacement next week. Call me a pessimist but I think he’s going to have problems. He’s old (83 years old) and frail. Is it possible to predict who will and who won’t have a good result?

Researchers are studying many problems patients face with the idea of predicting who will have a good/poor result. The hope is to give the right care to each group to get the most benefit.

When it comes to total knee replacements (TKRs), there are quite a few studies already done on this topic. One of the most recent ones looked at over 200,000 patients who had a TKR between 1991 and 2001. Rates of infection, blood clots, and death were compiled. Factors such as age, gender, health, and type of insurance were matched against the data.

They reported that age over 65 was a risk factor for problems. Likewise, patients with more than one other health problem had worse outcomes. High blood pressure, diabetes, and a previous history of blood clot(s) are all risk factors for problems after surgery.

Previous studies have shown that surgeon experience makes a difference. Surgeons who do more TKRs have the best results. It turns out that hospitals have similar track records. High volume hospitals have the lowest death rate and rate of infection after TKRs.

Your father-in-law’s best chances for a good recovery depend on his health, his surgeon’s skill, and the type of hospital he will be staying at. Type of insurance seems to have an impact, too. Medicare patients have worse results than patients covered by private insurance.

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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What happens if a total knee joint replacement fails?

January 3rd — admin

What happens if a total knee joint replacement fails? My father just got the bad news that his new joint isn’t working. Infection has caused it to become loose. The pain and loss of function is worse than his arthritis before the joint replacement.

The surgeon will make every effort to get the infection under control and save the implant. If this doesn’t work then the implant may have to be removed. At this point treatment is still focused on clearing up the infection.

A revision surgery may be possible. After the implant is removed and the infection is under control, then a second implant may be inserted into the joint. If this is not possible, then a fusion may be needed.

With a fusion or knee arthrodesis, the patient can still put weight on that leg and walk but motion is very restricted. Getting in and out of a car or on and off a bus can be very difficult. Sometimes the surgeon has to shorten the leg so the patient can swing the leg through when walking.

Knee arthrodesis isn’t ideal but it does save the leg.

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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After six years, my total knee replacement had to be replaced. How often does this happen?

December 30th — admin

Six years after my total knee replacement, the implant came loose and had to be replaced. The surgeon told me the first joint implant was turned in a few degrees too many and that’s what caused the problem. How often does this happen?

Alignment is one of the most difficult aspects of knee joint replacements for the surgeon. Instruments used to make the bone cuts are based on average bone shape. But bone size and shape can vary from patient to patient.

The surgeon can’t always tell when a joint with a new implant is still slightly flexed at the end of the operation. In fact it can be bent as much as 10 degrees when fitting the implant in but look straight. There is also a tendency to internally rotate the upper (femoral) half of the implant. The result is often loosening and failure of the prosthesis.

Scientists are working with surgeons to limit and eventually eliminate this problem. The use of 3-D computer programs before surgery may help surgeons plan ahead. Plotting out when and where to make bone cuts and forming a template of the patient’s joint may help improve accuracy of alignment.

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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My father had a total knee replacement six months ago and still has pain and stiffness. Does this happen very often?

December 22nd — admin

My father had a total knee replacement six months ago and still has pain and stiffness. We think the surgery was a big failure. Does this happen very often?

Total knee replacement (TKR) is usually a very reliable way to give arthritis patients relief from their symptoms. About 95 percent of all TKR patients have a good result after surgery. But in five percent problems of pain, stiffness, and swelling can persist.

There are many possible causes for this outcome. If your father hasn’t been to his doctor, a re-examination is important. The surgeon will conduct a careful evaluation to see if the problem is coming from inside or outside the joint.

Many older adults have multiple health problems. These are called comorbid conditions. Neurologic problems, poor circulation, even depression are just a few comorbidities that can affect the results of surgery.

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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Ligament damage during total knee replacement uncommon

November 1st — admin

My father had a total knee replacement that had some problems. During the operation one of his ligaments was damaged that was fine before the operation. Does this happen very often? Is it an indication that the surgeon wasn’t being careful?

Studies of hundreds of knee replacements show this can and does happen … even in patients with no risk factors or deformities. Ligament damage isn’t rare but it’s uncommon. It can happen to anyone but it does tend to occur in patients who are very overweight.

The surgeon usually repairs the surgically torn ligament. The surgeon may use an implant that is designed for use with a torn or absent ligament. Rotating-hinge knees are favored when the patient has severe joint instability. The doctor’s task is to balance the ligaments, stabilize the joint, and restore motion.

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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Options for senior citizen with broken kneecap

October 18th — admin

My 83-year old mother fell on some ice while trying to get across the street. She broke her kneecap. She already had arthritis in that knee and now this. The question is: should she wait and see if the fracture will heal? Have the kneecap replaced? Replace the entire joint? The doctor has left it up to her to decide and she’s depending on us to help her figure it out.

Decisions like this can be very difficult. It’s nice that patients have options and choices. Without knowing what can and will happen makes it a bit of a guessing game. Let’s look at each option.

Giving the bone time to heal can be a good choice. It’s non-invasive without the chance of surgical complications. However, if the person is a smoker, has a poor diet/nutrition, or other health issues, delayed healing can occur. Pain and stiffness may keep your mother from getting around during the six to eight weeks it will take to heal. Losing motion in an arthritic knee might cost her some function and independence. Under any of these circumstances it might be best to consider replacement.

At age 83 a patellar arthroplasty (kneecap replacement) will likely last the rest of her natural life. It won’t change the underlying arthritis in the joint but it will help keep her moving.

A recent long-term study of patients who had the kneecap replaced suggested older patients do better with a total knee replacement (TKR). With just the kneecap replacement, there are often revision operations needed. With the TKR motion is restored to the entire joint making it possible for the person to remain active.

Given all the factors to consider may help your mother decide what’s best for her health and lifestyle. If she tries the wait-and-see approach, she can always have an operation later. If she goes with the TKR her final recovery after rehab will be that much sooner.

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 joint injury always lead to arthritis?

October 14th — admin

I was in a car accident and crashed my left knee against the dashboard hard enough to break it. I’m only 23-years old and I know this might get arthritic later in life. What are options now to help prevent this from happening?

Good question. We don’t have studies to show the long-term results of each possible treatment option. Some may say don’t worry about it — what will be, will be. Others say don’t borrow trouble before it happens. In other words, not everyone develops arthritis in a joint after a traumatic injury. The event increases your risk but doesn’t guarantee it.

You didn’t mention what treatment you’ve had for this problem now. Sometimes even young people damage the patella enough that fracture healing isn’t possible. In those cases, the kneecap may be removed, a procedure called a patellectomy. Older folks might opt for a total knee replacement, especially if they already have arthritis in the knee. Middle-aged patients may be given the choice of just a kneecap replacement.

The biggest factor in long-term results may have to do with your knee alignment. Does the patella track up and down well during knee motion? Is it balanced and in the center? Does it tend to track more to one side or the other?

The knee joint axis is also important. Are you slightly knock-kneed or bow-legged? These positions can affect how well the knee holds up over the years.

Ask your doctor for his or her recommendations. It could be there’s nothing to be done just now. Or there may be an exercise program that could correct any weaknesses or misalignments.

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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Do you really need your kneecap?

October 7th — admin

Two years ago I had a total knee replacement. I was able to keep my own kneecap at the time. Last month I fell and broke my kneecap. It’s painful, and I want the doctor to take the kneecap out. Do I really need it anyway?

The kneecap (patella) has a very important job to do. It helps the knee joint move and work normally. The quadriceps muscle, the large muscle on the front of the thigh, comes down, crosses the patella and attaches to the lower leg bone. The patella acts as a pulley system to help you use the quadriceps muscle to straighten your knee. This is called the extensor mechanism.

Taking the patella out changes how the extensor mechanism works. Change in the forces around the knee from extensor lag can cause an unstable joint. There’s also a loss of protection of the bones in the knee joint.

Lastly, the appearance of your leg will change. This may not matter to you when you are in so much pain. Once the patella is gone you can’t get it back so it’s a fairly important decision.

Some doctors prefer patients try a conservative approach. This means pain management while the bone heals. Taking the patella out is more of a final treatment option.

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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What to expect from surgery to repair shattered kneecap

October 5th — admin

My mother fell and broke her kneecap into many little pieces. She’s having surgery to take them out. It’s complicated because she has a knee joint replacement in the same leg. I’ll be taking care of her. What can I expect?

Patellar fracture and patellectomy (removal of the kneecap) are fairly rare events. Since there aren’t very many cases reported, information about results is limited.

Doctors from the Mayo Clinic recently reported on eight cases of patellectomy after total knee replacement. Their patients were in a leg cast for six to eight weeks. After the cast was taken off, the patients started putting weight on the leg and began range of motion exercises.

Half the patients reported pain relief from this operation. Three people still had mild pain. One person had severe pain. Although the patellectomy gave them pain relief, motion and function were very poor even months to years later.

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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Will knee replacement interfere with this traveler’s plans?

October 3rd — admin

I have a trip to Italy planned in two months. I also need a knee replacement before I go. The surgeon offered me the new minimally invasive “faster” surgery. Should I do it?

It all depends on how important a quick recovery is to you…and how much it’s worth in terms of risk. There’s a chance that the implant won’t last as long as the standard joint replacement. This risk of early failure is usually accompanied by persistent pain.

On the other hand, most patients who have the mini-approach are back to their normal activities after only one to four weeks’ time. This would certainly fit in with your travel plans.

Studies done so far show no reason to think you shouldn’t go ahead with this plan. So long as you know the potential problems, you’ll know the worst that could happen. Bon voyage!

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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