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Uncategorized

5 Hip Replacement Symptoms to Watch For

It’s not unusual for people who are in their fifties or older to experience hip pain. The decades can take a toll on a person’s bones, muscles and joints, leading — in some cases — to osteoarthritis.

Younger people can also have hip pain, of course. Sometimes joint injuries can cause discomfort years later. So can extra body weight and repetitive movements (e.g., those made while training for and playing sports). Low back issues and genetic factors can play a role in hip pain. Even a difference in leg length, which may affect more than half of the population, can cause gait problems. These issues may eventually lead to the need for hip replacement.

So how do you know if your hip pain is caused by a temporary injury to the soft tissues around the joint, or an issue such as uneven hips, which might be addressed through the use of orthotics, or something longer term, like arthritis, that may warrant surgery?

Sometimes the location of the pain can help determine what’s causing it. Sharp discomfort in the groin area or on the inside of the hip is often an indication of a problem with the hip joint itself, whereas pain on the outside of the hip or in the upper thigh or outer buttock area may be associated with the soft tissues (ligaments, tendons, muscles, etc.) that surround the hip joint.

If you have persistent pain and/or stiffness in one or both of your hips, it’s a good idea to have it checked by a medical professional. Depending on the underlying cause, it may just need some extra attention. Not all hip pain calls for surgery or a joint replacement.

There are some warning signs, though, that could indicate a hip replacement may be necessary. We’ve compiled a list of five common hip replacement symptoms to be on the lookout for.

1. Stiffness in your hip limits your normal range of motion

Your hip doesn’t move as freely as it used to, and the stiffness is bad enough that it keeps you from engaging in regular everyday activities — like going for a walk, or squatting down to pick up something. One leg might feel as though it’s dragging, compared with the other leg, and you might have an actual limp. Maybe you wobble when you walk.

Your hip joint might feel as though it sticks, or locks up, especially when you start to stand up after sitting for a while. The stiffness might be worse in the morning, when you first wake up. You may also have a dull ache in your hip or groin, along with the stiffness.

Stiffness can come on gradually, and you might not notice it much in the beginning. These are common signs that you have stiffness in one or both of your hips:

  • It’s harder to put on your shoes and socks.
  • You can’t walk the same distance you normally would, or it takes you considerably longer.
  • Getting out of a car is a challenge.
  • It’s difficult to lift your leg in front of you, to the side, or behind you.
  • You have to use your hands to push against something or pull yourself up when getting up from the floor.

2.  Recommended treatments don’t relieve the pain

You’ve tried a variety of treatments to eliminate the pain — including medications such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, and injections of cortisone or hyaluronic acid. You may also have tried physical and/or occupational therapy, at-home remedies, transcutaneous electrical nerve stimulation (TENS) and even minor surgery.

Although these methods may provide some level of short-term relief, steadily returning pain is a hip replacement symptom to be aware of.

3. You have difficulty sleeping

Pain in your hip may make it hard to get in a comfortable position so you can fall asleep, particularly if you’re accustomed to sleeping on the side that is hurting.

Once you do go to sleep, the pain may cause you to toss and turn. The disruption in your sleep cycle can leave you feeling tired when you wake up and throughout the day.

4. Tests show that you have arthritis or joint damage

The hip is a ball-and-socket joint where the femur (thigh bone) joins the pelvis. The “ball” is the femoral head (the upper end of the femur), and the “socket” is the acetabulum, an area on the outer edge of the pelvis that is formed by three bones. The joint capsule, which is a connective tissue that attaches to the bones, and the muscles and ligaments that surround the hip joint stabilize the hip and provide support.

Cartilage separates the bones from each other and helps to cushion them as they glide back and forth across each other. The surface of the joint has a thin lining called the synovium, which produces synovial fluid that lubricates the cartilage and helps ease movement. Over time, the cartilage can break down, and as it wears away, the bones are left rubbing against each other. This is how osteoarthritis develops.

In people who have rheumatoid arthritis, an inflammatory disease can develop at any age, the synovium swells and becomes thicker, and as that occurs, chemical substances are produced that destroy the cartilage.

Soft tissues like cartilage don’t show up on an X-ray, but an X-ray can still be useful in diagnosing osteoarthritis. That’s because it will show hip arthritis symptoms such as narrowing of the space between the bones in the hip joint, as well as any bone spurs that might have formed around the joint.

For cases that are more complex, magnetic resonance imaging (MRI) may be appropriate. An MRI is a more detailed image that does show soft tissues, including cartilage.

5. You’re feeling emotional distress

Persistent pain can be debilitating. It can keep you from doing activities you enjoy and make it hard to get through the day. As the pain continues, you may start feeling frustrated, impatient and perhaps even a little hopeless.

Know that there is help. If it turns out that your symptoms do warrant a hip replacement, the surgery can rid you of the pain you’ve been experiencing and get you back to your normal activities. Depending on the type of surgery, you could be back in full swing in a matter of weeks.

Categories
Post Op

Home Recovery Tips for After Your Surgery

Once your surgery is over, your body can begin the healing process and you can be on your way to resuming your usual activities, free of pain. To help speed your recovery and reduce the risk of injury while you heal, there are steps you can take ahead of time to set up your home and simplify your daily routine. 

Ideally, you can also arrange to have a friend or family member take you home after your surgery, help you at home while you’re recovering, and provide transportation to and from your follow-up appointments and any other medical appointments you may have until you can safely drive.  

Having another person around who can assist you during your home recovery can make life easier in countless ways, but for now let’s focus on what you can do before your surgery.

How to Prepare Your Home for After Surgery

While it’s important that you follow your post-operative care instructions for walking and moving about after your surgery, you also want to avoid falling and possibly injuring yourself. Taking a few precautions before you have surgery can greatly reduce your chances of tripping or slipping. Here are some things to think about:

  • Will stairs be an issue? If your bedroom is upstairs, then you might want to look into having a bed set up temporarily in a room downstairs. If you will need to use the stairs, then having a railing to hold on to will make going up and down them much safer. 
  • Do you have room to move around? You can be proactive by clearing away objects and clutter that might get in your way — especially if you’ll be using a walker. Arrange your furniture so there’s enough space for you to walk around without bumping into it. Take up any rugs or mats that might cause you to trip. Get loose cords and other fall hazards out of your walking paths. 
  • Is your bathtub/shower as safe as possible? Even if you have grab bars in your bathtub or shower, consider adding a mat designed to keep you from slipping on wet surfaces. 
  • How’s your lighting? Is there enough light in the areas you’ll be using to easily see where you’re going? If not, add more lamps or install brighter bulbs. Adding nightlights in key areas is an inexpensive and effective way to help prevent a potentially dangerous middle-of-the-night tumble. 

By taking these steps before surgery, you can increase the likelihood of successful home care after surgery. And that leads us to some other things you can do to prepare for your home recovery.

Post-Operative Care at Home

Just like you can arrange beforehand to have someone drive you to and from your surgery, you can plan ahead to simplify or have help with your day-to-day routine once you’re back home. 

For example, map out your meals for a week or two and stock up on groceries and other household items you’ll need. Create a list of easy-to-make dishes and/or make a few meals before your surgery that will keep safely in the refrigerator (or freeze them). 

Also, be sure that you have an adequate supply of prescription and over-the-counter medications you take for existing conditions, and have a plan in place for getting any new prescriptions filled following your surgery. Have your medications in a spot that will be easily accessible (bearing in mind the safety of others who share your home, including pets). 

Speaking of pets, if you have a dog, cat or other pet that will need to be taken care of, either make arrangements for a family member or friend to attend to your pet’s needs or consider having your pet stay elsewhere while you’re recovering from surgery. 

Something else you can do that just might make a big difference is to jot down your emergency contact information and your doctor’s phone number, and keep both within reach or in a spot that someone else could find easily. Even though you might have all of that stored in your cell phone, another person might not be able to access it that way. 

You can probably come up with other ways to make your life easier in the days and weeks just after your surgery. As you go about your daily activities, keep in mind how much you’re having to lift, lean over or reach down to accomplish whatever it is you’re doing. Then, ask yourself if there’s a way to make that easier while you’re recovering — like using a long-handled shoe horn to put on your shoes, or having a reach extender (also called a grabber or gripper tool) handy to pick up things from the floor. 

The Advantages of Home Recovery

Less-invasive surgical procedures typically lead to shorter recovery periods, and for many people home recovery is an option. One of the main advantages of home care after surgery is the greater level of comfort you’ll have in your own home. You’ll be in a familiar environment, with easy access to family and friends who can provide emotional support and other assistance as you recover. 

Post-operative care at home is also considerably less costly than receiving care in, say, an inpatient rehabilitation facility. Most insurance companies recognize the value of home care after surgery, as long as it’s deemed a safe alternative for a particular patient. Even when health plans do provide coverage for post-operative care in a facility, it’s for a limited number of days and there are virtually always out-of-pocket costs for the patient. 

While every situation is different, there’s a very good chance that you’ll be able to begin your recovery at home either the same day as your surgery or within a day or two afterward. Greater Phoenix Orthopedics encourage you to follow the tips in this post and make your recovery as safe and smooth as it can be. 

Categories
Hip Pain

Hip Pain Remedies You Can Try at Home

If chronic hip pain is keeping you awake at night or interfering with your daily activities, you may have already tried some hip pain remedies. No doubt you’re hoping to find relief without resorting to surgery, and we can offer several suggestions for how to help ease your hip pain.

Several types of stretches and exercises can help make your pain less severe, and you can do most, if not all, of them at home. You might also unknowingly be doing some exercises that are worsening your condition.

If you’re still experiencing hip pain related to osteoarthritis after trying these and other treatments at home, then surgery may be your best option — but let’s try these options first.

Stretches to Ease Hip Pain

Stretches are some of the simplest hip pain remedies to try at home. Tightness in the structure of the hip joint can result in preventing the joint from moving freely and possibly even pinching muscles, ligaments and nerves in and around the capsule.

The right stretches can reduce stiffness, improve your mobility (making it more flexible) and strengthen muscles that support the joint. Try the following four stretches when you’re feeling less pain and stiffness, like after taking a warm shower or bath or after you’ve been up moving around for a while. Start slowly and gradually add more sets and/or repetitions as your pain subsides.

Stretch #1: Knee lift

  1. Lie on your back with both legs out straight against the floor.
  2. Keeping one leg straight, pull the other knee up toward your chest and use both hands on top of your knee to gently coax it further toward your chest.
  3. Hold for 10 seconds and then gently lower your leg back to the floor.
  4. Do the other side and then repeat 5 to 10 times for each knee.

Stretch #2: Double hip rotation

  1. Lie on your back with both knees bent and your feet on the floor.
  2. While keeping both shoulders on the floor, gently lower your knees to one side and turn your head in the opposite direction.
  3. Hold for 20 to 30 seconds and then bring your knees and head back to the center.
  4. Repeat on the other side.

Stretch #3: Bridge

  1. Lie on your back with both knees bent and your feet on the floor. Keep your arms at your sides, palms facing down.
  2. While engaging your abdominal muscles and keeping your shoulders and upper body on the floor, push down through your heels and slowly lift your pelvis and lower back.
  3. Hold for 3 to 5 seconds.
  4. Starting at the upper part of your spine and moving toward your tailbone, gradually roll your back and pelvis back down to the floor.
  5. Repeat 5 to 15 times.

Stretch #4: Hip extension

  1. Stand with your legs straight and spaced shoulder-width apart. Support yourself by holding on to the back of a chair, counter, table or wall.
  2. Keeping one leg straight, lift the other leg behind you without bending it at the knee.
  3. When you’ve lifted it as high as you comfortably can, tighten your buttock and hold for 5 seconds.
  4. Lower the leg and do the other side.
  5. Repeat 5 to 10 times on each leg.

Exercises to Help Reduce Hip Pain

One of the most important steps you can take to ease hip pain — especially if it’s related to osteoarthritis — is to exercise regularly. Like, every day, if possible. Not only can exercise help reduce pain and stiffness in your joints, but it can also improve your flexibility and balance.

Just like stretching, the right kind of exercise can increase the range of motion in your hip joints and strengthen the muscles that support them. Here are three easy, low-impact forms of exercise that can be effective hip pain remedies:

Walking

If you’ve been relatively inactive, then walking is a great way to start increasing your activity level. You use just about all of the major muscle groups in your body while you’re walking, and you can gradually increase your pace and distance as you build up your strength and endurance. Walking poles can give you extra stability and help ease any pain you might feel in your hips as you’re walking.

Swimming

This is one of the best exercises for people with chronic hip pain because the buoyancy of the water reduces the weight on the joint. If the pool is heated, so much the better for your joints, and you don’t even actually have to swim to benefit from being in the pool — walking through the water and doing water aerobics can go a long way toward reducing your hip pain. You might even be able to find an aquatic class specifically for people with arthritis at your local YMCA, health club or rehabilitation center.

Yoga

You don’t have to go to a yoga studio or fitness facility to do yoga. It’s a great hip pain treatment you can do at home, as long as you’re careful about which poses you do. Many yoga poses are designed specifically to help reduce stiffness in the hips by stretching and strengthening the muscles that support the hip joints. With a quick search online, you’ll discover which poses are best for addressing stiff or painful hips, and plenty of online classes are available as well. Remember to begin with gentle stretches and avoid overdoing it.

Exercises to Avoid if You Have Hip Pain

While we encourage anyone who suffers chronically to be active, there are certain kinds of exercise that you should steer clear of if hip pain is a problem. You don’t want to engage in exercises that will add more strain on your hip joints; those can include high-impact exercises that involve running and jumping, weight-bearing exercises, and exercises that are done while standing.

Many stretching and strengthening exercises that are traditionally done while standing can instead be performed while seated in a chair or on the floor, which can also be helpful if balance is an issue. The key is to avoid exercises that could ultimately increase your hip pain by adding to the burden your hip joints already have, and possibly even leading to an injury.

When to Seek Surgery for Osteoarthritis Hip Pain

Try the hip pain remedies we’ve suggested for a few weeks and see if you notice any difference in your pain level or frequency. If your pain persists, if it’s keeping you awake at night or making it difficult to walk, climb the stairs, and get in and out of chairs and/or the bathtub, then it might be time to consider surgery.

You don’t have to just resign yourself to putting up with the pain. In fact, doing so could lead to other health issues, such weight gain and diminished cardiovascular health. Bear in mind, too, that the healthier you are when you have surgery, the better your outcome may be.

If other hip pain remedies fail to provide the relief you need, then hip resurfacing or a minimally invasive total hip replacement might be the right course of action. For more information or to schedule a private consultation, contact us.

Categories
Uncategorized

Explaining Knee Pain When Sitting or Squatting

If you’re experiencing knee pain from squatting motions, sitting, or knee flexion, there is a possibility that your knee’s ligaments, tendons, or cartilage have been damaged or degraded.

To put scientific jargon into layman’s terms, if you’re experiencing front, back, inner, or outer knee pains, here is a break-down of what it could be.

Common Knee Pain Diagnoses

The anatomy of the knee is complex and interconnected in many ways.

Whether the pain resides with the back, front, or medial/ lateral (side) parts of the knee, the damage may originate from any part of the knee’s anatomy.

It is difficult to decipher where the pain may be coming from, which is why diagnosing the specific area of pain can help you understand which part of your knee has been affected.

Here are a few common questions you can ask yourself when experiencing knee pain when sitting or squatting.

  1. Is the pain coming from the front, sides, or back of my knee?
  2. Is my knee pain coming from standing, sitting, flexing, all of the above? Not sure?
  3. How active am I?
  4. Have I started new activities? 
  5. Am I wearing different footwear than normal? 

Answering these questions can help you pinpoint the possible cause of your pain and help give your doctor a better idea of where your knee pain is coming from.

With this knowledge in mind, there are four common diagnoses that are associated with acute knee pain. 

1. Jumper’s Knee (Patellar Tendonitis)

Jumper’s Knee is usually a result of the overuse of the Patellar tendon (refer to the picture above).

Oftentimes jumper’s knee is symptomatic of overload and overuse of your quadriceps (quad) muscle group.

The quad muscles are involved in a variety of movements which include jumping, kicking, squatting, running, or any generally explosive movement involving the legs.

Energy and the pressure of impact are often distributed among the Quad muscle. After extended use, however, the pressure begins to cause inflammation in the tendon.

Repeated use especially after sustaining the injury can lead to tears. 

Inflammation is usually a result of microscopic tears in the tendon.

This triggers a healing response from your body, flooding the damaged area with blood, nutrients, antioxidants, and other fluids that are designed to help the healing process. 

For the old, but young at heart, the cause of Jumper’s Knee is usually due to repetitive microdamage and degradation.

While resting the knee seems like the best method of healing, small and steady movements and use of your affected knee is also a vital part of the recovery process.

Here are a few symptoms to determine if you have Jumper’s Knee.

  1. Tenderness and pain originating from the front of your knee (beneath your knee knee cap)
  2. Pain with sudden movements
  3. Pain with extending your knee

2. Runner’s Knee 

Runner’s Knee is usually the result of irritating the lining and soft tissues in the knee. It is known as Runner’s Knee because the repetitive movements of running can easily cause pain and inflammation. These repeated movements are usually felt with knee pain when squatting.

Runner’s knee is a common term used to describe a group of conditions that create pain behind and around the patella or kneecap.

The conditions can include anterior knee pain syndrome, patellofemoral malalignment, chondromalacia patella, and iliotibial band syndrome.

For patients with runner’s knee the pain is often most acute when the knee sits in a flexed position. While there are many different diagnoses for Runner’s Knee, it is usually a series of linings and soft tissues that have become irritated due to consistent pressure.

Runner’s Knee is usually more common in women, particularly middle-aged women. Weight can also be a contributing factor to the development of Runner’s Knee along with failure to stretch/ warm-up. 

As the name of the condition suggests, Runner’s Knee is a common injury in people who enjoy recreational or professional running.

However, this is a problem that is not exclusive to runners. As previously mentioned, there are a number of reasons that one may develop Runner’s Knee including biking, hiking, and impact sports.

Here are a few indicators that you may have Runner’s Knee.

  1. Pain coming from the sides of your knee
  2. A grinding originating from your knee after a period rest
  3. Popping and pain from knee loading (walking up stairs or squatting)
  4. Pain or snapping along the outside of the knee 

3. Baker’s Cyst (Popliteal Cyst)

The popliteal area refers to the area behind the knee. Most symptoms of a Baker’s Cyst include general stiffness, a mass in the back of the knee, and pain in the back of the knee.

The injury is a result of cartilage or soft tissue damage which, in turn, causes a build-up of what is known as synovial fluid (a lubricant that greases the joint for movement).

After continued movement, the body produces a large amount to help cushion the knee, but the fluid pushes out the back of the knee and a cyst begins to form behind the knee.

Unlike some other knee pains, a Baker’s Cyst might go undetected. Some common ways to diagnose the pain is if you experience any of the following symptoms.

  1. Feel and/or see a lump behind the knee
  2. Pain when completely flexing your leg or inability to flex entirely.

4. Iliotibial Band Syndrome

Also known as IT Band Syndrome (ITBS), Iliotibial Band Syndrome is a series of connective “bands” of tissues that have become inflamed from overuse.

The pain is usually felt at the side of the knee as opposed to the front and back. 

When referring to this image, the pain is usually felt around the femoral condyle and top of the lateral collateral ligament. (Found as the cut ligament near the Lateral Meniscus). 

Most people easily call IT Band Syndrome a Runner’s Knee as Runner’s knee can include ITBS as noted above.

It is rather easy to confuse, especially because of the anatomical makeup of the bands of tissues. 

A common way to help detect the difference is if the epicenter of the pain is coming from the side, then it is usually a good indicator that you have IT Band Syndrome.

To help determine if you have ITBS these are a few questions you can ask yourself.

  1. Is my knee pain affecting the general kneecap area?
    1. This is usually a sign of a different cause of Runner’s Knee.
  2. Is my knee pain primarily in the sides of my knee
    1. This is usually a sign of ITBS.

ITBS specifically affects the outer side of your knee, whereas runner’s knee is a generalized pain to the knee.

To better diagnose your knee pain when squatting or sitting, call and visit the offices of Greater Phoenix Orthopedics, located in Scottsdale,  AZ. We provide solutions for total knee replacement surgery using a minimally-invasive technique with MAKO robotic-assisted technology.

Recovering from Knee Pain

Recovery is different for everyone, but not impossible. Chances are, if you’ve done research on your knee pain, you have come across R.I.C.E. (R – Rest, I – Ice, C- Compression, E – Elevate).

If you are looking for more in-depth tips on how you can recover and treat your knee pain, feel free to contact us here at the offices of Greater Phoenix Orthopedics.

Categories
Orthopedic Surgery

How Do I Know When To See An Orthopedic Surgeon

Orthopedic surgeons are medical doctors who specialize in problems with the musculoskeletal system. The human body has over 300 bones and joints and when one of those is not functioning properly it can cause daily pain and disability. Orthopedic surgeons provide patients with these symptoms options for treatment to help improve activities of daily living, pain control and prevent further injury. If you have pain in any of your joints, common problem joints are knees, hips, spine, wrists, fingers, an orthopedic surgeon can evaluate you for definitive treatment. If you have an emergent situation, such as a broken bone or signs of infection, do not wait for an appointment with a surgeon and head to the ER for immediate care. 

Indicators That You Should See An Orthopedist

General indications that you should see an orthopedist

  1. You are experiencing chronic pain

    • Chronic pain is defined as pain that lasts longer than twelve weeks. If you experience pain, even on and off, for longer than twelve weeks it is important to have an evaluation. 
  2. Inability to perform activities of daily living (ADLs) 

    • If you have pain, a limited range of motion, or instability in a bone or joint that prevents you from accomplishing daily tasks such as brushing your teeth, washing your hair, driving, or folding laundry, it is a good indication that you should seek an appointment. 
  3. Limited range of motion

    • Our joints are responsible for allowing our bodies to move in many different directions and participate in different tasks. When a joint is injured or damaged by disease it can lose the ability to move in different directional planes. This is a loss of your range of motion. A few examples of this include if your shoulder cannot reach above your head to grasp something or if your hip will not rotate enough for you to put your socks on normally. If you are losing range of motion it is a sign you should seek professional advice to prevent the problem from progressing. 
  4. You suffered an injury that is not improving

    • Patients often experience what seem like minor injuries, a sprained ankle or a tweaked knee, that fails to improve with conservative treatment after forty-eight hours. After an acute injury, if you have tried all of the basics including over the counter medications, rest, ice, elevation and compression (RICE), and your pain is not improving or worsening it is time to consult a medical professional. Some of these injuries can be evaluated by a primary care doctor, but oftentimes if conservative treatment has failed you will be referred to an orthopedic specialist for definitive diagnosis. 
  5. Your joint feels unstable when weight bearing (standing) or moving 

    • If you feel uncertain that a joint will perform its task; for example, if you are walking and feel as if your knee is going to lock up or buckle underneath you causing a fall, it is important to be evaluated. If you feel wobbly, uncertain, shaky or overall unstable when trying to perform a basic function like walking, sitting down, or climbing stairs it is a sign that something is not functioning properly in one or more of your joints. It is important to determine the underlying cause of the instability with an orthopedic surgeon. 

Common complaints that an orthopedic specialist can help treat: 

  • Shoulder Pain that prevents you from sleeping, combing your hair, dressing, working, etc
  • Trouble climbing or descending stairs
  • Tingling or Numbness in your hand Hands, especially after working on the computer or in the mornings 
  • Pain from Repetitive Motions such as golf, tennis, or work-related activities 
  • Prolonged painful joints 
  • Twisted Ankle where the pain persists or when you have instability 
  • Swollen Wrists
  • Swollen Joints 
  • Worsening Injury
  • Weak, Stiff and Bruised Muscles that do not heal with rest and time 

What To Expect From Your First Appointment With An Orthopedist

For your first appointment with an orthopedic doctor, you should bring any previous treatment records and imaging studies that you have had in the last few years regarding the area you wish to have evaluated. If you do not have any imaging studies often offices will send you for plain x rays prior to your visit to assess the bony anatomy of the problematic joint. You should also bring your picture ID and insurance cards to the appointment and be prepared to fill out a full medical history, not just pertaining to the current injury. Some offices like Dr. Martin’s are now all digital and you can fill this history outline prior to your visit. 

dr martin examining xrays

During the first visit, you will be asked about the history of your condition, this may include questions like:

  • When did this pain or disability start?
  • Was there an injury? 
  • Have you had an issue like this before?
  • What treatments or alleviating practices have you tried? 
  • What makes it worse? Better?
  • Do you have a family history of any conditions like this? 

After the initial intake, the doctor will perform a thorough examination of the joint testing for range of motion, strength, stability and neurovascular status. The doctor will often then review your images with you along with the exam findings and discuss likely diagnosis. Once you have a likely diagnosis they will outline treatment options for your specific condition.  If the surgeon recommends further testing, they may provide symptomatic care until your follow up to review the advanced images or tests. Throughout this process, you will have the opportunity to ask questions about the diagnosis and treatment. It is important to voice any concerns you have during this time and address any topic you may not understand. We will then provide you with greater detail on our MAKOplasty surgery procedures to see if this is something you want to proceed with.

Categories
Uncategorized

12 Ways to Treat Knee Pain

Knee pain and problems are universal issues and can affect any age group. If you or someone you know are experiencing knee pain, swelling, inflammation or soreness, here are a few ways to combat the symptoms.

1. R.I.C.E 

man pausing from run to remedy knee pain
  • Rest: initially it is important to rest a sore joint, especially with an acute injury. Avoid strenuous activities for 5 days to a week to allow your knee to begin healing
  • Ice: Icing the knee when knee pain appears can help reduce pain and inflammation. Start with ice 2-3 times a day for 15 minutes each session. Never place ice directly on the skin. 
  • Compression: Wearing a over the counter compression sleeve or ace wrap can help reduce swelling and improve the functionality of a sore knee joint. 
  • Elevation: After an initial injury or flare of pain elevating the sore leg above the hip ( ie laying down with the leg elevated) can help the excess swelling drain back into the body. 

2. Keep Moving

  • While recovery is vital, physical activity is also required to expedite the healing process.  Nonimpact activity is often the best treatment for a sore knee because it helps maintain a range of motion while bringing healing elements to the knee. 
  • Exercises like the stationary bike, walking in the water, swimming and the elliptical are recommended. 
  • Stop any activity that makes the pain worse. 

3. Walk Around

  • Without walking around and working the inflammation, the body cannot properly partition oxygen-rich blood and nutrients to the knee. 
  • A brisk 10-minute walk after a meal is advised, but choose a non-impact activity as listed above if walking irritates the knee.  It will serve as a double-edged sword, giving you a chance to digest your food properly and work the knee.

4. Hot & Cold Therapy

  • After the initial injury or flare has begun to heal, using both Hot & Cold Therapy interchangeably will promote a speedy recovery process
  • Hot: Using a heated compress, wrap the compress around your knee and apply pressure for a few minutes. It is important to set the temperature to a reasonably hot setting. The heat promotes blood flow into the injured area.
  • Cold: Using frozen packaged vegetables, ice wrapped in cloth or frozen ice packs, apply the pressure every so often. It is important to let your skin recover and come back to normal temperature after a few rounds of icing. NEVER PLACE ICE ON BARE SKIN. 
  • Be mindful of how you feel while using hot/cold therapy. Do not compress heat or cold against your skin for too long. 
  • A good rule of thumb is 3 Min/Hot to 1-2 min/Cold

5. Change up your tastebuds!

  • Certain anti-inflammatory foods and spices can help the recovery process.
  • Quercetin is a compound that has been found in apples, white & red onions, yellow & green bell peppers, and green tea that has shown to help with inflammation
  • It is recommended that you drink 3 cups of green tea and combine a variety of the aforementioned ingredients
  • Turmeric (curcumin) is also a great anti-inflammatory and can be added to many foods. 

6. Cushion your feet 

  • Switching out your shoe soles for cushioned ones can ease the pressure placed on your knee.
  • Make sure your shoes are supportive but not too  heavy or constricting 
  • Choose gym shoes or hiking sandals over flip flops or flats when walking long distances or standing for extended periods of time 

 7. Regular Stretches

  • The knee joint is interconnected with multiple leg muscles. Proper stretching of the hamstrings, quads, and calves will help alleviate the stiffness.
  • Being gentle with these exercises and stretches goes a long way. Being careful not to over-extend anything is advised. 
  • If you are unsure of where begin, start with a simple forward fold ( bending towards the toes) and other helpful stretches for knee pain!

8. Acupuncture

  • If you’re not afraid of needles, acupuncture is another great way to alleviate sharp pains.
  • A process that involves small needles that penetrate the skin. Studies suggest that acupuncture activates neurohormonal pathways via nerve stimulation.
  • Be sure to find a reputable practitioner who uses sterile techniques.

9. Losing Weight

  • Our knees take on a good amount of our weight. Losing weight will help alleviate some pressure on the knees. Each pound you lose can unweight your knees by around 5 pounds! 
  • Some aerobic exercises that can be done with higher intensity (not involving the knees) can be biking, swimming, rowing machine, weighted ball exercises, etc.
  • As a precaution, it is good to warm up sufficiently and hydrate well. Taking a few preventative measures will not only help with recovery but strengthen it.

10. Deep-Tissue Massage

  • Knee Pain may also be attributed to jumbled and knotted muscle fibers. Deep tissue massages to the hamstrings, inner thighs and around the knee may alleviate the pain. 
  • If you have a deep tissues massage be sure to hydrate well and stretch lightly after to avoid muscle cramping.

11. Use a Crutch (if needed)

  • Pretty self-explanatory, but using a crutch can relieve a sore knee of stress and pain. 
  • Following the RICE principle is advised.

12. Be Patient

  • Your age and overall health can determine the speed and length of your recovery. The severity of your knee pain and inflammation is something to take into consideration as well. 
  • Time and proper care of your knees will be a marathon. Taking a step at a time will go a long way (pun intended)
  • If you have waited but your pain is worsening or you have developed new symptoms like clicking, locking, or instability in the knee please follow up with a medical provider. 
Categories
Uncategorized

Partial vs. Total Knee Replacement: Which is Right for Me?

Patients dealing with debilitating knee problems like arthritis are often faced with a decision to proceed with a partial or total knee replacement.  Both surgeries can produce excellent results but there are significant differences between the two procedures that can affect overall satisfaction. Here are some things to take into consideration when deciding between partial vs total knee replacement.

  1. Age
  2. Overall Health
  3. Fitness level
  4. Recreational Activities
  5. Previous Injuries or Procedures

Run-Down of Partial and Total Knee Replacements

The human knee is made up of three compartments: 

partial knee diagram
Knee Diagram
  1. Medial (inside)
  2. Lateral (outside)
  3. Patellofemoral (under the kneecap).

A total knee replacement involves resurfacing all three compartments with metallic biomaterials designed to function similarly to cartilage.  A partial knee replacement selectively resurfaces one of the three compartments with similar but smaller implants. The most commonly used biomaterials are cobalt chrome, titanium, and polyethylene plastic.

While many problems can lead to knee replacement, the most common diagnosis is osteoarthritis.  This “wear and tear” disease results in the destruction of the protective, white, cartilage layer on the ends of the bones in a joint.  When all of the cartilage has been destroyed, exposing the underlying bone, it is commonly referred to as “end-stage” or “bone on bone” arthritis.  This and other signs of arthritis can easily be seen on a plain x-ray. Advanced imaging techniques such as CT scan or MRI are typically not needed to diagnose osteoarthritis.  Patients can often maintain good function for years with non-operative treatment. When symptoms worsen and stop responding to conservative treatment, knee replacement procedures can be considered.  

How do Partial Knee Replacements Work?

A good candidate for a partial knee replacement would have radiographic signs of “bone on bone“ arthritis in only one compartment of the knee with localized pain to that same compartment.  Patients with widespread pain in the knee who are unable to localize their symptoms are typically better candidates for total knee replacement. 

A partial knee replacement can be performed manually or with robotic assistance.  A manual partial knee replacement requires the surgeon to prepare the ends of the bones for implants using specialized jigs that help to align the components. A robotic-assisted partial knee replacement uses a robotic arm to help prepare the ends of the bones in a more accurate and precise way. Validation studies have shown better alignment of implants can be achieved with robotic technology. It is hoped that better alignment will lead to longer-lasting implants.  Although robotic technology has only been available for partial knee replacements for about 10 years early survivorship studies are encouraging.

Robotic-Assisted Procedures

Robotic-assisted procedures help provide a more thorough and efficient method of surgery. A robotic partial knee replacement starts with a CT scan of a patient’s knee. The CT scan is used to construct a three-dimensional image which is stored in the robotic system memory.  This allows the robot to understand the unique bony anatomy of a patient’s knee. At the time of surgery special reflectors are fixed to the patient’s femur and tibia.

The surgeon then identifies unique landmarks on the patient’s knee using special probes that the robot can “see“.  The robot can then confirm that the three-dimensional CT scan image in its memory is accurate and since it knows where the patient’s “knee” is in relation to the two reflectors it can “track“ the patient’s knee as the surgeon moves it in space. 

In this way when the surgeon identifies the system, the best location for the implants the robot knows exactly where that position is.  The robot’s arm, holding either a saw or a burr, is then used by the surgeon to remove bone in the precise location where the implants are to be placed.  Although the surgeon has to manipulate the robotic arm to remove bone the system “guides” the surgeon’s hands by allowing only the precise amount of bone to be removed to accommodate the implants.  After preparing the bone with the robotic arm the implants are typically cemented in place and the knee incision is repaired with suture.  

The majority of partial knee replacements are performed on an outpatient basis with most patients leaving the surgery center or hospital within one hour of waking from Anesthesia. Physical therapy is generally not required and most patients return to work within two weeks of surgery.  Patients usually experience 2 to 3 days of discomfort following the procedure and sometimes require pain medicine. Bandages are removed three days following the procedure and patients are allowed to shower provided there is no bleeding or drainage from the incision. There are numerous advantages to partial knee replacement but also some disadvantages.

Pros:

  1. Minimally invasive
  2. Quick recovery
  3. No PT (Physical Therapy) required
  4. Minimal discomfort
  5. All ligaments are retained
  6. More natural knee motion
  7. No long term activity restrictions
  8. Lower complication rates than total knee replacement 

Cons:

  1. Potential for additional surgery if arthritis develops in other knee compartments
  2. Risk of implants wearing out

How do Total Knee Replacements Work?

Total knee replacement can also be performed either manually or with robotic assistance.  Robotic assistance, similar to partial knee replacement, has consistently been shown to be a more accurate and precise technique for aligning and placing implants in a human knee.  Unlike partial knee replacement where a single compartment is replaced, total knee replacement resurfaces all three compartments with biomaterials. The incision is slightly longer than a partial knee incision to accommodate the larger implants.  The overall procedure is similar in that a CT scan is obtained prior to surgery and used to “visualize“ the patient’s knee. Similar trackers are placed in the femur and tibia during the surgery so that the robotic system can “locate” the patient’s knee in space.  After the surgeon determines the best position for implants the robotic arm precisely controls the saw used to shape the ends of the bones so that the implants fit in that exact location. Fine control of the saw-blade also protects the surrounding soft tissue such as ligaments, tendons, and skin.  After the implants are fixed to the ends of the bones the knee incision is repaired and the patient is awoken from anesthesia.

Pros:

  1. Less pain than with traditional knee replacement
  2. No chance of arthritis recurring
  3. High patient satisfaction
  4. Excellent function with few activity restrictions

Cons:

  1. Larger incision
  2. Longer recovery
  3. Greater blood loss
  4. Higher complication rates

Recovery after knee replacement surgery is a very individual process with many factors influencing the speed of recovery. Recovery can be defined in many different ways. For the purposes of this blog, recovery will be defined as either a return to work or activities of daily living.  Patients should never compare their recovery time to others but some generalities do exist. In general, patients recover from partial knee replacement faster than from total knee replacement. Most patients are able to return to work within 2 weeks of having a partial knee replacement but closer to 6 weeks for total knee replacement depending on work conditions.  

Physical therapy is another concern after knee replacement. Most partial knee patients do not require physical therapy but most total knee patients participate in 4 weeks of therapy.  In terms of pain, most patients report varying degrees of discomfort for 2 – 3 days after partial knee replacement but more like 2 – 3 weeks after total knee replacement. While full healing requires 6 to 12 months most patients report 80% improvement in symptoms two weeks after partial knee replacement and six weeks after total knee replacement.

From a functional standpoint, both partial and total knee replacements can provide excellent results. Most patients after either procedure can resume all activities.  The only exception is a general recommendation against impact type exercise such as running. The concern is that the repetitive loads placed on knee implants with running can lead to increased wear and premature failure. Kneeling can initially be difficult for patients undergoing either procedure but with proper instruction, most patients can perform this activity.  Competitive athletes who place huge demands on their knees may notice improved function with a partial knee replacement. This is likely due to the retention of the anterior cruciate ligament (ACL) which allows for more natural knee motion and increased proprioception. Total knee replacements compensate for the removal of the ACL with implants that fit more tightly together. 

Both partial and total knee replacement are excellent options for patients with advanced degenerative diseases of the knee who have failed conservative treatment. Both procedures can result in a highly functional knee that allows patients to resume almost all activities.  There are some differences however between partial and total knee replacement that should be taken into consideration when planning surgery. These differences should be discussed with your surgeon so that you can choose the procedure that fits you and your lifestyle the best.

Categories
Knee Sports Injuries Tennis

Common Tennis Injuries And How To Avoid Them: Protect Against Jumpers Knee

Tennis is an extremely enjoyable yet physical sport that requires agility, speed, strength, endurance, and coordination to play. Due to the multitude of physical requirements to play tennis, it is no wonder that injuries occur regularly. The most commonly thought of injury is “tennis elbow”, however, tennis can cause injury to many parts of your body including the spine, legs (hip, knee, and ankle), and dominant arm (shoulder, elbow, wrist, and fingers). This is due to the high speed of racket swing, the torque placed on the spine, and the repetitive impact and cutting required for quick court movements. Proper form, conditioning, stretching, and body mechanics are key for injury prevention. With these precautions in place and having an understanding of your body’s limitations, tennis can be a “lifetime” sport played at any age. 

1. Tennis Elbow

examining tennis elbow in patient

How Does It Occur?

Lateral epicondylitis, known widely as tennis elbow occurs as a result of repetitive strain on the tendons joining the forearm muscles to the outside of the elbow. These tendons become inflamed and painful. Tennis elbow is typically caused by overuse and can present as elbow pain, burning on the outside of the elbow, and weak grip strength. The symptoms can worsen with the use of the forearm. 

How Can I Prevent It?

Warm-up and cool down before you practice or play. It is also important to cross-train and condition to prevent injuries. Also making sure to alternate to your nondominant hand and most importantly, honor your body and stop when it hurts. If you are unsure about your form or technique, work with a professional trainer. 

How Is It Treated?

Treatment includes rest, ice, compression, and elevation (RICE), anti-inflammatories (NSAIDs) such as ibuprofen and in some cases bracing. Alternating your grip can help alleviate pain as well.  It is advised that if you have tennis elbow you need to address it immediately to avoid it becoming chronic. 

2. Rotator Cuff Tendonitis/Tears 

How Does It Occur?

Damage to the rotator cuff (the group of muscles, tendons, and ligaments that supports the upper arm around the shoulder joint) often causes significant pain and disability. The rotator cuff is formed by four separate muscles and tendons that come together to support the shoulder and allow for mobility. The rotator cuff tendons can become inflamed, can tear gradually due to overuse, but can also tear due to an acute injury. Rotator cuff injuries often present with pain, tenderness, and weakness in the shoulder, difficulty lifting the arm, and snapping and crackling noises while moving the shoulder. Rotator cuff symptoms are often present in recreational players with improper serving or swing form. 

How Can I Prevent It?

To prevent rotator cuff irritations and injuries it is important to always warm-up and cool down after playing. Utilizing rotator cuff exercises is essential for further injury prevention and rehabilitation. One such exercise you can begin doing is putting your back flat against the wall, forming 90-degree angles with your arms and pressing slowly upward, bringing your thumbs together. This promotes the shuttling of synovial fluids, which lubricate the impinged (pinched) joint. Make sure your serving technique and grip techniques are correct and if you are unsure it is important to get training to improve your form.

How Is It Treated?

Treatment is RICE, activity modification, light exercising of the rotator cuff muscles, and anti-inflammatory drugs. Persistent symptoms or extreme acute symptoms require medical evaluation as tears often require surgery. 

3. Stress Fractures

How Does It Occur?

Stress fractures are small cracks in the bone that are a result of overuse and repetitive impact movements such as running and jumping during tennis. The courts are typically made from asphalt or concrete cured with an acrylic sealant; this material increased the impact on the body. The fractures cause pain, swelling, stiffness, that present slowly and the symptoms will worsen over time. These fractures can occur in several areas including the leg, foot, and lumbar spine (lower back). 

How Can I Prevent It?

Warming up and stretching is always key in injury prevention as well as taking breaks regularly. Listening to your body and not forcing yourself to play through the pain is also important and be sure not to play through pain. When you increase your activity levels, do so slowly and in small increments. Be sure to alternate between low-impact activities like swimming and biking when you plan to participate in high impact activities like tennis.  

How Is It Treated?

Treating a stress fracture is multifaceted but the most important aspect is rest. Avoid the motion/ impact that caused the fracture in the first place to allow the bone time to heal and prevent further injury. If rest and other conservative treatments do not help your pain evaluation by an orthopedic specialist is the next step as more advanced stress fractures may require bracing or immobilization. As fractures exit the acute healing stage, physical therapy can help patients regain strength and stamina.  

4. Ankle Sprain

How Does It Occur?

Tennis is a fast-paced game that requires a lot of multidirectional movement, especially lateral cutting. These abrupt sideways movements lead many tennis players to suffer from ankle sprains by stretching the ligaments too far. Twisting, overextension, changing direction quickly, and catching uneven ground can lead to a sprain. Clay courts provide a softer surface for impact but can pose a greater risk for an ankle sprain. the side of the foot can dig into the surface more easily, resulting in a turned ankle. These injuries lead to loss of range of motion, stiffness, swelling, pain, bruising, and sometimes instability. 

How Can I Prevent It?

When playing tennis it is important to wear supportive footwear with ankle supports that can help prevent sprains. Also, you should be aware of uneven areas of your playing surface that are a pitfall for ankle injuries. As always it is also important to warm up and cool down properly. 

How Is It Treated?

A sprained ankle responds well to rest, bracing, ice and NSAIDs (Nonsteroidal anti-inflammatory drug). An ankle sprain can range from mild to extremely severe and if you suffer an ankle injury  it is important to have it evaluated to make sure you receive proper treatment.

5. Jumper’s Knee

How Does It Occur?

Patellar tendonitis, also known as Jumper’s knee, is an inflammation of the tendon that attaches the patella (kneecap) to the tibia (shin bone). This tendon is responsible for supporting the body on impact and aids in the motion of the leg when walking, jumping, and other movements.  Tennis requires a lot of repetitive jumping which can increase the risk of small tears in the patellar tendon which will lead to tendonitis. This irritation can lead to pain, warmth, and swelling in the front of the knee. Increased activity levels including walking, kneeling, running, ascending and descending stairs. 

How Can I Prevent It?

Avoiding overexertion is the first step in preventing Jumper’s knee and cross-training with non-impact exercises like swimming and biking.  Some players benefit from the use of a brace called achopat strap. 

How Is It Treated?

Like most inflammatory conditions, Jumper’s knee responds well to RICE and NSAIDs. It is important to avoid aggravating activities while the tendon is healing. After the initial pain subsides there are some stretches and strengthening activities that can help prevent a recurrence that can be done at home or in formal physical therapy. If the pain does not respond to conservative treatments or reoccurs it is prudent to follow up with a medical professional. 

How Can I Prevent Tennis Injuries

Tennis is a high impact sport which means cross-training with non-impact activities is imperative in the prevention of injury. Swimming, cycling, and strength-training will all strengthen the muscles and tendons while alleviating some of the excess stress. It is also important to be aware of your body’s limitations and avoid overuse, especially when starting a new sport or progressing your practice. Proper form is integral for tennis players as well due to the high velocity of swings and the unilateral nature of the sport. 

Additionally here are a few more tips to help you avoid injury while playing tennis: 

  • Have The Right Equipment
    • Shoes should be sturdy, lightweight and have proper ankle support 
    • Socks should be well padded 
    • Additional ankle support may be beneficial 
    • Purchase a racquet with the help of a professional to assure weight and size is appropriate 
    • Make sure your grip fits well
    • Make sure your string tension suitable’
    • Ensure your clothing is non-restrictive and not a tripping hazard 
  • Focus on Improving Technique
    • Work with a coach who can make sure your serve, swing, and jumping techniques are safe and effective 
    • Once you have been trained, practice the kinematics of the proper movements 
  • Warm-Up/ Stretch/ Cool Down

Create a routine for yourself with pre and post-game stretches

Continue your cross-training  with non-impact activity and strengthening of the core, shoulder, and spine

Icing problem joints after a workout can help prevent pain and further injury 

  • Take Breaks
    • It is important to allow your body time to recover from impact sports like Tennis, so allow yourself time to reset 
    • If you develop pain, listen to your body and stop playing. Playing through pain can lead to more severe injuries

Categories
Knee Replacement

Minimally Invasive Vs. Traditional Knee Replacement: What’s The Difference?

A total knee replacement, also known as total knee arthroplasty, is a surgery performed by an orthopedic surgeon to alleviate knee pain caused by arthritis and other knee damaging conditions. During a total knee replacement, Dr. Martin makes an incision to access your tibia (shin bone), patella (kneecap), and femur (thigh bone). After the damaged bones are exposed the bone is resected to a healthy portion which is then capped with metal components that recreate the joint surface. A layer of plastic is placed between the metal components to replace the cartilage layer to allow for the smooth movement of the joint. 

The traditional approach to a knee replacement required a large incision and significant soft tissue disruption which led to a longer and more painful recovery. Minimally invasive approach to knee replacement uses robotic-assisted arms to make smaller incisions with less soft tissue disruption. The advantage of minimally invasive surgery is that the approach allows for faster recovery, less pain, less blood loss, and the opportunity for same-day surgery. Most patients who are candidates for a traditional total knee replacement are candidates for a minimally invasive approach however the determination is made by the surgeon. 

Traditional Knee Replacement

When performing a traditional knee replacement, initially the surgeon makes an 8- to 10-inch vertical incision over the front of the knee to expose the joint. This incision extends into the quadriceps tendon which provides the surgeon good visualization.  Visualization is important for a traditional knee replacement to ensure proper positioning for the longevity of the joint.

 The surgeon will then:

  • Resect the damaged cartilage surface and bone from the femur and tibia. 
  • Remove and resurface the soft tissues of the knee that may impede the implants. 
  • Position the metal implants, typically with an external jig system. The removed cartilage and bone are replaced with metal components that recreate the surface of the joint.
  • Rest and replace the undersurface of the patella (kneecap) with a plastic button. Some surgeons do not resurface the patella, depending on the case.
  • Place the plastic spacer between the metal components to create a smooth gliding surface. 

Minimally Invasive Knee Replacement Surgery

  • When performing minimally invasive knee replacement, the surgical procedure is similar, but there is less cutting of the tissue surrounding the knee. The incision is typically 4-6 inches. 
  • The surgeon avoids cutting into the quadriceps muscles because much of the power of the knee comes from the quadriceps. When this muscle and tendon group cut or damage as in traditional knee replacement it takes longer to recover strength and stamina of the muscle group. Dr. Martin utilizes a midvastus approach. 
  • Due to the limited visualization of a smaller incision, other means are needed to ensure proper placement of the implants. Dr. Martin utilizes the Makoplasty robotics system which provides proper positioning of implants based on the patient’s anatomy from a CT scan. 
  •  The artificial implants used are the same as those used for traditional knee replacement. Dr. Martin uses Stryker Triathlon for his patients. 
  • Patients are often allowed to go home the same day as surgery, full weight on the leg, using a walker for balance purposes. 
  • Physical therapy recommendations are patient dependent, but all patients are recommended a home exercise program. They are encouraged to participate in non-impact exercises IE the recumbent exercise bike to help increase range of motion and reduce stiffness. 

Good Candidates For Minimally Invasive Surgery

Most patients who are candidates for a traditional total knee replacement are candidates for a minimally invasive approach with the robotics system. Dr. Martin, however, determines candidacy based on several factors including body structure, knee deformity, previous surgeries, and other disease processes that may affect the replacement and subsequent healing. 

Quicker Surgery Recovery Time

Recovery from a minimally invasive total knee replacement is much different now than traditional replacements were a few years ago.

dr martin demonstrating use of makoplasty robotic technology
  • Dr. Martin’s patients no longer stay overnight in the hospital unless there are specific  social or medical requirements. 
  • Patients are up and walking within hours of the surgery with the aid of a walker for balance. 
  • Exercises begin the same day as surgery, progressing to more aggressive exercises as the patient heals. Depending on how the patient is recovering Dr. Martin may recommend formal outpatient physical therapy. 
  • There are no stitches or staples to be removed as Dr. Martin uses all absorbable sutures.  Patients begin showering 3 days after surgery when the dressings are removed. 
  • Depending on the surgical leg and pain control, patients resume driving within 1-2 weeks for surgery. 
  • Returning to work is largely based on the type of job a patient has. Stationary or desk jobs can be resumed as early as 1 week but more physical jobs may take up to 6 weeks. 
Categories
Knee Minimally Invasive Knee Surgery

What Is Minimally Invasive Knee Surgery

Minimally invasive knee replacement surgery refers to modifications of conventional knee replacement surgery designed to reduce tissue trauma and improve recovery time. Knee replacement surgery is one of the most successful procedures in modern orthopedics. The procedure involves resurfacing the knee joint with biomaterials that substitute for the worn-out bone and cartilage.  Many conditions can lead to the need for knee replacement surgery. The most common causes are:

dr martin examining a knee fracture from xray

 

  • Osteoarthritis
  • Rheumatoid arthritis
  • Injury
  • Avascular necrosis
  • Knee deformity
  • Gout 

Although modern techniques have allowed conventional knee replacements to last well and improve function, many patients still experience considerable pain and lengthy recovery following surgery. Uncomfortable physical therapy is a particular concern for patients looking to make a quick return to work and activity.  While adults of any age can be considered for knee replacement, most are performed on patients between the ages of 55 and 80. The best results tend to be seen in healthy active patients with few medical problems. 

Surgeons are constantly modifying their technique to improve the results of knee replacement surgery. “Minimally invasive” refers to those techniques that minimize the trauma to the soft tissues and bone around the knee.  Traditionally this meant simply making a smaller skin incision but more recently implant companies have developed specialized instruments that cause less trauma beneath the skin as well. Perhaps the most radical form of “minimally invasive” knee replacement involves modern robotic-assisted procedures where the soft tissues are protected during the cutting of bone by a robotic controlled saw blade.  These modifications to conventional knee replacement surgery are allowing greater numbers of patients to return home within hours of their surgery. 

What Does Conventional or “Traditional“ Knee Replacement Surgery Typically Involve?

  • Large incisions
  • Significant postoperative pain
  • Several day stay in a hospital
  • Postoperative rehabilitation
  • Extensive physical therapy

Patient satisfaction after traditional knee replacement has been described as ranging from 75% to 92%. This means that up to 25% of patients are dissatisfied with their results following surgery.  There are many reasons why patients are dissatisfied after knee replacement surgery but the most common are pain, stiffness, and deformity. The demand for knee replacement is increasing and the average age of patients receiving knee replacement is decreasing.  As people live longer and stay active later in life they put a greater demand on their joints. Modern medicine has responded with technological advances designed to improve the function and longevity of knee replacements.

Another major reason for dissatisfaction after knee replacement is the development of complications associated with the surgery.  Although knee replacement is one of the safest orthopedic procedures performed serious complications can still occur. These can range from skin reactions caused by medications to infection and blood clots.  A person’s overall health should be optimized prior to undergoing surgery to lessen the possibility of complications. Many times a patient’s primary care physician or specialist is consulted to help with this process.  Major advances have been made to our surgical protocols that decrease the risk of complications.  

Benefits Of Minimally Invasive Surgery

One example is outpatient joint replacement.  Healthy patients undergoing “minimally” invasive surgery are usually candidates for returning home the same day as surgery.  This promotes rapid recovery with early walking and decreases the chances of hospital-acquired infection. Many other advances will be discussed in upcoming articles.  

The overall concept of knee replacement surgery is the same for minimally invasive and traditional knee replacement. Biomaterials are used to resurface the worn-out cartilage on the ends of the knee joint.  The most commonly used materials are cobalt chrome, titanium, and polyethylene plastic. The design of the implants is fairly standardized with slight differences between manufacturers. The same implants can be used for either minimally invasive or traditional knee replacement.  It may be best to think of “minimally invasive” and “traditional” knee replacement as different techniques used to perform the same procedure.  

What Should I Expect During Minimally Invasive Knee Surgery?

Knee replacement surgery begins with an incision over the front of the knee. A second lengthwise incision is made beneath the skin going around the kneecap. This allows the surgeon access to the knee joint. In traditional knee replacement surgery, blocks of metal are aligned and fixed to the bone to guide the surgeon as he removes the ends of the bones with a special saw.  Metal implants are then fixed to the ends of the bones with a piece of plastic fixed in between. A plastic button is also sometimes fixed to the underside of the kneecap to complete the joint replacement. The soft tissue incisions are then repaired with suture material and a soft tissue dressing is applied. Patients are encouraged to start walking as soon as possible after surgery.  A physical therapist often helps the patient get out of bed and walk during their stay in the hospital.   dr martin looking at stryker diagram of knee

The major difference between minimally invasive and traditional knee replacement is in the handling of the soft tissues. The same implants still need to be attached to the ends of the bones in the joint but how the soft tissues are handled appears to make a big difference in patient recovery.  Smaller incisions and less soft tissue dissection results in less soft tissue damage which can lead to less inflammation which in turn can lead to less pain and stiffness. However, as with most things there is a trade-off. Sparing soft tissue can lead to better results but it makes the procedure significantly more technically demanding for the surgeon.  A surgeon is typically only as good as what he can see. Making smaller incisions decreases the surgeons ability to see and visualize the joint and increases the potential to make mistakes with implant positioning. Where the implants are fixed on the ends of the bones is probably even more critical to optimal results than minimizing soft tissue damage.

Decreased visualization and the technically demanding nature of minimally invasive surgery are the two biggest disadvantages. The next generation of knee replacement surgery utilizing robotic-assistance promises to minimize or eliminate these drawbacks.  This next generation of minimally invasive knee replacement utilizes software that allows the surgeon to visualize a patient’s joint without physically “seeing” it and helps the surgeon determine the optimal position for the implants. After this is done a robotically controlled sawblade protects the soft tissue surrounding the bones of the knee during cutting.  The precise cutting with the robotic arm ensures accurate placement of the implants. These advances improve results with many patients experiencing less pain and better range of motion following surgery than with traditional knee replacement.