Other Knee Pain Treatments
Knee Pain Causes
Treatment for knee pain
Suppose initial treatment methods do not provide relief, and X-rays show problems with the joint. In that case, your surgeon may recommend total joint replacement for the knee, also called knee replacement.
Why have Knee Replacement Surgery?
Knee replacement surgery is indicated for the treatment of severe pain and mechanical stablity problems in the knee. The most common condition that results in the need for knee replacement surgery is osteoarthritis.
Destruction of the knee joint secondary to osteoarthritis is characterized by the breakdown of joint cartilage. Damage to the cartilage and bones then limits movement and causes pain. Patients with severe degenerative joint disease are unable to do normal activities that involve bending at the knee, such as standing for long periods, walking, or climbing stairs, because it is painful. As a result, the knee may swell or “give way” because the joint is not stable.
Find out if you are a candidate
Other types of arthritis, such as rheumatoid arthritis and traumatic arthritis that results from a knee injury, may also lead to degeneration of the knee joint. In addition, certain types of fractures, torn cartilage, and/or torn ligaments may lead to irreversible damage to the knee joint.
If non-surgical medical treatments do not work, knee replacement surgery may be an effective last option for treatment. Some of these medical treatments for degenerative joint disease may include, but are not limited to, the following:
1. Anti-inflammatory medications such as Motrin and Tylenol
2. Glucosamine and chondroitin sulfate injections
3. Narcotic Pain medications
4. Limiting painful activities
5. Help devices for walking (such as a cane)
6. Physical therapy
7. Cortisone steroid injections into the knee joint
8. Viscosupplementation injections (to add lubrication into the joint to make joint movement less painful)
9. Weight loss (for obese persons)
10. GAE (Genicular Artery Embolization)
Risks of a Knee Replacement Surgery
With any surgical procedure, complications can occur and knee replacement surgery is no exception. Some possible complications may include, but are not limited to, the following:
1. Bleeding: Bleeding inside the joint can lead to a collection that can lead to blood loss or compression syndrome resulting in re-opening the surgical incision to the site to fix.
2. Infection: A pus pocket can form inside the joint underneath the incision site which usually requires an entire replacement surgery where all of the old hardware has to come out and be replaced with new hardware.
3. Blood clots in the legs and the lungs: This is called a DVT that forms in the large veins in the legs because of the long period the patient is unable to walk after surgery. The danger here is that if this clot breaks free, it can travel into the lung and cause what is called a PE which can be fatal.
4. Loosening or wearing out of the prosthesis: Like any hardware, the metal components can get loose or get out of alignment whereby needs additional surgery to fix. Eventually, the hardware can wear out if the patient lives long enough and may need replacing.
5. Fracture of the leg bones: Spontaneous fractures of the leg bones above and below the knee replacement can occur as bones soften with age. The hardware can act like a hard shelf in between two weight-bearing bones that under the stress of the patient’s weight can fracture. This would require additional surgery to fix.
6. Continued pain or stiffness: Scare tissue can form surrounding the joint making the joint very stiff to move and resulting in a new type of pain altogether. Sometimes patients have to be put to sleep to help bend the knee joint under anesthesia in an attempt to break down the scar tissue. However, this does not always work.
The metal replacement knee joint may become loose, be dislodged, or may not work the way it was intended. The joint may have to be replaced again in the future.
Nerves or blood vessels in the joint area of surgery may be injured, resulting in permanent weakness or numbness. Joint pain may not be relieved by surgery.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure. The two biggest risk factors include:
- Diabetes: Patients who are diabetic are at very high risk of getting an infection after surgery which would likely require having to get a replacement surgery done.
- Anesthesia Risk: Patients have to be put to sleep for this surgery and if the patient has heart or lung problems, this surgery may be too risky to perform.
During the surgery
Knee replacement requires staying in a hospital for a day or two. Surgeries may vary depending on the patient’s condition and the doctor’s practice.
Knee replacement surgery is most often performed while patients are asleep under general anesthesia. Your anesthesiologist should discuss this with the patient in advance which should include the risk of having anesthesia
The usual day of the knee replacement surgery process:
1. The patient will be asked to remove clothing and will be given a gown to wear.
2. An intravenous (IV) line will be started in your arm or hand.
3. The patient will be positioned on the operating table.
4. A urinary catheter will be inserted.
5. If there is excessive hair at the surgical site, it may be shaved off.
6. The anesthesiologist will continuously monitor the heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
7. Skin over the surgical site will be cleansed with an antiseptic solution.
8. The surgeon will make an incision in the knee area.
9. The surgeon will remove the damaged surfaces of the knee joint and resurface the knee joint with the prosthesis. The prosthesis is made up of metal and plastic. The most common type of artificial knee prosthesis is a cemented metal prosthesis. Uncemented prostheses are not used anymore. A cemented prosthesis attaches to the bone with special surgical bone cement. An uncemented prosthesis attaches to the bone with a porous surface onto which the bone grows to attach to the prosthesis. Sometimes, a mix of the 2 types can be used to replace a knee.
The prosthesis is generally comprised of 3 components:
- The tibial component which is used to resurface the top of the tibia, or shin bone.
- The femoral, thigh bone, component is used to resurface the end of the thigh bone.
- The patellar component is used to resurface the bottom of the kneecap that rubs against the thighbone.
- The incision can be closed with stitches or surgical staples.
- A surgical drain will be placed in the incision site to remove fluid.
- A sterile bandage or dressing will be placed on top of the incision.
After the procedure
In the hospital :
After the surgery the patient will be taken to the recovery room for observation. Once the blood pressure, pulse, and breathing are stable and the patient is alert, they will be taken to the overnight hospital room. Knee replacement surgery usually requires a hospital stay of several days.
It is very important to begin moving the new joint after surgery the reduce the risk of scar tissue formation and a blood clot (DVT) forming the the leg. A physical therapist should meet with the patient soon after the surgery and plan out an exercise program. A continuous passive motion (CPM) machine is used to begin mechanical physical therapy. This machine moves the new knee joint through its range of motion while the patient is resting in bed. Pain should be controlled with narcotic medication so that the patient can tolerate and participate in the exercise. Lastly, the patient should be given an exercise plan to follow both in the hospital and after discharge.
The patient will be discharged home or to a rehabilitation center. In either case, the doctor should arrange for the continuation of the physical therapy until the patient can regain muscle strength and good range of motion.
At home:
Once the patient is at home, it is important to keep the surgical area clean and dry. The doctor should give specific bathing instructions. The stitches or surgical staples should be removed during a follow-up office visit.
To help reduce swelling, patients should be asked to elevate your leg or apply ice to the knee.
Patients are encouraged to take a pain reliever for soreness as recommended by the doctor. Aspirin or certain other pain medications may increase the chance of bleeding and so should be taken with care. Be sure to take only recommended medications as some pain medications can cause constipation related issues.
Notify the doctor if the patient has any of the following:
1. Fever and chills
2. Redness, swelling, bleeding, or other drainage from the incision site
3. Increased pain around the incision site
Patients may resume their normal diet unless the doctor advises differently.
Patients should not drive until the doctor tells them to. Other activity restrictions may also apply. Full recovery from the surgery usually takes several months.
It is important to avoid falls after knee replacement surgery because a fall can result in damage to the new joint. The physical therapist may recommend an assistive device (cane or walker) to help walk until strength and balance improve.
Making certain modifications to the patient’s home may help during recovery and include, but are not limited to, the following:
1. Proper handrails along all stairs
2. Safety handrails in the shower or bath
3. Shower bench or chair
4. Raised toilet seat
5. Long-handled sponge and shower hose
6. Dressing stick
7. Sock aid
8. Long-handled shoe horn
9. Reaching stick to grab objects
10. Removing loose carpets and electrical cords that may cause you to trip
11. Avoiding stair-climbing until recommended by your doctor
The doctor should give out additional or alternate instructions after the procedure, depending on the patient’s particular situation.