Knee Surgery

Causes of knee pain | Understanding symptoms | Diagnostics | Nonsurgical treatments | Surgical options | Joint Replacement | Knee prevention

 

When is surgery necessary?

When the knee is injured badly or when the joint is destroyed by arthritis, recovery will require a knee surgeon. Of all those people sitting in the doctor’s waiting room for knee trauma, probably 20 percent, or one in five people, will ultimately need surgery.

Those suffering from severe arthritis may have such restricted mobility that they are limited to walking distances as short as a block or two and standing for periods in excess of a quarter of an hour becomes nearly impossible. Eventually pain hampers all activities.

In other cases, where there is a complete ligament tear, surgery is required as the ligament at that point cannot repair itself.

So, who is a candidate?

Knee replacement is a procedure generally reserved for those who are over 60 years of age who are in relatively good health, aside obviously, from their knee pain. In fact, 72 percent of knee replacements are done on those over the age of 65. Generally, this means, they maintain a healthy weight, they do not suffer from cardiovascular problems, and they are not suffering from a terminal illness.

Active knee replacement candidates will find it comforting to know that they will be able to resume some athletics following surgery such as golf, swimming, and walking. Some knee replacement recipients have even continued to play tennis and snow ski. Unfortunately, a knee prosthesis is not quite as effective as a healthy, natural knee, however it will be a great improvement over the preoperative pain and discomfort.

Who is not a candidate?

To receive knee replacement surgery, you must be a good candidate. If not, surgery could prove counterproductive. For some, knee replacement surgery is not in their best interest. Those who are too young, with the exception of those who suffer from severe rheumatoid arthritis, should consider other types of treatment for knee pain since after 15 or 20 years, the prosthesis will need to be replaced. Unfortunately, the bone will need to be cut short to make room for a new prosthesis and function and mobility is likely to be damaged during the second operation. Those who are overweight are not good candidates as the prosthesis (just as the natural knee) is designed to carry a weight in proportion to the person’s body. Too much weight on the prosthesis can cause it to be damaged and subsequent knee surgeries will be necessary. Those with cardiovascular problems and with terminal illnesses are also not good candidates as the surgery may be too much for the body to handle. Also those with poor skin coverage over the knee are not good candidates as surgery could impair movement of the knee.

What knee replacement surgery is like?

During knee replacement surgery, you will be under general anesthesia meaning you will be asleep and without pain during the entire procedure, which usually lasts a few hours. The knee is opened up and the kneecap is moved out of the way. Doctors then, shave off the bottom of the femur and the top of the tibia and fibula bones. The prosthesis is then glued to the bones with special, surgical cement. The knee is then sutured back together and drainage tubes are used to prevent clogging.

Usually, a hospital stay for knee replacement surgery lasts between four and five days. During your time at the hospital, your leg will be attached to a device called Continual Passive Movement (CPM), which will move your knee to prevent stiffness. After the hospital stay, the patient will probably require the aid of a walker for a few days before putting full weight on the leg. Overall, full recovery can take anywhere from two months to one year although dramatic improvements should be seen sooner than that.

Arthroscopic knee surgery

Most knee surgery to treat torn ligaments is now done through tiny incisions using an arthroscope, rather than a large incision. The smaller incisions provide less disruption to tissues and faster recovery. By accessing the knee with an instrument the width of a ballpoint pen, there is less disruption to the joint and its ligaments. The instrument can be used to repair a torn meniscus or other knee problems.

However, the AAOS believes arthroscopic surgery of the knee to be ineffective against knee osteoarthritis symptoms from a degenerative joint surface. Typically, many patients with arthritic knee may have to ultimately consider knee joint replacement. .

Torn ACL Surgery

The Anterior Cruciate Ligament (ACL) works a lot like a guy wire that keeps the femur and the tibia stable. When an athlete tears their ACL, usually it is from a sudden impact that can cause an audible pop or at least a great deal of pain.

Generally speaking, a partially torn ACL stands a chance of recovery without surgery. If the ACL is completely torn, most will need surgery to repair the ligament. Many of those with a torn ACL will need surgery to get back to activity. The procedure itself takes about one hour.

Torn ACLs are one of the most common problems associated with sports. It is important to understand your options if you have a torn ACL.

If you have a completely torn ACL, you will likely need surgery to repair this ligament. If you have a partially torn ACL, depending on the extent of the tear, some people are able to rehabilitate the knee with extensive therapy AND COMMITMENT TO EXERCISE to the point that they have use of the knee again. But you may not have the same strength in the knee joint that you had prior to your knee injury.

Generally speaking, the more you expect to play aggressive sports in the future, the more likely you will need knee surgery to repair a fully torn or partially torn ACL. If you are professional athlete, chances are you will need surgery to get back to full activity.

If you have a torn ACL, the good news is that the problem is fairly common as knee injuries go, and in the hands of a surgeon who specializes in knees, the post surgical knee can be as effective as the knee prior to injury. But most of that depends on the willingness of the athlete to invest the time to rehabilitate and strengthen the knee.

Use of the patellar tendon or hamstring to repair a torn ACL

You should be aware that repairing the torn ACL does NOT involve sewing two torn ends together. Think of your ACL as a rubber band. Once it snaps, it can not be sewn together. Instead, you have to replace the rubber band completely. And that is exactly what the knee surgeon does. They attach a new rubber band to your shin, thread it through your knee and anchor it your femur.

You should ask your physician HOW they repair the ACL. Some knee surgeons use a patellar tendon while many others use a hamstring ligament. There are pros and cons to each.

Harvesting a patellar tendon from the front of the knee makes for a more painful recovery and painful rehabilitation. However, professional athletes who are used to pain from training are more able to tolerate this approach, especially considering that the patellar tendon is viewed by some surgeons to be a higher performance replacement for the torn ligament than the hamstring. Using a hamstring ligament is less painful on rehab of the knee, and some surgeons feel that for most people, the strength of the ligament is sufficient.

Overall, most surgeons would agree that the performance of the knee after ACL replacement is directly linked to how much commitment is given to strengthening the knee with exercises. With the right knee specialist, and with specialized knee rehab, a professional athlete can regain their competitive form and play professional sports again.

Using an arthroscope, the knee surgeon can repair the knee through two tiny half-inch incisions instead of a longer incision which requires a longer recovery and causes a bigger scar. The surgeon will remove a strand from the patellar tendon or hamstring, which will ultimately become the new ACL. A hole is then drilled through the shin bone and a new ACL is threaded through. The new ligament is prepared and secured into place. A plastic dowel locks the new ACL into place. About 30 minutes later, the anesthesia will wear off and the patient is dismissed from the hospital.

During the recovery process, a patient will start off by walking around. A few months later golf is acceptable. After five or six months, the patient is usually allowed to play sports without restriction.

Joint replacements for active seniors

After a lifetime of wear and tear on joints, many active seniors choose to undergo not one but two surgeries to replace their knees. Some seniors opt for joint replacement surgeries so they can still walk, ski, ride bikes and lift weights in their later years of life. While skiing and weight lifting might sound unusual, experts on aging say it hints at a new norm.

Many seniors have dealt with chronic hip and knee problems, and many remain very active after joint replacement surgery including skiing and hiking. They are choosing to undergo knee and hip replacements so they can continue being active in their later years in life. High pain levels and mobility issues associated with chronic joint problems are high contributors of seniors living at assisted care centers.

Joint replacements can make living independently in the later years of life possible for many people. A 12-year 135,000 patient Medicare study showed that seniors that elected to have knee replacement surgery had half the risk of dying within the next seven years as patients who opted against the procedure. Staying active late in life is essential to prolonging a healthy lifestyle in the later years of a senior’s life. It will help keep someone from becoming homebound and could lead to often life-ending problems. Many doctors agree that staying active in the later years of life, not only contributes to staying healthy but also prolongs lives.

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