Knee Replacement

What are the symptoms of knee arthritis?

The symptoms of knee arthritis are:

Knee pain and swelling begin to occur after physical activity. These symptoms gradually increase and eventually are present even at rest. In severe cases patients may have pain at night, as well as during the day. Motion in the joint decreases, and straightening and bending the knee becomes severely limited.

Arthritis can cause crepitus, which is a grinding noise in the knee during motion. Other symptoms include an inability to walk for long distances, difficulty rising from a chair, climbing stairs, and eventually, difficulty with routine activities.

History
Patients with knee arthritis usually describe a gradual onset of knee pain, restricted motion and activities, and pain at rest. The physical examination findings of knee arthritis may include:

• painful gait on the involved side which causes a limp.
• a a knock-kneed or bowlegged condition. Most often there is a loss of complete extension (flexion contracture), and the inability to fully bend the knee.
• Very often there is swelling.
• Frequently bone spurs may be felt on the inside or outside of the joint.
• When the knee is moved through a range of motion, crepitus is present.

There is usually tenderness around the inside and outside portions of the joint line.

It is important to distinguish knee arthritis from hip arthritis or disc degeneration in the lumbar spine, since the symptoms are similar. Diagnostic test and imaging usually, plain X-rays will show the presence of arthritis and any abnormalities in the alignment of the lower leg and changes in the mechanical axis. MRI scanning is usually not necessary to diagnose knee arthritis. There are four classic features of knee arthritis:

• Joint space narrowing
• Flattening of the femoral condyle (the end of the femur)
• Subchondral sclerosis (reactive bone thickening)
• Peripheral bone spur formation

Non-operativeTreatment
Conservative treatment options are always tried first. These include:

• activity modification.
• exercise and conditioning.
• anti-inflamatory medication.
• Physical therapy programs in water (aquatic therapy) allow patients to exercise in non-weightbearing situations.
• Shock-absorbing shoe inserts often relieve some pain during activities.
• The injection into the joint of either cortisone or newer visco supplements such as hyaluronic acid may provide temporary relief for moderate to severe conditions.
• neoprene sleeves and other dynamic braces to correct mal-alignment of the leg.

Operative Treatment
Patients having night pain, difficulty walking or performing normal activities may be candidates for surgery. Operative treatments may include:

• arthroscopy and debridement (removal) of loose chondral fragments in the joint lining if the patient has symptoms such as pain and swelling.
• osteotomy, which corrects the mal-alignment of the lower leg.
• Finally, knee replacement surgery may dramatically relieve the symptoms of knee arthritis.

Total Knee Replacement
Total knee replacement is an option for the patient who has not improved after trying the conservative measures described above and whose quality of life is severely affected. In knee replacement surgery all diseased cartilage is removed, and a metal and plastic prosthesis or replacement, is inserted. It is attached to the bone with bone cement or ingrowth of bone into the prothesis. The surgery takes one hour and is performed as out-patient. The results of knee replacement surgery are reliable, and over 95% of patients report good to excellent results at ten years.

Operative Recovery
The incision must be kept clean and dry for the first two weeks after surgery to allow for healing. Two to three weeks after the operation, sutures or staples are removed during an office visit. During the recovery process, most patients use:

• some form of walking aid such as a walker, crutches, or a cane for six to eight weeks following knee replacement surgery.
• NSAIDS (anti-inflammatory medicines) and water therapy to enhance the results of surgery by maintaining muscle tone and range of motion. Significant physical therapy is added 1-2 days after surgery to strengthen the muscles around the knee and achieve full range of motion.

In some cases, the symptoms of knee arthritis may disappear as early as two to three weeks after surgery, but it may take up to six months to achieve full recovery. Usually throughout this time pain steadily decreases.

The physician will check the patient's range of motion and functional status six to eight weeks after surgery. The prosthesis should be examined annually for loosening or wear.

Complications

Complications that follow knee replacement surgery are rare but can be severe. These include:

• infection of the joint, which usually requires additional surgery and treatment with antibiotics.
• If the wound doesn't heal properly, or the replacement components loosen, an additional surgery will be required.
• Medical complications such as deep venous thrombosis (blood clots) can occur.
• Existing heart, lung, and kidney problems can worsen.
• Fractures around the prosthesis may also require additional surgery.

Am I too young for knee replacement?

Older age is not a strict criterion for knee replacement. Incapacitating pain, limited function, and poor quality of life due to degeneration of the joint from arthritis are the indications for knee replacement.

How long do knee replacements last?

Modern knee replacements have a 90-95% survival rate and performance for multiple decades.

How long does it take to recover from knee replacement surgery?

Our knee replacement surgeries are outpatient. Walking begins the day of surgery. A walker or crutches are used for 2-3 weeks, and full recovery takes 3 months.