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An article published in the Journal of Arthroplasty compares patient satisfaction rates at 2 years after surgery for both Total Knee Replacement and Unicompartmental Knee Replacement (also termed Makoplasty or partial knee replacement).
This study confirmed that Unicompartmental Knee Replacement patients have higher satisfaction scores (86 % vs 71 %) than Total Knee Replacement patients. The reasons for this include better range of motion, more natural feeling knee, less stiffness, and less serious complications for patients receiving a Unicompartmental Knee Replacement. Additionally, Total Knee Replacement is a more invasive surgery with longer healing times.
For many patients there can be a choice between which type of knee replacement you can have. Make a thoughtful decision based on your specific clinical information and discuss the options with your surgeon. Choose wisely.
One of the most common orthopedic procedures is total knee replacement. This minimally invasive procedure is also known as arthroplasty. It is used to replace worn or damaged surfaces of the knees. Basically, an implant is placed as a replacement for the knee surfaces to increase mobility, relieve pain and help the patient return to his/her normal everyday activities.
Minimally Invasive vs. Traditional Approach
The main goal of total knee replacement procedure is to relieve the pain, restore the health and function of the, and to eventually help the patient return to daily activities. In this procedure, the damaged bone and cartilage are removed from the surface of the knee and replaced with artificial ones.
The traditional approach involves full surgery. It takes longer and leaves a long vertical incision in the center of the operated. Now minimally invasive knee replacement is gaining more popularity over the traditional approach. This is because, as the term suggests, the technique is less-invasive and faster. I also uses a shorter incision; hence, speeding recovery and reducing postoperative complications.
While both traditional and minimally invasive total knee replacement have more or less the same results; minimally invasive promises a faster recovery and lesser risk for complications. The only problem is that unlike traditional approach, minimally invasive procedure is not for everyone. You need to discuss with your surgeon first if you are a good candidate for the said procedure.
Minimally Invasive Knee Replacement
In minimally invasive TKR, the artificial implants used are the same as the ones used in traditional approach. However, the surgical instruments used for the removal of the damaged cartilage and bones and for the placement of the implants are different and more specialized. This is because in minimally invasive procedure, the incision is shorter, about 4 to 6 inches only, compared to the 10-inch incision in traditional surgery. This means less tissue disturbance and faster recovery. Additionally, the technique used in opening the knee is also less invasive, avoiding trauma and reducing risk for infection and other complications.
Among the benefits of minimally invasive knee replacement procedure are quicker and less painful recovery, rapid return to normal daily activities and lesser damage to soft tissues. It also means less stay at the hospital.
As already mentioned, not all people are a good candidate to undergo minimally invasive total knee replacement. If you wish to know if you are a candidate or not, and if you wish to know more about minimally invasive knee replacement; contact an orthopedic surgeon. Make an appointment with Dr. Tarlow today.
This past year, there have been more than 600,000 total knee replacements performed by surgeons in the United States alone. And this number is expected to continually rise for the years to come. This says that despite the long rehabilitation and recovery process of the procedure, more and more people trust the effectiveness and benefit of the knee replacement surgery. But when do you know that you may already need to undergo knee replacement surgery? The answer is both personal and practical.
Sometimes, people wait for things to become unbearable and too much before they decide to get knee replacement surgery. Well, this is more or less a normal response because surgery is a big deal to most people. People prefer minimally invasive and other non-surgical options to treat their knee problem. But there are cases where the only and best option left is to undergo total or partial knee replacement. And there are warning signs for this.
If you feel and experience these warning signs, immediately go to the surgeon and ask for an advice. Chances are, it is high time that you undergo knee replacement surgery before things get from bad to worse.
These are serious signs. These signify that you must not delay because things are surely starting to get worse. The best warning that you must really heed is when the surgeon himself has advised you to undergo surgery as soon as possible. If you don’t heed such warning signs, you may suffer from any of these repercussions.
There is no hard and fast rule as t when you should need knee replacement surgery. The best advice is that coming from a reliable, experienced surgeon. Factors like medical conditions, age, weight and lifestyle also play a vital role on whether you should undergo knee replacement or not, or when.
But if you already suffer from any of the mentioned warning signs, the best thing to do is not to delay. Immediately seek help from a qualified professional. If you decide to get a knee replacement surgery, don’t hesitate to come straight to TarlowKnee. We provide advanced knee care in Arizona.
Contact us to schedule an appointment.
Not all who have knee problems need to undergo knee replacement. Most of the time, only patients with severe destruction of the knee joint or osteoarthritis end up having their knee replaced. The procedure is medically known as Total Knee Replacement surgery. In this procedure, the defective knee will be replaced with an artificial one. The diseased or injured joint will be replaced with plastic and metal parts which function normally and last long enough for the patient to enjoy doing normal activities again.
Total Knee Replacement is a popular procedure not only for osteoarthritis patients, but also to those who have devastatingly injured their knee. Despite the success and innovativeness of this procedure, some people are still wary of its effects. Some patients are still concerned about the pros and cons of Total Knee Replacement.
But it is not only this that they are worried about. There are reports that say once you have undergone TKR on your one knee, you will likely undergo another procedure on your other knee. Patients raise concern that once you have had one knee replaced, there is a high chance that your other knee will need replacement too. So the question that needs to be answered is this: do both knees end up being replaced? Is this a fact or just a myth? Let us find out if there is any truth to this.
To answer the question, let us take a look into a particular study conducted on the subject. A population study spanning 40 years was conducted. This question was addressed to the TKR candidates: if you had one knee replaced, what are the chances that the other knee will also be replaced through Total Knee Replacement surgery? Based on the data studied, the general finding is this: there is 45% chance that the other knee will be replaced within 11 years after the first knee replacement. In the study, the data of 2,000 total knee patients, spanning from 1969 to 2008, were analyzed. The results show that out of the 2,000 patients who underwent one knee replacement, 809 had their other knee replaced within 11 years after the initial knee replacement procedure. In fact, most of the patients underwent the second knee replacement surgery within 10 years.
Now going back to the question, the answer is yes, it is a TKR surgery fact that both knees could end up being replaced. But this does not mean that TKR as a procedure is not working. It just goes to show that once one knee has encountered an injury or another problem that needs surgery; there is higher chance that the other knee will also encounter the same fate. Still, this does not take away the fact that TKR is an innovative and important procedure. And if you indeed end up having your other knee replaced too with an artificial one, you can still count on the procedure just as you had during the first surgery. As long as it is done right and by the right professional, there is really nothing to worry about.
If you wish to know more facts about Total Knee Surgery or if you need to consult anything about your knee problems or injury, contact Dr. Tarlow at Advanced Knee Care. Make an appointment with us and we will help you with your knee issues.
Knee problems such as osteoarthritis affect millions of Americans every year. Aside from this fact, many people are not that aware that there is a correlation between knee problem and sexual function. Based on a research presented at the annual meeting of American Academy of Orthopaedic Surgeons (AAOS), osteoarthritis of the knee limits sexual activity.
In a survey of Knee Replacement patients, several patients were observed. These patients have undergone knee replacement surgery two years prior. The results and findings of such survey were published in the Journal of Arthroplasty. Before knee replacement, 45% of the patients with knee arthritis said that before knee replacement, their sexual frequency and/or quality was limited. They cited knee pain and limited knee flexions as the major factors that make having sexual activity challenging. After they have undergone knee surgery, 72% of the patients said that they were no longer limited by the aforementioned factors. Postoperatively, patients were able to resume sexual activity at an average of 2 ½ months (ranging from 0-18 months) after the knee replacement operation.
In another study, patients under the age of 70 with a mean age of 57.7 years agreed to participate. The study required them to answer and fill out questionnaires prior their scheduled for primary total knee replacement. They were also asked again six months and then one year after surgery. Out of the 147 patients, 78 of which are women and 68 are men, 65% participated in and completed the three surveys. The result of said study contains the following findings and generalizations:
Sexual function is also a vital part of one’s life. It is only justifiable to include sexuality and sexual activity in the evaluation of the outcome of total knee replacement and other knee surgery. Sexual experience is part of one’s overall health and lifestyle, which is why it is great to note that knee surgery has something to offer as regards one’s overall sexual function.
But there must be a balance between sexual function and taking care of the knee replacement. This is better discussed personally with your surgeon or knee professional. If you need to learn more about knee surgery or if you want to undergo the same, contact Tarlow Knee. Make an appointment with us today.
Much is said about Total Knee Replacement. While many agree that it is a perfectly safe procedure, there are those who say that the surgery can be risky. One of the most common factors that increase the risk for knee replacement is obesity. There is a circulating belief that people who are obese are not fit to undergo TKR. There is higher risk for complications for patients who are obese, they say. How true is this and if so, what are the possible serious complications? Let us find out.
Let us take a closer look into this study conducted by Mayo Clinic which was published in 2016. The study seeks to the address the following question: Is Total Knee Replacement a more risky procedure in patients with high body mass index (BMI)? Luckily, this was answered in the same study.
The study used and reviewed the data of 22,000 patients who underwent Total Knee Replacement. The average BMI of the patients is 31. Out of the 22,000 patients included in the study, 5,500 have a BMI above 35. Based on the results of the study, there was an increased rate of repeat knee surgery (including revision total knee replacement surgery) as well a striking increase of knee joint infection, a serious complications in the morbidly obese group (BMI 35-40).
Complications arose following the Total Knee Replacement among the patients belonging to this group. This answers the question as to the complications that obese patients might encounter after undergoing TKR.
However, in the same study, it has been noted that the risk for complication can be minimized by delaying surgery until obesity and other modifiable risk factors are reversed. While obese patients are at risk for complications when undergoing the procedure, the case is not totally hopeless. In fact, the case can be remedied and these patients can still continue with their treatment with less risk. The risks can be minimized through best practices. This calls for experienced and reliable professionals. If the surgeons employ best practices and proven strategies, they can maximize patient outcomes and surgical success, as well as minimize risk for serious complications among obese patients. In other words, the key to lowering or totally eliminating the risk for such patients during and following TKR is to have the procedure conducted only by trusted and proven professionals.
So if you are obese and you have knee problems, don’t consider yourself as a hopeless cause. You can still have your knee issue fixed without having to worry about serious complications following the knee replacement. As already said, it’s just a matter of employing best practices With the right preparation and right measures before, during a and after the procedure, you will have a successful TKR operation. To reiterate, the key to a successful surgery is a reliable, trustworthy and experienced surgeon.
If you are obese and are having doubts whether to continue with the procedure or not, give us a call. You do not have to look further to find the right surgeon who can ensure a successful, risk-free procedure. We know exactly what needs to be done and what’s appropriate for you and your condition. Our surgeon has the right experience, expertise, knowledge, practices and passion for this kind of procedure to work. Make an appointment with us today for a consultation.
Being experienced is always an edge. Experience is highly important to the success of any endeavour, especially technical ones like medical procedures and surgeries. Knee surgery like unicompartmental knee replacement is specific and technical, and requires not just skills and expertise, but most importantly practice and experience. This is why it matters that you choose a surgeon with specific experience in performing the above mentioned procedure.
Before we tackle the importance of experience to the success of a knee replacement, let us understand the basics of unicompartmental knee replacement or arthoplasty first. This surgical procedure is also known as partial knee replacement, as opposed to total knee replacement (TKR). This procedure is most commonly used to treat and relieve arthritis affecting the knee. If the knee is not totally damaged but only parts thereof such as the medial, lateral or kneecap; only the damaged knee compartment or parts are replaced. This surgery has shorter recovery period and reduced post-operative pain. However, if the whole knee, that is, all the three compartments are damaged, the best solution is total knee replacement.
Whether it’s partial or total knee replacement, it does not take away the fact that the procedure is highly specialized. Not all surgeons perform these procedures. Only those with the special training and education can perform the same. This explains why there are knees-only surgeons.
Now you have a picture of what it takes to perform unicompartmental knee replacement successfully. Training, background and skills are important. But constant practice and experience are even more important. This is how you test whether the surgeon is better or not, this is what separates a best surgeon from the better or the good. With this, it is helpful if you look into the track record of the surgeon and see how many times has he done this type of surgery and what is his success rate. To be sure, you can go directly to a knees-only surgeon.
Knees-only surgeons are focused on treating knee injuries and other related problems. Their training is highly specialized. But again, not all knees-only surgeons are the same although they may have the same level of training and background. What sets a great doctor apart is his experience. We again emphasize the importance of experience when you choose a surgeon to perform a unicompartmental knee replacement or any knee surgery for that matter. The surest way to a successful procedure and fast recovery is through an experienced knees-only surgeon.
If you are in need of one, you don’t need to go far. Contact TarlowKnee today and schedule your appointment.
A 15 year study of middled aged (avg 53 years) of normal body weight (BMI avg 25) from the United Kingdom provides insight on the incidence and severity of symptomatic Knee OsteoArthritis.
These data are gender specific and since this is a normal weight population can not be extrapolated to the obese population. The annual rate at which middle-age women develop knee osteoarthritis (OA) is fairly low, but progression is common when x-ray changes in the joint are already present, a community-based cohort study found.
During 15 years of follow-up there is a 49% lifetime risk of developing symptomatic (not necessarily severe OA of the knee). 51% of normal weight women never develop knee arthritis.
Among the entire cohort, 561 had undergone knee radiography at baseline and then at years 5, 10, and 15.
High body mass index also was associated with an increased incidence, with a nearly 20% greater incidence by year 10 among obese women.
At 15 year followup nearly 30 % of those women with knee arthritis had the disease in both knees. 70 % had symptomatic arthritis in only one knee.
The rate of total knee replacement by year 15 was about 10 %.
The also know risk factors in order of significance are genetics, obesity, female gender, serious knee injury (bone or ligament or meniscus).
|OA is the death of the articular cartilage cells that cover the bone.|
Here is a summary of the recent literature review:
Hyaluronic acid has little effect on pain, none on function, new review states
Tuesday, June 12, 2012
If the first series of injections help then it is likely a repeat series will be successful. Not all insurers reimburse for this medication – so many patients pay out of pocket for the drug and come to the office for the doctor to inject the drug into their knee.
Another unknown is how and why this medication decreases pain – the mechanism is not clear at this time.
Report in JAMA September 25, 2013 (Journal of the American Medical Association) concludes Diet and Exercise is Effective in Improving quality of life (diminishing symptoms of pain, improving function/mobility) compared to exercise alone in overweight and obese patients with Osteoarthritis of the knee. Weight loss was greater in the Diet/Exercise group (11 %) compared to Exercise group (2%).
Details: According to a study published in the Sept. 25 issue of JAMA, diet and exercise may improve quality of life more than exercise alone for overweight and obese adults with knee osteoarthritis (OA). The authors conducted a randomized, single-blind trial of 399 patients who were allocated to one of three groups: diet, exercise, and diet plus exercise. At 18-month follow-up, the authors found that mean weight loss was 11.4 percent for participants in the diet plus exercise cohort, 9.5 percent in the diet group, and 2.0 percent in the exercise group. In addition, knee compressive forces were lower in diet participants compared with exercise participants, and concentrations of IL-6 were lower in diet plus exercise and diet participants compared against exercise participants. Finally, patients in the diet plus exercise group had less pain and better function than those in the diet group or the exercise group, and the diet plus exercise group had better physical health-related quality of life scores than those in the exercise group.
Link to Abstract – https://jama.jamanetwork.com/article.aspx?articleid=1741824.
Dr. T Speaks —– Hello People. There are simple measure that are dramatically effective in helping you treat yourself with medications, injections, or surgery. Make the effort to convert America into a healthier place. This is an easy way to treat a common problem that is effective and will lower health care costs. Take ownership of your own well being.
Research suggesting that physical activity could help prevent Knee Osteoarthritis has been presented this week at the AVS 62nd International Symposium and Exhibition, in San Jose, CA.
Researchers including Dr. Burris at the University of Delaware found that as the sliding speed increased toward typical walking speeds cartilage thinning was reversed. At slow sliding speeds (less than would occur in a joint at typical walking speeds) cartilage thinning and an increase in friction occurred over time. This may explain why walking or cycling can mitigate knee pain in patients with osteoarthritis of the knee.
A healthy joint surface is composed of 80 % synovial fluid (water and proteins). To investigate whether hydrodynamic pressurization could refill deflated cartilage, the researchers placed larger-than-average cartilage samples against a glass flat to ensure that there would be a wedge. Pressure forced fluid back into the articular cartilage stopping the joint surface from deflating. If movement occurs faster than the fluid can diffuse then continuous knee movement could prevent deflation.
Articular Cartilage is a firm, porous, rubbery material covering the ends of the bones in the knee joint. It reduces friction in the joint and acts as a “shock absorber.” Loss of synovial fluid occurs when articular cartilage is damaged or diseased. Osteoarthritis is a degenerative disease resulting from a reduction in the articular cartilage thickness, leading to an increase in friction, inflammation, pain and deformity of legs.
When cartilage becomes damaged or deteriorates, it limits the knee’s normal movement and can cause significant pain, and eventually the need for knee replacement surgery.
|Surface damage to articular cartilage in a knee|
Non Operative Treatment of Knee Pain/Arthritis with BracingAdvanced Knee Care offers a custom bracing service to patients. This service includes a brief physician visit to confirm the diagnosis and need for the brace, a confirmatory x-ray of the knee and a detailed visit with our bracing specialist, Megan. The charge for this screening visit is $50 (insurance will be billed, if applicable).
The concept for this service is that there are many people that can be treated without surgery. A knee brace may be just what is needed to keep one active for years—no surgery required. This treatment is for people with Knee Pain and Knee Arthritis (either in the main joint or in the patellofemoral joint) that do not want a complex or expensive work up by the doctor, have already tried the myriad of other options for knee arthritis (pills, injections, Physical Therapy, Arthroscopic Surgery) and want a streamlined way to purchase a knee brace to help improve their knee function, help them be more active, and help them exercise to stay fit. There are also good bracing applications for runners with knee pain.
A Korean study published in March, 2011 concludes that depression is linked to knee arthritis symptoms. The authors evaluated 660 patients aged 65 years or older; severity of knee OA was assessed based on radiographs and symptoms and depression was assessed based on interviews and patient questionnaires. The presence of a depressive disorder was associated with increased risk of symptomatic knee OA among patients with a radiographic severity of minimal to moderate OA.
Mental well being and a positive outlook help people cope with and tolerate symptoms of disease. In this study, a person with minimal to moderate Knee Osteoarthritis was more likely to have moderate to severe symptoms, and the reason for the increased dysfunction was thought to be due to poor mental health, not poor physical health.
This is a good lesson for both patients and doctors. Always consider a person’s overall health when formulating treatment plans. In some cases treatment should be directed at the cause of symptoms (treat depression, not knee arthritis) for the best outcome.
One way of improving the results of Total Knee Replacement Surgery is to optimize the risk factors. The common patient risk factors include the following: uncontrolled diabetes (Blood Sugar >150, HbA1C>8), Smoking, Obesity (BMI > 40), Opioid use, and Kidney disease. All these risk factors should be corrected prior to having the surgery.
There are treatments available to reverse these risk factors. Uncorrected, the above listed factors increase the chance a patient will suffer an prosthetic joint infection, a return to the operating room for another knee procedure, wound healing problems, revision knee surgery or an unsatisfactory surgical result.
Like any other surgery, total knee replacement carries some risks. However, the occurrence of these risks is quite low: infection, nerve damage, stroke or blood clot. The aforementioned risks are those that might occur during or after the surgery. What we are going to focus on are the factors that might affect the outcome of the surgery. Such factors or risks must be corrected before the surgery is conducted. They include the following: uncontrolled diabetes, smoking, obesity, opioid use and kidney disease.
According to a number of studies, people with diabetes face a higher risk of postsurgical complications. The possible complications that a patient may experience if he/she undergoes a surgery such as total knee replacement with uncontrolled diabetes are the following: joint loosening, fracture around the implant, blood clot, stroke and wound infection.
Diabetes is an important consideration before a patient undergoes a surgical procedure. The research suggests that patients need to control their diabetes before undergoing a major surgery such as total knee replacement. While your blood sugar will be tightly monitored right before and after surgery, it’s up to you to make the long-term lifestyle changes necessary to ensure you get the best outcome. This is an important conversation to have with both your surgeon and the physician or provider who helps you manage your diabetes. Eating well and exercising (if appropriate and with approval from your providers) can help you get your body ready for surgery.
Research shows that there is a correlation between smoking and the success of knee surgery. Some studies put the chance of redoing the surgery at a rate ten times higher in smokers than in non-smokers. Smokers also show higher rate of surgical complications which include blood clots, kidney problems, urinary tract infections, and abnormal or irregular heartbeats. This is because nicotine constricts the blood vessels, which interfere with and affect the healing process.
The best way to get rid of the risks is to quit smoking. You may have tried to do so in the past and not found success, but if you’re going to have total knee replacement surgery, let this be the big push you need to finally quit. In addition to the possibility of increased post-surgical complications, just imagine trying to find a place to smoke while you’re recuperating. Talk with your primary care provider about available techniques and support.
Obesity is the root of various health conditions and diseases like type 2 diabetes, obstructive sleep apnea, cardiovascular diseases, hypertension and metabolic syndrome. All these conditions increase the risk of knee replacement surgery. Aside from these, patients with obesity are also more at risk to experience the following postsurgical risks: blood clots, difficulty breathing, poor and slow wound healing, infection and pulmonary embolism.
To lower the risks and to promote a better result, patients with obesity are advised to lose some weight. It is important that the patient is in good health and weight prior the surgery. Try hard to lose some weight and eat healthy before the scheduled surgery. Your immediate post-surgical health will improve—and along with your new knee, being in better shape will give you a new lease on life.
One of the total knee replacement precautions a patient must know concerns opioid use. One study showed chronic opioid use before a total knee arthroplasty led to worse outcomes for patients, including “longer hospital stays, more postoperative pain, and higher complication rates… [patients] were also more likely to need additional procedures, require referrals for pain management, suffer from unexplained pain or stiffness, and have lower function and less motion in the replaced knee.”
The FDA suggests that patients undergoing knee replacement surgery should decrease the duration and amount of opioid use. There are many other pain management treatments available besides opioids, and you should explore them with your pain management physician—not just because of your surgery, but because chronic opioid use itself brings a whole host of problems you don’t want.
Patients with kidney disease, particularly chronic renal disease, have increased risk for readmission after the surgery. The success of knee replacement surgery is also low and the occurrence of common complications is high among patients with kidney problems.
If you have kidney disease and need to have surgery—any kind of surgery—you and the doctor managing your disease, as well as the surgeon, need to work closely together to assess your risk and make sure surgery is the right course for you. If you and your providers move ahead, techniques like post-operative dialysis, substituting or changing the normal dose of medications like antibiotics given before and during surgery and avoiding pain medications that are known to cause problems are all good strategies to keep you healthy.
We, the patient and the doctor, both want something in common. That is, the best outcome possible of the surgery. Knowing how to reduce the complications is powerful information. It is very important that you follow the tips mentioned in this article and control the risks mentioned to improve the results of your total knee replacement surgery.
If you’re contemplating knee replacement, schedule an appointment to see me and the rest of the team here at Advanced Knee Care. Assessing your needs and the appropriate treatment for you is our top priority.
Scottsdale Knee Specialist & Surgeon – Stefan D. Tarlow M.D
Stefan D. Tarlow, MD, is Arizona’s premier “knees only” orthopedic surgeon.
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