Advanced Knee Care

Knee Surgeon and Specialist Stefan D. Tarlow, M.D.

Warning Signs That You May Need Knee Replacement Surgery

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Signs You Need Knee Surgery

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.

Signs You Need Knee Surgery

  • Severe pain in the knee and the surrounding area, which already affects your daily activities.
  • Knee pain is still present even when you are resting, feeling moderate to severe pain day or night.
  • Knee swelling and inflammation that no longer respond to medications.
  • Knee stiffness.
  • Bowing out of the leg.
  • Taking NSAIDs no longer provide relief for the pain.

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.

  • Weakened muscles and ligaments in the knee.
  • Deformities of the area outside the knee joints.
  • Limited mobility due to loss of functionality and chronic pain.
  • Continued degeneration of the knee joints which leads to various complications.
  • Reduced success rate of surgery in the future.

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.

Contact a Surgeon

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 Makoplasty knee replacement surgery, don’t hesitate to come straight to TarlowKnee. We provide advanced knee care in Arizona.

Contact us to schedule an appointment.

Should I Wear a Custom Knee Brace after ACL Knee Surgery?

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acl knee surgery

ACL is one of the major and most important ligaments found in the knee. It is also susceptible to tear and injury. This kind of injury is common among athletes, particularly those playing sports which involve sudden changes in direction, stops, and jumping. ACL tear is a serious injury in the knee. If you have this, it becomes too painful and unstable for you to bear your own weight.

ACL tear can be treated in various ways, depending on the severity of the injury. However, in worst cases, reconstructive surgery is necessary. Patients undergo ACL knee surgery to fix their injury. This is followed by months of rehabilitation. After the rehabilitation, the athletes and other individuals who have undergone such reconstructive surgery will find themselves returning to their normal lives.

Many patients, particularly athletes, use knee brace to protect their knee from reinjury and to help them be quicker and stronger in doing functional activities like jumping, pivoting and running. So the question now is: should one wear a custom knee brace after ACL knee surgery?

There is no scientific data that supports this. It is true that wearing functional ACL brace helps protect the knee from twisting forces. It may also protect the implanted ACL graft particularly during the rehabilitation period. Some athletes feel more confident and safe when they are wearing a brace. They feel that it helps joint position and lowers their fear of reinjury. They believe that the ACL brace will prevent reinjury during the transition back to their normal lives and activities.

However, there is no scientific evidence that supports this belief. Based on scientific data, it is not yet proven that ACL brace help decrease the rate of reinjury. Not to mention the fact that the effectiveness of the brace diminishes as the activity levels increase.

Nevertheless, braces do increase the patient’s confidence in themselves, which psychologically helps them live and functionally normally again. Braces also protect healing tissues during the rehabilitation period.

Going back to the question, should one wear a custom knee brace? Yes, though it does not totally guarantee that you will be free from reinjury. Knee brace definitely helps in promoting a smoother and more efficient transition back to work or sport. In fact, in selected patients, ACL braces are prescribed as part of the rehabilitation program. They are advised to use ACL brace 3 to 12 months after the reconstructive surgery.

If you still have doubts whether to use custom knee brace after the ACL knee surgery, you can simply ask your orthopaedic surgeon. Make an appointment with our “knees only” orthopaedic surgeon so we can cater to your needs and concerns.

Total Knee Replacement Revision

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Total Knee Replacement

Despite the success of Total Knee Replacement, it can still fail over time due to various reasons. The most common are the following: wearing out of the replacement artificial joint, dislocation, and fracture. When any of these occur, your knee may become swollen, stiff, unstable and painful. If this happens to you, you may need to undergo a Total Knee Replacement Revision.

Revision of Total Knee Replacement

Basically, Total Knee Replacement revision is a second surgery. This is recommended when the knee replacement fails for some reason. In this surgery, the doctor will remove, either totally or partially, the prosthesis or artificial joint and replace them with new ones.

In the first total knee replacement, the knee joint is replaced with an artificial one, an implant also known as prosthesis. Such is made of plastic and metal components. If these fail, they will be replaced with new ones during the revision procedure. This is so because the implant may loosen or wear out over time and due to other factors.

Different types of revision surgery are available. In some cases, the whole implant is removed and replaced; while in others, only its parts are replaced. The artificial joint or prosthesis has three main components: femoral, patellar and tibial. They come with metal pieces which serve as substitute for the missing bone. All these may be replaced with new ones or only some, depending on the patient’s individual situation and condition.

Generally, the primary and revision Total Knee Replacement have the same goal; that is, to restore and improve function and to relieve pain. However, revision surgery is a more complex procedure. It requires specialized implants, extensive planning and longer procedure. But the result is still the same or even better.

Commonly Identified Benefits of Total Knee Revision

The revision procedure generally has the same benefits as the primary Total Knee Revision. But studies show that majority of patients who have undergone revision surgery experienced long-term outcomes. Some of these benefits are the following:

  • Increased function and stability.
  • More efficient pain relief.
  • Faster recovery period.
  • Regain of previous mobility.
  • Getting back to performing normal activities.

TKR Surgery Fact: Do Both Knees End Up Being Replaced?

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total knee replacement

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.

ACL Reconstruction Recovery

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ACL reconstruction knee surgery includes repairing or reconstructing the ACL, which is the anterior cruciate ligament. This type of surgery benefits the athletes who have injured or torn their ACL.

Effective, efficient recovery and patient satisfaction are two of the most important goals after ACL reconstruction knee surgery. This is done by restoring the normal stability of the knee, as well as the level of function. It also helps prevent degeneration and possible injuries in the future.

ACL Reconstruction Recovery

How effective is ACL reconstruction, especially when it comes to the return to play aspect? Let us take a look into a study conducted in New York. The study involved 230 patients and the results of which were published in the Journal of Bone and Joint Surgery in 2017. Based on the study, the efficient recovery and patient satisfaction are high after ACL reconstruction recovery in active athletes. The results and findings of the study are reported and recorded as follows:

  • 87 % of people returned to play by a mean of 10 months (range 3-17 months)
    Most notably, patellar tendon autograft patients had the highest likelihood of return to play. However, it was found out that participation in soccer and lacrosse decreased the odds of returning to play; as such sports require strenuous and intense usage of the knees and legs.
  • 95 % of people were satisfied with their surgical outcome, most of which are athletes. Moreover, 98% of patients stated they would undergo the surgery again. This goes to show that the patients who have undergone ACL reconstruction felt stronger and more confident after the procedure.
  • However, there are patients who are concerned about the “strength” of their knee. In fact, this is the most common reason why patients are afraid to or have doubts of returning to play.
  • But overall, patients who returned to play were very satisfied with their surgical results.

The important thing about ACL reconstruction is its effects and satisfaction rate. You may not be able to restore the same function as the original, but at least you will still be able to return to play and engage in sports and other activities.

If you wish to know more about ACL reconstruction, how it works, what are the risks and others, check out Tarlow Knee. We perform ACL reconstruction and other knee surgery. Make an appointment with us today.

Total Knee Replacements: An Overview

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Younger Patients Driving Increase in Total Knee Replacement Surgery

From 1997 to 2007, the number of total knee arthroplasty (TKA) procedures performed annually in the United States doubled, with much of the increase taking place in younger patients, according to a study presented at the 2011 AAOS Annual Meeting.  Data has shown that younger and healthier patients have better post-TKA outcomes, the indications for performing surgery have been expanded to include these patients.  Keep in mind that more surgery in younger patients drives up the cost of US Healthcare, but better outcomes in young people justify the increase in costs.  Treating severe knee disability increases the productivity of these working aged people and improves quality of life for 20-30 years.

During the study period, the overall U.S. adult population grew slightly (1.13-fold and the prevalence of obesity grew 1.12-fold). But the number of TKAs performed more than doubled—from 264,311 in 1997 to 549,707 in 2007. When researchers examined population growth, obesity rates, and number of TKAs performed by age group, they found the greatest growth in TKAs among those younger than age 65.

What is driving the increase?

Obesity and population size accounted for 22.6 percent of the approximately 100 percent increase in the number of TKAs performed,” said author Elena Losina, PhD, director of the Orthopaedic and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital in Boston.

The rapid expansion of TKA utilization can not be fully explained by increases in population and obesity prevalence.

Other factors that may be driving the increase in TKA include an increasingly active population and expanded indications for surgery among a younger patient population.
Previous studies have linked sport-related knee injuries and increased physical activity in younger people to an increase in early-onset osteoarthritis. Therefore, active lifestyle increases may help explain why rising numbers of younger patients are receiving TKAs.

4 Million Total Knees Walking Around the U.S.

From March, 2013 Journal of Bone and Joint Surgery

In the last decade, the number of total knee replacements performed by Knee Surgeons annually in the United States has doubled, with disproportionate increases among younger adults. While total knee replacement is a highly effective treatment for end-stage knee osteoarthritis, total knee replacement recipients can experience persistent pain and severe complications. We are aware of no current estimates of the prevalence of total knee replacement among adults in the U.S.

We estimated that 4.0 million  adults in the U.S. currently live with a total knee replacement, representing 4.2% of the population fifty years of age or older. The prevalence was higher among females (4.8%) than among males (3.4%) and increased with age.

Among older adults in the U.S., total knee replacement is nearly as prevalent as congestive heart failure. Nearly 1.5 million of those with a primary total knee replacement are fifty to sixty-nine years old, indicating that a large population is at risk for costly revision surgery as well as possible long-term complications of total knee replacement.

These prevalence estimates will be useful in planning health services specific to the population living with total knee replacement.

No Benefit Found For Continuous Passive Motion (CPM) After Total Knee Replacement

Advanced Knee Care, experts in knee replacement surgery,  is not able to recommend for the use of CPM after Total or Partial Knee Replacement surgery.  Unfortunately, some things that we do in medicine, we do because we’ve always done it, not because there are good data to support that practice.  Patients have come to expect the CPM — they hear previous patients talking about how it helped them recover, and they think they need it.  Here’s the thing — current data does not support it. Over the past 10 years, hospitals that specialize in total joint replacement have studied the use of CPM versus moving a patient rapidly into active therapy, and found that CPM is no better for a patient than introducing physical therapy shortly after the surgery. Evidence based treatment decisions show that  CPM had no significant advantage in terms of improving function or range of movement, and that its use increased blood loss and pain medication requirements. Another study concluded Continuous passive motion (CPM) gives no benefit in immediate functional recovery post-total knee arthroplasty (TKA), and the postoperative knee swelling persisted longer.  A third study concluded CPM did not lead to improved knee range of motion after Knee Replacement Surgery.

Dr.Tarlow says:  “It is time that we as surgeons only prescribe treatments in which costs are justified because of improved patient outcomes after knee surgery.  CPM machines do not satisfy this criteria.  It’s time to break the bad habit of prescribing things that do not aid in patient recovery”.

High-Impact Sports After Total Knee Arthroplasty

Patient reported activities often reveal non compliant behaviors after total knee
replacement (TKR). Although surgeons generally recommend avoiding heavy manual labor and high impact sports, there has been few medical studies to guide these traditional recommendations.

Mont et. al.reported on thirty one patients with knee replacements that participated in high impact sports including jogging, singles tennis, racquetball, squash and basketball on average 4 times per week. After an average four year followup, thirty two of the thirty three knees had successful clinical and x-ray outcomes. These results indicate that some patients will participate in high-impact sports and enjoy excellent clinical outcomes at a minimum 4 years after surgery. Clearly, patients with TKR participate in activities considered risky by surgeons.

At least in the short term, doing so does not appear to detract from the success of the procedure.

Total Knee Patient Experience Survey for Dr. Tarlow

The quality department at an inpatient surgical facility has provided the following survey summary.

1.  88 % of patients found the preop phone call from the hospital nurse helpful, and none of the patients would have preferred to come to the facility for an in person information session.  In 2016 the need for face to face communication for certain tasks is not desirable.
2.  3 months after Total Knee Replacement 37 % of patients rated their pain as worse than expected.  The average Total Knee patient needs 9-12 months of healing time so this survey result is expected.
3.  One year after Total Knee Replacement 90 % of people believe the surgery met their expectation and 10 % have not had their expectations met.  This is better than most scientific studies that report 80 % of patients had expectations met.

What is New in Total Knee Replacement

A summary appeared in the January, 2016 JBJS and here are the highlights.

Risk stratification is predictable and accurate for Knee Replacement patients.  Patients at higher risk for complications should postpone (if risk factors are modified) or avoid knee replacement surgery.  These risks are uncontrolled diabetes (higher risk of deep infection, blood clot, periprosthetic fracture, aseptic loosening, and poorer Knee Society function score.  Morbid obesity (BMI > 40)  is a patient factor associated with increased medical costs and complications including medical complication (heart attack, pneumonia, etc), postop knee infection, return to the operating room for a second procedure and longer hospitalization.  Morbidly obese patients have a higher risk of in hospital death after knee replacement surgery.

There is no evidence to support a particular design, brand, or material impact range of motion, clinical scores or quality of life.

The value of computer assisted TKR surgery remains undefined.  One study showed an insignificant improvement of leg alignment but no better rotation of tibial or femoral components compared to standard non navigated surgery.

Patient specific custom cutting blocks showed no improved clinical, operative or radiographic results.

 

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