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Knee Replacement

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Do you often skip taking the stairs and opt for elevators because of your knee pain? Does walking few meters feels like too much? If so then you are not alone, you are one of the millions of people who have been suffering from chronic knee pain. There is no point in sugar-coating it as we all know knee pain ruins the fun in life. The positive news is there are options available for those who are suffering from pain. At first, most doctors will try to treat in non-invasive ways that are non-steroidal anti-inflammatory drugs, therapy, or these days even stem cell-derived growth factor injection but if your knee pain is disabling and alternative treatments are not working, knee replacement surgery might be the best route for you. 

A knee replacement surgery can be life-altering for patients with knee pain. This surgery eliminates pain and helps restore mobility so that the patients can resume their active lifestyle. A knee replacement surgery might sound intimidating but advanced technology has made this procedure more effective with the best outcomes. This can be performed in a conventional way where the surgeon seats the implants manually or with the assistance of a robotic arm controlled by the surgeon. Let us understand the difference between these procedures so that they can help you be more at ease. 

 Traditional Knee Replacement Surgery

Traditional knee replacement surgery has been existing for more than 70 years. This technique typically replaces only a part of the joint. Based on the x-ray an experienced surgeon will carefully examine the correct alignment and positioning for the metal implant. The surgeon then cements the prosthesis and all this is done manually by a surgeon. This replaces the damaged part of the knee which results in more natural feeling and movement. It facilitates quicker recovery and returns to normal activities. 

Conventional knee replacement surgery started a revolution in the medical sector and with advanced research and development new forms of surgery have come up to benefit the patients in a better and effective way. It is one step ahead of traditional knee replacement surgery. With the intervention of robotics in medical science it has given another direction, it has touched the orthopedic sector and has proven beneficial in bringing effective results for the patients undergoing robotic knee replacement surgery. 

Do you often skip taking the stairs and opt for elevators because of your knee pain? Does walking few meters feels like too much? If so then you are not alone, you are one of the millions of people who have been suffering from chronic knee pain. There is no point in sugar-coating it as we all know knee pain ruins the fun in life. The positive news is there are options available for those who are suffering from pain. At first, most doctors will try to treat in non-invasive ways that are non-steroidal anti-inflammatory drugs, therapy, or these days even stem cell-derived growth factor injection but if your knee pain is disabling and alternative treatments are not working, knee replacement surgery might be the best route for you. 

A knee replacement surgery can be life-altering for patients with knee pain. This surgery eliminates pain and helps restore mobility so that the patients can resume their active lifestyle. A knee replacement surgery might sound intimidating but advanced technology has made this procedure more effective with the best outcomes. This can be performed in a conventional way where the surgeon seats the implants manually or with the assistance of a robotic arm controlled by the surgeon. Let us understand the difference between these procedures so that they can help you be more at ease. 

 Traditional Knee Replacement Surgery

Traditional knee replacement surgery has been existing for more than 70 years. This technique typically replaces only a part of the joint. Based on the x-ray an experienced surgeon will carefully examine the correct alignment and positioning for the metal implant. The surgeon then cements the prosthesis and all this is done manually by a surgeon. This replaces the damaged part of the knee which results in more natural feeling and movement. It facilitates quicker recovery and returns to normal activities. 

Conventional knee replacement surgery started a revolution in the medical sector and with advanced research and development new forms of surgery have come up to benefit the patients in a better and effective way. It is one step ahead of traditional knee replacement surgery. With the intervention of robotics in medical science it has given another direction, it has touched the orthopedic sector and has proven beneficial in bringing effective results for the patients undergoing robotic knee replacement surgery. 

Suffering from severe arthritis of the knees can be a tedious condition with consistent symptoms such as pain in the knees that worsens over time, stiffness, swelling of joints, etc. These persistent symptoms can become a hindrance in one’s day-to-day functioning.

Non-operative treatments like knee joint injections, activity modification, and anti-inflammatory medications can be the first option for most people, but when these have failed to provide adequate relief, Knee replacement surgery can be of help.

Knee replacement, also known as knee arthroplasty or total knee replacement, is a surgical procedure to resurface a knee damaged by arthritis. Metal and plastic parts are used to cap the ends of the bones that form the knee joint, along with the kneecap.

Traditional total knee replacement involves an incision over the knee of about 7-8 inches, and a recovery period of 3-5 days at the hospital.

According to an article by UW Medicine Orthopaedics & Sports Medicine on Total Knee Replacement surgery most reports of surgeons performing knee replacement surgery have been excellent and the results have shown ten-year success rates above 90 percent.

More than 90 percent of total knee replacement patients experience substantial or complete relief of pain once they have recovered from the procedure. The large majority do not require a cane even if there is the one used before the surgery and can walk without a limp.

The major benefit of total knee replacement surgery is the better quality of life. There is a restoration of the ability to carry out activities that they could not do before, due to the pain and stiffness, etc. The pain and the stiffness from the arthritis are relieved by the surgery. It is reported that the distance one can walk will improve well because of the diminished pain. 

One major complication that can hinder a total knee replacement surgery is the patient’s allergy to metal components. Some people may experience a reaction to the metal that is used in the artificial knee joint as implants may contain titanium or cobalt-chromium-based alloy. This is where Gold Knee Implants come in.

What are Gold Knee Implants?

For patients who have shown an allergic reaction to metals, the Gold knee replacement procedure can be considered a very good option. The knee implants used for the surgery have a Titanium Niobium Nitride (TiNbN) coating on their surface. This coating gives a golden color to the implant and makes it allergy-proof because of inert material’s coating.

Why one should opt for Gold Knee Implants?

The implant gold knee is one of the best artificial joint. It has a longer life span and does not trigger any allergic reactions. According to an article by Bone and Joint 360 the Golden knee implant is compatible with human tissues, and it is highly recommended for patients that are 60 years of age or below.

Knee implants are normally made of an alloy of chromium and cobalt and sometimes they tend to release metal ions inside your body. Patients who may experience an allergic reaction tend to experience inflammation in the knee joint because of the same. Eventually, complications like infections, loosening of the joint, and persisting knee pain develop.

Benefits of a Gold Knee Implant

  • Durable implants due to the titanium coating.
  • The higher life span of the Gold Knee implant as compared to regular knee implants.
  • Works well with new-age surgical techniques. The outcomes are better when compared to regular implants.

There are various types of implants used other than Gold Knee Implants as well, such as metal on plastic implants, which are the most common type of implants, or ceramic on plastic implants, for people who have a sensitivity to nickel used in metal implants, leading to an allergic reaction or people who are sensitive to nickel used in metal implants.

It is important to evaluate all your options before opting for a total knee replacement surgery, the cost, the biocompatibility, and especially about the type of metal that is used, in case the patient is allergic to a certain metal or alloy.

Knee Replacement Surgery is a surgical procedure to reverse knee damage caused by a disease or condition such as arthritis. Also known as arthroplasty or total knee replacement, this procedure involves cutting away the damaged bone and cartilage from the lower end of thighbone and an upper end of shinbone and replacing it with an artificial joint made of metal and plastic polymer.

Overview

For those who have severe knee trauma or knee joint conditions, your doctor might suggest a knee replacement surgery as an option to lead a pain-free life. This surgical procedure may be considered for someone with severe arthritis or knee trauma. The goal of knee replacement surgery is to repair the damage caused to the knee joint and relieve the pain when other forms of treatment such as medications do not work.

Knee replacement surgery is a common treatment for Osteoarthritis. When a patient is diagnosed with osteoarthritis, there is a breakdown of joint cartilage. If the cartilage suffers damage, movement becomes restricted and causes immense pain. People with osteoarthritis experience difficulties in performing day-to-day activities such as walking, climbing the stairs, or bending. These activities might strain the knee, causing it to swell or dislocate, as the knee joint is not stable. Another condition that may require knee replacement surgery is Rheumatoid Arthritis. Performed during an advanced stage, Total Knee Replacement has proven to be the most successful procedure that relieves the person from unremitting pain and deformity. With the advancement in science and technology, the medical fraternity has moved from traditional knee replacement surgery to robotic knee replacement surgery. Following is the detailed information on Robotic Knee Replacement Surgery.

What is Robotic Knee Replacement Surgery?

Severe joint conditions such as Arthritis may not have a complete cure yet. But the treatment methods are getting better and the long-term relief factor is improving as well. In traditional knee replacement surgery, the damaged part of the bone is removed and replaced with an artificial joint implant. Robotic knee replacement surgery is not carried out by a robot on its own (a common misconception due to its name). In this procedure, the same process of the traditional knee replacement surgery is carried out, but with the assistance of a robotic arm. This is the ideal treatment for patients suffering from severe knee pain, as the robotic knee replacement surgery offers long-lasting relief with maximum effectiveness.

When can you undergo robotic knee replacement surgery?

If you are eligible to undergo a traditional knee replacement surgery, then you are also eligible for a robotic knee replacement surgery. But, before you go in for the robotic knee replacement surgery, take the opinion of your doctor. For conditions like osteoarthritis and rheumatoid arthritis, your doctor might prescribe other forms of treatment before suggesting the surgery. Depending upon the severity of your condition and pain, they may recommend less invasive methods such as:

  • Anti-inflammatory medications
  • Pain killers
  • Limiting strenuous physical activities
  • Weight loss
  • Healthy diet
  • Physical therapy
  • Cortisone injections
  • Devices to assist walking (cane/walker)
  • Viscosupplementation injection (to make joint movements less painful)

If you do not get relief through these treatments, your doctor will suggest a knee replacement surgery. 

How does the robotic knee replacement procedure take place?

As mentioned above, the procedure is assisted by a robotic arm, while the orthopedic surgeon controls it. The traditional method involves the surgeon manually removing the damaged bone and cartilage, replacing it with an artificial joint. However, the robotic arm in this method helps the surgeon in performing knee replacement surgery with utmost precision.

Before the surgery, a CT is taken, through which a 3D model of the patient’s knee is created. This allows the surgeon to be more accurate while planning for the surgery and thus executing it further inside OT. As per the plan approved by surgeon, the robotic arm performs a series of tasks such as bone registration, bone resection, intra-operative monitoring followed by implant positioning. During the surgery, the robotic arm works in a predefined space by the surgeon during 3D pre-planning, ensuring maximum bone cutting precision and safety as the surrounding tissues are not damaged.

What are the benefits of Robotic Knee Replacement Surgery?

Since this technique is quite new, the long-term benefits of robotic knee replacement surgery are yet to be determined. But, the short-term benefits of robotic knee replacement surgery are plenty and quite promising.

Reduced recovery time: In a traditional knee replacement surgery, an average patient won’t be able to resume physical activities such as walking, driving, or any strenuous activity until 4 – 6 weeks. But with robotic knee replacement surgery, this time is reduced by half. This is due to the comparatively lesser invasive nature of this procedure, involving smaller incisions and great precision, which ensures that there is lesser bone trauma and the nearby tissues aren’t damaged.

Fewer complications: Patients who undergo robotic knee replacement surgery tend to have fewer complications as compared to those who undergo traditional knee replacement surgery. The minimally invasive nature of this surgery ensures lower chances of infection, so that the patient does not have to take another trip to the hospital.

Lower joint awareness: After the completion of the knee replacement surgery and the associated resting period, you should be able to go about your daily tasks without any hindrance. But, for many patients, these day-to-day tasks might be difficult as they may trigger Joint awareness in the form of stiffness, numbness, or pain. Improved accuracy of the robotic knee replacement surgery, reduces the possibility of joint awareness and relieves pain.

Even though robotic knee replacement surgery is a relatively new procedure to treat arthritis and knee trauma, it has been proven to give better results as compared to the traditional procedure. According to studies, robotic knee replacement surgery offers more accuracy, and its less invasive nature prevents damage to the surrounding areas resulting in lesser blood loss and faster recovery. But before you zero down on your final treatment option, consult with your doctor/healthcare provider and analyze the pros and cons of this treatment method to see if it is ideal for your condition.

You might be thinking: “Why do my joints ache when it’s cold?”

Usually, joint pains are symptoms of some injury or an extension of an underlying health condition. But, the winter season does create more muscle stiffness and joint aches if one is spending more time outdoors. It is also true that many people who suffer from chronic joint issues like arthritis and osteoarthritis find that their condition worsens during the winter season. And, as we all know that warmth improves your blood circulation, keeps all tissues well-nourished, cold weather can lead to a drop in blood circulation levels. Though there’s no scientific evidence behind this relationship, taking a few extra measures to ease joint pain may help you tackle problems related to fluctuating temperatures. Let’s now take a brief look and understand the possible reasons for this kind of pain, tips on tackling joint stiffness during cold, and the reason why you should not have a Total Knee Replacement surgery during the winter season.

POSSIBLE REASONS FOR JOINT PAIN IN THE WINTER SEASON

1. During winters, the protective fluid inside our joints gets thicker leading to stiffening of the joints.

2. Drop in the barometric pressure can cause your muscles, tendons, and surrounding tissues to expand beyond the confined body space which causes pain.

3. Even the nerves become sensitive during the winter season leading to increased anxiety and tension on the muscles and joints.

4. People who are less active in the winter season face issues while maintaining the good health of the joints.

5. During winters, our body circulates less blood to the entire body and even to the central areas of the body causing more pain and stiffness.

TIPS ON TACKLING JOINT PAIN AND STIFFNESS DURING THE WINTER SEASON

During the winter season people who experience chronic joint stiffness and pain, their symptoms get worse due to the cold weather. Taking few measures and extra efforts during winter would help you fight the pain. These tips would not cure your joint pain but help you in causing relief during the winters.

  1. Stay warm

This tip would depend on the area an individual stays in. Depending on the area, if it is too cold they should wear warm clothes and make sure that their hands, legs, and joints that are affected by arthritis are covered at all times. Try to stay indoors whenever possible.  

  • Hydrating is a must

Dehydration makes people sensitive to pain. Drinking lots of water during winter is very important as the dry air makes people feel dehydrated, tired, and achy. Apart from drinking water at regular intervals, drinking warm soups and tea can also help you stay warm.  

  • Take your Vitamin D

Lack of Vitamin D can also be a reason for joint pain. It also raises the risk for osteoporosis. Consult your doctor regarding the best supplement for you.

  • Exercise and be active

People often gain weight during winters. As the weather makes you lazy and you tend to eat more. The excess weight would make your joints pain more as it puts a lot of pressure on it. Hence it is important to stay active and maintain your weight.

REASONS WHY YOU SHOULD NOT HAVE TKR DURING THE WINTER SEASON 

Many patients have this question regarding when is the best time to have a Total Knee Replacement surgery. People should always do their TKR surgery during warm weather as it makes the recovery process better for a majority of people.

1. Changing of clothes

Changing clothes during the summer season is less hectic as you put on fewer layers for obvious reasons on your body making it easier for the wound to be untouched for a longer period. It is always advisable to wear clothes that are easy to wear and remove.

2. Sleeping

Sleeping for few weeks just after the surgery can be a big task and hence it is always good to wear light cotton clothes and light bedding for a sound sleep.

3. Air conditioner and heater

The normal temperature will make less unnecessary usage of the heater and air conditioner while you are recovering from the surgery. Warm weather always allows you to get out for small walks and trips without any hassle.

4. Travelling

Post your in-home therapy, you would be often visiting your therapist for offsite therapy and that’s when avoiding unnecessary (traveling in winter season) and load on your surgery site is crucial. Driving by yourself is a strict NO during this period.

5. Work-life balance
Taking days off and resting for an adequate amount of time is paramount and hence deciding on the right surgery time during your long holidays will help you go through it faster and better. It’s always advisable for seasonal workers to have surgery, especially during their off-season.
 
Several additional factors contribute to one’s recovery, especially total knee replacement. And, despite a successful TKR, rehabilitation will play a key role in a successful recovery. Also, it is important to acknowledge the fact if you are a person that gets affected negatively, then paying closer attention to your diet and supplements becomes of the highest importance. Preparing yourself from the inside out can help you minimize the impact of cold weather in general and also in case of surgery. Consuming vitamin-rich foods and consulting your primary care doctor in case of any difficulty will only in faster recovery.

Overview

A condition that is characterized by pain in the front part of the knee and surrounding the patella (kneecap) is called patellofemoral pain syndrome (PFPS). Doctors also refer to this condition as “jumper’s knee” or “runner’s knee.”

The condition is not serious, despite leading to symptoms ranging from sore to very painful kneecap. Just rest and conservative treatment measures can also lead to pain reduction in patients affected by this disorder.

Causes of Patellofemoral Pain Syndrome

  • Knee Overuse: In many cases, PFPS is caused by vigorous physical activities that put repeated stress on the knee —such as jogging, squatting, and climbing stairs. It can also be caused by a sudden change in physical activity. This change can be in the frequency of activity—such as increasing the number of days you exercise each week. It can also be in the duration or intensity of activity—such as running longer distances.

Other factors that may contribute to patellofemoral pain include:

  • Use of wrong sports training techniques or equipment
  • Altered sizing in footwear or playing surface
  • Wrong Alignment of the Kneecap: Patellofemoral pain syndrome can also be triggered by irregular tracking of the kneecap in the trochlear groove. In this condition, the patella is protruded to one side of the groove upon knee bending. This deviation may lead to elevated pressure between the rear of the patella and the trochlea, irritating the soft tissues.

Factors that add to poor kneecap tracking include:

  • Malalignment of the legs between the hips and the ankles. Malalignment may lead to shifting of kneecap which is very far to the outside or inside of the leg, or it may ride very high in the groove of the trochlea—leading to patella Alta.
  • Muscular disparities or weaknesses, particularly in the front thigh muscles (quadriceps). During knee bending and straightening, the quadriceps muscles and tendon aid in keeping the kneecap inside the trochlear groove. Weak or imbalanced front thigh muscles can lead to poor kneecap tracking inside the groove.

Any individual can be affected by this condition, however, athletes more frequently encounter this problem.

Symptoms of Patellofemoral Pain Syndrome

The sure sign symptom of patellofemoral syndrome is a dull, aching pain usually occurring on the front portion of the knee or around the kneecap. The pain may be felt in one or both knees and often deteriorates with movement.

Other painful symptoms are:

  • Pain during exercise
  • Pain during knee bending, including navigation through stairs, jumping or sitting on your heels
  • Pain after sitting for a prolonged period with bent knees
  • Cracking or popping sounds in the knee during stair navigation or post sitting for a prolonged duration

Diagnosis of Patellofemoral Pain Syndrome

Your doctor will inquire about your knee history and apply pressure on your knee areas. He/she will also move your leg in various positions to help exclude other conditions, having similar signs and symptoms.

To determine the exact cause of your knee pain, your doctor may prescribe imaging tests like:

  • X-rays: A small quantity of radiation enters your body to create X-ray images of your body on a screen. Though this tool sees bone well, it is less effective at enabling soft tissue visualization.
  • CT scans. This technique combines images of X-ray from different angles to form thorough images of internal structures. Though CT scans can envisage both bone as well as soft tissues, the procedure carries a much higher radiation dose as compared to plain X-rays.
  • MRI: MRIs create thorough images of bones and soft tissues, such as the knee ligaments and cartilage using a combination of radio waves and a strong magnetic field. However, they are much more costly as compared to the above diagnostic tools.

Treatment of Patellofemoral Pain Syndrome

In many patients, simple home remedies can improve pain in patients affected by this condition.

1) Treatments at home

Changes in daily routine

Discontinue performing activities that hurt your knee, till your pain is sorted out, including alterations in your exercise routine or moving to low-impact exercises. Latter activities may apply less stress on your knee joint. If your body weight is above normal, dropping weight also helps in reducing pressure on your knee.

RICE Method

Opting for the RICE method may go a long way in improving your state. RICE is an acronym for Rest, Ice, Compression and Elevation.

  • Rest: Avoid applying weight on the knee which is paining.
  • Ice: Apply ice packs for 20 minutes at a single time, multiple times in a single day.
  • Compression: Cover the knee lightly with an elastic bandage, leaving a cavity in the kneecap area, to avoid extra swelling. Ensure that the bandage is loose enough to not cause any pain.
  • Elevation: Rest with your knee elevated to a height above your heart, as frequently as possible.

Medicines

Taking certain NSAIDs like ibuprofen or naproxen can aid in the reduction of swelling and pain. If your pain continues or worsens, preventing knee motion, kindly contact your doctor. Medical treatment for patellofemoral pain syndrome is meant to relieve pain and re-establish the range of knee motion and its strength. In the majority of cases, this pain can be treated by non-surgical means.

2) Non-surgical Treatment

Physical Therapy

Dedicated exercises for improving range of motion, strength, and knee joint endurance can contribute to providing relief in this condition. It is particularly vital to concentrate on strengthening and stretching your front knee muscles as these muscles are the key stabilizers of your kneecap. Experts may also recommend core muscle exercises to build up the muscles in your abdomen and lower back.

Using Orthotics

Orthotics/shoe inserts can contribute to alignment and stabilization of your foot and ankles, withdrawing stress from your lower leg. These devices can either be customized or bought directly.

3) Surgical Treatment

Surgery is very rarely required to treat patellofemoral pain syndrome, only in extreme cases, which are not responding to non-surgical modes of treatment.

Arthroscopy

During this procedure, your surgeon inserts a small camera, referred to as an arthroscope, into your knee joint. The camera shows images of the knee joint on a screen, which your surgeon uses to guide small surgical instruments in the area to be operated on.

  • Debridement: In some cases, removal of damaged smooth, white tissue covering the ends of bones at the joints (articular cartilage) from the kneecap’s surface can give relief from pain.
  • Lateral release: If the affected muscle is very tight to pull the kneecap out of the trochlear groove, this procedure can relax the tissue and resolve the improper alignment of the kneecap.
  • Tibial tubercle transfer: In some cases, kneecap realignment by shifting the patellar tendon along with a portion of the bony prominence on the shinbone may be essential.

A conventional open surgical cut is needed in this procedure. The surgeon detaches the tibial tubercle, partially or completely, to enable shifting the bone and the tendon to the knee’s inner side. The piece of bone is then reattached to the shinbone using screws. In the majority of cases, this transfer permits better kneecap tracking in the groove of the trochlea.

Realignment

In more extreme cases, a surgeon may require operating your knee for re-alignment of your kneecap’s angle or to reduce pressure on the cartilage.

To conclude, Patellofemoral pain syndrome is one of the most common causes of anterior knee pain today. And, while there are several treatment options available to treat the syndrome, it is crucial to accept the fact that your knees are absorbing a huge amount of pressure since the time you have started walking. Plus, with regular wear and tear, knee pain is bound to happen and take a toll over a while as even the knee’s two shock absorbers — pads of cartilage called menisci — start to deteriorate with age. But certain steps like regular stretching and mobility drills, wearing good footwear, and practicing correct form while exercising should be paramount if you are looking to age-proof your knees.