What causes knee pain and what do I do when it becomes unbearable?
As the largest joints in the human body, knees absorb a tremendous amount of stress. Arthritis, tendonitis, bursitis, sprains and strains, cartilage and ligament tears cause knee pain and swelling. Range of motion is usually diminished and weight bearing can become very painful. You should consider seeing an orthopaedic physician when your knee swells or is painful with range of motion activities such as walking, going up and down stairs, squatting and getting up from a seated position.
An orthopaedic surgeon will examine you and obtain an x-ray to determine evidence of arthritis or fractures. An MRI may be indicated to look for cartilage or ligament damage. Treatment often starts with a period of rest and ice for swelling with prescribed anti-inflammatory medications. Sometimes a brace or physical therapy is ordered as well. In cases of arthritis, a corticosteroid or a lubricating medication may be injected. For cartilage tears, arthroscopic surgery may be indicated and if all other conservative measures fail in the face of severe arthritis, the answer may be a knee replacement.
Surgery is usually the last resort when all other conservative measures have failed. Some knee problems such as cartilage tears may not be amenable to conservative treatment and may require arthroscopic surgery immediately. Similarly, some ligament tears require surgical treatment. For more advanced arthritis, conservative measures are tried. A knee replacement surgery usually takes about an hour and has been significantly advanced in recent years. Most patients spend three to four days in the hospital followed by a short stay in a rehabilitation facility, or discharged home with physical therapy.
Recovery depends on the type of knee surgery performed. Arthroscopy for a simple cartilage tear typically recovers in three to six weeks with physical therapy. A ligament reconstruction can take anywhere from five to seven months of rehabilitation, and knee replacement surgery can take up to six months. With arthroscopic surgery and ligament reconstruction, patients are expected to return back to 100% participation. The expectations after a knee replacement are a little different with the goal being pain free motion, and the ability to perform most activities that were done prior to developing the arthritis. Overall, the goal is to positively affect the quality of life and return the patient to most, if not all, of his or her pre-injury or pre-arthritic activities.
Written by Kim L. Stearns, M.D.
How Has Computer Technology Affected Total Joint Replacement Surgery?
It is clear that computers aid and improve the quality of patient care in clinical settings. We are beginning to learn that they will have increasingly important roles in the operating room as well. Computer assisted surgery, particularly in Total Knee Replacement and Total Hip Replacement, is finding its way to the U.S. Better results of knee and hip replacement surgeries are achieved if the technical details of alignment and stability are optimal by being extremely accurate. Until recently, most tools available to help surgeons correctly place knee or hip implants have been mechanical. Now, surgeons are able to use a computer to align and confirm the proper positioning of implants.
We started using computer assisted orthopaedic surgery for Total Knee Replacement in July of 2003 at Lutheran Hospital. This technology has improved the consistency with which we can accurately place total knee implants, as well as our ability to document the stability of the replacement. These are two critical aspects of knee surgery that allow for long-term success of a total knee implant, up to 10, 15, 20 or more years. Similar improvements with Total Hip Replacement are yet to be demonstrated, but are likely to be similar.
With computer assisted surgery the surgeon cannot only determine the appropriate position of implants before they are placed, but can also document that the parts are placed where intended. As we approach a time where minimally invasive surgery (reduced tissue trauma surgery) is possible, it will become extremely important to confirm that implants are properly placed – a problem with approaches that don’t allow easy visualization of landmarks!
In the coming years we will see substantial evolution in the use of computers to assist in orthopaedic surgery – with their ease of use improving. We at the Cleveland Orthopaedic and Spine Hospital are committed to being at the forefront of the development and use of these techniques here in Cleveland and nationally.
Written by Bernard N. Stulberg, M.D.
What new technologies are available for treating musculoskeletal problems of the knee and hip?
Maladies of the knee and hip can be traumatic or atraumatic. When an injury occurs, it can result in either soft tissue trauma or fractures of either long bones or joint surfaces. Atraumatic problems most commonly arise due to arthritis, but special conditions like avascular necrosis or infection can lead to joint destruction.
The last two decades have witnessed remarkable advancement in orthopaedic trauma. Fractures of the hip and knee are often repaired with titanium hardware so that early mobilization can occur. Long bone fractures are often surgically fixed with titanium rods implanted in the center of the femur or tibia.
Soft tissue injuries of the knee include ligament disruption and cartilage damage. Both of these problems can be taken care of with a minimally invasive technique called arthroscopic surgery. Rehabilitation is more rapid today, making recovery even quicker.
If cartilage damage occurs on the surface, various techniques are available to repair or replace the cartilage. One technique requires harvesting cartilage from the patient, growing it in a lab and then reimplanting it 6 to 8 weeks later. New cartilage grows and can create a renewed joint surface.
The most common atraumatic problem is knee and hip arthritis. While at times arthroscopic surgery and hyaluronic acid injections can be helpful, total joint surgery is sometimes necessary. Smaller incisions are now routinely used and are less traumatic. Materials are improved and more advanced, and full weight bearing after surgery is routine.
Bloodless total joint surgery can often be accomplished for single hip and knee surgeries. By building up the blood count before surgery and limiting the blood loss during the surgical procedure, blood transfusions are rarely needed. This makes the hospital stay progress more smoothly and results in less chance of infection.
Written by Laurence Bilfield, M.D.
To make an appointment with an orthopaedic physician at Lutheran Hospital, please call 800.220.8202.
This information is for educational purposes.