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Total knee replacement is a successful procedure in the majority of patients with arthritis. It relieves pain and restores the function and alignment of the joint.


Older patients undergoing knee replacement surgery today are more active than in the past, and the surgery is being performed in younger, more active patients. Education and marketing material for patients often depict them enjoying a physically active life after surgery. These factors lead to the question: Can I resume my active lifestyle after knee replacement?



Total knee replacement involves a mechanical device, and the forces applied to the implant are much higher while playing sports than during regular daily activities. These forces could cause wear and tear on the implants. They could loosen, and osteolysis could occur where the bone wears away around the implant as parts of it break down.


Even though implant design and materials have improved over the last 40 years, and surgeons have a better understanding on how the knee replacement responds to the stresses imposed by athletic activities, you should discuss these concerns with your surgeon.


There has not been a major study answering how long knee replacements last in patients who are physically active in relation to those who live a more sedentary life. Surgeons traditionally make recommendations about participation in sports after surgery based on personal preference and “common sense.” The American Association of Hip and Knee Surgeons has these recommendations.


Know your body and have realistic expectations.

Having knee replacement surgery doesn’t mean you can participate in strenuous sports that you didn’t do before surgery. The sports you are likely to participate in after surgery are those you played prior to surgery.


There is a study where 40 patients who underwent total knee replacement surgery were followed up after surgery. Seventy-five percent of patients participated in high-impact sports before surgery. Ninety-three percent of those patients were able to return to practicing these types of sports after surgery.


Your ability to return to playing sports will also be affected by your general health. Studies show that the healthier you are, the more likely you are to return to playing sports after surgery. Studies also show that if you participated in high-impact sports before surgery, you will be more likely to return to medium and low-impact sports after surgery.


Use common sense.

The greater the impact from playing sports has on your knee implants, the greater chance there may be of damage. You can make the analogy to the tires of your car – the more off-road driving you do, the more your tires will wear out.


Stay active after knee replacement!

The beneficial effects of physical activity on your general health and wellbeing are undeniable. With athletic activity, expect better cardiovascular health, muscular strength, endurance, balance, coordination and personal satisfaction.


Which sports are OK?

Remember that physical activities and sports that your surgeon recommends should be performed in moderation. If in doubt, be cautious and protective of your knee replacement!


Low-Impact Sports

Members of The Knee Society recommend that if you’ve had total knee replacement, practicing low-impact activities and sports is fine.


Intermediate-Impact Sports and High-Impact Sports are probably not a great idea and could increase the risk of damage to the implants or increase the rate of loosening from the bone interface.


It’s important to set expectations with Mr Frame prior to surgery to discuss what level of activity is best for you. Ask how long your knee replacement will last if you are very active. Talk about your activities and your involvement in sports. How long your implant tolerates your activities depends on the type of sport you do and how often you do it after surgery.


A new knee replacement or resurfacing is only the begining. Good Luck!


Source from AAHKS

Full vs. Partial Knee Replacement: What’s the difference?


While it may seem appealing to have half of a surgery compared to a full surgery, it is important to understand the differences between a unicompartmental or partial resurfacing or replacement and a total knee replacement surgery. Each type of knee replacement surgery is unique and has its own outcomes after surgery for knee pain and osteoarthritis.


The knee is composed of three compartments: the inside (medial), outside (lateral) and underneath the knee cap (patellofemoral or anterior). Each of these compartments can be replaced individually in partial knee replacement surgery, or all three can be replaced in total knee replacement surgery. A partial knee replacement is technically one-third of the surgery of a total knee replacement. If you have a partial knee replacement, you will find improvement in the function of your knee and reduction of knee pain, but there are some long-term factors to consider.


Partial Knee Replacement



In the past, partial knee replacement was for patients over 60 years old whose ligaments were in good condition, had little knee deformity and could move their knee pretty well. Today, the procedure is being done on younger patients who have pain and other symptoms in one part of the knee.


Because a partial knee replacement is less surgery with a smaller scar, it has often been reported to have an easier, quicker, more complete recovery and greater satisfaction than a full knee replacement. Complications during surgery like blood loss, transfusion and blood clots (DVT) tend to be less with a partial replacement or resurfacing. The risk to your life (mortality) from the surgery although very small normally is significatly lower with a partial replacement versus a total knee replacement.


Because partial knee replacement retains most of your knee tissue, you are still susceptible to meniscal tears and progression of arthritis in the rest of the knee. When a partial knee replacement fails, it can be converted to a full knee replacement with an excellent degree of success. The surgery and recovery may be more involved, but the overall outcomes are highly successful.


Total Knee Replacement



This procedure has been revolutionary to orthopaedics giving many patients the ability to return to function and enjoy their lives with implants lasting about 10-15-years. While the surgery is longer, there is a higher rate of complications and greater cost, the lifetime of the implants is much greater than in partial knee replacements. Physiotherapy is tougher early on, and the knee ultimately doesn’t quite feel the same as your own knee. Despite these potential limitations, patients who are good candidates for total knee replacement have great patient satisfaction, high functional scores and longer-lasting replacements. In the United States, over 90% of knee replacement surgeries are total knee replacements; while 10% or less are partial knee replacements. However studies from Oxford have shown that one of the most important factors in your success is the skill and experience of your surgeon. Those surgeons who are doing a higher proportion of partial knee resurfacings have a better patient satisfaction and long term outcomes. It has also shown that nearly 50% of those treated in England with a total knee replacement could have been a candidate for a partial knee resurfacing or replacement.


Overall Outcomes


Both partial and total knee replacements can be highly successfully for patients who are good candidates. If you take care of your total or partial knee replacement it will provide you with the greatest longevity possible.


Source data from the AAHKS

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A torn knee meniscus and knee osteoarthritis can present in similar fashions, This can make it difficult to know what the cause of your pain might be


Common symptoms of both osteoarthritis (OA) and a torn meniscus include:

  • Pain around the knee joint, worse after activity. Walking, running, or climbing stairs can make the knee pain worse.

  • Swelling and fluid in your knee. This occurs because of inflammation and may make the knee painful to the touch because it is tense and streches the lining of the knee joint.

  • Knee locking. True locking is when the knee often wont come out fully straight. It will often bend fine.

A knee meniscus tear and knee osteoarthritis affect different types of cartilage in the knee:

  • Knee osteoarthritis or OA refers to damage to articular cartilage. Articular cartilage is a very specialised coating that covers the ends of the bones in the knee joint, the femur (thigh bone) the top of the tibia (shin bone) and back of the patella (knee cap).

  • A torn meniscus refers to damage to a small C shaped wedge of rubbery cartilage that sits between the joint like a shock absorber and to transition between the very curved surface of the femur and the flat surface of the tibia.

Here are a few questions to ask yourself when determining the cause of knee pain. This is the thought process we at wessex knee would go through to diagnose your pathology.


When did the pain start?


The biggest difference between arthritis and a torn meniscus is how acute the pain comes on. osteoarthritis pain comes on gradually and will often not have an injury or event to set it off. A meniscal injury requires some kind of force or twist and a very specific event.

  • If your knee pain increases gradually and cannot be placed back to a specific injury it is more likely to be arthritis.

  • If your knee pain arose suddenly, you may have a meniscus tear. Sporty and very active people are more likely to experience the type of injuries that cause meniscus tears. Skiing and football are very common means of causing a meniscal tear.

It is possible for a meniscus to break down slowly, but this is less common and is secondary to osteoarthritis rather than a true acute injury.


What does the pain feel like?


Another difference between arthritis and a torn meniscus is the pain.

  • Osteoarthritis tends to be an intermittent, dull, or aching pain. Often described as a tooth ache type pain. The breakdown of cartilage may cause bone rubbing on bone when moving, which can cause a feeling of stiffness or produce a grinding noise.

  • People with a torn meniscus often complain of acute and sharp, immediate pain following an injury. It is often swollen and stiff the next day. Tenderness to the inside or outside of the knee alone the joint line between the bones may indicate a meniscus tear.



Diagnosis of a Meniscal Tear?

Diagnosis of a meniscal tear requires us to examine your knee and carry out some investigatiosn such as an X-Ray to see narrowing of the joint in osteoarthritis. An MRI is best to see the cartilage layer and the little disc of cartilage the meniscus. If you have a meniscal tear it can be an emergency and we are now able to repair them rather than remove them. Having a consultation and MRI within 3 weeks is important to maximise the chances of healing and repair of your meniscus which would be done arthroscopically.

If you have early osteoarthritis an injection may be useful for you and one of the best is Hyaluronic acid which is a viscosuppliment ans acts as a gell lubricant within the knee to help reduce pain and inflammation.

If it is very severe arthritis joint resurfacing could be an option rather than a full total kee replacement. It has been shown in studies that nearly half of those treated with a full total knee replacement could have been candidates for a partial knee resurfacing. This is a smaller procedure, preserves your ligaments and gives you a more normal feeling knee. It also carries a lower surgical risk.


Getting a Diagnosis and Treatment for Knee Pain


Whether you think you have knee arthritis or a torn meniscus, your best bet is to visit us here at Wessex Knee and Mr Frame. Early treatment can prevent your symptoms from worsening and, in some cases, help you avoid future surgeries.


We hope this information has been useful. Please feel free to share it or link to it.



Thanks


Mark


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