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Orthopaedic Associates of Central Texas (OACT) has board certified physicians and orthopaedic surgeons to treat injuries, trauma or diseases affecting the knee. Starting with a complete evaluation, we review treatment options to include non-surgical approaches, advanced surgical options, and rehabilitation. Our physicians and surgeons have advanced training in caring for the knee and use the latest advancements in technology to diagnosis, and perform the correct treatment plan to maximize your recovery.
The Knee Joint:
Your knees are involved in just about everything you do, from standing to walking, stopping, stretching, and running. The human knee is a wonderfully constructed, versatile joint, formed by a hinge-type mechanism that lets you move both forward and backward (and even a bit from side to side). Both the articular cartilage that covers the bones and the thick fibrous capsule that surrounds the knee contribute to its strength and stability and also serve as shock absorbers against all the activities knees encounter every day. Within the cavity of the knee joint is a substance called synovial fluid, which promotes smooth movement and helps prevent friction between the two main bones that connect at your knee, the femur and tibia.
Injury, Trauma, or Aging to The Knee Joint:
Smooth, pain-free movement in the knee depends on all of these components working together. Sometimes trauma (from a sport injury, fall, or car accident, for example) weakens the knee ligaments and cartilage, upsetting the synovial fluid balance. Over time and with age, the cartilage can break down. When bony surfaces begin to rub together without the buffers that were once there, walking, bending, and standing can be very painful. This is what often accounts for the pain and discomfort associated with osteoarthritis or rheumatoid arthritis. Joint diseases can result in stiffness, swelling, and tenderness in the knee joint. Even the simplest daily activities can become painful, slowly diminishing your mobility and, ultimately, your quality of life.
Non-surgical Treatment of Knee Injuries:
Your physician may determine your injury is best treated without surgery. Some injuries that are most commonly treated non-operatively are sprains, strains, bruises, and some stable fractures. Non-operative treatments include:
- Activity modification
- Cortisone injections
- Joint fluid replacement
- Physical therapy
Total Knee Replacement:
The goal of knee replacement surgery is to relieve the pain caused by damage to the cartilage of the joint surfaces on the femur and tibia. The pain can be so intense that a person will avoid using the joint, weakening the muscles around the joint, and making it even more difficult to move. To determine whether you may need surgery, consult the physicians at Orthopaedic Associates of Central Texas (OACT). An orthopaedic surgeon, or certified physician assistant, who specializes in treating knee disorders will perform a comprehensive exam to include: a complete medical history, x-rays, assess your walking, leg motion, general joint condition and level of daily function. Additional testing may be required to show the full extent of damage to the joint. Total knee joint replacement surgery will be considered if other treatment options will not relieve your pain and disability. If, together, we decide that surgery is required, the aim of this surgery is to correct the deteriorating condition of your present knee and to help you regain movement and eliminate most of the pain you have been experiencing.
New Surgical Advancements:
Minimally Invasive Joint Replacement Surgery
Minimally Invasive Surgery (MIS) is a general term used to describe any surgical procedure that utilizes a smaller incision than conventional surgery. In some MIS procedures, the amount of soft tissue (muscles and tendons, etc) that is disrupted during surgery may also be reduced. MIS for joint represents a new way to perform joint replacement that involves surgical techniques performed through a smaller soft tissue “window”.
Computer-Assisted Knee Replacement
This process of combining digital images for the patient’s femur and tibia with an implant-specific software package, new computer hardware can track the precise position of the patient’s leg, the implant and the surgeon’s instruments at all times during knee surgery. It is as if the patient’s leg has a GPS tracking system the computer uses to follow it during the procedure. The Computer puts together all of the information coming from the patient and the instruments. It also tells the surgeon where the precise cuts should be made. Given that every patient’s knee geometry is different, this level of patient-specific, computer-guided accuracy is unprecedented in the history of knee replacement surgery.
After surgery, some leg movement may be initially limited, but this will improve over time as you become more comfortable with your new knee. Specially designed stockings and inflatable leg wraps may be used to maintain circulation in your legs. The walking aid (a cane, walker, or crutches) will allow gradual weight increase on your new knee and assist in healing and controlling the pain. During the process you will learn more about using a safe walking pattern and equipment in your home with self-help devices such as a raised toilet seat, a bath bench, and reaching tools. Your activity will be restricted at first. Observe these restrictions to give your hip and surrounding tissues proper time to heal.
A personal exercise program designed by one of our staff physical therapists will help to restore muscle balance and allow you to walk more comfortably. Continuing exercises at home (with a home health agency) and in an outpatient physical therapy program for several months following surgery will help you regain strength and independence. An active lifestyle that includes water exercises, walking, and biking is essential in maintaining movement of your joints and keeping you and your new knee healthy. Gauge your daily activities with your new knee in mind. Avoid strenuous movements such as twisting, jumping, and running which may damage your prosthesis.
After surgery, the knee pain you had will be gone, but you may have some discomfort when you stretch, and you may experience some pain at the site of the surgery. This will decrease and disappear over time.
Q) Once I decide to have the surgery, how soon can it actually take place?
A) Allow at least three weeks to prepare for the surgery. You may need additional examinations and testing, and you may need to arrange to donate your own blood for the surgery.
Q) What is a total knee replacement made of?
A) Total knees are made of metal and polyethylene. The piece covering the lower end of the femur (thigh bone) is made of a corrosion-resistant alloy of stainless steel, usually cobalt chromium or titanium. The opposing surface of the tibia (shin bone) is made of polyethylene and designed to mate with the piece attached to the femur. The undersurface of the patella (kneecap) is replaced with polyethylene, which moves against the metal of the femoral component. This combination of metal on polyethylene creates a joint of minimal friction and wear, helping to maximize the life of your new knee.
Q) How painful is total knee replacement?
A) As with all forms of surgery, knee replacement is painful, but the pain is manageable. For the first one to three days after surgery, pain is very well controlled with an epidural catheter. After that, oral medications, such as Percocet or Vicodin, are usually adequate. Sometimes patients require further (but less frequent) pain medication once they leave the hospital. Typically within two to three weeks after surgery, most patients find that their pain is greatly diminished and nothing stronger than aspirin or Motrin is needed.
Q) What are the possible complications?
A) Although chronic illnesses increase the risk for any surgical patient, knee replacement surgery has a very low rate of complications. On a national average, fewer than 2 percent of patients experience knee joint infection or other major difficulties. Complications within our practice have been even lower. Blood clots in the leg veins are the most common complication, but these can be prevented with medications or by using special support hose, inflatable leg coverings, and gentle exercises that begin soon after surgery.
Q) Is bleeding around the incision after surgery normal?
A) It is not unusual to have some mild bleeding that soaks through the dressing but this should have stopped before you are released from the hospital. Should this happen and you are at home, you should reinforce the dressing with more sterile gauze. However, if bleeding persists, contact the office.
Q) What if I can't go home immediately after surgery?
A) Unfortunately, many patients don’t have a healthy spouse or close family member at home to help them during the initial days and weeks after surgery. For those unable to depend on family or close friends, staying in a skilled nursing facility at the hospital for one to three weeks is an excellent alternative. By transitioning back into your home routine through a nursing facility, you’ll regain your independence more safely and comfortably. This, in turn, reduces your home-care needs to a level that friends or family can help you manage more easily.
Q) Are there important tips for post-joint replacement surgery?
A) It’s critically important to avoid situations in which you could fall or injure your joint. You will need special assistance for a few weeks, especially while you are regaining your balance, strength, and flexibility. Follow the instructions from your physical therapist regarding regular, light exercise. You will need to take antibiotics prior to dental surgery or any other surgery to prevent bacteria from entering your bloodstream. Do not sit in low seats or chairs, squat to pick objects off the floor, cross your legs or drive until your physical therapists indicates you may begin to do so.
Q) When can I return to sports?
A) Most patients who undergo total knee replacement are ready to return to extensive travel and light activities, such as golf, within six to eight weeks after surgery. More vigorous sports such as tennis and skiing are possible within three to four months.
Q) How long will my new knee last?
A) Most knee replacements can be expected to last 10 to 20 years. If you are overweight or extremely active, your new knee’s life span may be shorter.
Expectations for Knee Replacement Surgery (Before and After Surgery)
Pre-operative: It will take approximately 45 to 60 minutes to get signatures for surgical consents and to review the instructions regarding your surgery. Be sure to bring a list of current medications, including the drug name, dosage, and the days and times you typically take them.
Pre-admission Appointment: Prior to this appointment—which takes place at the hospital—you should have had your pre-operative tests performed by your family doctor. This appointment will take approximately one to two hours for lab tests, including blood work, EKG, and chest X-ray. If you have a heart or lung condition, or if you are an insulin-dependent diabetic, you must see your family doctor prior to surgery and get medical clearance. Before you leave, you will also meet with someone from the anesthesia department.
Admission: You will be admitted to the hospital the morning of your surgery.
Medications: Stop anti-inflammatory medications and/or aspirin; if you take anticoagulants such as Coumadin, your surgeon will tell you how long you should cease taking them prior to surgery.
Food and drink: Do not eat or drink anything for eight hours prior to surgery, except for prescribed medications. On the day of surgery, if you do have a prescribed medication to take, swallow it with a small sip of water.
Length of Surgery: The length of surgery is one to two hours, followed by another one to two hours in the recovery room.
Length of Hospitalization: Average stay is three to five days.
Anesthesia: A spinal or epidural is usually recommended, but some patients undergo general anesthesia. IV sedation is used with the epidural to help you relax and sleep.
Blood Transfusions: We generally have patients donate one unit of their own blood to be used after their surgery if necessary. This will be arranged for you pre-operatively in coordination with your family doctor.
Physical Therapy: Physical therapy begins the day after surgery. A therapist will come to your room and help you with exercises and walking. On the first day, your leg will be placed in a continuous passive motion (CPM) machine for approximately six to eight hours per day to help you regain range of motion. Arrangements will be made for you to have the CPM machine and physical therapy at home for three weeks following discharge. Following home physical therapy you may go to an outpatient physical therapy facility two to three times a week for four to six weeks. Before surgery, please consult with our staff to arrange for home health nursing and therapy as well as outpatient physical therapy.
IMPORTANT: Prior to surgery, VERIFY INSURANCE BENEFITS FOR YOUR CONTINUOUS PASSIVE MOTION (CPM) AND PHYSICAL THERAPY. THESE ITEMS ARE NOT ALWAYS COVERED BY ALL COMPANIES. IT IS VERY IMPORTANT THAT YOU CONFIRM THE NUMBER OF PHYSICAL THERAPY VISITS APPROVED BY YOUR INSURANCE COMPANY FOLLOWING SURGERY. INFORM YOUR PHYSICAL THERAPY PROVIDER ABOUT WHAT HAS BEEN APPROVED BEFORE YOU BEGIN THERAPY.
Crutches/Walker: Initially you will walk with a walker, which will be provided while you are in the hospital. As you progress, your physical therapist may switch you to crutches or a cane.
Wound Care: The surgical dressing is usually removed after two days. You may keep the incision open to air as long as there is no bleeding or drainage. We will remove your sutures in the office approximately two weeks after your surgery.
Pain management: For the first one to two days after surgery, pain is very well controlled with a PCA (patient controlled anesthesia). It is important to maintain a schedule for the pain medications provided and prescribed. It is best to address the pain before it intensifies. Pain is manageable with medications and will lessen as your surgery heals. Pain medicine can cause itching, nausea, and/or constipation. These are all common side-effects of narcotic-based medications and do not necessarily indicate a drug allergy.
Driving: Most patients are able to safely drive a car approximately six weeks after surgery for very short distances only. We recommend that patients do not drive cars with a manual transmission while they are healing because of the sudden and jerky movements that can accompany shifting gears and using the clutch.
Home Care: You will need help with meal preparation for one to two weeks following discharge from the hospital. We recommend that you have someone stay with you after you leave the hospital for at least a week (and longer if possible). If this is not possible, please let the nurse know you will need assistance after surgery.
Things to Report: Call the office at (512) 244-0766 if you develop any of the following:
- Redness around the incision
- Drainage or bleeding from the incision
- Fever over 101 degrees
- Increased swelling
- Calf pain
- Calf swelling
- Persistent headaches or lightheadedness
Return to Work: Following total knee replacement, you will be able to return to sedentary work four to six weeks after surgery. We recommend restricting certain work activities:
- No heavy lifting
- Limited bending, stooping, and squatting
- Follow Physicians orders
PLEASE NOTE: After knee replacement, it will be necessary for you to take antibiotics before you undergo any standard dental work or teeth cleaning. Please contact our office at (512) 244-0766 to arrange for a prescription. If you are on any blood thinners, (Coumadin, aspirin) or if you are diabetic, please notify one of the nursing staff at Orthopaedic Associates of Central Texas.