Recovery periods after knee replacement
Replacement of the knee joint is not such a simple matter. Your life after prosthetics will never be the same. Rehabilitation after knee arthroplasty - what should it be?
Rehabilitation is the second half of the success of knee replacement
Rehabilitation after knee replacement
To perform an operation to replace the joint is not all.
- A complex exercise program for the joint
- will be required. The load on the joint will have to be limited, as well as some types of exercises:
- for convolution
- jogging and jumping
- It will be necessary to abandon many sports( light and heavy athletics, wrestling, mountain and water skis, parachute andetc.)
- Within a few years after the operation, it will be necessary to observe the doctor
It may seem that after the operation you will have to spare and protect the knee painfully. This is not quite true:
A gentle mode for several days will certainly be, but the first exercises will need to start literally on the second day. And then the load will only increase
It takes a long time to develop the joint after the operation, and even more nerves and patience. I'll have to work through overcoming pain. How else?
Rehabilitation is needed to ensure that :
- No contracture occurs and the prosthesis bends and rotates with the same approximate amplitude as the once healthy joint
- The risk was not in vain( the operation is always a risk) and the expended funds
What determines the success of the
rehabilitation Halfsuccess depends on the skill and skill of the surgeon, and the second half only on the patient :
- Will he go through the entire rehabilitation program
- Will not he relax after a few weeks and even years
- Will he deal withshould not only be in the rehabilitation center, but also at home
. When the rehabilitation program is performed, the patient is not alone:
- Patient should not guess:
- will not dangerous or undesirable exercises that hurt him
- will not the side complications arise
- He does not need to produceself-selection of exercises
- There is no need to purchase mechanical simulators( they should be in the rehabilitation center)
Special treadmill in the rehabilitation center
All these issues are solved by leaschy doctor and Rehabilitation.
Surgeons are aware of the main dangers of the early postoperative period:
Risk of developing blood clots :
Risk of thrombosis can be caused by pain, swelling and redness below or above the knee
Risk of developing infectious inflammation:
Elevated temperature, the surges of blood leukocytes can be alarming symptoms of
To prevent postoperative complications, coagulants( blood thinners) and antibiotics
are prescribed. The rehabilitator visits the patient within a few hours afterie the operation and shows the first necessary exercises that it will need to perform.
After the discharge, the question of the rehabilitation center is usually put, however, studies there are not cheap, and therefore many patients decide to be engaged in the rehabilitation themselves.
But if a person does not intend to undergo rehabilitation at all( nowhere in the center or at home), then it is better to abandon the very operation
. Is it possible to independently repair the house
? Probably, yes, because the impossible is really nothing.
But in practice alone and for a long time to restore the joint after prosthetics difficult :
- There is a lack of purely specific knowledge that orthopedists-traumatologists own
- . Because of the fear of pain, a barrier arises that reduces the volume and amplitude of
- movements. The self-pity, the disorganization of the schedule of activities, etc., interfere.
Orthopedics practice mechanotherapy - the method of passive rehabilitation, when movements of the diseased limb are carried out by mechanical simulators that are always in the rehabilitation center
Exercises of the early operational period
These exercises are necessary to prevent thrombosis and muscle atrophy and maintain the functions of the musculoskeletal system
The first two daysafter operation
Exercises for hands
- Squeeze and unclench fists
- Bend and unbend arms in elbows
- Rotation kuvarnishes in both directions
- Similar rotation with elbows
- "Box" with separation of the blades from the bed
- Straight and cross "scissors"
Exercises for a healthy leg
The goals of such exercises are to control thrombosis and muscular atrophy
- Circumferential motion of the ankle
- Compression and unclenchingfingers
- Leg bending in the knee
- Raising the straight leg
- Leaning on the heel and elbows, lift the buttocks
- We start to sit down with the help of the handrail, first without lowering our legs to the floor, and on the secondwe drop them
Exercises for a sick leg
- Squeeze and unclench fingers
- Pull the foot on yourself and away from yourself
- Alternately bend and unbend your legs while lying down and sitting
- In the sitting position, put the feet on the bench, raise and lower them without taking off the heels
The gymnastics of the first two days is performed at a slow pace :
- Several exercises take breaks from three to five minutes
- Some exercises are combined with the respiratory rhythm
After it turned out to sit on the bed withlowered legs, you need to learn to stand on crutches or walkers.
Walking on walkers or crutches
Walking with auxiliary tools is already on the second day of .Walking on crutches is somewhat more difficult, since more physical strength is required. For the elderly it is preferable not to walk on crutches, but on the walker
It's easier, of course, to see or experiment with crutches before the operation, but the general technique is simple:
Walking on crutches with the help of an instructor is already on the second day
To get up,for the handrail, the other for the handle of a crutch or walker, with the support of a healthy leg
Walking on both crutches and walkers is built on the same principle :
- They serve as additional support for the body:
We rely on the crutchand armpits, and on the walker with the hands of
- First we move forward at a distance of a small step both crutches or walkers
- With a healthy foot we make a step and tighten the sliding foot on the floor with the operated leg
- The leg should first touch the floor with the heel and then the whole foot
- They serve as additional support for the body:
with additional support should be short-lived and carried out with the help of the instructor
Two to seven days after the operation
The patient by this time independently sits in the bed, having lowered his legs to the floor, and the course itselft on crutches.
Repeat all previous exercises in the supine and sitting position, but more actively and in larger amplitudes
Increase the number of repetitions
The following exercises are added:
- retention of the elongated foot
- retention of the straight leg
- raised by 20-30 раз with the heel inserted under the heel
- isometric exercises with tension of buttock muscles and quadriceps femoris
- tilts and turns of the trunk with outstretched arm
- imitation of walking
- exercises in the lying position on the sidefoot joint) with the roller between the legs
Starting from the second day, the development of the knee joint with the help of mechanotherapy begins - passive flexion-extension of the knee joint on the mechanical simulator with gradual increase in speed, angle and duration.
Passive flexion-extension of the knee joint on the mechanical simulator:Exercises begin two days after surgery
Ninth day after surgery
Exercise in sitting position - swing with foot
Dynamics of exercises for the operated leg in
- Lying on the side bend and unbend the leg in the ankle
- Pull the toe up and raise the foot by 10 cm( specialist's help is allowed)
- We make small flails with a sick leg
- We add exercises with the emphasis on the handrails standing:
Swing forward and raising the leg ona small angle
Rehabilitation of the house
Extract usually occurs after two weeks.
Walking on crutches will last an average of six to eight weeks, although some patients refuse them and before
at home you will repeat all those exercises that were done in the hospital in all three positions plus the will be added:
- abdominal exercises
- risings on tiptoes
It is also necessary to repeat passive mechanotherapy: at home, this can be done with a conventional elastic band.
Passive exercises for knee joint with elastic band
Task of home exercises :
- Do not allow contracture
- Restore function of knee joint
- Improve trophic of soft tissues of lower leg and hip
Late recovery period
It begins 1.5 months after the operation.
Objectives of the late recovery period - restoration of the functions of the aching limb
Adding exercises with support and load on the injured leg :
- Makhi standing on the aching leg
- Walking on bent legs, holding the handrails
- Exercises "scissors" and "bicycle", etc..
Late rehabilitation period
This period is usually considered to be a period of more than two months after the operation. However, for all its terms.
The tasks of this period are mainly adaptive :
- The patient learns to walk with a cane
- Executes exercises with weighting
- Begins to work on an exercise bike
In the photo below - exercises with traction for knee joint development:
Exercise with traction for knee joint
How long it takes to recover
Follow-up examinations at the doctor after endoprosthetics are performed every year
Actually, the care of the joint will last a lifetime. It is impossible to forget about the prosthesis immediately after the rehabilitation.
- Six months after the operation, it is necessary to conduct a follow-up inspection of the knee from a surgeon
- Then to visit an
- doctor every year. For several years, you need to practice active active exercises
- . Then you can just perform daily gymnastics, maintaining your normal weight
- Ten years after surgery,a thorough examination, since the prosthesis resource could come to an end
Video: Rehabilitation after knee replacement
If you have planned an endoprosthesis operationknee joint, see the full methodology of the Federal Center for Traumatology, Orthopedics and Endoprosthetics:
- How the preparation for operation
- is completed. A full set of exercises after knee replacement in various rehabilitation periods.
Knee replacement surgery: reviews. Knee replacement: rehabilitation
In orthopedics, a procedure for replacing part of a damaged joint is often used. However, unlike hip arthroplasty, which passes without complications and is well tolerated, replacement of the knee joint is more difficult, and complications such as:
- infectious processes at the site of the endoprosthesis;
- bias prosthesis;
- patellar incision or tearing can occur in the patella;
- thrombus formation in the lower leg;
- violation of the integrity of the femur( fracture).
Because of the presence of such complications, people leave such dissimilar responses. Endoprosthetics of the knee joint can take place without any complications.
It is worth noting that 10 years ago there were more patients with different complications after this joint replacement method. Over time, everything was improved - it's improving the quality of the prosthesis itself, as well as the process itself. An important function in the rehabilitation is the rehabilitation period and a set of necessary exercises for a speedy recovery. These factors significantly reduced the likelihood of problems in the postoperative period.
When is arthroplasty necessary?
The knee joint is a joint of the condylar type, the osseous parts of which are covered with a protective cartilage consisting of fibers of collagen and chondrocytes, a germ layer and a basic substance. Due to the articular cartilage and the substance allocated to it, the necessary movements occur. The synovial membrane covers all articular surfaces, thanks to its assistance, the necessary liquid is developed, which prevents friction in the joint.
Because of various diseases degenerative processes of articular cartilage begin, hence the change in the shape and direction of the knee. In the presence of such diseases at the initial stage, it is necessary to conduct medical treatment, which will improve the state of cartilage and remove the inflammatory process.
In later stages, when there is already cartilage destruction and friction, in this case it is recommended to perform a knee joint operation for prosthetics by installing a metal or plastic implant in place of the destroyed joint.
Indications for implantation
- Joint deformation with age.
- Joint deformity accompanied by inflammation.
- Osteoarthritis dysplastic.
- The presence of an ossified site in the joint.
Potential patients - people who have:
- Restriction of movement with not passing severe pain.
- Significant change in the shape of the joint.
Common causes of
- Sporadic cases of loss of normal functioning of the knee joint are characteristic diseases. This is arthritis after trauma, fracture, rupture or sprain, and others.
- In rheumatoid rheumatoid arthritis, the synovial membrane is inflamed and compacted, which results in the active development of the joint fluid, which leads to the destruction of the joint.
- The appearance of osteoarthritis in elderly people, which is characterized by impaired mobility and wear of the joint.
What is the benefit of implanting an artificial joint?
Knee replacement surgery is performed to relieve or completely remove pain for up to fifteen years. An artificial implant, similar and suitable anatomically, is inserted instead of the destroyed joint.
After the operation on the knee joint was successful, patients noted an increase in the volume of movements. The quality of life is drastically changing. Therefore, many people and leave positive reviews. Endoprosthetics of the knee joint in most cases is without complications, which leads to an early recovery of a person and a return to normal life.
Complications associated with
endoprosthetics Knee joint surgery is also associated with a number of risks, as with any other surgical intervention. Such risks include blood loss, in elderly people, possible exacerbation of chronic diseases, thrombosis in the lower extremities, infectious processes at the implant site and in the urinary tract. Recently, this has become rare.
One of the worst options is the formation of an infectious process, the treatment of which is rather difficult and very expensive. Often, complications of this kind can only help remove from the body of an alien body, in this case an endoprosthesis. There is a percentage of people who are more prone to infection than others, including those with rheumatoid arthritis, overweight, patients who need to take hormone preparations.
Operating life of the
The fixed prosthesis can last up to fifteen years, in some cases even longer, however, with wear and when the implant loosens, it is possible to repeat the operation on the knee joint, that is, replacement or re-prosthesis. In the case of the appearance of painful sensations before the expiry of the ten-year period or loosening, an operation is also necessary.
Endoprosthetics The duration of the implant operation can be 2-3 hours. Before surgical intervention, mandatory prevention of infection occurs. Before the operation, the patient undergoes spinal anesthesia.
To install the endoprosthesis, it is necessary to remove the fractured part of the joint and patella, the doctor also aligns the curved leg axis, if necessary, restores the ligaments.
Modern prostheses made of high-quality and non-corrosive materials, allow the leg to bend up to 150 degrees. Some after the operation left positive reviews. Endoprosthetics of the knee joint makes it possible to bend the knee 75 degrees before discharge. However, one should never forget about the rehabilitation period, without which the treatment will not be complete.
An important reminder is that the operation in most cases is under local anesthesia, that is, in a wakeful state. However, you can express your wish to an anesthesiologist or surgeon about making general anesthesia, if possible. One must be very brave and patient in order to calmly listen to the sounds that accompany the procedures of enoprosthesis.
After the operation, the lack of sensitivity and functioning of the lower extremities is considered the norm. During the intervention, the patient loses a large amount of blood, transfusion of blood substitutes, the introduction of necessary medications for anesthesia and antibiotics.
Further within a few days, the patient's vital signs are monitored( heart rate, pressure, ECG, change in blood counts).
In the absence of deterioration and normalization of the condition, the patient is transferred 24 hours from the intensive care unit to a simple room.
Rehabilitation after knee replacementAfter the endoprosthesis is installed, the rehabilitation period lasts an average of about 3 months, but it also lasts longer, depending on the patient's condition.
A mandatory recommendation is the daily workload and exercises after knee replacement to restore its functioning.
Most often, the rehabilitation period of the patient is spent in a specialized clinic( about one month).
Stages of rehabilitation period
After the operation, the patient should stay for about two months in the clinic and perform the specified set of exercises by the doctor. With an increase in the rate there will be an improvement in the motor activity of the joint, which will lead to an early return to the habitual course of life. An extract from the clinic is also possible.
After staying in the rehabilitation center( in 2-3 months), the patient is recommended to continue physical activities in the form of swimming, walks and yoga sessions. It is worth remembering that excessive physical activity is contraindicated.
Exercises for restoration
Rehabilitation after knee replacement includes a set of exercises that help overcome stiffness of movements, build muscle strength in the joint, and reduce painful sensations.
Begin with low rates and loads, gradually shifting to more complex ones, as adjusted by the physiotherapist. It is recommended to avoid too active sports so that it is not traumatic for a new joint.
Complex of necessary exercises for daily execution( 4-5 times a day):
- Ankle joint - flexion-extension with a gradual increase in tempo, starting from 5 and reaching to 12.
- Reduction of anterior femoral muscles for 5 seconds.
- Reduction of the hind femoral muscles for 5 seconds.
- Raising a leg in an erect state.
- Cut the muscles of the buttocks for 5 seconds.
- Extension-flexion of the lower limb in the knee joint.
- Hip to the side.
- Straighten your leg to a level of 45 degrees and hold it in a submerged position for up to 5 seconds.
- With the foot in the straightened state to a level of 45 degrees and holding in this state for up to 5 seconds.
- Application of the apparatus of "Dikul".
Contraindications to prosthetic procedure
- Self-movement is not possible.
- Heart diseases and CVS.
- Thrombosis with inflammatory process.
- Pathological impairment of respiratory function, respiratory failure of a chronic type.
- Infectious processes.
- Neuromuscular pathology.
- Mental disorders.
endoprostheses Modern prostheses have a protective function and are subdivided as follows:
- prosthesis directly to the surface of the joint;
- single pole.
The prosthesis is fixed in several ways:
- without cement.
In order for the implanted prosthesis to last a long time, high-quality anti-corrosion and wear-resistant are used in production, and, most importantly, biocompatible materials:
- alloys of metals;
- bone cement.
Many people, in order to decide on an operation, it is necessary to analyze various reviews. Endoprosthetics of the knee joint is performed by a physician taking into account the individual characteristics of the physiology of the patient.
Endoprosthetics of the knee joint in Moscow, Israel, Turkey, Lithuania, Germany are carried out by qualified specialists who know their business.
There are quite a few clinics that specialize directly in performing an operation to replace the joint or its parts, including those performing arthroplasty of the knee joint. The cost of endoprostheses corresponds to the quality of the materials of which it consists, and the firm that produces it. Reviews of foreign clinics are often much better( especially with regard to the rehabilitation period).However, in Russia this intervention is carried out at a high level.
Thanks to many years of experience and high qualification, the doctor will select the most suitable biocompatible prosthesis and will perform knee replacement without complications. The price of this procedure depends on the complexity of the operation and the cost of the prosthesis.
Rehabilitation after knee replacement
Endoprosthetics of joints have been practiced since the beginning of the 1980s. In America, over four hundred thousand such operations are carried out annually. The modern level of development of medicine has allowed to perfect endoprostheses, which now represent complex technical designs designed to improve the mobility of the joint, as well as eliminate pain.
Endoprosthetics have a long history. Attempts to replace affected joint surfaces were made as far back as the nineteenth century, but due to the development of medicine at that time, they could not succeed. To date, the situation has changed and now endoprosthetics helps to achieve the most successful results by ten to fifteen, or even twenty years. Annually around the world about eight hundred thousand such operations are performed, 90% of which are successful.
Indications for arthroplasty
The knee joint is the largest joint in the human body. Its strength is provided by the muscles of the thigh. It consists of three bones, which are covered with articular cartilage, as well as smooth substance. The latter and allows the bones to move freely. All other surfaces of the joint are covered with a very thin and smooth tissue - synovial membrane. It helps in the release of fluid that lubricates the joint and reduces friction to zero.
In various joint diseases, damage and destruction of the protective cartilage and knee bending occur. The cause of this can be arthritis, trauma and arthrosis. Patients who suffer from these diseases are first prescribed conservative treatment, which is designed to improve the condition and nutrition of cartilage tissue, as well as reduce its inflammation.
However, this type of treatment helps only at the initial stages of the development of the disease, in far-reaching cases it is already powerless and one has to resort to replacing the destroyed surfaces. In the operation of endoprosthetics, damaged parts are replaced by artificial implants made of plastic or metal.
Candidates for such an operation are patients with the following symptoms:
- daily severe pain limiting normal life;
- significant restriction of joint motion;
- severe knee deformity.
The most common cases of
The most common cause of joint pain and subsequent loss of its functionality is arthritis, namely: osteoarthritis, polyarthritis and traumatic arthritis. Osteoarthritis is a frequent companion of people, whose age has reached fifty years. The cartilage that covered the bones gradually wears out and becomes stiff, thereby causing pain. Rheumatoid polyarthritis has a slightly different scheme. In this case, the synovial membrane thickens, increases in size and becomes inflamed. An excessively large amount of fluid is produced which, over time, overflows all the space around the joint, which subsequently leads to its destruction. Traumatic arthritis is also responsible for the destruction of the knee joint and can occur after a serious injury: fracture, rupture of ligaments, etc.
Use of the
Endoprosthesis The endoprosthesis is not an exact replica of a healthy human joint, but a good replacement. The most important goal of surgery for endoprosthetics is to reduce or completely get rid of the pain for ten to twelve years. Moreover, after a successful operation, almost ninety percent of patients note that the volume of joint movements increases markedly.
Many patients eventually return to an active lifestyle and even sports.
Endoprosthetics As with any other operation, complications may occur after endoprosthetics. The operation is traumatic and may be accompanied by blood loss, but frequent complications are those caused by exacerbation of various chronic diseases that every elderly person necessarily has. Also, occasionally, nevertheless, development of thrombosis of the veins of the lower extremities, infectious complications, as well as the development of urinary tract infection are noted. Fortunately, the appearance of such problems is unlikely.
The most severe variant of the development of events can become an infectious complication, the treatment of which is long, painful and costly. Most often, the process of infection can be stopped only by removing the delivered endoprosthesis.
There are also patients who have a higher risk of getting a postoperative infectious complication than others. These are overweight patients, as well as patients suffering from rheumatoid arthritis and having to take hormonal drugs.
Most of the time, the endoprosthesis is used in most patients for twelve years, after which it requires replacement - re-prosthesis. After this period, some loosening of the implants, which is associated with the destruction of bone cement or resorption of the bone, to which it is fixed, is possible. During the first ten years, only ten to fifteen percent of patients experience a loosening of the endoprosthesis. If the patient experiences pain, then a second operation is performed.
endoprosthesis service life
In the first hours after surgery, the patient has completely no sensitivity of the lower limbs. Since the operation is accompanied by a loss of blood, transfusion of the blood-substitution solutions is carried out, as well as the injection of antibiotics and anesthetics.
A few days of constant monitoring of all vital indicators: pulse, pressure, electrocardiogram. Blood is monitored. If everything is normal, then the patient is transferred to a regular ward in one day.
Features of rehabilitation
The main factor in rehabilitation after knee replacement is time. After the operation, it should take about three months before the patient is healthy. In some cases, much more time is required.
The main objectives of the recovery period are as follows:
- increasing the volume of joint movements;
- protector protection;
- return to the previous level of physical activity.
Doctors recommend gymnastic exercises, which the patient must perform daily. For this purpose, a special order of their conduct was specially created. After being in a specialized clinic, the patient goes to the rehabilitation center, where he should spend about three to four weeks.
Stepwiseness of the rehabilitation process
The first two months after the operation is the period that the patient should be in the clinic and do the exercises that are shown to him by the doctor. Gradually, their build-up should lead to greater mobility of the joint and a return to the habitual way of life. It is possible and the patient's discharge home. Being engaged in simple household work on the au pair, the patient can quickly return to the previous loads.
After two or three months, yoga, swimming, cycling, and dancing will be useful. Nevertheless, the patient can not be overworked, significant loads in this case are contraindicated.
Complex of exercises
These exercises are recommended for daily execution for four to five times.
- Flexion - Ankle Extension. Start better with five times, and then, increase the volume to twelve times.
- Strain the front muscles of the thigh for three to five seconds.
- The tension of the hamstrings of the hamstrings for three to five seconds.
- Raising a straight leg.
- Strain of the gluteus muscle for three to five seconds.
- Flexion - knee extension.
- Hip to the side.
- Raise the straightened leg to an angle of 45 degrees and hold it in this position for up to five seconds.
- Mahi straightened his foot at an angle of 45 degrees and holding it in this position until five seconds.
- Using the Dikul apparatus.
Contraindications are divided into two types: relative and absolute. In the first case it is:
- oncological diseases;
- obesity of the second or third degree;
- lack of motivation in the patient.
- complete absence of the possibility of independent movement;
- diseases of the cardiovascular system;
- serious pathology of external respiration and chronic respiratory failure;
- presence of infection in the body;
Knee replacement |NIITO
( compiled by EE Malyshev)
One of the most significant achievements in orthopedics of the 20th century, total knee arthroplasty was first performed in 1968.The improvement of surgical materials and equipment has since significantly increased the effectiveness of this operation. In the United States, approximately 300,000 such operations are performed annually.
If you have only thought about this method of treatment or have already taken a decision with an orthopedic surgeon to perform an operation, in this edition you will learn about the peculiarities of this method.
The main indication for endoprosthetics of the knee joint is pain. If medications, lower physical activity and the use of additional support during walking no longer help, the question of knee replacement may be considered. As a result of this operation, pain sensations are usually reduced, limb deformity is corrected and normal physical activity returns.
Normal knee joint
The knee joint is the largest in the human body. It is formed by the lower end of the femur, the upper end of the tibia and the patella( patella), which slides in the groove on the femur. Large ligaments attached to the femur and tibia provide stability of the joint.
The joining surfaces of these three bones are covered with articular cartilage - a smooth tissue that softens the articular surfaces of bones and facilitates movement.
All the remaining surfaces of the knee joint are covered with a thin, smooth tissue called the synovial membrane. This membrane produces a special fluid that lubricates the joint surfaces and reduces the frictional force to almost zero in a healthy knee.
Normally, all these components interact harmoniously. However, illness or trauma can destroy this harmony, leading to pain, muscle weakness and impaired function.
before endoprosthetics after endoprosthetics
Is total knee replacement
indicated? The decision on the need for surgical treatment should be taken together by you, your family and an orthopedic physician. Your family doctor can refer you to an orthopedic surgeon for the final resolution of the issue. The surgeon can offer you such alternatives to traditional total endoprosthetics, like single-implant endoprosthetics or corrective osteotomy.
Total endoprosthetics are indicated under the following conditions:
- Severe pain that restricts everyday movements such as walking, climbing or descending stairs, sitting on a chair. When walking for long distances, you may need additional support: crutches or walking stick.
- Moderate or severe pain at rest day or night.
- Chronic inflammation and swelling of the joint not decreasing at rest or with medication.
- Deformation is the deviation of the shin from the outside or inside.
- Stiffness is a violation of flexion or extension in the joint.
- Decreased effect of non-steroidal anti-inflammatory drugs. These drugs, including aspirin, ibuprofen, diclofenac, etc., are often very effective in the early stages of arthritis. Their effectiveness varies significantly among different patients. The effect of these drugs decreases with the progression of arthritis.
- Tolerance or complications when taking pain medications.
- No effect from other treatments, such as hormone injections, hyaluronic acid preparations, physiotherapy or other surgical intervention.
Despite the fact that most of the patients subject to total knee arthroplasty, usually between the ages of 60 and 80, the orthopedic surgeon chooses indications for surgery based on an individual approach. Recommendations for surgical intervention are based on the intensity of pain syndrome, limitation of mobility in the joint, and general health, regardless of your age. Total knee arthroplasty can be effective at any age: from young people with juvenile arthritis to the elderly with deforming arthrosis.
Examination before operation
In preparation for the operation, a mandatory examination is carried out, which allows to identify all the risks associated with the operation that the operating surgeon evaluates together with the anesthesiologist and therapist:
- X-ray of the joint( with description)
- specialist report:
- analysisblood total( hemoglobin, erythrocytes, leukocytes, platelets) - valid for 14 days;
- urinalysis total( valid for 14 days);
- coagulogram( prothrombin index, APTT, fibrinogen, orthophenanthroline test)( valid for 14 days);
- biochemical blood test( glucose, transaminases, bilirubin, total protein, urea, creatinine, prothrombin index)( valid for 1 month);
- blood test for syphilis( valid for 14 days), HIV infection, hepatitis B( HbSAg) and C( HCV)( valid for 1 month);
- analysis of feces for eggs worm( valid for 10 days).
- required volume of instrumental studies:
- fluorographic examination data( valid for 1 year);
- electrocardiogram with decoding and conclusion( valid for 21 days);
- triplex scanning of veins and arteries of the lower extremities( really 3 weeks), in case of deviation from the norm of the results of USDG - consultation of the vascular surgeon;
- Fibrogastroduodenoscopy( valid for 4 weeks)( in case of changes, it is necessary to undergo treatment, the presence of erosions or ulcers is a contraindication for conducting surgical intervention);
is an echocardiographic study for all patients over 60 years old, as well as patients with atrial fibrillation, ischemic heart disease, myocardial infarction in history.
- additional findings of medical specialists with concomitant pathology:
-infectionist( for patients with viral hepatitis B and C, elevated transaminases and bilirubin),
- endocrinologist( for diabetes, thyroid, adrenal, obesity),
- neurologistwith a history of acute impaired cerebral blood flow,
- ophthalmologist( measurement of intraocular pressure, examination of the fundus - according to indications, after 60 years - all),
- rheumatologist( in the presence of pEpidemic pathology),
- urologist( according to indications),
- dermatologist( with skin diseases),
- phthisiatrician( if there is a history of tuberculosis).
- with additional diseases requires additional studies:
patients with thyroid disease need to additionally have a blood test for TSH, free T4 and perform ultrasound of the thyroid gland.
Contraindication for hospitalization with planned endoprosthetics of the knee joints are
1. Ulcerous and erosive lesions of the gastrointestinal tract.
2. Anemia( hemoglobin less than 100-110 g / l).
3. Presence of purulent inflammatory diseases( fistulous form of osteomyelitis, ulcerative lesions of the skin of lower extremities, etc.).
4. Recent acute respiratory infections( 1-2 weeks).Increase in body temperature at the time of intake( more than 37 g).
5. Recently transferred thrombophlebitis or deep vein thrombosis of the lower limbs( the recommended interval before the planned intervention is 6 months).
6. Obesity 3-4 tbsp.(Body mass index = Weight( kg) / Growth( m) * Height( m)) no more than 40).
7. Diseases of the cardiovascular system: uncontrolled arterial hypertension( blood pressure level more than 160/100 mm Hg);suffered during the last 6 months myocardial infarction or stroke;marked disturbances of rhythm and conduction( frequent extrasystoles, three-beam blockade of the conduction of the heart, tachysystolic form of atrial fibrillation, atrioventricular blockade of II-III degree).The operation in patients with sinus syndrome is possible only after the pacemaker is installed.
8. General surgical contraindications to the planned operative intervention.
What will change after total knee arthroplasty?
An important factor in deciding whether to perform an operation is knowing what will happen without surgery and what surgical treatment can give you.
More than 90 percent of the people who performed this operation expect complete disappearance of the pain syndrome and a significant increase in mobility for the possibility of a normal, active life. However, total knee arthroplasty can not do more than you could before the development of arthritis.
After the operation, you must beware of certain movements and sports, including running and contact sports.
Even with the normal use of the endoprosthesis, its components, especially the polymeric liner, will wear out. If you experience increased stresses on the joint or are overweight, the wear process can accelerate and cause instability of the prosthesis and the resumption of pain. With adequate use, the knee endoprosthesis can last for many years.
Hazardous activities after the operation: running, jumping, contact sports, aerobics.
Activity exceeding usual recommendations after surgery: too long or tiring walks, big tennis, lifting weights over 25 kg.
Allowed activity after surgery: tireless walks, swimming, golf, driving, "non-extreme" tourism, ballroom dancing, climbing on a low staircase.
Preparation for operation
Medical examination. If you have decided on total knee arthroplasty, you should be examined a few weeks before the surgery. This is necessary for assessing the state of your health and determining possible contraindications to the operation at the moment.
Laboratory and instrumental examination. Need tests such as blood tests, urine, electrocardiogram, chest X-ray, gastroscopy.
Preparing the skin for surgery. On your skin, there should not be any infectious diseases or injuries before the operation. If they are present, you should inform the surgeon so that he advises you how to prepare the skin for surgical intervention.
Medications. Inform the orthopedist about the medicines that you are taking. Your surgeon will recommend which medications you can and which can not be taken before surgery.
Weight reduction. If you are overweight, the surgeon can advise you to reduce weight before surgery to reduce the burden on the new prosthesis and, if possible, reduce the risk of surgical intervention.
Sanitation of the oral cavity. Although the risk of infection after total knee arthroplasty is very low, infectious complications can occur if bacteria enter the systemic circulation. Sanitation of the oral cavity, including removal of sick teeth and treatment of peridontitis, should be performed before the operation.
Urological preparation. Acute or chronic infectious diseases of the genitourinary system should be stopped when preparing for surgery. For elderly patients with prostate diseases, appropriate treatment is required before total knee arthroplasty.
Social support. Despite the fact that you can walk with crutches or walkers a few days after the operation, within a few weeks you may need help in such matters as cooking, walking shopping, washing, washing clothes. If you live alone, you can contact the social assistance service to help you.
Recommendations for the home.
Following are some recommendations that will make your return home easier in the rehabilitation process.
- Durable fixed handrails in the bathroom or in the shower.
- Durable handrails along all stairs.
- Stable chair with a strong, high seat, strong back, two armrests, and a footrest.
- High toilet seat.
- Stable bench in the shower or chair in the bathroom.
- Removal of loose-fitting carpets and electric wires from the area where you walk.
You will go to the clinic for a while before the operation. Then you will be examined by an anesthesiologist. The most common type of anesthesia with total endoprosthetics is spinal or epidural anesthesia( in which you can breathe on your own, but your legs will not feel anything).An anesthesiologist will discuss with you the advantages and disadvantages of these methods and help you choose the most appropriate type of anesthesia.
The operation lasts an average of about two hours. The surgeon will remove the damaged cartilage and part of the bone and then install new metal and polymeric articular surfaces in order to restore the limb axis and the function of the knee joint.
Many different types of prostheses are currently used for total knee arthroplasty. Almost all of them consist of three components: the femoral component( made of highly polished durable metal), the tibial component( composed of a strong polymer often located on a metal platform), and the patella( also polymeric), although in most cases it is not used.
After the operation, you will be transferred to the post-operative room, where you will stay for several hours, until the anesthesia is over and constant monitoring monitoring is carried out. After a full awakening, you will be transferred to your ward.
Minimally invasive total knee arthroplasty
One of the latest advances in orthopedics is the promotion of a minimally invasive technique for total knee arthroplasty. This technique is suitable for a smaller number of patients than traditional prosthetics. Approximately two times smaller cuts make rehabilitation faster, less pain and shortens hospitalization.
Minimally invasive endoprosthetics is suitable for patients who are not overweight.
Many researchers do not consider minimally invasive access a more advantageous technique. Complications with this method have so far been little studied. Discuss with the attending physician whether it is possible to carry out a minimally invasive endoprosthetics.
The operating surgeon may be encouraged to use computer navigation during the operation.
It should immediately be noted that this equipment is extremely expensive and only large orthopedic clinics have it.
Computer navigation allows you to accurately install the components of the endoprosthesis and perform the steps of balancing the ligaments of the knee joint, which are either not feasible with simple tools, or require a very large experience of the operating surgeon.
Negative feedback from some surgeons that computer navigation does not provide benefits to the patient is not due to reality, but to the fact that they do not possess this technique sufficiently or simply do not have this equipment.
Your stay at the
clinic You will be in the clinic for several days. After the operation, you will feel pain in the operated joint. To relieve pain, you will receive painkillers.
Walking and light exercises for the operated joint are necessary for recovery and should begin soon after the operation.
To prevent pulmonary complications, you must breathe deeper and more often cough.
The surgeon will take certain measures to prevent thrombosis and prevent edema such as elastic bandages, stockings, and the use of anticoagulants.
Exercises in the foot and ankle must also be carried out immediately after the operation and promote the acceleration of blood flow in the limbs, reducing edema and the risk of thrombus formation. Many patients begin exercises in the knee joint the next day after the operation. The physiotherapist will teach you special exercises to strengthen the knee joint and restore the movements necessary for walking and normal daily activity shortly after surgery.
Possible complications after operation
The risk of complications after this operation is low.
Serious complications, such as infection of the operated joint, occur in less than two percent of cases. Such formidable complications as myocardial infarction or stroke are even less common. However, chronic diseases can increase the risk of complications. Although they are rare, these complications can prolong the period of your rehabilitation.
Thrombosis of the veins of the thigh or pelvis is the most common complication of total hip arthroplasty. Your orthopedist will take steps to prevent blood clots in the veins of the legs and pelvis. These measures include special elastic bandages or stockings, exercises and anticoagulants.
Although the biocompatibility of implants and the technique of the operation is constantly progressing, the endoprosthesis may wear out or weaken its fixation in the bone over time. In rare cases, important vessels or nerves in the knee joint area may be damaged during surgery.
The success of an operation largely depends on how you follow the orthopedist's recommendations at home within the first few weeks after the operation.
Careful attitude to the postoperative wound. Along your wound, stitches or special staples will be placed along the front surface of the knee joint area or it will be sutured with a subcutaneous suture. Braces or stitches will be removed approximately two weeks after the operation. The subcutaneous suture does not require removal.
Be careful not to get water on the wound until it is completely sealed. You can wear a special bandage on the wound to prevent irritation of the wound with clothing or elastic stockings.
Diet. A slight decrease in appetite often occurs within a few weeks after the operation. A balanced diet with high iron content is necessary to help in tissue healing and muscle strength recovery. Of course, you need to consume a sufficient amount of liquid.
Activity. Exercises are a crucial component of your home rehabilitation especially during the first weeks after surgery. You must return to normal activity and daily life within 3 to 6 weeks after surgery. During this time, you will experience a slight discomfort with active movements and at night.
Your activation program should include:
- Gradually increasing the length of walking first at home, and then on the street.
- Training necessary movements, such as landing, getting up from the chair, walking the stairs.
- Return to the necessary household chores.
- Special exercises a few minutes a day to develop movements in the knee joint.
- Special exercises a few minutes a day to strengthen the knee joint.
- It is possible to conduct physiotherapy activities at home.
Driving is possible when you develop movements in the operated joint to easily get into the car and when the muscles can provide an adequate response when pressing the pedals. Most often it occurs 4 to 6 weeks after the operation.
Falling during the first weeks after surgery can damage the endoprosthesis and lead to the need for another operation. Especially careful to be with walking on the stairs. You should use a cane, crutches, walkers, handrails or other auxiliary devices until the joint becomes stronger, the mobility or strength of the muscles entering it will be restored.
Your surgeon or doctor will advise you what auxiliary devices are needed after the operation and when you can safely stop using these devices.
What is the peculiarity of your new knee joint
After the operation, you can feel the numbness of the skin around the scar. You can also feel some embarrassment when flexing at the knee joint. Restoration of joint movements is one of the goals of total endoprosthetics, but full recovery is not always possible.
Metal detectors can respond to metal joint components at airports and other facilities. In such cases, inform the guards that you had an operation with metal implantation. You can ask the surgeon for a certificate stating that you have implanted an endoprosthesis.
For complete recovery and a gradual return to normal life, regular exercises are needed to help restore normal movements in the joint and muscle strength.
Exercises in the early postoperative period.
Begin following exercises shortly after surgery, as far as possible. You can start them already in the aftercare room. At first, you may experience discomfort, but they will speed up your rehabilitation.
Day of operation
After surgery until the next morning, the patient is transferred to the intensive care unit, where he will be followed by constant monitoring and necessary medications are introduced. Immediately after restoring the movements of the foot and toes of the foot, it is necessary to perform exercises that reduce the swelling of the limb and prevent the formation of blood clots in the vessels: movements in the ankles and toes.
To prevent the formation of a calcaneus sore, it is necessary to change the position of the foot by rotating the foot outside and inside. You can sit in bed, not lowering your legs( if the doctor allows intensive care unit).To reduce the edema of the operated knee joint, reduce pain in the joint, you can use the elevated position of the leg and cooling the operated joint. A bubble with ice should be wrapped with a diaper and applied to the knee for 20-30 minutes two to three times a day.
The first-second days after the operation
The patient is transferred to the ward. Usually, the drainage tube remains in the operated joint. On average, it is left for 48 hours, although the exact time of removal is determined by the attending physician or operated surgeon. The following exercises are performed by the patient lying on his back.
- Movement in the ankles - work the leg muscles, which in their work contribute to the normal movement of blood in the operated leg. Prevent the stagnation of blood and the formation of blood clots.
- Exercises for the quadriceps femoris muscle - restores the tone and strength of this muscle to lift the straightened leg. Even if you can not lift your leg, you must constantly continue to try to do it, then the muscle will contract and gradually restore its strength and tone.
- You can sit in bed unaided, lowering your unoperated leg.
From this day on, the patient can lie on his side( on the side of the operated leg), turn on the abdomen through the operated leg. Extremely important for restoring the leg's ability to rest is to achieve full extension in the knee joint. For this, the patient with an evenly recumbent leg in the position on the back tries to press the back of the knee joint to the plane of the bed. At the same time, the full extension is achieved only if an ankle is 10-15 cm high under the ankle joint.
Second or third day after operation
Usually on this day, the drainage tubes are removed from the joint. The patient is already doing some exercises independently. Pain in the knee joint gradually subsides. To all exercises the following are added:
- Flexion in the knee and hip joints.
- Active leg extension at the knee joint placed under the knee joint.
- From this day on, the patient can sit, dropping both legs from the bed. Under the operated leg, a support is needed for less painful flexion of the operated knee as far as pain permits. Before the patient will sit down, having lowered legs from a bed, the operated leg should be bandaged with an elastic bandage from the tips of the toes to the upper part of the thigh. In the first days, sitting with lowered legs should not be more than 40-45 minutes a day, because of a possible violation of venous outflow of blood.
Third-fourth day after operation
On this day, the patient should begin walking with crutches. The principle of installing the endoprosthesis allows you to immediately load the knee joint. However, each patient has its own characteristics: a different degree of severity of osteoporosis, different training of leg muscles, the use of bone plastic when installing the prosthesis. Therefore, the attending physician establishes the procedure for increasing the load on the operated leg.
Walking in the early postoperative period.
Shortly after the operation, you will start walking for short distances within the ward and begin to service yourself. Early activation will strengthen the muscles, restore the volume of movements in the joint and accelerate recovery.
Walking with a walker / walking with full load on the operated leg. Stand upright and spread the weight of the body on crutches or walkers. Move crutches or walkers forward a short distance. After that, move forward yourself, lifting the operated leg so that you feel the floor, touching it. As you move, the knee and ankle joint will be bent. For rest, lower your foot to the floor. When you take a step, it is permissible to tear your foot off the floor. Move the walkers forward again and move the foot forward again for the next step. Remember, first you need to touch the heel of the floor, then straighten your leg, then tear your foot off the floor. You are allowed to walk as much as you can. Do not hurry. As the muscle strength increases and the exercise tolerance is increased, you will be able to walk more and more. Gradually, you will increase the weight load on the operated leg.
Walking with a stick or crutches. Walkers are often used the first few weeks to help balance and prevent falling. Then a cane or crutches are used until the strength and volume of movements are fully restored. Hold the cane in the hand opposite to the operated joint. You will be ready to go to a cane or crutches, when you can keep your balance and stand without a walker, when you can fully distribute the weight on both legs and when the walker becomes uncomfortable to hold in your hands.
Climbing and descending the stairs. The ability to move up the stairs requires a certain amount of movement and muscle strength. Firstly, you will need handrails to maintain balance and additional support and at first you can step over only one step at a time. Always climb the stairs with a healthy leg and get down from the operated leg. Remember the "rise from a healthy" and "descent from the sick."At first you may need help. Climbing the stairs is a very good exercise for muscle training and joint development. Do not climb stairs above 20 cm high and always use handrails.
Exercises in the late postoperative period
Complete recovery will take many months. Soreness before the operation and pain after weaken your muscles. The following exercises will help restore muscle strength.
1. Bending the knee while standing. Standing straight with support for walkers or crutches, lift the hip and bend the knee as much as possible while holding in this position for 5 to 10 seconds. Then lower your leg, trying to feel the floor. Repeat several times until you get tired.
2. Knee flexion with support. Lying on your back, wrap the belt around your lower leg and, helping yourself with your hands, try to bend the knee as much as possible.
3. Exercises with load. You can arrange a small load in the area of the ankles and perform the above exercises. The load can be given 4 to 6 weeks after the operation. At first use the load in 500 - 1000 g, then gradually increase.
Exercise bike. Exercise bike is an excellent exercise for restoring muscle strength and full movement. Adjust the seat height so that so that when the knee is almost straight, your foot just touches the pedal. First, the pedal turns back. Moving forward is possible if the pedal is turned back pedal comfortably. As the strength of the muscles increases( for about 4 to 6 weeks), strengthen the resistance of the simulator. Do 10 to 15 minutes twice a day, gradually increasing to 20 to 30 minutes three to four times a week.
Pain and swelling after exercise. You can experience pain and swelling in the area of the operated knee after performing the exercises. You can reduce them by holding your foot in an elevated position and applying cold.
Basic rules for doing the exercises:
To practice lying or sitting. Frequent repetition of exercises during the day for several minutes. The intensity of training depends on the presence( absence) of pain in the joint. Energetic movements "through pain" are contraindicated. The volume of movements should be increased gradually. It is recommended that you do the exercises regularly. During the exacerbation, it is required to reduce physical activity( rather than stop!) - exercises help to remove pain and inflammation. Increase physical activity is necessary gradually.