Relief from knee pain starts here.

Relief from knee pain starts here.

Table of Contents How Knees Work Common Conditions and Treatment Options Surgical Procedures What Sets Us Apart START Start the Journey to Pain-Free Knees Your Source for Knee Relief PAGE 2

How Knees Work It goes without saying that our knees play a pretty important role in our ability to move about, so when injuries, chronic conditions, bruises or skin wounds occur around the knee area, even routine movements can become excruciating. What can you do to protect and treat your knees? How do you know when you need to see a doctor, or consider a surgical treatment for knee pain? The answers start with a better understanding of how our knees work. The knee is a pivotal hinge joint that allows motions such as flexing and extending as well as some internal and external rotation. It connects the femur (thighbone) to the hip, and the tibia (shinbone) and fibula (a shorter and thinner bone that runs parallel to the tibia) to the ankle. The patella, or kneecap, is a small bone on the front of the knee. A number of ligaments, most notably the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL), stabilize the knee and prevent it from being overstretched or twisted. Two concave pads of cartilage called menisci act as a pad between the femur and tibia, separating the bones and dispersing friction, along with synovial fluid that bathes the joint and lubricates the knee. Knee problems and knee pain are common, as the knee is a frequent point of contact during traumatic accidents and is prone to wear and tear due to its weight-bearing nature. It is also a common site for arthritis pain, which is caused by damage to the cartilage at the ends of the bones. Did you know? The knee is the largest joint in the human body. When climbing stairs, the knee withstands up to four times body weight. More than 600,000 knee replacements are performed each year in the United States. PAGE 3

Common Conditions and Treatment Options Arthritis The most common type of arthritis of the knee is osteoarthritis, a chronic condition in which the cartilage that cushions the movement of the joints wears away. Rheumatoid arthritis is another type of arthritis that affects the knee. In rheumatoid arthritis, the knee becomes inflamed and cartilage may be destroyed. We provide an array of treatment options for these conditions, depending on their severity. These treatments include: Medicines and joint injection to reduce pain, swelling and inflammation Physical therapy and/or exercises to improve movement and strength Knee replacement surgery Bursitis/Tendonitis If you garden, play tennis or ski, you may be at a higher risk for developing bursitis or tendonitis. Bursitis is the inflammation or irritation of the bursa, a fluid-filled sac located between tissues such as bone, muscle and skin. The bursa helps lubricate and decrease rubbing, friction and irritation when you move your knees. Tendonitis is an inflammation or irritation of a tendon, the thick cord that attaches bone to muscle. Bursitis and tendonitis are most often caused by repetitive, minor impact on the knee, or from a sudden, more serious injury. Age also plays a role. As tissues and tendons age they are able to tolerate stress less, are less elastic, and are easier to tear. The knee is prone to these conditions. We treat bursitis and tendonitis with: Activity modification and rest Icing at the sight of pain Medicines and joint injection to reduce pain, swelling and inflammation Cartilage Injuries and Disorders Chondromalacia (KON-dro-muh-lay-she-uh) occurs when the cartilage of the kneecap softens. This can be caused by injury, overuse or muscle weakness, or if parts of the knee are out of alignment. Meniscal cartilage can be injured if the knee is twisted while bearing weight. This may be the result of a sports injury or even something simple, like twisting when getting out of a chair. A partial or total tear may occur. The seriousness of the injury depends on the location and the size of the tear. Our treatments for cartilage injuries include: Exercises to strengthen muscles Electrical stimulation to strengthen muscles Arthroscopic surgery PAGE 4

Knee Fracture Your bones are rigid, but they are also designed to give somewhat when an outside force is applied. However, if a bone experiences an extreme force, it will break or shatter. Our knee fracture care follows one basic rule: the broken pieces must be put back into position and prevented from moving out of place until you can heal properly and as comfortably as possible. Our treatment options for a fractured knee or kneecap include: Cast immobilization Bracing Traction Arthroscopic and open surgery Ligament Injuries Two commonly injured ligaments in the knee are the ACL and PCL. An injury to these ligaments is sometimes called a sprain. Because they stabilize the knee in a rotational fashion, if one of them is significantly damaged, the knee will be unstable when planting the foot, causing the knee to buckle and give way. The ACL is most often stretched or torn (or both) by a sudden twisting motion. The PCL is usually injured by a direct impact, such as in an automobile accident or football tackle. The MCL and LCL are usually injured by a blow to the outer side of the knee, causing the ligament to stretch or tear. These blows frequently occur in sports such as football or hockey. We treat ligament injuries with: Icing (right after the injury) to reduce swelling Exercises to strengthen muscles A brace or splint to immobilize the joint Arthroscopic surgery (in some cases, including reconstruction of the damaged ligament) Most knee problems are the result of a direct blow or sudden movement that strains the knee. Such injuries are very common in sports. Arthritis and inflammation are also major contributors to knee problems. These conditions can be caused by genetics, gradual wear and tear or certain rheumatic diseases such as rheumatoid arthritis and lupus. Our orthopedic surgeons have spent years studying and advancing ACL reconstruction, meniscus repair and other joint preservation and restoration techniques to help provide better movement. Our comprehensive knee care starts with an evaluation of your medical history, along with a physical examination and diagnostic tests (such as X-rays, CAT scan, MRI and Arthroscopy), to accurately identify and recommend the proper course of treatment to bring you pain relief and improved knee function. PAGE 5

Surgical Procedures Arthroscopy Procedure Arthroscopic surgery is an extremely valuable tool in the treatment of joint conditions. It allows us to examine, diagnose and treat problems inside a joint. An arthroscopy can be more precise than an X-ray or open surgery in evaluating certain problems. Our physicians are highly skilled to perform arthroscopic surgical procedures on many joints in the body, including the knee. We use arthroscopy to aid in: Diagnosis of synovitis, an inflammation of the lining in the knee. The procedure can then be used to remove the inflamed lining. Reconstruction of the ACL or PCL of the knee. Repair or resection of torn meniscus (cartilage) in the knee. During an arthroscopic procedure, one of our physicians will examine your joint by inserting a pencil-sized instrument known as an arthroscope through an incision in the skin. The arthroscope is made up of a tiny lens, light source and video camera. The camera displays a large image of the joint on a television screen, allowing us to look at cartilage and ligaments throughout your knee and locate the source of damage and pain. Through an additional one to two small incisions made around the joint area, we can insert surgical instruments and perform a repair as needed. In most cases, the incisions made during arthroscopy leave tiny scars that are almost unnoticeable. Post Surgery and Recovery After surgery, our staff will provide you with instructions on post-operative care and exercise procedures. Most of the time, hospitalization is not necessary. In fact, many of our patients are able to have their arthroscopic surgery on an outpatient basis and are home several hours after the surgery. It is not unusual for patients to go back to work or school or resume daily activities within a few days. Athletes who are in good physical condition may in some cases return to athletic activities within a few weeks, but each patient s arthroscopic surgery and recovery time is unique. Let us help you determine if arthroscopy is right for you. PAGE 6

Partial Knee Replacement Procedure The knee is a combination of three joints, or compartments. Osteoarthritis may affect all parts of the knee, or the damage may be limited to one compartment. If nonsurgical treatments such as medications and use of a walking support are no longer helpful, you may want to consider knee replacement surgery. Knee replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity and help you resume normal activities. If only one knee compartment is damaged, we may recommend a partial or unicompartmental knee replacement, in which only the damaged compartment is resurfaced with an implant. The most common partial knees go on the inside compartment, or medial side, of the knees. Newer surgical techniques permit the partial knee implant to be inserted through a small incision without splitting the quadriceps muscle, which is routinely done in total knee surgery. There is much less swelling and bleeding, and partial knee replacements require significantly less recovery time than total knee replacement surgery. The procedure itself takes approximately 1 to 2 hours. There are three basic steps: There are three basic steps to the procedure: 1 2 3 Prepare the bone Our surgeon will remove the cartilage and bone from the damaged compartment of your knee. Position the metal implants The ends of the femur and tibia are capped with metal coverings that recreate the surface of the joint. The metal components are cemented to the bone. Insert a spacer A plastic insert is placed between the two metal components to allow for a smooth gliding surface. Post Surgery and Recovery Walking, knee movements and physical therapy begin as you experience less pain. Often these activities start the day after surgery. But you will begin putting weight on your knee immediately after surgery. You may need a walker, cane or crutches for the first several days or weeks until you become comfortable enough to walk without assistance. In most cases, patients who have had a partial or unicompartmental knee replacement go home 1 to 3 days after the operation. A physical therapist will give you exercises to help maintain your range of motion and restore your strength. You will most likely resume your regular activities of daily living by 6 weeks after surgery. Our staff will manage your progress and be available every step of the way. PAGE 7

Total Knee Replacement Procedure Total knee replacements are one of the most successful procedures in all of medicine. At Orthopedic Surgery Specialists, we stay at the forefront of advances in total knee replacements in order to provide a safe return to your active lifestyle. In a traditional total knee replacement, the damaged areas of the femur, tibia and kneecap are removed and replaced with prostheses. The procedure itself takes approximately 1 to 2 hours. There are four basic steps to a total knee replacement procedure: 1 2 3 4 Prepare the bone Our surgeon will remove the damaged cartilage surfaces at the ends of the femur and tibia along with a small amount of underlying bone. Position the metal implants The removed cartilage and bone is then replaced with metal components that recreate the surface of the joint. These metal parts are cemented into the bone for optimal fixation. Resurface the patella The undersurface of the patella (kneecap) may be cut and resurfaced with a plastic button. We perform this procedure on a case-by-case basis. Insert a spacer A plastic insert is placed between the two metal components to allow for a smooth gliding surface. Post Surgery and Recovery After surgery, you may receive medication to help with pain management. Walking, knee movements and physical therapy begin as you experience less pain, many times starting the day after surgery. Patients usually remain in the hospital for 2-3 days following total knee replacement surgery, then either return home or proceed to a rehabilitation facility. Physical therapy is an important part of the recovery process following knee replacement surgery. More than 90% of people who have total knee replacement surgery experience a dramatic reduction in knee pain and a significant improvement in the ability to perform common activities of daily living. Total knee replacement will not allow you to do more than you could before you developed arthritis, but realistic post-surgery activities include unlimited walking, swimming, golfing, driving, ballroom dancing and other low-impact sports. Because every patient is different, we work with you to develop an individualized plan for recovery and healing and manage your progress every step of the way. PAGE 8

What Sets Us Apart We re More Than Just Bone Doctors At Orthopedic Surgery Specialists, we understand musculoskeletal conditions and injuries. Our multidisciplinary team of board-certified orthopedic surgeons has pursued advanced training in several musculoskeletal subspecialties including joint replacement, arthroscopic surgery and sports medicine, and stays at the forefront of medical advances in the prevention, diagnosis and treatment of orthopedic conditions. We have decades of combined experience in providing high-quality, comprehensive orthopedic care to North Texans of all ages. Plus, we re known for using the least invasive surgical techniques whenever possible to promote better joint health and to minimize pain. To help Orthopedic Surgery Specialists meet the growing need for advanced fracture surgical care for athletes and aging baby boomers, our Dr. Jay Bender has completed the country s first fellowship program in geriatric orthopedic surgery and trauma. The unique program, offered at the University of California at San Francisco, is one of the most respected orthopedic trauma fellowships available in the United States. It s another way that Orthopedic Surgery Specialists is helping lead the way in caring for the orthopedic needs of North Texans. Personalized Care, Advanced Services are Our Cornerstones At Orthopedic Surgery Specialists, we want to serve you with compassion, precision and speed. Our on-site ultrasound capabilities allow us to do all three. For years, orthopedic surgeons have relied on X-ray images to assist in diagnosing and treating a variety of musculoskeletal conditions. Although still a clinical necessity, X-rays provide a limited picture of the tissues that may be involved in an injury. Today, advanced ultrasound technology enables our orthopedic surgeons to see your anatomy in real time for quicker assessment and diagnosis of an injury or to guide an injection with on-target accuracy into just about any joint in your body. Ultrasound imaging is also painless and there s no radiation involved. Having this technology right in our office allows us to diagnose and/or treat many conditions with minimal downtime and recovery time for you. PAGE 9

START Start the Journey to Pain-Free Knees Preventing Injuries Maintain a healthy weight Extra pounds put additional strain on your knees, increasing the risk of injuries and osteoarthritis. Prepare your knees for activity Athletes should take time for conditioning to prepare muscles for the demands of sports participation. Ensure that your technique and movement are the best they can be. Vary your routine to stay strong and limber Weak muscles are a leading cause of knee injuries. Mix up your routine with balance and stability training, as well as stretching and flexibility exercises, to help your knees avoid injury. Exercise appropriately for your condition If you have osteoarthritis, chronic pain or recurring injuries, consider low-impact forms of exercise, such as swimming or water aerobics. Avoid high-impact activities. PAGE 10

When to See Our Specialists The knee has to support the weight of the body as you run, walk, jump and climb stairs. The stress on the knee means that knees are more frequently injured than other joints. When knee pain interferes with your ability to carry out everyday activities, or disturbs your sleep, it may be time to contact Orthopedic Surgery Specialists. Why is arthroscopy necessary? Diseases and injuries can damage otherwise healthy knee cartilage, ligaments, muscles and tendons. Arthroscopy helps us accurately identify the source of damage, whether it be disease, inflammation or loose bodies of bone or cartilage. Through arthroscopy, we may then be able to repair the damage or recommend another course of action. Aren t I too young for knee replacement? With new techniques and technology, joint replacements are lasting longer than ever and are more suitable for active people of all ages. Pain relief is the major advantage of knee replacement, with restoration of joint mobility a big factor as well. If your knee pain is interfering with your life, you may want to consider joint repair or replacement at any age. Will I have to change my lifestyle after knee replacement? In general, you will want to avoid high impact exercises such as running or jogging on hard pavement. Implants are durable, but will wear out with heavy use. To insure a long life for your implant, talk with one of our orthopaedic surgeons about what results you can expect and make sure you have a realistic idea of what you will be able to do after the surgery. Preparing for Surgery Ready your environment for post-surgery arrival Arrange for help upfront so that when you get home you are ready to let recovery and healing begin without delay. Talk to your doctor about medications and potential illnesses You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs. It is very important for us to also know which drugs you should still take on the day of your surgery. Tell us if you have been drinking a lot of alcohol, especially more than one or two drinks a day. If you smoke, try to stop. Smoking can slow down your healing. Let us know about any cold, flu, fever, rashes or other illness you may have before your surgery. If you have not seen a dentist in the past two years or have known loose or broken teeth, these should be evaluated before knee replacement. A bad tooth is a type of chronic infection. PAGE 11

Your Source for Comprehensive Knee Care W. University Dr. 2900 I-35 North, Suite 200 Denton, Texas 76201 Phone: 940-323-3400 OrthoSurgeryDenton.com I-35 Oak St. I-35 A Tradition of Caring At Orthopedic Surgery Specialists, we have been helping lead the way in knee preservation and replacement for more than two decades. Our board-certified, fellowship-trained orthopedic surgeons strive to bring the latest techniques to the care of our patients who are ready to resume active lifestyles, sooner. We work in collaboration with orthopedic-focused nurses, therapists and staff members at Texas Health Presbyterian Hospital Denton who are also trained to care for joint patients. We believe patient education is an important part of your joint health. Therefore, we make it a priority to explain signs and symptoms, potential causes, treatment options and prevention methods to you. We also will provide you with resources we feel will be helpful for better understanding your specific condition. If you have questions or concerns about your orthopedic health, please don t hesitate to contact our staff. This information is an educational resource only and should not be used to make a decision on medical treatment. All decisions about the proper course of medical treatment should be made in conjunction with your surgeon or a licensed health care provider. Orthopedic Surgery Specialists is part of Texas Health Physicians Group, a network of more than 800 physicians, nurse practitioners and physician assistants dedicated to providing safe, quality care for the communities throughout North Texas. Physicians employed by Texas Health Physicians Group practice independently and are not employees of the hospital or Texas Health Resources. PAGE 12