Why knees hurt, and what you can do about it.

Why knees hurt, and what you can do about it.

Table of Contents How Knees Work Common Conditions and Treatment Options Surgical Procedures START Start the Journey to Pain-Free Knees START What Sets Us Apart 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 or 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 a person s body weight. More than 600,000 knee replacements are performed each year in the United States. Last year, Texas Center for Joint Replacement performed close to 400 knee replacement procedures. 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 to reduce pain, swelling and inflammation; Physical therapy and/or exercises to improve movement and strength; Weight loss; and Knee-replacement surgery. 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. Treatment for cartilage injuries includes: Exercises to strengthen muscles; Electrical stimulation to strengthen muscles; and Arthroscopic 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. Ligament injuries are treated with: Ice packs (right after the injury) to reduce swelling; Exercises to strengthen muscles; A brace; and 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 orthopaedic surgeons have spent years studying and advancing the art of joint replacement for knee problems. We typically use your medical history, along with physical examinations 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 4

Surgical Procedures Arthroscopy Procedure Arthroscopy is a surgical procedure we use to examine 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. 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 postoperative 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 5

Surgical Procedures, Continued Partial or Unicompartmental 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 the latter is the case, one treatment option we offer is 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. TCJR has been performing this procedure since 1986, and our surgeons stay at the forefront of advances in the surgical technique and prosthetic implant designs. 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. We perform partial knee replacement surgeries at Texas Health Presbyterian Hospital Plano. The procedure takes approximately one to two hours. There are three basic steps to the procedure: 1 Prepare the bone Our surgeon will remove the cartilage and bone from the damaged compartment of your knee. 2 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. 3 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 one to three 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 six weeks after surgery. Our staff will manage your progress and be available every step of the way. PAGE 6

Surgical Procedures, Continued Total Knee Replacement Procedure 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 one to two hours. There are four basic steps to a knee replacement procedure: 1 2 Prepare the bone The damaged cartilage surfaces at the ends of the femur and tibia are removed 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. TCJR uses cemented total knee replacements because our experience indicates that this method of fixation provides the most predictable and consistent results. 3 4 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 two to three 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 percent 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 7

START What Sets Us Apart Rapid Knee Recovery Program Texas Center for Joint Replacement is known for using the least invasive surgical techniques whenever possible to promote better bone and joint health and to minimize pain. Our Rapid Knee Recovery Program has been incorporated in most of the surgeries we perform in an effort to control postoperative pain and get you moving again. TCJR was the first medical group to employ an integrated joint replacement recovery program, and it now serves as the model for outstanding post-operative care. Advanced Recovery One of the drawbacks of lower-body joint replacement is that it has traditionally required four to six weeks or longer of rehabilitation. This presents a particularly difficult problem for younger patients who are employed and are unable to stay away from work for four to six weeks. Our program is designed as much as possible to permit younger and more-able patients to recover faster and return more quickly to everyday activities than in the past. Many of our patients who undergo knee surgery return to driving a car and to work activities in as little as two weeks. New materials and implant designs, combined with our modern imaging techniques, allow for a surgical approach that has less effect on muscles and other tissues. Our individualized plans for physical therapy, advanced pain management and counseling, enable each patient to experience an optimal level of recovery based on their unique needs for healing. PAGE 8

STARTStart 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. Stay strong and limber Weak muscles are a leading cause of knee injuries. Balance and stability training, as well as stretching and flexibility exercises, can 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. 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 Texas Center for Joint Replacement. 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 resurfacing 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 ensure a long life for your implant, talk with one of our orthopedic 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 9

Your Source for Knee Relief W. Parker Rd. W. Parker Rd. 6020 W. Parker Road, Suite 470 Plano, Texas 75093 Phone: 972-608-8868 Toll-free: 844-340-5672 TCJR.com Midway Rd. Communications Pkwy. Dallas North Tollway Parkwood Blvd. A Tradition of Caring At Texas Center for Joint Replacement, we are dedicated exclusively to joint replacement surgery. In fact, we have been leading JOINT the way REPLACEMENT in knee and hip replacement for more than 30 years. Our board-certified, fellowship-trained physicians have Total joint pioneered care for a the lifetime latest techniques to bring the best care to our patients who are ready to resume active lifestyles, sooner. The orthopedic professionals at Texas Center for Joint Replacement specialize in the diagnosis, education, care and treatment of joint replacement patients. Our combined expertise has made a number of accomplishments possible, including: First Oxford partial knee in Texas First reverse shoulder in North Texas First anterior hip in North Texas First successful titanium hip stem in the U.S. First mobile-bearing unicompartmental knee replacements in the U.S. First group to employ an integrated joint replacement recovery program Our Healing Ways 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. Texas Center for Joint Replacement 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 10