Partial and Total Knee replacement

What is the difference between partial and total knee replacement?

A replacement of the weight-bearing surfaces in patients suffering from arthritis mainly osteoarthritis is indicated when the pain is unbearable and effects the patients walking ability and quality of life.

The knee has three compartments – the inside aspect of the knee n the medial compartment , the outside of the knee – the lateral compartmentand the patellofemoral compartment is the front of the knee. The medial compartment is usually affected by osteoarthritis followed by the lateral compartment.

A total knee replacement is when all three compartments of the knee are replaced. In comparison to this a Partial knee replacement or Unicompartmental knee replacement is when one of the knee compartments only is replaced.

By removing less bone and trying to maintain most of the patient’s bone and anatomy a partial knee replacement will cause less trauma or damage than traditional Total knee replacement. This coupled to the potential use of smaller implants will also allow more of the patient’s bone to be kept and can help the patient return to normal function faster.

However a partial knee surgery is only possible if the arthritis in the knee is confined to a limited area.  If the arthritis is more widespread, then the partial knee replacement will not be considered. In addition a partial knee surgery is usually recommended in patients who are older than 55 years and relatively sedentary but not obese.

Partial knee replacement has the following benefits:

* The incision size is about 1/3 of that of a total knee replacement.
* The operation is usually accompanied by less pain and tha patient may leave the hospital the day after surgery.
* The physical rehabilitation process is quicker and patients can expect to be walking with just a stick with a return to their routine activities in just 4 to 6 weeks
* The range of motion of the knee usually approaches that of a normal knee making functional activities easier.

There are risks though which include:

* A higher rate of revising the partial knee replacement than total knee replacement. This revision may be associated with a worse functional outcome than if the total knee had been replaced in the beginning.

Knee Surgery Rehabilitation* Some patients may develop arthritis in other areas of the knee resulting in revision surgery.

*  Some patients may wear out the unicompartmental knee implant resulting in revision surgery.

However long-term results are very good when the minimally invasive Partial knee replacement is done on the right cohort of patient and when a partial knee replacement is done on a properly selected patient the results are quite successful.

Alternatives to Knee Replacement Surgery

James Jacobsen, 70, knew he would need knee surgery when he saw the x-rays to explain why he was suffering so much pain. It was bone on bone now. But is knee replacement surgery really the only answer? Jacobsen was referred to an orthopedic specialist. At this point he was given information listing the pros and cons of the surgery but also alternative solutions. In this way he could make an intelligent decision about his future. “I’ve got to have my legs under me,” ”I’m not going to have a knee replaced until it’s absolutely necessary” he said.

A study published in September 2012 in the journal ”Health Affairs” found that introducing alternative solutions to knee replacement surgery in Seattle led to 38 percent fewer knee replacements, 26 percent fewer hip replacements, and significantly lower costs for the health system during a period of six months.

This information is especially important as it comes when there is a phenomenal rise in knee surgeries. There are many factors for this rise: an active population of baby boomers now facing osteoarthritis, growing rates of obesity and the continuing improvement of artificial joints. There has been improved communication between orthopedists and their patients recently to help bring this about.

Studies by the Agency for Healthcare Research and Quality and what was published in The Journal of the American Medical Association found that the increase in knee replacement surgery has increased 2.5 times for those middle aged in a period of 10 years and that the surgery for medicare patients has increased 162 percent in 20 years.

Osteoarthritis is the major contributor to this phenomenon followed by obesity. Advertisements for artificial joints has also been a factor.

However, Dr. John Tierney, an osteopath and orthopedic surgeon based at New England Baptist Hospital and Greater Boston Orthopedic Center, who is one of several doctors recommending a more conservative approach said that he tries to help patients forestall the surgery step as long as possible. Some of those delaying tactics are: losing weight of bariatric surgery to treat obesity, changing lifestyles in order to avoid certain activities, strengthen muscles around the joints and taking pain medication to reduce inflammation. Sometimes there can be a benefit to wearing a brace to offset an unbalanced set of legs. Cortison injections are also an alternative treatment against the joint pain. Since no medication exists yet to counter the progression of osteoarthritis, it is important to remember  that artificial joints wear out eventually so delaying the surgery as long as possible makes sense.

Dr. David Arterburn, lead author of the Health Affairs study and a researcher at Group Health Research Institute in Seattle, says “…to make sure that patients understand that there is more than one option when it comes to osteoarthritis treatment.”

Karen Sepucha, of the Health Decision Sciences Center at Massachusetts General Hospital, says that just because you’re ‘clinically appropriate’ for the surgery doesn’t mean you should have it.

To make sure that patients who decide to go through major procedures truly want them, Mass. General now gives patients decision aids for 36 different conditions, including knee osteoarthritis.

Being an educated patient is crucial to making the right decision because even physicians will not be able to guarantee success.

The LEGTUTOR is a physical therapy product that has a dual function. It can be used prior to knee surgery to strengthen the muscles around the knee joint so that surgery will be more successful, less painful and allow for  a more speedy recovery or in fact it may even prevent the need for surgery. Alternatively it can be used as a device to exercise the leg, knee or hip after surgery in order to speed recovery.

The LEGTUTOR is an ergonomic wearable leg brace with dedicated rehabilitation software. The LEGTUTOR rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. This means that the LEGTUTOR system allows the physical therapist to prescribe a leg rehabilitation program customized to the patient’s knee and hip movement ability at their personal stage of rehabilitation. The LEGTUTOR uses biofeedback to keep the patient motivated to do the exercise practice in the form of challenging games. They are suitable for a wide variety of other neurological and orthopedic injuries and diseases as well as post trauma and orthopedic surgery.

The LEGTUTOR is also used by physical and occupational therapists in combination with the HANDTUTOR, LEGTUTOR and 3DTUTOR for upper and lower extremity rehabilitation. The TUTOR system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. It is designed for children and adults and can be used at home supported by telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Frisbee Player’s Arm Can Speed His Recovery With ArmTutor

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ROWENA JOY A. SANCHEZ writing for MB.COM.PH on November 28, 2011 tells us the following story.

Derek sustained knee injuries in a Frisbee game last year even prior to breaking his arm.  This was the actor’s Derek Ramsay “biggest nightmare” to be injured in a Frisbee tournament.

The Nov. 28 operation on his forearm will fix metal plates to reduce the breaks. This is not the first Derek was injured and last year he tore the anterior cruciate ligament (ACL) and lateral collateral ligament (LCL) of his right knee, while his left left leg suffered a fracture.

Even a frisbee player or the actor Derek Ramsaycan expect to get help from the newly developed ArmTutor during his rehabilitation of his arm and forearm. Not to mention rehabilaition after ACL and LCL surgery by means of the LegTutor.

Following orthopedic injury, disease and surgery, Physical and occupational therapists use the LegTutor, ArmTutor and HandTutor as part of their manual therapy tools. Physical therapy is based on prescribing intensive controlled and isolated movement practice for the lower limb limb and ankle and the upper limb, shoulder, elbow and wrist and fingers.

The ArmTutor™ system together with its sister devices (HandTutor, LegTutor, 3DTutor) is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. See http://www.HandTutor.com for more information.

LegTutor an Important Boost for People With Stiff-Knee Gait Following Stroke

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Dr. James S. Sulzer from the Rehabilitation Institute of Chicago  Chicago, Ill; the Departments of Mechanical and Biomedical Engineering, Northwestern University, Evanston, Ill; and the Department of Bioengineering, University of Illinois–Chicago, Chicago, Ill.writing for the American Heart and Stroke Associations made the following study:

Study Background—  Reduced knee flexion during the swing phase is called stiff-knee gait is defined. This is accompanied by circumduction and hip hiking which are examples of frontal plane compensatory movements that result from reduced toe clearance. The group researched whether  knee flexion assistance before foot-off would result in a reduction of the  exaggerated frontal plane movements seen in stiff-knee gait after stroke.

Methods— 9 chronic stroke subjects with stiff-knee gait underwent assist knee flexion torque during the preswing phase using a robotic knee orthosis on a treadmill. This was compared to peak knee flexion, hip abduction, and pelvic obliquity angles of 5non impaired control subjects.

Results— Maximum knee flexion angle was significantly increased in both groups however the gait compensation of  hip abduction  in the stroke subjects significantly increased, no change was observed in nondisabled control subjects.

Conclusions— Hip abduction was seen to increas when stroke subjects received assistive knee flexion torque at foot-off. These findings were in direct contradiction to the belief that pelvic obliquity combined with hip abduction is a compensatory mechanism that facilitates foot clearance during swing.

The LegTutor has proven to be an important complement in improving functional outcomes in physical rehabilitation for post stroke patients.

The LegTutor provides a safe and comfortable leg brace with position and speed sensors that precisely record three dimensional hip and knee extension, flexion and hip abduction. Rehabilitation games allow the patient to exercise Range of Motion (ROM), speed and accuracy of movement of the hip and knee individually or the knee while looking at the compensatory movement of the hip. In this way the physiotherapist can set up the knee range of motion and ask the patient to perform an isolated swing phase of the movement. The patient can be given secondary feedback of the hip abduction  during this knee swing. The patient in the rehabiliation game will be forced to do repetive movement practice of the knee swing without hip abduction. The patient can also work on strengthening and control of isolated hip abduction aduction exercises so they learn motor control in this movement as well.  The LegTutor will also allow for evaluation and reporting of the knee movement during the isolated swing movement of gait.

The LegTutor together with its sister devices namely the HandTutor, ArmTutor and 3DTutor) aim to optimize motor, sensory and cognitive performance and allow the patient to do customized repetitive and intensive isolated and combined joint movement practice. The Tutors are being successfully used in leading U.S, German, Italian and UK rehabilitation clinics by both occupational and physical therapists. They are available for children as well as adults.

http://www.handtutor.com

LegTutor Enhances Range of Motion for Knee Replacement Patients

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Pazit Levinger et al conducted a study published in  Springer Link in October 2011.

The purpose of the study was to determine why knee pain and disability still persists following knee replacement surgery (TKR) which will place patients at increased risk of falls. This study looked at the falls risk and the occurrence of falls of people with knee osteoarthritis (OA) before and at 12 months following knee replacement surgery.

The method used in the study was:

Thirty-five patients with knee OA were tested using Physiological Profile Assessment both prior to undergoing knee replacement surgery and also at 12 months following surgery. The Physiological Profile Assessment  is an outcome measure that looks at vision, lower limb proprioception, knee extension strength, reaction time and postural sway. Other outcome measures included Physical activity, number of falls, fear of falling, pain, disability and health-related quality of life were also assessed.

The results  found no significant differences between no’ of falls pre- and post-surgery with 48.5% compared to 40% reporting at least one fall in the 12 months before and following the surgery. Improvement in knee strength/ reaction time/ fear of a fall were seen following surgery. There was no improvement in lower limb proprioception. Self-reported pain, function and stiffness did  significantly improve, but health-related quality of life (HRQOL) deteriorated following the surgery.

The group concluded that persistence of impaired lower limb proprioception may have contributed to the number of falls experienced following knee replacement surgery. In addition, although knee replacement surgery(TKR) improves function and alleviates pain, patients post TKR may need to engage in proprioception rehabilitation following the surgery to reduce the risk of falling.

The LegTutor has shown remarkable success in post knee replacement surgery. The LegTutor™ system has been developed to allow for functional rehabilitation of the lower extremity. Together with the 3DTutor the LegTutor can be used to increase the patients proprioception performance with dedicated games being developed in the rehabilitation software for this outcome. The Tutor system rehabilitation concept, which includes the HandTutor, ArmTutor and 3DTutor, is based on performing controlled exercise rehabilitation practice at a patient customized level including balance and proprioception training. This is achieved with real time accurate feedback on the patient’s performance.  The exercises are designed in the form of challenging rehabilitation games that are suitable for a wide variety of neurological and orthopedic injury and disease. The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice. Exercise practice is the most important manual therapy tool in the armory of physical and occupational therapists to ensure optimal rehabilitation.

The LegTutor™ allows for isolated and a combination of knee and three directional hip treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multi joints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.

The LegTutor™ system is used by many leading rehabilitation centers worldwide for both neurological and orthopedic patients including adults and children. the Tutor system holds FDA and CE certification.

http://www.handtutor.com

LegTutor Twice as Helpful in Bilateral Knee Replacement Therapy

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As reported on NBC’s Channel 2 in Ft. Meyers, Florida on Oct. 4 the story of Chris Naylor is encouraging.

The pain from bone on bone of one crunching knee wasn’t enough Chris Naylor had two!! When her walk turned to a hobble Chris underwent bilateral knee replacement (TKT) in stages. The procedure is used to resurface the knee joint, remove damaged cartilage and bone. Surgeons cap the resurfaced bones to keep much of the knee intact.

Dr. Ed Humbert who is an orthopedic surgeon  from the medical staff of Lee Memorial Health System  speaking about ligaments and the muscles and tendons aid that “”The good parts stay and we keep as much of your own parts as we can.”

It’s not just the surgery that determines success or failure and once the surgery is over the real work will begin.

“Physical therapy after knee replacement is very, very important and even the best implant or knee replacement (TKR) put in properly and perfectly, if that patient did little or no therapy will become very stiff and very painful,” says Dr. Humbert.” Physical therapy after Total knee replacement will help improve range of motion, muscle strengthening and also keep the swelling down.

Chris jumped into physical therapy with both feet and even planned a trip to Disneyland within weeks of her last surgery. Physical therapy usually starts the next morning after surgery. The patient is then discharged from hospital a few days surgery this is followed by home care physiotherapy calls.

The LegTutor™ system is a key component of physical therapy after total knee replacement. The LegTutor is an ergonomic wearable leg brace with dedicated rehabilitation software.  The LegTutor™ rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. This means that the LegTutor™ system allows the physical therapist to prescribe a leg rehabilitation program customized to the patients knee and hip movement ability and their stage of rehabilitation. The LegTutor uses biofeedback to keep the patient motivated to do the exercise practice with the exercises designed in the form of challenging games that are suitable for a wide variety of other neurological and orthopedic injury and disease as well as post trauma and orthopedic surgery.

The LegTutor™ is a physical therapy product used by physical therapists in combination with the HandTutor, ArmTutor and 3Dtutor for upper and lower extremity rehabilitation. The Tutor system is a physical therapy solution is used by physiotherapists and occupational therapists in many leading rehabilitation centers worldwide and has full FDA and CE certification. It is designed for children and adults and can be used at home use and can be supported by telerehabilitation.

Post Knee Replacement Therapy Includes the LegTutor

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William C. Shiel Jr., MD, FACP, FACR associate clinical professor of medicine at University of California, Irvine, writing in MedicineNet.com composed important questions and answers concerning total knee replacement . Listed below are some of them.

What is a total knee replacement?

A total knee replacement is a surgical procedure where the diseased knee joint is replaced with an artificial joint. The knee is a hinge providing motion where the thigh meets the lower leg. During a total knee replacement (TKR), the end of the femur bone is removed and replaced with a metal shell. Then the lower leg bone (tibia) is also removed and replaced with a channeled plastic piece together with a metal stem.

The posterior cruciate ligament stabilizes each side of the knee joint preventing the lower leg from sliding backward in relation to the thigh bone. In total knee replacement surgery, this PCL ligament is either retained, removed, or substituted by a polyethylene post.

What happens in the post operative period?

It is important for patients to continue in an outpatient physical-therapy program along with home exercises for optimal outcome of total knee replacement surgery. Patients will be asked to continue exercising the muscles around the replaced joint to prevent scarring (contracture) and maintain muscle strength for the purposes of joint stability.

How does the patient continue to improve as an outpatient after discharge from the hospital?

Future activities are generally limited to those that do not risk injuring the replaced joint. Sports that involve running or contact are avoided, in favor of leisure sports, such as golf, and swimming. Swimming is the ideal form of exercise, since the sport improves muscle strength and endurance without exerting any pressure or stress on the replaced joint. An important device that can assist in improving leg (and hip) movement in post knee replacement physical therapy is the LegTutor. The LegTutor provides a safe and comfortable leg brace with position and speed sensors that precisely record three dimensional hip and knee extension and flexion. Rehabilitation games allow the patient to exercise Range of Motion (ROM), speed and accuracy of movement. The LegTutor facilitates evaluation and treatment of the lower extremity including isolated and combined hip and knee movements.

The LegTutor  and the other devices in the Tutor system including the HandTutor, ArmTutor and 3DTutor use controlled intensive exercise practice aim to optimize motor, sensory and cognitive performance to allow the patient to better perform everyday functional tasks and improve quality of life. The Tutor system is being successfully used in leading U.S. and foreign (UK , German) hospitals and clinics and are suitable for home use through telerehabilitation.

LegTutor is used following Knee Replacement Surgery

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Writing in ORTHOPEDICS September 2011 in an article entitled:Instability in Primary Total Knee Arthroplasty
Drs. Daniel J. Del Gaizo, MD and Craig J. Della Valle, MD from Rush University Medical Center, Chicago, Illinois. have found that instability is one of the most common causes of failure of total knee arthroplasty (TKA). The presentation of instability can vary from pain to dislocation and the etiologies can be just as varied. Instability after TKA is seen when the instability occurs in the knee’s arc of motion. Acute instability is either related to intraoperative injuries or excessive release of coronal stabilizers including the medial collateral ligament in extension or the posterolateral corner in flexion. Whereas chronic instability in extension is often related to varus/valgus malalignment. In flexion, chronic instability can be related to an undersized femoral component or excessive tibial slope and or excessive elevation of the joint line which affects the isometry of the collateral ligaments in midflexion. Recurvatum instability is rare and usually coincides with extensor mechanism dysfunction or neuromuscular disorders. The authors state that when addressing instability after TKA, it is critical to understand the root cause of the problem and also to evaluate for other causes of pain such as infection or aseptic loosening.

When revision surgery is needed it should aim to restore a neutral mechanical alignment and set the appropriate component rotation, balance the flexion and extension spaces, and also restore the height of the native joint line.

The LegTutor™ system has been developed to allow for functional rehabilitation of the lower extremity. It is extremely helpful following knee surgery and hip surgery. The system consists of an ergonomic wearable leg brace and dedicated rehabilitation software. The LegTutor™rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.

The LegTutor™ system is being used by many leading rehabilitation centers worldwide and has full FDA and CE certification.

LegTutor Shows Success in Post Knee Surgery Therapy

Dr.Giles R. Scuderi, in an online publication,  August 2011, reported that between May 2001 and June 2004, 388 total knee – arthroplasty cases were enrolled in a prospective, randomized and multicenter investigational device exemption trial. The patients received either a high-flexion mobile-bearing knee or a fixed-bearing control knee. The patients were assessed at 2 to 4 years . The results show 293 patients with degenerative joint disease were compared using Knee Society Assessment and Function scores, radiographic results, complications analysis, and survival estimates. Both the mobile-bearing and fixed-bearing groups demonstrated similar, significant improvement over preoperative assessments in Knee Scores including maximum flexion, and range of motion (ROM).

Post knee surgery physical therapy received a major boost with the advent of the LegTutor. This is a new device that improves motor, sensory and cognitive impairments through intensive active exercises with augmented feedback. The repetitive training is tailored to patient performance and allows the therapist to customize the most suitable rehabilitation program to the patient’s ability. The LegTutor together with its sisters the HandTutor, ArmTutor and 3DTutor are currently in use in major U.S. and foreign hospitals. Used in private clinics and even at home with tele rehabilitation the Tutors are successful for children as well as adults. The LegTutor is used to improve knee and hip movement ability in both neurological and orthopedic injury and disease.