TOTAL KNEE REPLACEMENT by chenshu

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									Total Knee Replacement
MATTHEW E. MITCHELL, M.D.




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              Disclaimer
• The opinions in this presentation are based
   on my personal experience and review of
    the literature. Decisions should only be
  made after consultation with your primary
      doctor or orthopedic surgeon. More
      information can be gained from the
       American Academy of Orthopedic
                Surgeons Website.
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         KNEE ARTHRITIS
Cause
 1. Previous Injury
 2. Disease such as rheumatoid arthritis
 3. Many times the cause is uncertain




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                 Symptoms
1. Progressive pain with activities
2. Loss of motion
3. “Crunching” sensation in the knee
4. Pain at the start of activity that gets better
  “warms up over time”
5. Over time deformity can occur in the knee

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               Treatment
1. Anti-inflammatories such as motrin or
   aspirin
2. Physical Therapy
3. Activity modifications such as using a
   cane
4. Injections
5. Surgery
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                  Injections
• Steroids
  – Takes up to 7 days to take effect
  – Possibility of infection (extremely rare)
  – May last more than 6 months
• Visco supplements
  – Hyalgan and Synvisc
  – Multiple injections
  – Usually used for early arthritis

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               Osteotomies
• Used to correct deformity due to arthritis
• Useful in younger patients
• Indications are more limited than knee
  replacement
• Some patients are candidates for
  osteotomies


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           Knee Replacement
• Unicompartmental
  replacement
  – Replaces half of the
    knee




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        Knee Replacement
– Total Knee Replacement
  • Replaces all of the knee




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   Minimally Invasive Surgery
• About ½ of patients are candidates
• May allow earlier discharge from hospital
• No studies to date show that MIS
  (minimally invasive surgery) gives better
  long term results than traditional surgery
• Some institutions have noted higher
  complication rates with MIS

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            Before Surgery
• Talk with your physician about stopping
  anti-inflammatory medication
• You may need a clearance from your
  medical doctor
• Expect hospitalization for 3-5 days
• It is a good idea to visit your physical
  therapy location before surgery

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                After Surgery
• You will usually be on some type of clot
  prevention medication (lovenox or coumadin)
• Physical therapy should begin immediately after
  surgery
• You will need a cane for 4-6 weeks after surgery
• I like to take sutures out of the incision at 14 days
  after the day of surgery


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   Follow Up and Expectations
• My preference is to see patients at 6 weeks,
  3 months, and 6 months after surgery
• You should also be given yearly follow up
  for xrays
• Most people are doing well by 3 months
  and by 6 months can resume most activities

              Back to Patient Information
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