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Thursday, 08 January 2015 00:00

Knee Arthroscopy Post Surgery Information

The following is what can be expected following Knee Arthroscopy surgery: 

  • Knee Arthroscopy is usually only a day surgery procedure.
  • The night after the surgery use an ice pack over night with a towel between the ice pack and the leg. 
  • Pain medication will be provided and should be taken as directed. 
  • Mobilise and weight bear with crutches as tolerated after surgery. Before your hospital discharge a physiotherapist will meet with you and guide you in what exercises you should be doing following surgery.
  • You may walk on the operated leg within the limits of pain. But don't overdo it. 
  • Avoid putting a pillow under the knee in order to encourage movement of the ankle and toes.
  • The bandage can be removed after 24 hours and the provided waterproof dressings can be placed over the wound.
  • It is normal for the knee to swell after the surgery. Elevating the leg when you are seated and placing an ice pack on the knee will help to reduce swelling. Apply the ice pack for 20 minutes three to four times a day until the swelling has reduced.
  • An appointment with Dr Al Muderis will be made for 7-10 days after surgery to monitor your progress and remove the two stitches in your knee.
  • Return to driving and work when comfortable unless otherwise instructed.
  • To stabilise muscles and ensure the success of the surgery, commence strengthening exercises six weeks after surgery. At this time jogging in a straight line can be commenced as well as a return to most other sports. At this stage it is advised to avoid any sports or movements that involve twisting and turning of the knee.
  • Skiing, snowboarding or any similar sport that involves twisting and turning of the knee can be commenced six months after the surgery. 

 

Concerns: Please contact the office if you are worried about your level of pain, have significant bleeding, or have fever or redness around the surgical site.

If you require assistance after hours, please contact the hospital where the surgery was performed and they will contact Professor Al Muderis on your behalf. 

Norwest Private Hospital: (02) 8882 8882

Sydney Adventist Hospital: (02) 9487 9111

Macquarie University Hospital: (02) 9812 3000

Published in Post Surgery

Knee Arthroscopy is usually performed under a general or regional anaesthetic. 

Once the anesthetic has been administered, the knee is prepared in a sterile fashion and tourniquet is placed around the thigh.

The Arthroscope is introduced through a small incision, about the size of a pen, on the outer side of the knee. A second incision on the inner side of the knee is made to introduce the instruments that allow examination of the joint and treatment of the problem inside the knee joint. 

A camera is attached to the arthroscope and the picture is displayed on a TV monitor. 

Published in Surgery
Thursday, 08 January 2015 00:00

Knee Arthroscopy Pre-Surgery Information

The following is what can be expected prior to Knee Arthroscopy surgery:

 Examinations: X-rays will be taken and a CT scan or MRI may be needed in order to identify the extent of the injury and damage.

Skin preparation: Night prior to and morning of operation, patient is required to wash leg with a sponge provided in the pre-admission clinic. Betadine Skin test is occasionally used if there is suspicion of an allergy to iodine.

Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic. Patient to is required to administer the evening prior to surgery (instruction leaflet given at the pre-admission clinic).

Patient education: Physiotherapy assessment will include: instruction of gait training, use of crutches and pre and postoperative exercises. Patient will be fitted for crutches to take home and practice preoperatively.

Medications: Cease aspirin or anti-inflammatory medications 10 days prior to surgery as well as any naturopathic or herbal medications.

 

Day of Surgery

Surgical paperwork will be administered by the nurses and the anaesthetist will meet with you to ask a few questions.

A hospital gown will be given and the operation site will be shaved and cleaned.

Betadine skin prep will be applied to above area and wrapped.

All x-rays are to be sent with patient to theatre.

Published in Pre Surgery
Wednesday, 07 January 2015 00:00

Knee Arthroplasty Post Surgery Information

The following can be expected after having knee arthroplasty surgery:

Immediately after surgery you will be taken to the recovery room where you will be motioned. Once stable you will then be transfered to the ward.

Usually post knee arthroplasty surgery you will be set up with a button to press to administer pain relief through a machine called a PCA machine (Patient Controlled Analgesia).

The post-op protocol will vary slightly from patient to patient, but generally you can expect your drain to be removed after 24 hours. Once this is removed you can sit out of bed and start moving your knee and walking on it within a day or two of surgery. The dressing will be reduced usually on the second day post op in order to make movement easier. You will be visited by a physiotherapist who will prescribe exercises and assist you with your rehabilitation and mobilisation.

 

It is expected you will remain in hospital for five to seven days post-surgery. Depending on your needs and situation you will either be discharged home or transferred to a rehabilitation hospital. Either way you will need to do physio exercises on your knee following surgery.

A large amount of the long-term results and success of knee replacement surgery depends on how much work you as the patient put in following your operation. It is important to do the physio exercises that are prescribed in order to get the best results from your knee replacement. 

 

Once discharged you will be expected to walk with a walker or crutches for six weeks after which you can progress to a walking stick. Also at the six week point, once you feel you have confidently regained control of your leg, you can return to driving.

 

Knee flexion (bend) will vary from patient to patient but it is expected that by six weeks the knee should be able to bend to 90 degrees. The goal post surgery is to obtain 110-115 degrees of movement.

More vigorous physical activities, such as sports, may take three months until you are able to perform them comfortably.

 

Upon return home post-surgery special precautions will be needed to be taken around the house. An occupational therapist will assess the home and assist you with this. For example, you may need rails in the bathroom or if there are a lot of stairs in your home you may need to modify sleeping arrangments.

 

Concerns: Please contact the office if post-surgery you are worried about your level of pain, have significant bleeding, or have fever or redness around the surgical site.

If you require assistance after hours, please contact the hospital where the surgery was performed and they will contact Professor Al Muderis on your behalf.

Norwest Private Hospital: (02) 8882 8882?

Sydney Adventist Hospital: (02) 9487 9111

Macquarie University Hospital: (02) 9812 3000

Published in Post Surgery
Wednesday, 07 January 2015 00:00

Knee Arthroplasty Surgical Procedure

Knee arthroplasty surgery (Total Knee Replacement) is preformed under a spinal or general anesthesia. The patient is placed on their back and a tourniquet applied to the upper thigh. The surgery takes approximately two hours.

An incision is made to expose the bones of the knee joint.

The damaged portions of the femur (thigh bone) and tibia (shin bone) are then cut at the appropriate angles using specialised jigs. Test components are then inserted to check the accuracy of the cuts and determine the thickness of plastic required to place in between the two components. Each knee is highly individual and will vary from patient to patient. To cater for this the knee replacement implants range in size and will be chosen and matched according to each individual patient. If there is more than the standard amount of bone loss then extra pieces of metal or bone can be added. The patella (knee cap) itself may be replaced depending on the condition of the knee.

The permanent components are then inserted and the knee is checked again to insure everything is working correctly.

The knee is then carefully closed, drains inserted and the knee dressed and bandaged.

Published in Information
Wednesday, 07 January 2015 00:00

Knee Arthroplasty Pre-Surgery Information

The following is what can be expected prior to knee arthroplasty surgery: 

Examinations: X-rays will be taken and a CT scan or MRI may also be needed to indentify the extent of the injury and damage.

Skin preparation: Night prior to and morning of operation, patient is required to wash leg with a sponge provided in the pre-admission clinic. Betadine Skin test is occasionally used if there is suspicion of an allergy to iodine.

Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic. Patient to is required to administer the evening prior to surgery (instruction leaflet given at the pre-admission clinic).

Patient education: Physiotherapy assessment will include: instruction of gait training, use of crutches and pre and postoperative exercises. Patient will be fitted for crutches to take home and practice preoperatively.

Medications: Cease aspirin or anti-inflammatory medications 10 days prior to surgery as well as any naturopathic or herbal medications.

 

Day of Surgery

Surgical paperwork will be administered by the nurses and the anaesthetist will meet with the patient to ask a few questions.

A hospital gown will be given and the operation site will be shaved and cleaned.

Betadine skin prep will be applied to above area and wrapped.

All x-rays are to be sent with patient to theatre.

Published in Pre Surgery
Wednesday, 07 January 2015 00:00

Indications and Contraindications

Indications 

The most common indication for a total knee replacement (knee arthroplasty) is degenerative arthritis (osteoarthritis) of the knee joint. This type of arthritis is generally seen with aging, congenital abnormality of the knee joint or prior trauma to the knee. Other conditions leading to a total knee replacement include avascular necrosis, osteochondritis, sepsis and inflammatory arthritides. 

 

Contraindications

There are no absolute contraindications for knee arthroplasty however, few relative contraindications include a skeletally immature patient and active sepsis or active infection in the joint.

Published in Information
Wednesday, 07 January 2015 00:00

History Of Knee Arthroplasty

The Total Knee Replacement is one of the most important orthopaedic surgical advances of the twentieth century. The first knee replacement was performed in 1968. Since then improvements in surgical materials and techniques have greatly increased its effectiveness. Approximately 25,000 knee replacements are performed each year in Australia alone. 

 

  • The development of total knee arthroplasty began back in 1860, when the German surgeon, Themistocles Gluck, surgically implanted the first primitive hinge joints made of ivory.

 

  • 1951 saw the introduction of the Walldius hinge joint. Initially this was manufactured from acrylic, then in 1958 it was manufactured from cobalt and chrome. Unfortunately, this hinge joint suffered from early failure. 

 

  • During the early 1960s, John Charnley’s cemented metal-on-polyethylene total hip arthroplasty inspired the development of the modern total knee replacement. Frank Gunston, from the same hospital as Charnley, went on to design an unhinged knee that replaced both the medial and lateral sides of the joint with separate condylar components. Improved biomechanics resulted from the preserved intact cruciate and collateral ligaments, which maintained the stability of the femoral and tibial components and the design allowed the centre of rotation to change with flexion of the knee.

 

  • The metal-on-polyethylene condylar design which completely replaced the femoral and tibial articulating surfaces, was pursued throughout the early 1970s. The result was an implant that relied on component geometry and soft tissue balance to provide stability and a large articulating surface area to spread load and minimise polyethylene wear. Improvements in component materials, geometry and fixation continued throughout the 1970s and 1980s. 

 

  • Advancements in more accurate sizing, the option of patella femoral replacement, better instrumentation as well as components that allow an increased range of motion and a lower wear rate have since been developed and implemented.

Published in Information
Wednesday, 07 January 2015 00:00

Knee Arthroplasty Information

Knee Arthroplasty, otherwise known as Total Knee Replacement, is a surgical procedure that replaces an arthritic knee joint with an artificial joint. The aim is to take away pain, restore function and preserve anatomy.

A typical knee replacement replaces the ends of the femur (thigh bone) and tibia (shin bone) with a plastic prosthesis. The patella (knee cap) is usually replaced as well. The prosthesis replicates the knee’s natural ability to roll and glide smoothly as it bends.

The knee is the largest joint in the body and consists of the lower end of the thigh bone (femur), which rotates on the upper end of the shin bone (tibia) and the knee cap (patella), which slides in a groove on the end of the femur. Large ligaments attach to the femur and tibia to provide stability. The long thigh muscles give the knee strength.

The joint surfaces where these three bones touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to move easily and smoothly.

All remaining surfaces of the knee are covered by a thin, smooth tissue liner called the synovial membrane. This membrane releases a specialised fluid that lubricates the knee and in a healthy knee reduces friction to nearly zero.

In a healthy knee all of these components work in harmony. But disease or injury can disrupt this and result in pain, muscle weakness and reduced function.

In an arthritic knee the components no longer function at their optimum level which restricts movement and interferes with day to day activities.

 

Symptoms 

In an arthritic knee the following is often found:

  • The cartilage lining is thinner than normal or completely absent. The degree of cartilage damage and inflammation varies with the type and stage of arthritis.
  • The capsule of the arthritic knee is swollen
  • The joint space is narrowed and irregular in outline; this can be seen in an X-ray image
  • Bone spurs or excessive bone can also build up around the edges of the joint

The combinations of these factors make the arthritic knee stiff and limit activities due to pain or fatigue.

 

Total Knee Replacement Surgery is usually recommended for older patients who suffer from pain and loss of function from arthritis and after other conservative methods of intervention have failed.

Most patients who have a total knee replacement are aged between 60 to 80 years, but each patient is assessed individually and patients as young as 20 or as old as 90 are occasionally operated on and with good results.

 

 Benefits of Knee Arthroplasty

The benefits following surgery are the relief of symptoms of arthritis. A total knee replacment can result in the reduction or complete disappearance of:

  •          Severe pain that limits your everyday activities including walking, shopping, visiting friends, getting in and out of chair, gardening
  •      Pain waking you at night
  •      Deformity; either bowleg or knock knees
  •      Stiffness

Published in Information
Thursday, 18 December 2014 00:00

Tibial Osteotomy Post Surgery Information

Following tibial osteotomy surgery a patient can expect to spend three to five days in hospital. 

A physiotherapist will provide exercises for your leg that can be performed whilst in bed. On the day after surgery you can start to mobilise. After having a closing wedge osteotomy it is common to be on crutches for up to six weeks and and sometimes up to three months on crutches after an opening wedge osteotomy.

The post surgery physiotherapy will involve regaining motion in the knee, improving mobility and regaining muscular strength around the knee joint. Additionally you will be provided with techniques to control the swelling in the knee.

You can be discharged once you are mobilising safely, have regained appropriate motion in the knee and your pain is well controlled with pain medication.

During the first postoperative week, the leg may be swollen and the knee may feel somewhat stiff. It is normal to require regular pain medication during this period.  It is very important to perform your exercises regularly whilst at home to optimise your outcome following surgery.

The osteotomy is expected to heal over a period of three months. For the last six to eight weeks the knee is typically in a hinged knee brace and all weight is kept off the leg. 

The most important part of your rehabilitation is maintaining your strength and motion while the osteotomy is given time to heal. It is important during this period that you are diligent with the exercises given to you by your physiotherapist. This commitment to your prescribed physio exercises will be reflected in your recovery following tibial osteotomy surgery.

It is important to realise that the leg will look different following surgery. Apart from a scar, the alignment of the knee will be very different. Typically it will change from a bowed leg to a knocked knee appearance. A return to manual work typically takes about three to six months, however, sedentary/office duties can be performed about two weeks following surgery.

 

Concerns: Please contact the office if you are worried about your level of pain, have significant bleeding or have fever or redness around the surgical site.

If you require assistance after hours, please contact the hospital where the surgery was performed and they will contact Professor Al Muderis on your behalf. 

Norwest Private Hospital: (02) 8882 8882?

Sydney Adventist Hospital: (02) 9487 9111

Macquarie University Hospital: (02) 9812 3000

Published in Post Surgery