FAQs-KNEE ARTHRITIS
Here are answers to some frequently asked question about knee arthritis (also called osteoarthritis):
Injuries and conditions vary. The answers to these questions are not meant as medical advice. Talk to your doctor about your questions.
Questions About Knee Pain and Stiffness
What does stiffness in my knee mean?
Stiffness in your knee could be many things, including early arthritis. Medications and other health problems can make your knee stiff. Or having a stiff knee could be normal for you.
If the stiffness limits your normal activities or you have swelling and/or pain that gets worse, talk to your doctor. Often, physical therapy can improve a stiff knee.
Could my knee pain from arthritis?
Yes. If you didn’t injure your knee and you’re 50 or older, the pain is probably from arthritis. Knee pain from arthritis (also called osteoarthritis) is caused by “wear and tear” on the knee. This happens over time. Pain from an injury is sudden.
When should I call a doctor about knee pain from arthritis?
If your knee pain doesn’t get better or if you have swelling that doesn’t go away, talk to your doctor. There are effective treatments for knee arthritis (also called osteoarthritis).
Is it normal for my knee to hurt after playing basketball?
If both of your knees are sore, it may be because you have changed or increased your activity. If one knee is sore and you didn’t hurt it, and the knee doesn’t get better, talk to your doctor.
Can anything be done to open up the space between the bones in my knee?
Once arthritis has narrowed the space between the bones in the knee, there isn’t any way to “open it up” again. Often, people with arthritis also have a stiff knee that makes the knee feel worse.
Our specialized knee arthritis physical therapy program helps relieve knee pain and stiffness. Many of our patients feel and function better within 4-6 weeks of starting physical therapy. If physical therapy doesn’t help enough, knee replacement may be an option.
Questions About Physical Therapy for Knee Arthritis
Does physical therapy work for knee arthritis?
Many doctors tell patients that physical therapy won’t help with knee pain and stiffness from arthritis. Our research shows that physical therapy definitely helps patients feel and function better.
76% of our patients didn’t need knee replacement surgery after completing our specialized knee arthritis physical therapy program. If physical therapy doesn’t help enough, knee replacement may be an option.
Why does Shelbourne Knee Center have patients do most physical therapy at home?
It is easier for you to do most physical therapy at home, especially if you’ve had knee replacement surgery, than to come into our office regularly. We designed our physical therapy program so you can do it at home.
Your physical therapist will teach you how to do your exercises and use the equipment. During periodic visits to our office, he or she will measure your progress and give you new exercises if you’re doing well.
Why is range of motion important?
Range of motion is the ability to straighten and bend your knee. If you have good range of motion, you’ll have less knee pain and will be able to function better.
If you need knee replacement surgery, improving your range of motion first helps you recover more easily afterwards. After surgery, improving your range of motion relieves pain and helps you function better.
That’s why our physical therapy program focuses on improving your range of motion both before and after surgery. Once you have good range of motion, we focus on strengthening your knee.
FAQs-KNEE REPLACEMENT
How do I know if I need a knee replacement?
Reasons to consider knee replacement surgery, also called total knee arthroplasty (TKA), include:
- Severe knee pain that isn’t getting better and is interfering with your life.
- Swelling that doesn’t get better with rest or medications.
- Knee stiffness.
- Knee pain hurts when you rest.
We believe that you should try physical therapy for knee arthritis before considering surgery. Most of our patients—76%—didn’t need knee replacement surgery after completing our specialized knee arthritis physical therapy program.
If physical therapy doesn’t help enough, knee replacement may be an option.
Why should I get a second opinion before having knee replacement surgery?
Orthopedic surgeons often have different opinions about the need for knee replacement surgery. A second opinion can help you decide whether this is the best treatment for you.
Also, there are different ways to do knee replacement surgery and different implants (artificial knees) that the surgeon can use. You should understand your options.
What should I know if I had a knee replacement but I’m not doing well?
If you don’t feel like you’re making progress after a knee replacement, see the surgeon who performed the procedure. If you’re not getting the answers or help that you need, get a second opinion.
You may just need better physical therapy to improve the function of your knee. But if your knee replacement wasn’t done right, you may need revision knee replacement surgery to fix the problem.
Many orthopedic surgeons who do knee replacements don't do revision surgery. Make sure that you see a surgeon who has a lot of experience in revision knee replacement surgery.
What's the average age of a TKA patient?
Our research indicates an age of 64-65 as the average age.
How long will the prosthesis last?
Research says 90–95 % last 12–15 years or more. Our goal is to give you a knee that will last the rest of your life.
Do you do partial TKA?
Yes, we offer partial TKA (medial, lateral and patellofemoral).
What happens to the kneecap in a TKA?
The decision regarding surgery on the patella is made at the time of surgery. The kneecap is examined to look for areas of full thickness wear. If this is noted the patella is resurfaced with a patella button. If no wear is noted, the patella is left alone.
How long before I can drive?
There are several factors that we look at to allow a patient to return to driving. A patient must be off narcotic pain medication, have adequate range of motion and have adequate leg control to manipulate the pedals in the car. On average, that is 3-4 weeks following surgery.
How long will I go to physical therapy post-surgery?
Our focus with therapy is to educate ad empower you to do your home exercise program. In the first three months post-surgery, we will see you in the office for therapy for a total of (5) visits: 1 week post op, 2 weeks post op, 1 month post op, and 3 months post op. Additional visits may be done at 6 months, 9 months, and 1 year post op. However, this schedule may be adjusted based on your needs and progress.
What other equipment might I need to get prior to surgery?
You may consider getting a foam bolster, stretch strap, Ideal Knee or Ideal Stretch for stretching activities. Ankle weights or theraband may help with strengthening. A bike or elliptical machine can help with low impact conditioning. A gym membership or use of Silver Sneakers may also be beneficial.
Where will I go after I get out of the hospital?
Most patients return home following surgery. However, we understand not everyone may have a caregiver available to provide the necessary post-operative care. In these circumstances, a short rehab facility stay may be necessary.
How long will I be in the hospital?
While hospital stays can vary in length, the average patient spends one evening in the hospital post-surgery. You will begin physical therapy while there and be instructed on various exercises to perform at home.
Will I need a caregiver after surgery? If so, for how long?
Yes, you will need a caregiver on the day of surgery, while you are in the hospital and after surgery for at least one week. The caregiver will learn how to help you exercise your knee and help with the cryo-cuff in addition to helping with meals. You will also need someone to drive you to your one-week and two-week post-surgery therapy and doctor visits.
What activities can I do after TKA surgery?
By three months after surgery, many patients have returned to daily activities and low-level exercise. You will eventually be able to participate in a broad range of activities following TKA surgery. However, high impact sports and long-distance running are not recommended.
FAQs-ACL INJURIES
Here are answers to some frequently asked questions about anterior cruciate ligament (ACL) knee injuries:
ACL tears
Do females tear their ACLs more than males?
Yes, but not because they are female. The research we have done over the past 25 years tells us that the size of the notch (space) in the knee is the primary reason that some people are more likely to have an ACL tear than others. The notch inside the knee is where the ACL is located. Our research shows that the smaller a person’s notch is, the more likely they are to tear their ACL. A male with a small notch is just as likely to tear their ACL as a female with the same notch size. It also works the other way around; females with large notches are no more likely to tear their ACL as a male with the same size notch.
Can kids with open growth plates have an ACL reconstruction?
Yes, kids with torn ACLs can have ACL reconstruction at Shelbourne Knee Center because the way we do surgery does not disrupt the growth plate. However, kids need to be at a certain stage of their growth. This will be determined at your evaluation.
Is it possible to partially tear my ACL?
Technically, an ACL can be “partially” torn, but it is rare. What you have to consider is whether the knee is stable or not. If the ACL cannot keep the knee stable with dynamic (twisting/cutting/pivoting) activities, the ACL is not working properly. If this is the case, it does not matter whether the ACL is fully or partially torn.
Why don't ACL tears heal without surgery?
When the ACL tears, it separates and the frayed ends do not touch. Since the ends do not touch, they cannot grow back together.
SURGERY
How soon after ACL reconstruction will I be able to walk without crutches?
You can start walking short distances without the use of crutches immediately after surgery, but if you are feeling dizzy or light-headed, you can use crutches to help you walk. Your therapist or trainer will work with you to make sure that you are walking properly after surgery and most patients are able to walk without crutches after 1-2 weeks.
When will I be able to go back to my day-to-day activities after ACL reconstruction?
Returning to day-to-day activities is a gradual process that is dependent on your ability to maintain good motion and keep the swelling down. For the first week after surgery, you will be on a bed rest period that helps to keep your knee from swelling and allows you to have better motion. The second week is a “transition” week, where you can gradually start standing and walking more, as long as you keep your swelling down. Your physical therapist or athletic trainer will teach you how to monitor your swelling and modify your activity level should you develop increased swelling.
How often do I have to go to physical therapy after ACL reconstruction?
We try to minimize the number of visits that you return to the office for physical therapy, as you are taught how to do most of your exercises on your own. These “check-in” visits allow us to check your progress and make changes to your program, as well as instruct you on how to progress back to your desired activities. Usually patients come in at one week, two weeks, one month, two months, four months, six months, nine months, and one year after surgery. Sometimes patients come in a little more often if needed.
When will I return to sports after ACL reconstruction?
It depends on when you get your strength and range of motion back and you have no swelling. On average, our patients return to their sport at about 4-6 months after surgery. This all depends on the person and the sport.
Why should I get a second opinion before having surgery?
Full recovery from an ACL tear requires treatment by an experienced orthopedic surgeon and rehab specialist. The first surgeon an injured athlete sees may not be the best doctor to provide this level of care. A national study shows that only about 50% of athletes who have ACL reconstruction are able to return to sport at the same level. Based on our research, 85-90% of our patients return to their desired sport at the same level within a year. An ACL tear isn’t an emergency and doesn’t require surgery right away. Take the time to seek a second opinion before making a decision about treatment. When you meet with an orthopedic surgeon about treatment, ask them about their choice of graft, how many ACL reconstructions they do in a year, their rate of patients returning to sports at the same level, and recovery time.
GRAFT
Why do you use the patellar tendon graft?
There are several graft choices available for an ACL reconstruction. We use the patellar tendon because it has a higher success rate than the other graft options available. It is the strongest type of graft found in the body and is just as strong as a normal ACL. The other benefit is that the tendon will grow back after taking the tissue out to create the new ACL. This means that the patient will not have permanent strength loss due to the graft harvesting process.
What about other grafts like hamstrings or allografts?
Hamstring tendon grafts are not as strong as patellar tendon grafts. Once the hamstring tendons are taken for the graft, they do not grow back and therefore, leave the hamstring weaker than it was before surgery. Also, hamstring grafts tend to stretch out over time, causing the graft to “fail” and no longer work properly. Allografts, or cadaver grafts, are not taken from the patient’s own body. There is a higher failure rate with allografts. Since they heal slowly, patients cannot get back to their activities as fast as when you use the patellar tendon.
Why doesn’t the Shelbourne Knee Center use screws to fasten the ACL graft in place?
The new ACL graft is what we call a “bone-tendon-bone” graft, in that it is made up of tendon in the middle with small pieces of bone on each end. These bone plugs fit tightly into the tunnel that has been drilled into the thigh bone and the shin bone. The bone plugs heal to the bone around it very quickly, like how a bone fracture would heal. We use plastic buttons on each end of the tunnels to hold the graft in place while the bone plugs are healing. In our experience, screws are not necessary to hold the graft in place.