News & Events

Common Spinal Issues From Sitting All Day At A Desk

Many of us have worked at a computer in an office for many years, and at the moment we may be working from home. Regardless of where you are working, there is no question sitting at a desk all day takes its toll on the spine. Learn how you can overcome the common spinal issues from sitting all day at a desk.

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Category: Back, Spine
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New Extended Hours for Our Fast-Track Clinic

Nevada Orthopedic & Spine Center’s Fast-Track Clinic is now open on Saturdays!

Nevada Orthopedic & Spine Center’s Fast-Track Clinic’s same-day visits are now available for extended hours. The clinic is open Monday thru Saturday from 10:00 AM – 7:00 PM.

View office details on the Fast-Track Clinic’s page here.

The clinic offers:

  • Call-Ahead or Walk-In Appointments
  • Short Wait Times
  • Most Insurances Accepted
  • Major Credit Cards Accepted
  • Care Credit

Parking and entrance are located on the West Side of the Parkway Medical Building.

Download the flyer for this announcement by clicking here.

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Enchondroma

Dr Ronald Hillcock MD
Orthopedic Surgon
Adult Reconstruction and Orthopedic Oncology


Enchondroma (en-kon-DRO-ma) is a type of benign (noncancerous) tumor that begins in the cartilage found inside the bones. Enchondromas rarely cause pain or other symptoms, so most remain undiagnosed until x-rays are taken for an unrelated injury or condition.

In the majority of cases, enchondromas do not require treatment. In rare cases, however, multiple tumors may weaken the bone, causing it to fracture. When this occurs, surgery may be needed to remove the tumor and prevent additional fractures.

Description

Enchondromas can occur in anyone but are most common in patients between 10 and 20 years old. They are most often found in the small bones of the hand. In fact, enchondroma is the most common tumor in the hand. Enchondromas can also develop in the body’s long bones, such as the femur (thighbone), tibia (shinbone), and humerus (upper arm bone).

Enchondromas are most often solitary tumors. In rare cases, however, multiple tumors can appear as part of a condition such as Ollier’s disease or Maffucci’s syndrome.

Single enchondromas rarely become cancerous, though the chances are a little higher in patients with Ollier’s disease and Maffucci’s syndrome. When enchondromas do become cancerous, they usually become a type of malignant cartilage tumor called a chondrosarcoma.

Distinguishing between a noncancerous enchondroma and the very low-grade form of a cancerous tumor can be difficult, even for orthopedic tumor surgeons.

Cause

The exact cause of enchondromas is unknown. Some research indicates that they may result when cells turn into cartilage instead of bone.

It is not believed that the tumors are caused by radiation or chemical exposure or by any specific activity.

Symptoms

In most cases, enchondromas are not painful and do not cause any symptoms. However, if the tumors appear in the hands or feet, or if there are multiple lesions, the bone can weaken and become deformed. This can lead to pathologic bone fractures and enlargement of the affected fingers.

In patients with Ollier’s disease and Maffucci’s syndrome, bone deformities can be quite severe. If pain from other sources has been excluded, your doctor will carefully study the tumor to determine whether it could actually be a low-grade chondrosarcoma. Pain at night or at rest is more likely to indicate a malignant tumor. However, because pain is a common symptom of many conditions and injuries, your doctor will conduct a thorough evaluation.

Doctor Examination

Because they do not often cause symptoms, most enchondromas are found when routine x-rays are taken for another reason such as an injury or arthritis. When this occurs, your doctor will conduct an examination and order a number of tests to confirm that your tumor is actually an enchondroma—and not a more aggressive or cancerous tumor.

Physical Examination

During the exam, your doctor will take a complete medical history and ask about your symptoms. He or she will ask if your tumor is painful and when the pain occurs. There is greater concern if the pain occurs when you are at rest or at night and does not go away. Pain caused by activity is less worrisome.

In some cases, your doctor may give you an injection into the joint near the tumor. If the injection relieves your pain, it indicates that the enchondroma is not the cause.

Tests

X-rays. X-rays provide images of dense structures such as bone. On x-rays, enchondromas appear as small (less than 5 cm), lobe-shaped, darkened tumors in the middle of the bone. They usually contain white spots or calcification within. The white areas of the tumor show a pattern of rings and arcs that indicates the tumor contains cartilage.

x-ray of bone density

Other imaging studies. Your doctor may order a computerized tomography (CT) or magnetic resonance imaging (MRI) scan to help further evaluate your tumor. These scans give a more complete picture of the bone around the tumor. If the tumor has turned into a malignancy, the scans may show bone erosion, bone inflammation, or a mass growing outside the bone.

mri scan

In some cases, your doctor may order a bone scan. During this test, a very small amount of radioactive dye is injected into the body intravenously. Both benign and malignant tumors can cause an increased uptake of the radioactive material in the bone due to bone activity. Enchondromas are typically active on bone scans.

radioactive dye on thigh bone

Bone scan shows an uptake of radioactive dye near the end of the thigh bone.

Biopsy. A biopsy may be necessary to confirm the diagnosis of enchondroma. In a biopsy, a tissue sample of the tumor is taken and examined under a microscope.

A biopsy can be performed under local anesthesia with a needle or as a small open operation.

Grading. The grade, or aggressiveness, of the tumor is determined by imaging studies and how the tumor looks under a microscope.

Under the microscope, enchondromas have islands of cartilage that are easy to tell apart from the normal bone that surrounds them. Usually, cartilage is not found in the center of bones. Enchondromas in the hand and foot or in patients with Ollier’s disease or Maffucci’s syndrome may contain more odd-looking cartilage. It may be difficult to distinguish these tumors from low-grade chondrosarcomas.

Low-grade chondrosarcomas look more cellular than enchondromas under a microscope and there is less normal bone in the tumor. Because low-grade chondrosarcomas and enchondromas look similar, experienced surgeons, radiologists, and pathologists will work together to get the best interpretation of the tumor.

Characteristics of a more aggressive tumor or a malignant chondrosarcoma include:

  • Thickening of the bone’s outer cortex
  • Reactive bone growth on the outer surface of the bone
  • Destruction of the bone by the tumor
  • Soft-tissue mass
  • Large amounts of bone erosion
  • Bone erosion that is growing
  • Erosion surrounded by reactive bone

Treatment

Nonsurgical Treatment

If your tumor does not cause symptoms, your doctor may recommend observation and monitoring to see if it grows. During this time, you may need periodic x-rays or other tests. Most doctors think that tumors without symptoms do not need to be removed.

Surgical Treatment

Curettage

Curettage is the surgical procedure most commonly used to treat enchondromas. In curettage, the tumor is scraped out of the bone. Once enchondromas are removed, most will not return. If a tumor has caused your bone to fracture, your doctor will usually allow the fracture to heal before treating the tumor. The tumor will then be curetted out to prevent another fracture.

Bone Graft

After curettage, your doctor may fill the cavity with a bone graft to stabilize the bone. A bone graft is bone taken from a donor (allograft) or from another bone in your body (autograft). In some cases, another substance may be used to fill the cavity.

Some tumors may look like simple enchondromas on x-ray—but are painful. Treatment of these lesions can be controversial. Some doctors recommend surgical curettage. Others think that the tumors are not likely to be the cause of the pain in the area—so they recommend monitoring with regular x-rays.

Unfortunately, biopsies are not often helpful in these cases. Even for specialized bone pathologists, it can be difficult to differentiate between a benign enchondroma and a low-grade chondrosarcoma. In this setting, needle biopsies are not recommended.

More aggressive tumors with bone destruction or with a mass growing outside the bone are usually chondrosarcomas. These malignant tumors need to be removed in their entirety. The specific procedure used depends upon the grade of the tumor.

If you have concerns about a bone lesion please make an appointment in my clinic and I would be happy to provide an evaluation.


If you have concerns about a bone lesion please make an appointment in my clinic and I would be happy to provide an evaluation.

Category: Orthopedics
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5 Common Shoulder Injuries From Weight Lifting

There are those who lift weights as part of their exercise routine, and then there are the serious weight lifters. The second group are certainly more rigorous and set goals well beyond their own body weight. Whichever group you fit in to, take some care and pay close attention to 5 common shoulder injuries from weight lifting.

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Chondromalacia patella

Chondromalacia patella (or patellae), also referred to as “runner’s knee” is a condition in which the cartilage cushioning the area under the patella (kneecap) begins to deteriorate and wear out. Due to this, the kneecap may start to rub against the femur (thigh bone) and cause discomfort or pain. This condition is often common among young athletes or sports people do to increased activity and action involving the knees. The condition can also occur in adults who are suffering from arthritis.

Chondromalacia patella can often occur due to misalignment of the knee or as a result of overuse, which can be seen it treated by a few days of rest. In the case of improper knee alignment, resting will not be enough and physiotherapy or surgery may be necessary to correct it.

Causes

Chondromalacia patella is most common in teenagers and young adult, usually affecting women more than it does men. It is
not fully known the reason why it occurs, but studies have indicated that when the patella (kneecap) rubs against the
femur (thigh bone) this can damage the cartilage underneath the patella, which is necessary for cushioning and reducing friction between the bones and joint. The main causes for this condition are usually:

Alignment problems with the knee or foot.

  • Overuse of the knee
  • Wear and tear as part of the aging process
  • Arthritis of the knee
  • Hypermobile joints
  • Imbalance of thigh muscles surrounding the knee

There are also certain risk factors, which increase the likelihood of having “runner’s knee” (chondromalacia patella), these include:

  • Age – growth spurts can often lead to imbalances between the bones and
    muscles
  • Flat feet – those with flat feet are more likely to have more pressure placed
    on the knee
  • Prior injury – previous injury to the knee region may increase the risk of
    runner’s knee
  • Gender – women are said to be more likely to develop this condition as
    they generally have less muscle mass than their male counterpart causing
    more lateral pressure on the patella.
  • High movement – participating in sports that require a high level of
    movement can increase the wear on the knees and joints increasing the
    risk of injury.

Symptoms

Individuals suffering from chondromalacia patella will often record similar symptoms to other conditions in the knee. The common symptoms being:

  • Pain and swelling around the kneecap
  • Clicking or grinding noise when bending or straightening the knee
  • Discomfort when walking up or down stairs
  • Discomfort when in a seated position for a long duration (it can be
    sometimes referred to as ‘theatre knee’ or ‘movie-goers knee’)

Diagnosis

A provisional diagnosis of chondromalacia patella is usually made after an examination by a doctor or qualified physiotherapist. It is usually an active diagnosis as it requires further follow ups, due to lack of access to the cartilage. If the initial signs show no proof of damage to the cartilage then the doctor is likely to view the injury as patellofemoral pain syndrome rather than runner’s knees.

Based on the results of the tests there are provided, different levels and of severity that can be experienced.

  • Grade 1 – softening of the cartilage around the knee
  • Grade 2 – softened cartilage alongside erosion of the tissue and an uneven surface
  • Grade 3 – increased deterioration with thinning of the cartilage
  • Grade 4 – bone exposure and significant deterioration of the cartilage tissue. In this event the bones are likely to be rubbing against each other and surgery may be required

If a diagnosis cannot be gathered from the initial physical examination by the doctor or it is unclear, then further tests may be carried out in certain situations. Tests that may be carried out include:

  • X-ray – this alongside standard blood tests can help in ruling out any
    underlying issues such as inflammation or arthritis
  • Arthroscopy – this is usually carried out to provide a direct look into the actual state of the cartilage. In this procedure, a small flexible camera is inserted into a keyhole through the knee
  • MRI scan – this provides a more detailed view of the knee and surrounding joints, it is usually the most flexible method of confirming chondromalacia patella.

Treatment

The initial mode of treatment for injuries such as chondromalacia patella after diagnosis is the application of the R.I.C.E principle (Rest, Ice, Compress, and Elevate). Although applying this in itself will not cure chondromalacia patella, it will help in reducing the discomfort, swelling or pain associated with the injury. It is essential to understand and correct the initial cause(s) of the injury and the treatment program that is recommended may be a mixture or one of the following:

  • Painkillers and anti-inflammatory medication – apart from the application of the RICE principle, the health professional may also recommend the use of NSAIDs and other anti-inflammatory medication which can aid in reducing the pain also.
  • Physiotherapy – exercises and a range of movement to strengthen the surrounding muscles and joints can help in the rehabilitation of the knee. Improving the lateral quadriceps structure leading to the knee can help in reducing pressure on the knee and cartilage and prevent further injury to the knee.
  • Patella taping – this treatment form can help to lessen the pain by preventing the rubbing together of the kneecap and the sore spot which causes the pain. The adhesive tapes are placed along either side of the affected knee, helping to guide and correct the movement of the patella. There are two main forms of patella taping techniques including the controlling technique for new injuries and the correct tracking technique for those looking to get back into sports activities. Knee supports specially designed for the patella can also help in relieving pain and pressure.
  • Surgery – this is usually not common for this kind of injury and only occurs when other treatment methods or rehabilitation have proved to be unsuccessful. The surgical procedure is usually simple and involves the use of an arthroscopy or keyhole surgery, whereby the damaged or deteriorated cartilage is either removed or shaved.

Prevention

To avoid a repeat of chondromalacia patella or to prevent it from occurring in the first instance, the following steps can be followed to prevent the likelihood:

  • Wearing the correct footwear can help to improve the arch of the feet, which is particularly useful for those with flat feet. As the pressure on the kneecap is reduced, it may help with the proper alignment of the kneecap.
  • Use of knee pads and patella supports, especially during repeated use can help reduce the likelihood of injury.
  • Performing regular strengthening exercises can help with muscle balance, especially for the hamstrings, quadriceps, adductors, and abductors.
  • Lowering body weight can reduce overall stress and pressure on the knees lowering the risk of chondromalacia patella. Reducing overall calorie intake and eating a balanced diet alongside regular exercising can help in keeping the knees and joints healthy in the long run.

If you are experiencing knee pain, chondromalacia may be the cause. Please make an appointment to be seen in my clinic and we can explore the issues and design a treatment plan for your unique needs.

Ronald Hillock MD
Fellow American Academy of Orthopedic Surgeons
Diplomat American Board of Orthopedic Surgery
Adult Reconstruction and Orthopedic Oncology

 

Category: Knee, Knee Surgery
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When to See a Specialist for Your Child’s Knee Pain

With the warm weather on its way, parents are likely to be faced with kids complaining of knee pain. They fall, overdo it playing sports, combined with bending, climbing and stretching the wrong way. Sometimes they may complain about it, and then never mention it again. But other times the pain becomes severe and doesn’t go away. It is important to know when to see a specialist for your child’s knee pain.

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Category: Knee, Pediatrics
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Surgery and Smoking

Ronald Hillock MD
Fellow American Academy of Orthopedic Surgeons
Diplomat American Board of Orthopedic Surgery
Adult Reconstruction and Orthopedic Oncology

Cigarette smoking is recognized as one of the major causes of preventable disease. Most people know that smoking is linked to heart and respiratory diseases, as well as to several cancers. However, many people are not aware that smoking has a serious negative effect on bones, muscles, and joints, and that smoking often leads to poorer outcomes from orthopedic surgery.

Smoking has a negative effect on fracture and wound healing after surgery.

  • Broken bones take longer to heal in smokers because of the harmful effects of nicotine on the production of bone-forming cells.
  • Smokers also have a higher rate of complications after surgery than nonsmokers – in fact, smoking may be the single most important factor in postoperative complications. The most common complications caused by smoking include:
    • Poor wound healing
    • Infection
    • Less satisfactory final outcomes of surgery

Researchers have noted that patients who quit smoking have improved outcomes for surgical treatments of musculoskeletal conditions and injuries.

Research on Smoking and Orthopedic Procedures

In two specific types of surgeries (spinal fusion and rotator cuff repairs), results were significantly better for people who never smoked and for those who stopped smoking than for smokers.

Smoking and Spinal Fusion Surgery

Spinal fusion surgery is often used to treat disk disorders in the neck and the lower back. Two or more of the small bones in the spinal column (vertebrae) are “welded” together with bone grafts and internal devices, such as metal rods.

The success of the surgery depends on how well the bones heal into a solid unit. A successful spinal fusion can reduce pain and improve the patient’s ability to perform activities of daily living.

In a study on spinal fusions in the lower back, the success rate was 80% to 85% for patients who never smoked or who quit smoking after their surgery. The success rate dropped to under 73% for smokers. More than 70% of nonsmokers and previous smokers were able to return to work. But only about half of the smokers were able to resume working. Another study on spinal fusions in the neck showed successful fusion in 81% of nonsmokers, but in only 62% of smokers.

Smoking and Rotator Cuff Surgery

Smoking also has a negative impact on surgeries that focus on muscles, such as rotator cuff repairs. One study compared the results of 235 patients treated at two different medical institutions. Results in nonsmokers were significantly better than results in smokers. Nonsmokers experienced less pain and a higher degree of function after surgery than smokers. Good or excellent results were seen in 84% of nonsmokers, but in only 35% of smokers.

Evidence like this continues to indicate that smoking is harmful, not only to your lungs, but also to your bones and muscles.

Quit Smoking Now

You can improve your chances for a successful outcome after surgery if you are a nonsmoker or have stopped smoking, according to researchers.

Before you plan your orthopedic surgery, be sure to talk to your surgeon about your tobacco use. Find out about support programs to help you quit. There are many low-cost smoking cessation programs available. The American Lung Association is a great place to start: American Lung Association.

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Common Causes of Worsening Sciatica Pain

If you have ever had sciatica pain, you know the frustration of trying to relieve that nagging, seemingly elusive shock down the back of your leg. It radiates down the sciatic nerve from your lower back to your hips, buttocks, and leg. Maybe the best way to prevent its return is understanding the common causes of worsening sciatica pain. Read the rest of this entry »

Category: Back, Spine
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Total Knee Replacement

Ronald Hillock MD
Fellow American Academy of Orthopedic Surgeons
Diplomat American Board of Orthopedic Surgery
Adult Reconstruction and Orthopedic Oncology

If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.

If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.

Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Total knee replacements are one of the most successful procedures in all of medicine. According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States.

Whether you have just begun exploring treatment options or have already decided to have total knee replacement surgery, this article will help you understand more about this valuable procedure.

The knee is the largest joint in the body and having healthy knees is required to perform most everyday activities.

The knee is made up of the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the kneecap (patella). The ends of these three bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily.

The menisci are located between the femur and tibia. These C-shaped wedges act as “shock absorbers” that cushion the joint.

Large ligaments hold the femur and tibia together and provide stability. The long thigh muscles give the knee strength.

All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage, reducing friction to nearly zero in a healthy knee.

Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and reduced function.

Cause

The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

  • Osteoarthritis. This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
  • Rheumatoid arthritis. This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”
  • Post-traumatic arthritis. This can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

Diagram of knee pain caused by osteoarthritis

Is Total Knee Replacement for You?

The decision to have total knee replacement surgery should be a cooperative one between you, your family, your family physician, and your orthopedic surgeon. Your physician may refer you to an orthopedic surgeon for a thorough evaluation to determine if you might benefit from this surgery.

When Surgery Is Recommended

Bowed knee deformity. Varus

Knocked knee deformity. Valgus

There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from total knee replacement often have:

  • Severe knee pain or stiffness that limits your everyday activities, including walking, climbing stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker
  • Moderate or severe knee pain while resting, either day or night
  • Chronic knee inflammation and swelling that does not improve with rest or medications
  • Knee deformity — a bowing in or out of your knee
  • Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries

Candidates for Surgery

There are no absolute age or weight restrictions for total knee replacement surgery.

Recommendations for surgery are based on a patient’s pain and disability, not age. Most patients who undergo total knee replacement are age 50 to 80, but Dr Hillock will evaluate patients individually. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

Orthopedic Evaluation

An evaluation with an orthopedic surgeon such as Dr. Hillock will consists of several components:

  • A medical history to gather information about your general health and ask you about the extent of your knee pain and your ability to function.
  • A physical examination. This will assess knee motion, stability, strength, and overall leg alignment.
  • X-rays. These images help to determine the extent of damage and deformity in your knee.
  • Other tests. Occasionally blood tests, or advanced imaging such as a magnetic resonance imaging (MRI) scan, may be needed to determine the condition of the bone and soft tissues of your knee.

Dr Hillock will review the results of your evaluation with you and discuss whether total knee replacement is the best method to relieve your pain and improve your function. Other treatment options — including medications, injections, physical therapy, or other types of surgery — will also be considered and discussed.

In addition, Dr Hillock will explain the potential risks and complications of total knee replacement, including those related to the surgery itself and those that can occur over time after your surgery.

Deciding to Have Knee Replacement Surgery

Realistic Expectations

An important factor in deciding whether to have total knee replacement surgery is understanding what the procedure can and cannot do.

More than 90% of people who have total knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement will not allow you to do more than you could before you developed arthritis.

With normal use and activity, every knee replacement implant begins to wear in its plastic spacer. Excessive activity or weight may speed up this normal wear and may cause the knee replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports for the rest of your life after surgery.

Realistic activities following total knee replacement include unlimited walking, swimming, golf, driving, light hiking, biking, ballroom dancing, and other low-impact sports.

With appropriate activity modification, knee replacements can last for many years.

Possible Complications of Surgery

The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, occur in fewer than 2% of patients. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery.

  • Discuss your concerns thoroughly with your primary doctor, your family and Dr Hillock prior to surgery.
  • Infection. Infection may occur in the wound or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.
  • Blood clots. Blood clots in the leg veins are one of the most common complications of knee replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopedic surgeon will outline a prevention program, which may include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings, and medication to thin your blood.
  • Implant problems. Although implant designs and materials, as well as surgical techniques, continue to advance, implant surfaces may wear down and the components may loosen. Additionally, although an average of 115° of motion is generally anticipated after surgery, scarring of the knee can occasionally occur, and motion may be more limited, particularly in patients with limited motion before surgery.
  • Continued pain. A small number of patients continue to have pain after a knee replacement. This complication is rare, however, and the vast majority of patients experience excellent pain relief following knee replacement.
  • Neurovascular injury. While rare, injury to the nerves or blood vessels around the knee can occur during surgery.

Preparing for Surgery

Medical Evaluation

If you decide to have total knee replacement surgery, your orthopedic surgeon may ask you to schedule a complete physical examination with your family physician several weeks before the operation. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist, such as a cardiologist, before the surgery.

Tests

Several tests, such as blood and urine samples, and an electrocardiogram, may be needed to help your orthopedic surgeon plan your surgery.

Medications

Tell your orthopedic surgeon about the medications you are taking. He or she will tell you which medications you should stop taking and which you should continue to take before surgery.

Dental Evaluation

Although the incidence of infection after knee replacement is very low, an infection can occur if bacteria enter your bloodstream. To reduce the risk of infection, major dental procedures (such as tooth extractions and periodontal work) should be completed before your total knee replacement surgery.

Urinary Evaluations

People with a history of recent or frequent urinary infections should have a urological evaluation before surgery. Older men with prostate disease should consider completing required treatment before undertaking knee replacement surgery.

Social Planning

Although you will be able to walk on crutches or a walker soon after surgery, you will need help for several weeks with such tasks as cooking, shopping, bathing, and doing laundry.

If you live alone, your orthopedic surgeon’s office, a social worker, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at home. They also can help you arrange for a short stay in an extended care facility during your recovery, if this option works best for you.

Home Planning

Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:

  • Safety bars or a secure handrail in your shower or bath
  • Secure handrails along your stairways
  • A stable chair for your early recovery with a firm seat cushion (and a height of 18 to 20 inches), a firm back, two arms, and a footstool for intermittent leg elevation
  • A toilet seat riser with arms, if you have a low toilet
  • A stable shower bench or chair for bathing
  • Removing all loose carpets and cords
  • A temporary living space on the same floor because walking up or down stairs will be more difficult during your early recovery

YOUR SURGERY

You will most likely be admitted to the hospital on the day of your surgery.

Anesthesia

After admission, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural, or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The anesthesia team, with your input, will determine which type of anesthesia will be best for you.

Procedure

The procedure itself takes approximately 1 to 2 hours. Dr hillock will remove the damaged cartilage and bone, and then position the new metal and plastic implants to restore the alignment and function of your knee.

After surgery, you will be moved to the recovery room, where you will remain for several hours while your recovery from anesthesia is monitored. After you wake up, you will be taken to your hospital room.

Your Hospital Stay

You will most likely stay in the hospital for several days.

Pain Management

After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster.

Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

Blood Clot Prevention

Your Treatment team may prescribe one or more measures to prevent blood clots and decrease leg swelling. These may include special support hose, inflatable leg coverings (compression boots), and blood thinners.

Foot and ankle movement also is encouraged immediately following surgery to increase blood flow in your leg muscles to help prevent leg swelling and blood clots.

Physical Therapy

Most patients begin exercising their knee the day after surgery. In some cases, patients begin moving their knee on the actual day of surgery. A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement to allow walking and other normal daily activities soon after your surgery.

To restore movement in your knee and leg, your surgeon may use a knee support that slowly moves your knee while you are in bed.

Preventing Pneumonia

It is common for patients to have shallow breathing in the early postoperative period. This is usually due to the effects of anesthesia, pain medications, and increased time spent in bed. This shallow breathing can lead to a partial collapse of the lungs (termed “atelectasis”) which can make patients susceptible to pneumonia. To help prevent this, it is important to take frequent deep breaths. Your nurse may provide a simple breathing apparatus called a spirometer to encourage you to take deep breaths.

Your Recovery at Home

The success of your surgery will depend largely on how well you follow your discharge instructions at home during the first few weeks after surgery.

Wound Care

You will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed several weeks after surgery. A suture beneath your skin will not require removal.

Avoid soaking the wound in water until it has thoroughly sealed and dried. You may continue to bandage the wound to prevent irritation from clothing or support stockings.

Diet

Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to help your wound heal and to restore muscle strength.

Activity

Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within 3 to 6 weeks following surgery. Some pain with activity and at night is common for several weeks after surgery.

Your activity program should include:

  • A graduated walking program to slowly increase your mobility, initially in your home and later outside
  • Resuming other normal household activities, such as sitting, standing, and climbing stairs
  • Specific exercises several times a day to restore movement and strengthen your knee. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery.

You will most likely be able to resume driving when your knee bends enough that you can enter and sit comfortably in your car, and when your muscle control provides adequate reaction time for braking and acceleration. Most people resume driving approximately 4 to 6 weeks after surgery.

Avoiding Problems After Surgery

Blood Clot Prevention

Follow your orthopedic surgeon’s instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. He or she may recommend that you continue taking the blood thinning medication you started in the hospital. Notify your doctor immediately if you develop any of the following warning signs.

Warning signs of blood clots. The warning signs of possible blood clots in your leg include:

  • Increasing pain in your calf
  • Tenderness or redness above or below your knee
  • New or increasing swelling in your calf, ankle, and foot

Warning signs of pulmonary embolism. The warning signs that a blood clot has traveled to your lung include:

  • Sudden shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing

 Preventing Infection

A common cause of infection following total knee replacement surgery is from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your knee replacement and cause an infection.

After knee replacement, patients with certain risk factors may need to take antibiotics prior to dental work, including dental cleanings, or before any surgical procedure that could allow bacteria to enter the bloodstream. Your treatment team will discuss with you whether taking preventive antibiotics before dental procedures is needed in your situation.

Warning signs of infection. Notify your doctor immediately if you develop any of the following signs of a possible knee replacement infection:

  • Persistent fever (higher than 100.5°F orally)
  • Shaking chills
  • Increasing redness, tenderness, or swelling of the knee wound
  • Drainage from the knee wound
  • Increasing knee pain with both activity and rest

 Avoiding Falls

A fall during the first few weeks after surgery can damage your new knee and may result in a need for further surgery. Stairs are a particular hazard until your knee is strong and mobile. You should use a cane, crutches, a walker, hand rails, or have someone to help you until you have improved your balance, flexibility, and strength.

Dr Hillock and physical therapist will help you decide what assistive aides will be required following surgery and when those aides can safely be discontinued.

OUTCOMES

How Your New Knee Is Different

Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery can be predicted by the range of motion you have in your knee before surgery. Most patients can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently to climb stairs and get in and out of a car. Kneeling is sometimes uncomfortable, but it is not harmful.

Most people feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities.

Most people also feel or hear some clicking of the metal and plastic with knee bending or walking. This is a normal. These differences often diminish with time and most patients find them to be tolerable when compared with the pain and limited function they experienced prior to surgery.

Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated.

Protecting Your Knee Replacement

After surgery, make sure you also do the following:

  • Participate in regular light exercise programs to maintain proper strength and mobility of your new knee.
  • Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.
  • Make sure your dentist knows that you have a knee replacement. Talk with your Dr Hillock about whether you need to take antibiotics prior to dental procedures.  Usually Dr Hillock recommends antibiotic prophylaxis for the rest of your life following any total joint surgery.
  • See Dr Hillock or another surgeon periodically for a routine follow-up examination and x-rays

Extending the Life of Your Knee Implant

Currently, more than 90% of modern total knee replacements are still functioning well 15 years after the surgery. Following Dr Hillock’s instructions after surgery and taking care to protect your knee replacement and your general health are important ways you can contribute to the final success of your surgery.

Knee Implants

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