Knee Replacement

KNEE EFFUSION

Knee effusion happens where fluid increases in the tissues surrounding the joint. It can happen in any joint but is particularly common in the knee. It’s commonly seen in those with arthritis (such as osteoarthritis, rheumatoid arthritis and psoriatic arthritis). Gout can also cause knee effusion, although gout is typically seen in the toes. Anything that injures or inflames the knee can cause an effusion.

Symptoms:

• Abnormal or limited movement; stiffness
• Pain
• Feeling of warmth around the joint

Medications are typically prescribed to reduce the swelling. If the knee doesn’t respond to those medications, steroid medications or injections may be prescribed. It’s rare that knee surgery is needed to treat the swelling.

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ACL STRAIN OR TEAR

The ACL (anterior cruciate ligament) provides stability to the knee. Chances are, you know someone who has had an ACL strain or tear — it’s a common injury. The ACL connects the thigh bone to the shin bone and is typically injured with a sudden twisting motion (which is why it’s so common in athletes).

Symptoms:

• Sometimes an audible pop or snap when the injury occurs
• Intense pain
• Extreme pain when bearing weight on the joint, or the inability to put weight on it at all
• Swelling after the injury occurs

Your doctor will perform an exam to assess the severity of the tear. An MRI may sometimes be ordered in addition to the exam.

Some ACL injuries can be treated without surgery, by reducing activity, perhaps wearing a brace and going to physical therapy. Your doctor may recommend additional treatments. Severe ACL tears are incredibly complex. They often require reconstructive knee surgery to replace the torn ligament.

The PCL (posterior cruciate ligament) also connects the thigh to the shin, although it’s stronger and bigger than the ACL. Injury to the PCL is rarely seen and is typically caused by traumatic injuries, such as a car accident.

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MENISCUS TEAR

The meniscus is a rubbery disc that provides a cushion to your knee. There are two menisci in each knee, one on each side. They help keep your knee stable by dispersing your weight across your knee.

The tear is caused by a quick twist or turn, usually, while the foot is on the ground. The tears become more common as people age — this is because the meniscus becomes worn as you age. Tears sometimes occur in sports or when lifting heavy objects.

There are three types of meniscus tears: minor, moderate, and severe. Minor tears cause pain and swelling that typically subsides in a few weeks. Moderate tears will cause swelling and stiffness that may be accompanied by sharp pain when you move the knee. It’s common for the pain to subside and then come back — a cycle that can continue for years if untreated. Severe tears can make the knee feel unstable, causing it to unexpectedly give way. The knee may “pop” as pieces of the torn meniscus may move into the joint.

Symptoms:

• Pain and swelling
• Limited range of motion
• Limping/difficulty extending the knee
• Stiffness

The severity of the meniscus tear will determine the treatment. Your doctor may recommend rest, physical therapy, or arthroscopic knee surgery — depending on your activity level, age and how bad the tear is. The surgery is minimally invasive and typically requires a 4 to 6 week recovery period. Full knee replacement is not generally necessary for meniscal tears.

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KNEE BURSITIS

Your knees have small fluid-filled sacs that reduce friction and provide a cushion between the bones, muscles, and tendons. Knee bursitis is an inflammation of the bursa — typically those over the kneecap or the inside of the knee below the joint.

People who kneel for extended periods of time (gardeners, plumbers, etc.) have an increased risk of developing knee bursitis along with those who play certain sports.

Symptoms:

• Tenderness and swelling
• Pain when moving (sometimes when resting, too)
• Symptoms generally worsen over time

Your doctor will perform a physical exam and may use an X-ray, MRI, or ultrasound to confirm the diagnosis. Prescribed treatment may be rest, physical therapy, a corticosteroid injection, or aspiration (a procedure to drain excess fluid). Knee surgery is a last resort for bursitis and is typically only recommended to those who don’t respond to other treatments or have recurrent/chronic bursitis.

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PATELLAR TENDINITIS

​When the tendon that connects the kneecap (patella) to the shin bone, patellar tendonitis occurs. Tendinitis occurs when a tendon (the thick cord that connects muscles to bones) becomes inflamed or irritated.

It’s typically caused by a repetitive impact on the knee or sometimes from a more sudden and serious injury. It can be caused by playing sports, doing household activities, and more. The risk is increased in those who have poor posture or do not stretch or warm-up adequately before exercise.

Doing too much too soon can also cause tendinitis — for example jumping into an exercise plan that’s above one’s ability level. It’s most common in middle-aged adults as the tendons lose elasticity with age. It’s also common in sports that require a lot of jumping.

Symptoms:

• Pain on the front of the knee that may gradually build or be sudden and intense
• Swelling and stiffness

It’s recommended that you avoid the activities that aggravate the tendon and rest the knee. Putting ice on the joint can be helpful. With more severe and persistent pain, your doctor may recommend corticosteroid injections, stem cell injections, or physical therapy. Knee replacement surgery is rarely needed for tendinitis.

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PREVENTION

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DYNAMIC STRETCHING

Dynamic stretches lengthen the muscles over a series of movements. This range of motion is typically progressive, for example, swinging your leg to waist height, then to chest height and (depending on the activity you’re warming up for) head height. Dynamic stretches use a more functional range of motion that prepares you specifically for the exercise you’re going to do. So, if you are going to squat, air squats or banded squats at a relatively quick pace would be the perfect dynamic stretches to warm up with.

STATIC STRETCHING

Static stretches are held steady for around 15 seconds — for example touching your toes and holding. Static stretching can reduce recovery time by reducing lactic acid build-up. It can also help reduce DOMS (delayed onset muscle soreness), which is why it’s great after exercise.

Some sports have a higher incidence of specific injuries, for example, ACL tears are more common in football and basketball while bursitis is common in wrestling and volleyball.

It’s also important to remember that there are hereditary components to some knee problems, namely arthritis-related issues. That’s why it’s good to know your family health history and make sure you share any relevant issues with your doctor.

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KNEE SURGERY AT MOA

At Mountainstate Orthopedic Associates, we take great pride in the reputation and ability of our surgical staff. One of our former doctors (now retired) actually designed and developed the artificial knee replacement we use today. This knee replacement has incredibly positive results for our patients, with a drastic reduction in pain and an overall improvement in their quality of life.

Many of our patients are up and walking within a few days of their surgery. And while we readily admit that the knee will never feel quite like it did when the patient was younger, it will feel vastly better. The reduction in pain allows patients to resume their normal activities with ease.

At MOA, we truly believe that the time for a knee replacement surgery is when the patient is ready — not when the doctor recommends it. When the pain becomes unbearable and patients are even having trouble sleeping due to the discomfort, it may be time to seriously discuss knee surgery with your doctor.

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How We Can Help with Knee Pain

Mountainstate Orthopedic Associates is one of the region’s leading orthopedic practices specializing in knee replacement surgery. We take pride in the education and experience that each of our doctors holds.

From your initial appointment to the conclusion of your treatment, we strive to keep you informed and active in the decision-making process. It’s always our policy to be conservative with our course of treatment, only recommending surgery if it is truly needed.

We also seek to be minimally invasive in our treatments, reducing the amount of time a patient is in the hospital. With many of our surgical treatments, patients are home the same day of knee surgery.

If you have a knee injury or concern, get in touch — we’ll schedule an appointment and create a plan to get you back to your normal activities.

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SOURCES

www.mayoclinic.org

www.nih.org

www.niams.nih.gov

www.hopkinsmedicine.org

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