Knee pain can be debilitating and significantly impact daily life. Simple tasks such as driving or simply walking around can become unbearable. Once becomes too much to bear, many individuals will seek a doctor’s advice on how to best treat the pain. Through different diagnostic tests, doctors can determine the source of pain and figure out how to solve it.
The last resort in the recovery process is total knee replacement surgery. This surgery is typically only employed when all else has failed. It is considered a major surgery, but due to advancements in technology and surgical techniques, has a relatively short recovery period. Many of the symptoms that patients experience during recovery can be managed to provide maximum comfort while healing. So, what does the recovery process look like? Read on to learn about the knee and how knee injury is treated.
Anatomy of the Knee
The knee is the joint that is formed by three bones, the patella (kneecap), tibia (shin), and femur (thigh). Between the three bones there is articular cartilage – the purpose of this soft tissue is to act as a cushion between the bones. If the bones begin to rub against one another, they can cause pain and discomfort.
There is also a type of cartilage called the meniscus that is slightly tougher than articular cartilage. The meniscus acts to absorb shock between the thigh and shin bones.
There are several large ligaments in the knee, such as the ACL (Anterior Cruciate Ligament) and PCL (Posterior Cruciate Ligament) which are used to provide support and mobility to the joint. These ligaments can become torn or damaged during activity and cause pain, swelling, and inability to walk.
Due to the complex nature of the muscle structure surrounding the knee joint, there are many small injuries that could potentially occur and lead to a knee replacement surgery if left untreated.
Diagnosing Knee Injury
Knee pain can be a burden, but once it starts to impact daily activities it might be time to see a doctor. Informing them of medical history, symptoms, previous injury, and length of time since pain began can all help doctors make a diagnosis. It is important to answer their questions honestly so that they can make the correct diagnosis.
Diagnosing knee pain typically begins with a minimally invasive diagnostic test that will determine relevant factors, such as range of motion and location of pain. This includes watching the knee bend and straighten in different positions. They may watch a patient walk in order to observe it there is a limp. Some doctors can make a diagnosis based on these tests alone, but many will order slightly more invasive diagnostic techniques so that they can be certain. These diagnostic methods include:
- MRI: Magnetic Resonance Imaging allows doctors to look at the soft tissue in a patient’s body which may indicate if cartilage, tendons, or muscles have been damaged.
- X-Ray: this imaging technique is used to look at bones. This may be employed if a patient’s knee pain is being caused by an abnormality in the bones’ alignment, or if there are bone spurs around the joint.
- CT Scan: this imaging technique is used to show a 3D image of a cross-section. This can allow doctors to diagnose certain conditions, but is often not used as a diagnostic method because the MRI and X-Rays are often enough to inform a diagnosis.
If knee pain is addressed in its early stages, surgery is often not necessary. Conventional treatments are often enough to fix the issue and stop the progression of an injury.
Conventional Treatments of Knee Pain
There are many potential causes of knee pain, each with its own treatment process. Doctors will also be able to tailor a patient’s recovery to specifically meet their needs. Many of the details of recovery very, but the general process of often the same. Doctors may choose to begin a patient in any stage of recovery based on the patient’s situation. This recovery process, in order, generally follows this path:
- RICE Method: Rest, Ice, Compression, and Elevation. Employing these techniques can be enough to get an injury to begin healing. These are often coupled with anti-inflammatory NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) for pain relief.
- Wearing a Brace or Using an Assistive Device: some doctors may recommend that a brace be worn – sometimes it is only recommended to wear during activities such as sleeping or driving, or it may be prescribed for full-time use. It may also be recommended that a patient uses a cane or a walker to alleviate some of the pressure on the joint. How often these devices should be used is individual to each patient. Doctors or physical therapists will recommend how these devices should be used.
- Physical Therapy: one of the most successful forms of treatment is physical therapy. Professionals are able to guide patients through the recovery process using different exercises. These exercises can often be done at home as well as in the meeting with a therapist. The main goals of physical therapy are to improve range of motion and strengthen the muscles surrounding an injury so that the joint has more support while it heals. If physical therapy is started at the beginning stages of an injury, it has a vast potential to stop further progression of the injury.
- Corticosteroid Injections: these are used as a pain reliever for many knee injuries. The cortisone delivers an injection of a powerful anti-inflammatory into the injury, which can significantly reduce pain. These shots pose the risk of damaging soft tissue over time, however, and should be monitored closely. Some doctors will not recommend these injections depending on a patient’s condition.
- Surgery: total knee replacement surgery is on the extreme end of the surgical spectrum for knee injury. There are many other minor surgeries that a patient may need in order to repair the knee joint. Many of these surgeries are done together in one operation. Minor knee surgeries can include:
- Arthroscopy: this form of surgery uses a tiny camera to go into the joint and see what damage has occurred and where. This can be used as a diagnostic method but is most often used for surgery. While the tiny camera is there, doctors can use other tiny tools to accomplish a number of things. Some of the injuries that can be fixed during arthroscopy include removing bone spurs, repairing a torn meniscus and repairing damaged ligaments, among others.
- Partial Knee Replacement: this surgery is used to replace one or two of the parts of the joint rather than three (all three bone ends being replaced is considered a total knee replacement). This surgery requires a smaller incision than total knee replacement, and the recovery time is often a bit shorter as there are less adjustments for the body to make.
Each treatment method will be experienced differently by each patient. Choosing to be committed to the recovery process means doing the physical therapy as it is recommended, using assistive devices as recommended, and sticking to the plan. Deviation from the treatment plan isn’t fatal, but it can cause greater pain and discomfort later on.
Making the Decision
Almost all total knee replacement surgeries are elective, meaning that the patient can decide whether or not they may go through with it. Many factors may influence this decision, including money, overall health, support system, and work or home life.
Doctors and surgeons are here to help their patients as much as they can – having an open discussion about what to expect before, during, and after surgery can be extremely beneficial to a patient. Having clear expectations of what will happen in the future can ease a lot of stress and anxiety that may be surrounding the decision.
Total Knee Replacement Surgery Timeline
Each patient’s recovery timeline will be a little different from the next. This surgery timeline is based on a typical recovery process and may not reflect yours exactly. This is a guideline meant to help patients prepare for total knee replacement with the most common outcomes. Remember to discuss with doctors and surgeons when questions arise. The typical timeline is as follows:
- Preparing for Knee Replacement Surgery: before heading into the operating room, there are some steps patients need to take in order to ensure safety. These include scheduling blood work, arranging a ride from the hospital once it is time to leave, bringing a clean change of clothes, and taking time off of work. Doctors will inform a patient if it is necessary to refrain from eating or drinking for a certain period of time before surgery. It is important to get plenty of sleep in the days leading up to surgery if possible to help ensure that you are as healthy as possible going into the operation. Learning about anesthesia is also useful during the preparation process. Find out if your anesthesiologist is planning to use a general, regional, or localized anesthetic. The biggest risks of anesthesia are stroke, blood clots, and pneumonia.
- The Procedure: a total knee replacement surgery involves inserting a prosthesis to the end of each knee bone to ensure fluid movement. Doctors begin by changing the shape of the bone to better fit the prosthesis, which often in turn cuts off any damaged parts of the bone. The prosthesis is placed on the bone and held in place using bone cement. Before closing the surgical incision, surgeons will test the knee’s ability to bend. This determines if the attachment has been placed correctly. In this stage, if the prosthesis is loose or misaligned it can be quickly fixed, though this is unlikely.
- First Few Hours After Surgery: most patients will be encouraged to stand up within the first couple hours after the surgery is complete. Doing so will help test the new knee to make sure that it can handle the patient’s weight, as well as indicate a patient’s comfort level. Within the first four hours after surgery, most patients have taken at least a couple of steps using the assistance of a walker or other device.
- 1-2 Days After Surgery: The first two days after surgery are generally spent in the hospital. This time typically involves some light physical therapy and exercise that will help the joint heal more quickly. Some patients stay in the hospital longer than two days – this will depend on the patient’s progress. Some patients, especially those who have minimal in-home assistance, may move to a physical rehabilitation center until they can be by themselves.
- One Week Post Operation: physical therapy should begin within the first week after surgery. The aforementioned benefits of doing physical therapy properly can significantly improve the recovery process by reducing pain and increasing mobility. Many physical therapists will also assist patients with how to use walkers or canes, as they can hinder progress if used incorrectly.
- One Month Post Operation: the first month after surgery is an important one, as the three-week mark typically comes with improved daily function and activity. Within one month to 6 weeks, patients can often begin to drive again. Every new activity that a patient can complete without assistance is indicative of recovery.
- One Year Post Operation: most patients, if they have stuck with their doctor’s plan, can resume activity as it was before the surgery within 4 to 6 months. Some patients, especially those who are elderly, smoke, are obese, or have diabetes, may take longer than this to recover fully.
This process can seem overwhelming – keep in mind that knee replacement surgeries are common and have a very high success rate. Compared to other surgeries, the recovery time is also relatively short. There may be a way to make the recovery process even shorter, using regenerative medicine.
The Role of Regenerative Medicine in Total Knee Replacement
The new field of regenerative medicine seeks to use a patient’s own cells to enhance the healing process, to regenerate the cells. CELLAXYS offers two types of regenerative therapy:
- Stem Cell Therapy: this form of therapy begins with taking a patient’s stem cells, which are harvested using blood cells, fat cells, or bone marrow. The cells are then processed to be more concentrated, then reinjected into the injury or surgery site. Stem cells contain healing properties that the body already uses when an injury or damage occurs. Placing a concentrated stem cell solution into a part of the body that is healing can help the damage heal faster. When coupled with total knee replacement, this therapy could allow the cut bone to heal more quickly.
- Platelet-Rich Plasma Therapy: this form of therapy begins with a simple blood draw. The patient’s blood is then placed in a centrifuge to separate platelets in the blood from other components. The platelets are then injected into the injury or surgery site, similarly to stem cell therapy. Platelets contain proteins and growth factors that the body uses naturally to heal damage. Increasing the amount of these properties where damage has occurred could help the injury heal faster.
Each type of regenerative therapy comes with a low risk, as it uses the patient’s own cells. Some experience a slight pain at the injection site, but this typically goes away in a matter of days. Regenerative medicine can be a great option during the recovery process of knee replacement surgery. These treatments could provide the boost you need to complete recovery tasks more easily.
It should be noted as well that some patients who have undergone these treatments have been able to surpass the need for surgery. In some cases, regenerative medicine can heal an injury to the point where surgery is no longer necessary. When this is the case, the recovery process is simplified drastically. The healing process for regenerative therapy is virtually nonexistent. It is still generally recommended that patients continue with physical therapy, as it can help in ways that regenerative medicine cannot.
It can feel overwhelming to have to consider total knee replacement surgery. It is considered a major surgery and can be associated with risks. If a patient is facing this option, it usually means that they have exhausted all nonsurgical treatments.
Going through the process of attempting to relieve knee pain can be exhausting – knowing as much as possible about the surgery can make it feel a little less overwhelming. It’s helpful to doctors, surgeons, and patients alike to maintain an open dialog throughout the process so that any questions can be answered and recovery can go as planned.
Though 4 to 6 months can seem like a long time to be “in recovery”, it will ultimately be worth it to live pain-free. Speeding up the recovery process may be possible with regenerative medicine, which is worth considering as a means of helping the knee to recover, or as a way to possibly skip the need for surgery.