Knees – Part 2
By: Brad Hankins
This month we are taking a further look at knees https://my.clevelandclinic.org/health/body/24777-knee-joint and the various interventional and surgical options available when knees become so worn that they negatively impact our day-to-day lives. We will also explore what we can do to prepare for knee procedures and surgery.
The most common knee procedure is arthroscopy or knee scoping https://my.clevelandclinic.org/health/treatments/17153-knee-arthroscopy . Knee scopes are typically done as day surgery and can be performed under a variety of anesthesia to include general anesthesia and spinal blocks as well as local anesthetic to help numb the surgical area. Soft tissue injuries such a meniscus tears, torn tendons (ACL and MCL tears), bursitis and even minor fractures are some of the knee conditions that are routinely repaired with knee scopes. The procedure itself involves several small incisions made in the knee so a camera (not the camera itself, an extremely small diameter lens at the end of a thin tube) and instruments can be inserted into the knee compartments. Typically physical therapy follows knee scopes with most people returning to normal activity in weeks to months.
A relatively new surgical procedure is partial knee replacement or knee compartment replacement https://my.clevelandclinic.org/health/treatments/14599–partial-knee-replacement . In these procedures one of the three knee compartments is replaced leaving the others intact. The knee has three compartments the medial (inside), lateral (outside) and patellofemoral (under the kneecap). Though not as common as total knee replacement due to arthritis often affecting all three compartments simultaneously, there are still almost one million partial knee replacements per year. People who have compartment replacements can eventually need total knee replacement, but total replacement can be delayed for several years. This procedure is typically done as a day surgery with people recovering in six weeks to several months.
Total knee replacement https://my.clevelandclinic.org/health/treatments/8512-knee-replacement is a common surgical procedure that can be done as a day surgery with the procedure itself typically lasting one to two hours. The knee joint is replaced with a prosthetic made of titanium and plastic composites that is extremely durable with most lasting 15 to 20 years and 80-90% of current replacements often remain functional for more than 20 years. Recovery can take months to a year depending on the age, overall health, activity level and, in my opinion, the presurgical preparedness of the patient.
Other options to increase the milage of worn knees include Platelet Rich Plasma Therapy (PRP) https://my.clevelandclinic.org/health/treatments/platelet-rich-plasma-prp-injection . Platelet Rich Plasma Therapy is a process where components of your own blood are injected into the knee to decrease inflammation and stimulate growth of new tissue. Please talk with your medical provider to explore PRP and other non-surgical options.
Preparing for any knee procedure is a vital step in ensuring a good result and quick recovery. Often post procedure rehabilitation is prescribed after knee interventions but, again in my opinion, just as critical is prehabilitation before knee procedures. What can be done before knee procedures to ensure the best outcome:
- First and foremost, lose weight. This seems counterintuitive as knee problems often lead to inactivity which leads to weight gain. This is why prehabilitation should begin as soon, or preferably well before, the procedure is scheduled. With help (please visit a SSSYMCA Personal Trainer) activity levels and exercise can be adapted to fit knee limitations. Adaptive exercise combined with sustainable dietary changes can result in appreciable presurgical weight loss.
- Improve overall strength and stamina with a focus on core and leg muscles. Leg and glute muscles can strengthen, even if a (or both) knee restrict range of motion. Isometric exercises, the use of recumbent bikes and rowing machines are just some of the adaptive approaches.
- Improve your balance by using chairs and balance balls if your knee will not allow you to fully bear standing weight. Standing balance exercises can be performed using the non-operative leg which will in turn improve overall balance. Again, please visit with a SSYMCA Personal Trainer to help get started.
- In the days close to your procedure:
- Schedule a dental exam and tooth cleaning to decrease the chance of bacteria entering your blood system.
- Ensure you are well hydrated beginning 48 hours before your procedure and follow your medical providers instructions to stop drinking fluids before your procedure – usually 12 hours before your procedure start time.
- Schedule a rest day, or two, immediately before your procedure.
- Take your medications as prescribed and follow your medical providers pre-procedure medication orders.
As always I would enjoy hearing your fitness journey, please feel free to email me at hankinsb@ssymca.net
I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.
Brad Hankins RN, CPT
