6 Types of Knee Exercises and Which Ones to Avoid

6 Types of Knee Exercises and Which Ones to Avoid

Article Featured on Medical News Today

The knee is the largest joint in the body. People use it heavily every day as they walk, run, climb, or jump. As a result, it is also very prone to injury and pain. When these occur, a doctor may recommend exercises to help a person strengthen the muscles around the knee.

People of all ages may experience knee pain. According to one article, a type of knee pain called patellofemoral pain syndrome, or runner’s knee, is the most common orthopedic condition in sports medicine. In addition to being common in athletic people, knee pain can also be a problem for people who have arthritis.

While it may be tempting to avoid exercise when knee pain occurs, this is not always the appropriate solution. Certain types of exercise can help alleviate existing knee pain and prevent future pain or injury by providing the knee with extra support.

Benefits of knee strengthening exercises

The Arthritis Foundation state that exercise may be the most effective way to treat osteoarthritis without surgery, while the American Academy of Orthopaedic Surgeons note that strong and flexible muscles can keep knees healthy and prevent injury.

Knee strengthening exercises do not affect the knee joint directly, but they strengthen the muscles surrounding it. Strong muscles in the legs can help provide support for the knees. This support may alleviate pressure and strain on these joints, which can relieve pain and help a person be more active.

The following exercises can help strengthen the muscles surrounding the knee. If a person experiences pain during these exercises, they should stop doing them and speak to a doctor. Anyone with severe knee pain should consult a doctor before trying to exercise.

It is best to warm up with light exercise before starting any knee strengthening exercises. Examples of gentle exercise include walking, cycling, and using an elliptical machine, all of which put minimal stress on the knees. This activity will help increase blood flow to the muscles and allow them to be more flexible.

1. Leg lifts

Muscles involved: Quadriceps (front of the thigh) and abdominal (stomach) muscles.

  1. Lie down on the floor with the back flat. Use a yoga mat, folded blanket, or exercise mat for comfort on a hard floor.
  2. Keep the left leg straight and bend the right leg slightly at the knee, bringing the foot closer to the body.
  3. Pull the abdominal muscles inward by imagining the belly button pulling down toward the floor. Doing this should bring the lower back down against the floor and help provide extra support during the exercise. Place a hand beneath the lower back to make sure that there is no space between the small of the back and the floor. If there is space for the hand, gently push the lower back down on top of the hand.
  4. Slowly lift the left leg without bending the knee. Keep the toes pointed toward the ceiling and stop when the leg is about 12 inches off the floor. It should not be higher than the bent knee on the right leg.
  5. Hold the left leg up for 5 seconds.
  6. Slowly lower the leg back down to the floor. Do not put it down too quickly or let it drop.
  7. Repeat two more times with the same leg.
  8. Switch sides and repeat.

What not to do

  • Do not let the back arch during the exercise.
  • Do not jerk or bounce the leg or lift it above the knee on the bent leg.
  • People who have osteoporosis or a back compression fracture should not perform this exercise.

2. Standing hamstring curls

Muscles involved: Hamstrings (back of the thigh) and gluteal (buttock) muscles.

  1. Stand straight with the knees only 1–2 inches apart. Hold on to a stable chair, the countertop, or another object for balance.
  2. Slowly bend one knee behind the body, lifting the heel off the floor while keeping the thighs aligned. Continue to lift the heel in a smooth motion until the knee bend reaches a 90-degree angle. Keep the straight leg slightly bent to avoid locking it.
  3. Hold the bent leg up for 5 seconds and then slowly lower it to the floor.
  4. Repeat two more times with the same leg.
  5. Switch sides and repeat.

What not to do

  • Do not point the toes or flex the foot on the lifted leg. Allow the foot to remain in a neutral, flat position.

3. Hamstring curls on a weight bench

Muscles involved: Hamstrings and gluteal muscles.

This exercise is a variation of the standing hamstring curl. A person can try this version if they have access to a weight bench that is purpose-built for this exercise. It may be more challenging than the standing hamstring curl, depending on how much weight a person uses.

  1. Lie face down on the bench with the knees close together. Grip the handles for stability.
  2. Tuck the feet under the weight. The weight should sit just above the heels.
  3. Slowly bend both knees, using the force of the legs to raise the weight up. Continue to lift the weight in a smooth motion until the knees bend at a 90-degree angle.
  4. Hold the weight up for 5 seconds and then slowly lower it back down.
  5. Perform up to 15 repetitions (reps).

What not to do

  • When first attempting this exercise, do not use a heavy weight. Beginners should use the lowest weight and work their way up to heavier weights as they build strength.

4. Step exercises

Muscles involved: Quadriceps, hamstrings, hip flexors, and gluteal muscles.

  1. Use a large, sturdy stool or exercise platform no taller than 6 inches.
  2. Step up onto the stool with the right foot and allow the left foot to follow behind. The left foot should not be on the stool but should hang behind it.
  3. Keep the body weight on the right foot and hold for up to 5 seconds.
  4. Slowly lower the left foot down and then follow it with the right foot.
  5. Switch legs, stepping up with the left foot first.
  6. Repeat.

What not to do:

  • Do not lock the knees during this exercise. The knees should remain slightly bent.
  • Do not allow any part of the stepping foot to hang off the stool or platform.
  • People who have issues with balance should not perform this exercise.

5. Chair dips

Muscles involved: Quadriceps, hamstrings, hip flexors, and gluteal muscles.

  1. Use two high-backed, stable chairs, placing one on either side of the body with the chair backs next to the arms. Place a hand on the back of each chair for balance.
  2. Bend both legs at the knee, being careful not to let the knees extend past the toes.
  3. Extend the right leg out in front of the body in a slow kicking motion. Focus on keeping the weight balanced on the left foot.
  4. Bring the right leg down slightly, holding it just a few inches off the floor for 5 seconds while continuing to balance on the left leg.
  5. Slowly lower the right leg completely to the floor.
  6. Stand up straight on both feet.
  7. Switch sides and repeat.

What not to do:

  • Do not bring the leg up more than 45 degrees off the floor.
  • Do not lean backward when lifting the leg. Keep the back and upper body straight.

6. Wall squats

Muscles involved: Quadriceps and gluteal muscles.

  1. Stand with the head, shoulders, back, and hips flat against a wall.
  2. Step both feet out about 24 inches away from the wall, while keeping the back and shoulders against it. Keep the feet no more than hip width apart.
  3. Slide the back down the wall slowly until the body is just above a normal sitting position.
  4. Hold for 5 seconds and then slide back up.
  5. Repeat.

What not to do:

  • Do not squat too low. The knees should not go over the toes.
  • Do not use fast, jerky movements. Perform the exercise slowly and smoothly.

Post-exercise stretching

After exercising any muscle group, it is essential to stretch the muscles. Stretching helps improve flexibility and reduce pain and injury.

Quadricep stretch

  1. Hold on to the back of a chair or put one hand on a wall for balance.
  2. Lift one foot behind the body and grab the ankle with the hand.
  3. Keep the back straight and the knees close together.
  4. Pull the heel close to the buttocks without forcing it or causing pain.
  5. Hold for up to 30 seconds and then slowly lower the leg.
  6. Switch sides and repeat.

Toe touches

There are many different ways to stretch the hamstrings in the back of the legs. One is through traditional toe touching.

  • With the feet close together, slowly bend over at the hips and extend the arms downward. Keep the legs straight but do not lock the knees.
  • Reach the fingers to the top of the toes and hold for 30 seconds.
  • Initially, it may not be possible to reach the toes. In this case, try to get the fingers as close as possible to the toes without causing pain.

What not to do:

  • Do not use a bouncing motion. Hold the body still.

Standing hamstring stretch

A standing hamstring stretch is also an effective way to stretch the backs of the legs, and it is less strenuous for the lower back than toe touches.

  1. Stand up straight with the feet no more than shoulder width apart.
  2. Bend at the hips slightly and extend the right leg out a few inches in front of the body. Allow the left leg to bend slightly.
  3. While keeping the back straight, slowly bring the chest downward.
  4. Bend down as far as possible without causing pain. Hold for 30 seconds.
  5. Slowly bring the leg back toward the body and stand up straight.
  6. Repeat with the other leg.

Summary

Exercise is a noninvasive and healthful way to help with minor knee pain due to overuse, arthritis, or other causes. Knee strengthening exercises are an effective way to help prevent injury and keep the legs strong. Stretching can also help keep the muscles flexible, which can prevent or alleviate pain.

People who have health conditions should speak with a doctor before beginning any exercise program.

Patellar (Kneecap) Fractures

Patellar (Kneecap) Fractures

Article Featured on AAOS

A patellar fracture is a break in the patella, or kneecap, the small bone that sits at the front of your knee. Because the patella acts as a shield for your knee joint, it is vulnerable to fracture if you fall directly onto your knee or hit it against the dashboard in a vehicle collision. A patellar fracture is a serious injury that can make it difficult or even impossible to straighten your knee or walk.

Some simple patellar fractures can be treated by wearing a cast or splint until the bone heals. In most patellar fractures, however, the pieces of bone move out of place when the injury occurs. For these more complicated fractures, surgery is needed to restore and stabilize the kneecap and allow for the return of function.

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What are the symptoms of knee ligament injuries

What are the symptoms of knee ligament injuries?

What are knee ligament injuries?

Knee ligaments are the short bands of tough, flexible connective tissue that hold the knee together. Knee ligament injuries can be caused by trauma, such as a car accident. Or they can be caused by sports injuries. An example is a twisting knee injury in basketball or skiing.

The knee has 4 major ligaments. Ligaments connect bones to each other. They give the joint stability and strength. The 4 knee ligaments connect the thighbone (femur) to the shin bone (tibia). They are:

  • Anterior cruciate ligament (ACL). This ligament is in the center of the knee. It controls rotation and forward movement of the shin bone.
  • Posterior cruciate ligament (PCL). This ligament is in the back of the knee. It controls backward movement of the shin bone.
  • Medial collateral ligament (MCL). This ligament gives stability to the inner knee.
  • Lateral collateral ligament (LCL). This ligament gives stability to the outer knee.

What causes knee ligament injuries?

Cruciate ligaments

The ACL is one of the most common ligaments to be injured. The ACL is often stretched or torn during a sudden twisting motion. This is when the feet stay planted one way, but the knees turn the other way. Slowing down while running or landing from a jump incorrectly can cause ACL injuries.  Skiing, basketball, and football are sports that have a higher risk for ACL injuries.

The PCL is also a common ligament to become injured in the knee. But a PCL injury usually occurs with sudden, direct hit, such as in a car accident or during a football tackle.

Collateral ligaments

The MCL is injured more often than the LCL. Stretch and tear injuries to the collateral ligaments are usually caused by a blow to the outer side of the knee. This can happen when playing hockey or football.

What are the symptoms of knee ligament injuries?

Cruciate injury

A cruciate ligament injury often causes pain. Often you may hear a popping sound when the injury happens. Then your buckles when you try to stand on it. The knee also swells. You also are not able to move your knee as you normally would. You may also pain along the joint and pain when walking.

The symptoms of a cruciate ligament injury may seem like other health conditions. Always see your healthcare provider for a diagnosis.

Collateral ligament injury

An injury to the collateral ligament also causes the knee to pop and buckle. It also causes pain and swelling. Often you will have pain at the sides of the knee and swelling over the injury site. If it is an MCL injury, the pain is on the inside of the knee. An LCL injury may cause pain on the outside of the knee. The knee will also feel unstable, like it is going to give way.

How are knee ligament injuries diagnosed?

Your healthcare provider will ask you have your health history and do a physical exam. You may also needs one or more of these tests:

  • X-ray. This imaging test can rule out an injury to bone instead of a ligament injury. It uses energy beams to make images of internal tissues, bones, and organs on film.
  • MRI. This test uses large magnets, radio waves, and a computer to make detailed images of organs and structures within the body. It can often find damage or disease in bones and a surrounding ligament, tendon, or muscle.
  • Arthroscopy. This procedure is used to diagnose and treat joint problems. The healthcare provider uses a small, lighted tube (arthroscope) put into the joint through a small cut (incision). Images of the inside of the joint can be seen a screen. The procedure can assess joint problems, find bone diseases and tumors, and find the cause of bone pain and inflammation.

How are knee ligament injuries treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

  • Treatment may include:
  • Pain medicine such as ibuprofen
  • Muscle-strengthening exercises
  • Protective knee brace
  • Ice pack to ease swelling
  • Surgery

Key points about knee ligament injuries

  • Knee ligaments are the short bands of elastic tissue that holds the knee together. There are 4 main ligaments in each knee.
  • Knee ligament injuries can be cause by trauma, such as a car accident. Or they can by caused by sports injuries.
  • The anterior cruciate ligament (ACL) is one of the most common ligaments to be injured.
  • Treatment may include medicine, muscle-strengthening exercises, a knee brace, or surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

8 Ways to Prevent Knee Problems Before They Begin

8 Ways to Prevent Knee Problems Before They Begin

Article Featured on Active Implants

As the largest joint in your body, the knee is a common source of pain and injury. Protect your knees now, and they’ll keep you stepping strong for years to come. Here are some tips to help you keep your knees in tip-top shape.

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3 Lifestyle Choices for Healthier Knees

3 Lifestyle Choices for Healthier Knees

Article Featured on Active Implants

The knee is one of the largest, most complex joints in the human body and the most common joint injured. While several common causes for knee pain exist, many lifestyle choices may reduce pain and postpone or eliminate the need for knee surgery in the future. Here are 3 tips for maintaining healthy knees and a healthier life:

Take care of your overall health

Taking better care of your physical and mental health will not only make for a happier and more fulfilled life, but can also improve the strength of your knees. Studies have shown that ailments such as back pain and depression have been linked to knee pain, so making even the simplest of changes like strengthening your core and losing weight can help stave off the prospect of knee surgery. Did you know losing 10 pounds relieves about 40 pounds of pressure on your knees?

Drink more water

Water is not only vital to healthy bones and skin, it is also vital to knee health. The cartilage in our knees is made up of mostly water – up to 80 percent when we’re properly hydrated. But as we get older, the water content gets lower, resulting in unhealthy cartilage and possibly degenerative joint disease. Lack of water can also lead to dehydration, which can drain your energy and make you tired. So drink up! The Institute of Medicine recommends an adequate intake is roughly about 13 cups of total beverages a day for men, and 9 cups of total beverages a day for women.

Keep moving

Knee cartilage depends on movement to stay healthy and heal. Aim to be active up to 30 minutes a day, five days a week doing any of your favorite knee-safe activities like walking, yoga, swimming or low-impact aerobics. Consider adding in knee exercises to your routine, such as marching, sit to stand/stand to sit, hamstring curls, heel raises and squats for added knee strengthening.

Even after making these healthy lifestyle choices, you may still experience knee pain or injury. If your pain gets to the point that you are unable to enjoy your favorite activities or if it affects your quality of life, it’s time to see a doctor to determine the cause of pain and choose a treatment plan that’s right for you.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Combined Knee Ligament Injuries

Combined Knee Ligament Injuries

Article Featured on AAOS

The knee is the largest joint in your body and one of the most complex. It is also vital to movement. Your knee ligaments connect your thighbone to your lower leg bones. Knee ligament sprains or tears are a common sports injury.

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Seven Most Common Knee Injuries

Seven Most Common Knee Injuries

Article Featured on ReboundMD

The knee joint is one of the largest and most complex joints in the body. It is also one of the most important joints. Connecting the thigh bone to the shinbone, it plays an important role in supporting the body’s weight, and facilitating movement –allowing you to bend your knee.

Due to the complexity of the knee joint, it is susceptible to a number of different injuries. Some of the most common knee joint injuries include tears in the ligaments, tendons, and cartilage. The kneecap itself can also be fractured or dislocated.

Let’s look at some of the most common knee injuries. See how they are caused and the treatment that’s required to address them.

Fractures

The kneecap (patella) is a shield for your knee joint, and protects it from becoming injured or damaged during a fall. Because of this, the kneecap can become broken during a high impact fall or sports injury.

Kneecap fractures are a common yet serious injury that usually requires immobilization or in some cases surgery to correct.

Dislocations

Knee dislocations occur when the knee bones become out of place. This can occur after a major trauma such as a fall, car crash, or high-speed impact. It can also be caused by twisting the knee while one foot is firmly planted on the ground.

Dislocations require relocation. Sometimes the kneecap will spontaneously correct itself and return to the proper position. Other cases will require a mild sedative to allow the doctor to relocate the knee without causing too much discomfort. It generally takes about six weeks to fully heal from a dislocated knee.

Anterior Cruciate Ligament Injuries

The anterior cruciate ligament (ACL) is knee tissue that joins the upper and lower leg bones together and helps keep the knee stable.

The ACL can be torn if the lower leg extends forward too much or if the leg becomes twisted. ACL injuries are one of the most common types of knee injuries and account for about 40 percent of all sports-related injuries.

An ACL injury can range from a small tear in the ligament to a severe injury –when the ligament completely tears or becomes separated from the bone itself.

Treatment options for ACL injuries depend on the extent of the injury. Not all ACL injuries require surgery, however depending on various factors including the severity of the tear, surgery may be required. Physical rehabilitation is often recommended after an ACL injury.

Posterior Cruciate Ligament Injuries

The posterior cruciate ligament connects the femur bone to the shinbone and keeps the shinbone from moving too far back. As the name suggests, this ligament is located at the back of the knee.

A posterior cruciate ligament injury occurs when trauma occurs to the knee –this can happen in sports when the player lands on a bent knee. If the damage is only to the posterior cruciate ligament –then treatment is generally non-surgical. But if there are a combination of injuries such as a dislocated knee and multiple torn ligaments, then surgery may be required.

Collateral Ligament Injuries

The collateral ligament is one of the four major ligaments in the knee.

A collateral ligament injury is a common sports-related injury. This ligament can easily be torn when the lower leg is forced sideways.

Surgery may not be required if the collateral ligament has been torn. However, if other structures in the knee are injured at the same time then surgery is generally recommended.

Meniscal Tears

The meniscus is the piece of cartilage between the knee joint that helps absorb the shock that occurs when running or playing sports. The pieces help cushion the joint and keep it stable.

Unfortunately though, meniscus tears are common in sports that require jumping –like volleyball and soccer, as well as contact sports like football. When a person changes direction suddenly while running, the meniscus can tear.

Surgery may be required, depending on the extent of the injury and severity of the tear.

Tendon Tears

The tendon in the knee, known as the patellar tendon –works together with the knee muscles in the front of the thigh to help straighten the leg. While tears in the patellar tendon are most common among middle-aged people and those who play running or jumping sports –it is possible for anyone to tear their tendon.

A complete tear is considered a disabling injury and requires surgery to regain complete function. However most tears are only partial tears and require rest and physical therapy to help facilitate healing.

If you have experienced a knee injury or are experiencing knee pain, it’s important to see an orthopedic specialist as soon as possible. Your orthopedist will be able to make a diagnosis and recommend treatment options to help get you back on track as soon as possible.

Common Knee Injuries

What to do if you think your joint replacement is infected

Article Featured on AAOS

Knee and hip replacements are two of the most commonly performed elective operations. For the majority of patients, joint replacement surgery relieves pain and helps them to live fuller, more active lives.No surgical procedure is without risks, however. A small percentage of patients undergoing hip or knee replacement (roughly about 1 in 100) may develop an infection after the operation.Joint replacement infections may occur in the wound or deep around the artificial implants. An infection may develop during your hospital stay or after you go home. Joint replacement infections can even occur years after your surgery.

This article discusses why joint replacements may become infected, the signs and symptoms of infection, treatment for infections, and preventing infections.

Description

Any infection in your body can spread to your joint replacement.

Infections are caused by bacteria. Although bacteria are abundant in our gastrointestinal tract and on our skin, they are usually kept in check by our immune system. For example, if bacteria make it into our bloodstream, our immune system rapidly responds and kills the invading bacteria.

However, because joint replacements are made of metal and plastic, it is difficult for the immune system to attack bacteria that make it to these implants. If bacteria gain access to the implants, they may multiply and cause an infection.

Despite antibiotics and preventive treatments, patients with infected joint replacements often require surgery to cure the infection.

Total knee implants

Examples of total knee implants. Joint replacement implants are typically made of metal alloys and strong, durable plastic called polyethylene.

Cause

A total joint may become infected during the time of surgery, or anywhere from weeks to years after the surgery.

The most common ways bacteria enter the body include:

  • Through breaks or cuts in the skin
  • During major dental procedures (such as a tooth extraction or root canal)
  • Through wounds from other surgical procedures

Some people are at a higher risk for developing infections after a joint replacement procedure. Factors that increase the risk for infection include:

  • Immune deficiencies (such as HIV or lymphoma)
  • Diabetes mellitus
  • Peripheral vascular disease (poor circulation to the hands and feet)
  • Immunosuppressive treatments (such as chemotherapy or corticosteroids)
  • Obesity

Symptoms

Signs and symptoms of an infected joint replacement include:

  • Increased pain or stiffness in a previously well-functioning joint
  • Swelling
  • Warmth and redness around the wound
  • Wound drainage
  • Fevers, chills and night sweats
  • Fatigue

Doctor Examination

When total joint infection is suspected, early diagnosis and proper treatment increase the chances that the implants can be retained. Your doctor will discuss your medical history and conduct a detailed physical examination.

Tests

Imaging tests. X-rays and bone scans can help your doctor determine whether there is an infection in the implants.

Laboratory tests. Specific blood tests can help identify an infection. For example, in addition to routine blood tests like a complete blood count (CBC), your surgeon will likely order two blood tests that measure inflammation in your body. These are the C-reactive Protein (CRP) and the Erythrocyte Sedimentation Rate (ESR). Although neither test will confirm the presence of infection, if either or both of them are elevated, it raises the suspicion that an infection may be present. If the results of these tests are normal, it is unlikely that your joint is infected.

Additionally, your doctor will analyze fluid from your joint to help identify an infection. To do this, he or she uses a needle to draw fluid from your hip or knee. The fluid is examined under a microscope for the presence of bacteria and is sent to a laboratory. There, it is monitored to see if bacteria or fungus grow from the fluid.

The fluid is also analyzed for the presence of white blood cells. In normal hip or knee fluid, there are a low number of white blood cells. The presence of a large number of white blood cells (particularly cells called neutrophils) indicates that the joint may be infected. The fluid may also be tested for specific proteins that are known to be present in the setting of an infection.

Treatment

Nonsurgical Treatment

In some cases, just the skin and soft tissues around the joint are infected, and the infection has not spread deep into the artificial joint itself. This is called a “superficial infection.” If the infection is caught early, your doctor may prescribe intravenous (IV) or oral antibiotics.

This treatment has a good success rate for early superficial infections.

Surgical Treatment

Infections that go beyond the superficial tissues and gain deep access to the artificial joint almost always require surgical treatment.

Debridement. Deep infections that are caught early (within several days of their onset), and those that occur within weeks of the original surgery, may sometimes be cured with a surgical washout of the joint. During this procedure, called debridement, the surgeon removes all contaminated soft tissues. The implant is thoroughly cleaned, and plastic liners or spacers are replaced. After the procedure, intravenous (IV) antibiotics will be prescribed for approximately 6 weeks.

Staged surgery. In general, the longer the infection has been present, the harder it is to cure without removing the implant.

Late infections (those that occur months to years after the joint replacement surgery) and those infections that have been present for longer periods of time almost always require a staged surgery.

The first stage of this treatment includes:

  • Removal of the implant
  • Washout of the joint and soft tissues
  • Placement of an antibiotic spacer
  • Intravenous (IV) antibiotics

An antibiotic spacer is a device placed into the joint to maintain normal joint space and alignment. It also provides patient comfort and mobility while the infection is being treated.

Knee Implant Compressors

(Top) These x-rays show an original knee replacement from the front and from the side. (Bottom) An antibiotic spacer has been placed in the joint during the first stage of treatment for joint replacement infection.

Spacers are made with bone cement that is loaded with antibiotics. The antibiotics flow into the joint and surrounding tissues and, over time, help to eliminate the infection.

Patients who undergo staged surgery typically need at least 6 weeks of IV antibiotics, or possibly more, before a new joint replacement can be implanted. Orthopaedic surgeons work closely with other doctors who specialize in infectious disease. These infectious disease doctors help determine which antibiotic(s) you will be on, whether they will be intravenous (IV) or oral, and the duration of therapy. They will also obtain periodic blood work to evaluate the effectiveness of the antibiotic treatment.

Once your orthopaedic surgeon and the infectious disease doctor determine that the infection has been cured (this usually takes at least 6 weeks), you will be a candidate for a new total hip or knee implant (called a revision surgery). This second procedure is stage 2 of treatment for joint replacement infection.

During revision surgery, your surgeon will remove the antibiotic spacer, repeat the washout of the joint, and implant new total knee or hip components.

An antibiotic spacer in a hip joint.

This x-ray shows knee components used in a revision surgery (stage 2). Note that the stems of the implants are longer to help support bone that has been compromised due to infection and removal of the previous implants.

Single-stage surgery. In this procedure, the implants are removed, the joint is washed out (debrided), and new implants are placed all in one stage.  Single-stage surgery is not as popular as two-stage surgery, but is gaining wider acceptance as a method for treating infected total joints. Doctors continue to study the outcomes of single-stage surgery.

Prevention

At the time of original joint replacement surgery, there are several measures taken to minimize the risk of infection. Some of the steps have been proven to lower the risk of infection, and some are thought to help but have not been scientifically proven. The most important known measures to lower the risk of infection after total joint replacement include:

  • Antibiotics before and after surgery. Antibiotics are given within one hour of the start of surgery (usually once in the operating room) and continued at intervals for 24 hours following the procedure.
  • Short operating time and minimal operating room traffic. Efficiency in the operation by your surgeon helps to lower the risk of infection by limiting the time the joint is exposed. Limiting the number of operating room personnel entering and leaving the room is thought to the decrease risk of infection.
  • Use of strict sterile technique and sterilization instruments. Care is taken to ensure the operating site is sterile, the instruments have been autoclaved (sterilized) and not exposed to any contamination, and the implants are packaged to ensure their sterility.
  • Preoperative nasal screening for bacterial colonization. There is some evidence that testing for the presence of bacteria (particularly the Staphylococcus species) in the nasal passages several weeks prior to surgery may help prevent joint infection. In institutions where this is performed, those patients that are found to have Staphylococcus in their nasal passages are given an intranasal antibacterial ointment prior to surgery. The type of bacteria that is found in the nasal passages may help your doctors determine which antibiotic you are given at the time of your surgery.
  • Preoperative chlorhexidine wash. There is also evidence that home washing with a chlorhexidine solution (often in the form of soaked cloths) in the days leading up to surgery may help prevent infection. This may be particularly important if patients are known to have certain types of antibiotic-resistant bacteria on their skin or in their nasal passages (see above). Your surgeon will talk with you about this option.
  • Long-term prophylaxis. Surgeons sometimes prescribe antibiotics for patients who have had joint replacements before they undergo dental work. This is done to protect the implants from bacteria that might enter the bloodstream during the dental procedure and cause infection. The American Academy of Orthopaedic Surgeons has developed recommendations for when antibiotics should be given before dental work and for which patients would benefit.  In general, most people do not require antibiotics before dental procedures. There is little evidence that taking antibiotics before dental procedures is effective at preventing infection.

    Antibiotics may also be considered before major surgical procedures; however, most patients do not require this. Your orthopaedic surgeon will talk with you about the risks and benefits of prophylactic antibiotics in your specific situation.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Knee Replacement Surgery for Arthritis

What Can I Do After Knee Replacement Surgery? When to Return to Normal Activity

Article Featured on AAOS

After having a knee replacement, you may expect your lifestyle to be a lot like it was before surgery— but without the pain. In many ways, you are right, but returning to your everyday activities takes time. Being an active participant in the healing process can help you get there sooner and ensure a more successful outcome.

Even though you will be able to resume most activities, you may want to avoid doing things that place excessive stress on your “new” knee, such as participating in high-impact sports like jogging. The suggestions here will help you enjoy your new knee while you safely resume your daily activities.

Hospital Discharge

Your hospital stay will typically last from 1 to 4 days, depending on the speed of your recovery. If your knee replacement is performed on an outpatient basis, you will go home on the same day as surgery.

Before you are discharged from the hospital, you will need to accomplish several goals, such as:

  • Getting in and out of bed by yourself.
  • Having acceptable pain control.
  • Being able to eat, drink, and use the bathroom.
  • Walking with an assistive device (a cane, walker, or crutches) on a level surface and being able to climb up and down two or three stairs.
  • Being able to perform the prescribed home exercises.
  • Understanding any knee precautions you may have been given to prevent injury and ensure proper healing.

If you are not able to accomplish these goals, it may be unsafe for you to go directly home after discharge. If this is the case, you may be temporarily transferred to a rehabilitation or skilled nursing center.

When you are discharged, your healthcare team will provide you with information to support your recovery at home. Although the complication rate after total knee replacement is low, when complications occur they can prolong or limit full recovery. Hospital staff will discuss possible complications, and review with you the warning signs of an infection or a blood clot.

Warning Signs of Infection

  • Persistent fever (higher than 100 degrees)
  • Shaking chills
  • Increasing redness, tenderness or swelling of your wound
  • Drainage of your wound
  • Increasing pain with both activity and rest

Warning Signs of a Blood Clot

  • Pain in your leg or calf unrelated to your incision
  • Tenderness or redness above or below your knee
  • Increasing swelling of your calf, ankle or foot

In very rare cases, a blood clot may travel to your lungs and become life-threatening. Signs that a blood clot has traveled to your lungs include:

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

Notify your doctor if you develop any of the above signs.

Recovery at Home

You will need some help at home for several days to several weeks after discharge. Before your surgery, arrange for a friend, family member or caregiver to provide help at home.

Preparing Your Home

The following tips can make your homecoming more comfortable, and can be addressed before your surgery:

  • Rearrange furniture so you can maneuver with a cane, walker, or crutches. You may temporarily change rooms (make the living room your bedroom, for example) to avoid using the stairs.
Home recovery center

Prepare a “recovery center” by placing items that you use frequently within easy reach.

  • Remove any throw rugs or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
  • Get a good chair—one that is firm with a higher-than-average seat and has a footstool for intermittent leg elevation.
  • Install a shower chair, gripping bar, and raised toilet seat in the bathroom.
  • Use assistive devices such as a long-handled shoehorn, a long-handled sponge, and a grabbing tool or reacher to avoid bending over too far.

Wound Care

During your recovery at home, follow these guidelines to take care of your wound and prevent infection:

  • Keep the wound area clean and dry. A dressing will be applied in the hospital and should be changed as often as directed by your doctor. Ask for instructions on how to change the dressing before you leave the hospital.
  • Follow your doctor’s instructions on how long to wait before you shower or bathe.
  • Notify your doctor immediately if the wound appears red or begins to drain. This could be a sign of infection.

Swelling

You may have moderate to severe swelling in the first few days or weeks after surgery. You may have mild to moderate swelling for about 3 to 6 months after surgery. To reduce swelling, elevate your leg slightly and apply ice. Wearing compression stockings may also help reduce swelling. Notify your doctor if you experience new or severe swelling, since this may be the warning sign of a blood clot.

Medication

Take all medications as directed by your doctor. Home medications may include opioid and non-opioid pain pills, oral or injectable blood thinners, stool softeners, and anti-nausea medications.

Be sure to talk to your doctor about all your medications—even over-the-counter drugs, supplements and vitamins. Your doctor will tell you which over-the-counter medicines are safe to take while using prescription pain medication.

It is especially important to prevent any bacterial infections from developing in your artificial joint. Some patients with special circumstances may be required to take antibiotics prior to dental work to help prevent infection. Ask your doctor if you should take antibiotics before dental work. You may also wish to carry a medical alert card so that, if an emergency arises, medical personnel will know that you have an artificial joint.

Diet

By the time you go home from the hospital, you should be eating a normal diet. Your doctor may recommend that you take iron and vitamin supplements. You may also be advised to avoid supplements that include vitamin K and foods rich in vitamin K if you taking the blood thinner medication warfarin (Coumadin). Foods rich in vitamin K include broccoli, cauliflower, brussel sprouts, liver, green beans, garbanzo beans, lentils, soybeans, soybean oil, spinach, kale, lettuce, turnip greens, cabbage, and onions.

Continue to drink plenty of fluids and avoid alcohol. You should continue to watch your weight to avoid putting more stress on the joint.

Resuming Normal Activities

Once you get home, you should stay active. The key is to not do too much, too soon. While you can expect some good days and some bad days, you should notice a gradual improvement over time. Generally, the following guidelines will apply:

Driving

In most cases, it is safe to resume driving when you are no longer taking opioid pain medication, and when your strength and reflexes have returned to a more normal state. Your doctor will help you determine when it is safe to resume driving.

Sexual Activity

Please consult your doctor about how soon you can safely resume sexual activity. Depending on your condition, you may be able to resume sexual activity within several weeks after surgery.

Sleeping Positions

You can safely sleep on your back, on either side, or on your stomach.

Return to Work

Depending on the type of activities you do on the job and the speed of your recovery, it may take from several days to several weeks before you are able to return to work. Your doctor will advise you when it is safe to resume your normal work activities.

Sports and Exercise

Continue to do the exercises prescribed by your physical therapist for at least 2 months after surgery. In some cases, your doctor may recommend riding a stationary bicycle to help maintain muscle tone and keep your knee flexible. When riding, try to achieve the maximum degree of bending and straightening possible.

As soon as your doctor gives you the go-ahead, you can return to many of the sports activities you enjoyed before your knee replacement.

  • Walk as much as you would like, but remember that walking is no substitute for the exercises prescribed by your doctor and physical therapist.
  • Swimming is an excellent low-impact activity after a total knee replacement; you can begin swimming as soon as the wound is sufficiently healed. Your doctor will let you know when you can begin.
  • In general, lower impact fitness activities such as golfing, bicycling, and light tennis will help increase the longevity of your knee and are preferable over high-impact activities such as jogging, racquetball and skiing.

Air Travel

Pressure changes and immobility may cause your operated leg to swell, especially if it is just healing. Ask your doctor before you travel on an airplane. When going through security, be aware that the sensitivity of metal detectors varies and your artificial joint may cause an alarm. Tell the screener about your artificial joint before going through the metal detector.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

4 Tips For Senior Citizens Recovering From Knee Surgery

4 Tips For Senior Citizens Recovering From Knee Surgery

BY JOAN TIMPSON | Article Featured on Sunrise Care

As senior citizens age, their bodies become increasingly vulnerable to conditions that decrease mobility and cause chronic pain. One of the most commonly experienced diseases that impacts the joints and muscles of older adults is osteoarthritis, which affects approximately 8.75 million people, according to Arthritis Research UK. As a result of osteoarthritis and other forms of arthritis, many senior citizens turn to knee replacements for relief from pain and to regain mobility.

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