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September 5, 2016 | Adult and Adolescent Medicine • Family Medicine • Sports Fitness and Physical Therapy • Surgery Center
Doctors sometimes recommend knee surgery when other prescribed treatments, such as physical therapy and medications, do not resolve knee pain. The type of surgery largely depends on the patient’s particular condition. Surgeons usually perform a knee operation to treat pain resulting from arthritis or a mechanical problem, such as a torn ligament or cartilage.
Many people who need knee surgery worry about the risks involved. Fortunately, advances in medical technology and procedures greatly reduce the risks associated with knee surgery. In fact, avoiding knee surgery increases the risk for chronic pain, lost hours on the job, treatments that do not work and a poor quality of life.
There are many types of knee surgery, but the most common include:
Arthroscopy is a procedure where the surgeon uses a small camera and tiny instruments to diagnose and treat pain. The surgeon inserts the surgical instruments, which are about the diameter of a pencil, into small incisions in the knee. Complications include infection, blood clots, and accumulation of blood in the knee. The benefits of arthroscopic surgery are that advanced technology makes it very accurate and it involves very small incisions that heal quickly.
The ACL is one of four ligaments that connect the femur bone in the upper leg with the shinbone, or tibia, in the lower leg. These ligaments keep the knee stable. The ACL prevents the shinbone from sliding out in front of the thighbone and provides stability to the knee when a person stops moving quickly and changes direction while running, turning, or landing from a jump.
Surgery to repair ACL tears involves a tissue graft to rebuild the damaged ligament. The tissue graft, frequently obtained from the kneecap or shinbone area, acts as scaffolding on which the new ligament grows.
Risks for arthroscopic ACL repair include 0.2 percent to 0.48 percent incidence of infection, bleeding, blood clot, and instability or stiffness of the knee. An overwhelming number of active adult patients who are involved in jobs or sports that require turning, pivoting, and heavy manual work find relief from knee pain and disability associated with an ACL tear. Advances in medical technology and procedures also make ACL knee surgery available to patients previously excluded from consideration for this surgery just a few years ago.
At more than 600,000 procedures each year, knee replacement is one of the most common surgeries performed in the United States today. Infection, blood clots, implant problems, continued pain, and injury to nerves or blood vessels near the treatment area are possible. Going without a knee replacement, however, leaves a person at risk for continued severe pain or stiffness that limits their everyday activities, such as walking, climbing stairs, and rising from a chair. Avoiding knee replacement surgery can also lead to moderate to severe knee pain while at rest, chronic knee inflammation that does not respond to treatment, or deformity of the knee.
Total knee replacement surgery relieves almost all the pain for 90 percent of people who undergo the procedure, according to the American Academy of Orthopaedic Surgeons (AAOS).
Medical professionals classify complications associated with knee surgery into three categories:
Any type of surgery, including knee surgery, presents risk. Complications associated with any type of surgery include reactions to anesthesia, infection, hemorrhage, and bleeding.
Deep vein thrombosis (DVT) may occur. DVT is a blood clot developing in a vein deep within the body, usually in the legs, which may break loose then travel to the lungs to cause serious respiratory problems. Research shows that being older, poor health, and having a personal history of other medical increase the risk of heart problems and blood clots in patients who undergo knee replacement surgery.
Infection rarely occurs after knee surgery. In fact, infection occurs in only 1 to 2.5 percent of all total knee replacement surgeries. The risk for infection is higher for people with other medical conditions. Research shows the risk for infection after total knee replacement is 1.6 times higher for patients with rheumatoid arthritis than in those with osteoarthritis, for example. Still, modern surgical techniques and sterile operating room conditions significantly reduce the risk for infection from knee surgery.
Taking appropriate precautions, such as moving the knee soon after surgery, using medications to prevent the formation of clots, and wearing compression stockings, will reduce the risk of developing blood clots and DVT.
There are risks associated with any type of surgery but going without knee surgery can be risky too.
Using medications to control chronic knee pain can be dangerous. Extended and regular use of opioid pain medicines, such as Oxycodone, to alleviate chronic knee pain increases the risk for physical dependence and addiction to these drugs.
Corticosteroids reduce arthritis symptoms but use of these steroids can cause side effects, such as elevated pressure inside the eyes, known as glaucoma, fluid retention that causes swelling of the lower legs, high blood pressure, weight gain causing fat deposits in the abdomen, face and neck, along with mood, memory and behavior disorders. Long-term corticosteroid use can cause clouding of the lens in one or both eyes, high blood sugar that can trigger or worsen diabetes, thinning bones associated with osteoarthritis, and thin skin that heals slowly and is prone to bruising.
Knee pain prevents people from exercising. This can lead to weight gain and obesity, which are associated with a number of health problems
Knee problems are one of the most common reasons people go to the doctor. Knee surgery helps people get back to work, school, sports, and fun with friends and family. Undergoing knee surgery significantly improves the quality of life for those with chronic knee pain and disability. Surgery helps patients reclaim their mobile, productive lives when medications, physical therapy, and other treatments fail.
Arthritis is the most common cause of chronic knee pain and disability. Osteoarthritis, caused by mechanical wear and tear, and rheumatoid arthritis that occurs when the immune system attacks the joints are the most common types of arthritis associated with knee problems.
Nearly half of all adults in the United States develop osteoarthritis of the knee at some point in life. Job-related osteoarthritis of the knee costs $3.4 to $13.2 billion dollars annually. Knee surgery helps people overcome osteoarthritis of the knee and get back to work.
Knee surgery helps people return to work so they can avoid retirement and stay off public assistance. These societal savings are beneficial for the individual and for the community. AAOS estimates the societal savings from indirect costs equals $39, 697 per patient. About 85 percent of these savings are due to increased employment and savings, and 15 percent from fewer missed workdays and lower disability payments.
The number of total knee replacements will likely rise 673 percent to 6.3 million procedures annually by the year 2030 as the population of the United States ages. This means knee surgery has a great potential to save billions of dollars and improve the quality of life for millions of Americans to come.
For more information about knee surgery, contact Revere Health. We use advanced medical technology, fine surgical skills, and efficient teamwork to reduce operating time, thereby minimizing wound exposure and risk for infection. Surgical experience and the use of proven surgical techniques prevent deep vein thrombosis, unnecessary scarring and other complications of knee surgery.
Orthopedics is rewarding for me because it allows me to help patients with injuries and get them back into action quickly. My classes in anatomy initially sparked my interest in medicine and also led me to choose orthopedics as a specialty. I love meeting people of all ages in my practice—I see kids, athletes, adults and retirees. I enjoy being able to understand people’s unique situations and trying to help them recover. I tend to be conservative with my surgical treatment, and much of my training is in minimally invasive procedures, such as arthroscopy. I believe everyone deserves a trial of more conservative treatment before moving to more invasive treatments such as surgery.
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This information is not intended to replace the advice of a medical professional. You should always consult your doctor before making decisions about your health.