Knee Arthritis|Knock Knees|Virtual Knee Surgery

Having your knee replaced with an un-cemeted prosthesis has it advantages and dis-advantages. The advantages however outweigh the disadvantages depending on your age. Younger adults generally but not always get un-cemented components initially for several reasons.

Having components that are un-cemented are used for those patients that have healthy bone stock and quality. The un-cemented components have what is called a porous material that is built within them. This allows for your bone to grow naturally into the prosthesis giving them a more natural fit.

With an un-cemented prosthesis this will allow a younger patient who is active and who typically outlives the original knee replacement to get a revision later down the road with out the damage to the bone stock that the cement causes over time. They are also easier to remove overall then the cemented replacements.

The dis-advantage with un-cemented components is that after surgery generally your weight bearing status will be modified for the first four to six weeks while the bone begins to grow into the implant. This however is only temporary and if allowed to heal properly will work just fine.

Many younger patients and some older ones too however can get somewhat impatient after a couple of weeks and we as rehabilitation professsionals have to at times frequently remind the patient about their weightbearing precautions. Most patients I have found will at times exceed the precautions without further damage to the knee however constant non-compliance or total disregard for weightbearing precautions will have you back in the surgeons office in no time back on the operating table.

After surgery follow closely what your surgeons instructions are carefully and listen to your physical therapist and you will be on the path to a better quality of life in no time.

Common Characteristics of Osteoarthritis

Osteoarthritis, also known as degenerative joint disease, is one of the most common ailments associated with getting older, and it is therefore most common in those parts of the world where people live the longest. More than 15 million Americans receive medical attention for osteoarthritis each year, and more than twice that many are affected by it to some degree. However, it rarely results in serious disability.

Osteoarthritis is essentially a "wear-and-tear" disorder. In typical cases, symptoms appear after the age of 50, and usually in the large joints that bear the most weight--the hips, knees, shoulders and spine.

Pain and stiffness are at their most uncomfortable upon arising in the morning and are likely to be intensified during damp, cold weather. (This does not mean, however, that symptoms are likely to disappear in a warm, dry climate.) Redness and swelling of the affected joints may also occur. Joints, particularly in the fingers, may become permanently gnarled by osteoarthritis, but this almost never interferes with their function. Painless bony bumps, known as Heberden's nodes, may also appear symmetrically on the fingers of both hands or on toe joints as well.

Causes of Osteoarthritis

When a person is young and spry, the joints between the bones swing freely like efficient, well-oiled hinges. Stresses and strains are absorbed by the cartilage pads that provide cushioning and lubrication at the ends of the bones where they constantly come together as the parts of the body make their coordinated movements.

Over the years, these protective layers become eroded, lubricating fluids diminish and the result is a sensation often described as "creaking" at the joints. In addition to a decrease in smoothness of function, small growths, or spurs, may develop on the bones in the area of the joints. These are 10 times more prevalent among women than among men and are likely to aggravate an already uncomfortable condition.

Signs and Symptoms of Osteoarthritis

Since the weight-bearing joints are the ones most commonly affected, stiffness and discomfort in the knees and hips are likeliest to occur first, especially in the overweight person or in someone whose life style involves long stretches of standing or walking. A visit to the doctor for diagnosis normally includes close inspection of painful areas as well as X-ray examination of the joints in question. (when X-ray pictures are taken for diagnosis of some other condition in younger patients, they usually reveal the beginnings of cartilage erosion in the weight-bearing joints at a stage that does not yet produce associated symptoms.) Other than X-rays and visual examination, there are no other diagnostic tests for osteoarthritis.

Treatment of Osteoarthritis

Where overweight exists as a contributing factor, efforts should be made to lose the extra pounds and keep them off. Application of warm, moist heat, slow and gentle massage of the affected joints and a reduction (not a total cessation) of normal activities are ways in which patients can help themselves when there is an intensification of discomfort. Where pressure on the weight-bearing joints can be diminished through postural adjustments, special exercises may be recommended.

Drug Therapy

Although inflammation is not one of the initial symptoms of osteoarthritis, as the joint degeneration progresses, swelling, redness and other signs of inflammation may occur. When this happens, anti-inflammatory drug therapy may be recommended.

Aspirin. Patients who can tolerate high doses of aspirin may be treated with this drug alone. However, patients on anti-inflammatory aspirin therapy, which may involve taking 16 or more tablets a day, should be aware of possible side effects, among which the most common are ringing in the ears, heartburn and other gastrointestinal upsets. To minimize gastrointestinal complications, the aspirin should be scheduled after meals. Acetaminophen, in smaller dosages, may be recommended as an alternative to aspirin.

Non-steroidal anti-inflammatory agents. These are relatively new drugs that relieve the pain and joint inflammation of osteoarthritis. It is the physician's role to match the patient with the particular drug that will be most suitable and effective without adverse effects. Sometimes drugs are used in combination, but whatever the procedure, supervision by the doctor is usually indicated if maximum benefit is to be achieved.

Steroids. In those few cases where other measures fail, steroid drugs (cortisone) may be injected into the damaged joint for temporary relief. However, long-term treatment with steroids is not recommended for osteoarthritis.

Surgery

When an older person suffers such severe osteoarthritis that most normal activity becomes impossible, surgical replacement of the affected joints may be considered. Hip replacement, in which the entire hip joint or head of the femur is replaced, is the most common operation of this type. The replacement joint is made of plastic and metal parts and is held in place by special plastic cements. The artificial joints allow the previously immobilized patient to be relieved of crippling pain, and most activities can be resumed following physical therapy and regaining of muscle function.

More recent joint replacements include the knee--a joint that is more complicated than the hip and, consequently, poses more engineering problems in replacing. However, the newer artificial knee joints are providing good results, both in terms of pain relief and restoration of function.

Traumatic Arthritis

Closely related to osteoarthritis, traumatic arthritis is usually the result of excessive joint use combined with injury. It is commonly seen in athletes. Rest will usually resolve the problem, although in some instances, drugs or surgery may be required, particularly in the case of athletes who need to quickly regain the use of the injured joints.

Summing Up

For millions of people, osteoarthritis is an inevitable condition of aging. Most cases can be handled by rest and common sense. Anti-inflammatory drugs--both non-prescription painkillers such as aspirin or acetaminophen, or prescription non-steroidal anti-inflammatory agents--may be used during flare-ups.

Osteoarthritis rarely turns into a crippling disease, but as newer and more effective drugs are available for reducing aches and pains to a minimum, there is little reason for allowing this particular cause of physical discomfort to be a dominating factor in determining one's life style in advancing years.

Exposing a psoriatic elbow, or a pair of red knees, can be pretty uncomfortable, but imagine how difficult it can be when the psoriasis is hidden beneath your underwear! It's the most private part, the part that is not normally shown to the world for fear of indecent exposure. How do you deal with psoriasis in this area?

Genital psoriasis affects the most intimate of your body parts, and it can be hard to deal with when the people that see them are the people who matter most - your partners, girlfriends, boyfriends, lovers... Sometimes you just have to take a deep breathe and allow one more person to see it - your skin specialist / dermatologist.

It can lead to a negative knock-on effect on your sex life, the level of intimacy you share with your partner and your body-image... But there are ways of dealing with it!

When it comes to sex and genital psoriasis, the best option is to be open about it. Sit your partner down on the bed and explain what it is, stressing that it's not contagious, it's not an STD (or Sexually Transmitted Infection STI) and they don't have to worry about anything.

Once you turn the lights down, you can't see it any more and the biggest obstacle is the uncomfortable feeling you get during intercourse. So don't forget to moisturise beforehand and use sensitive soaps and body wash in the shower so as not to irritate the skin unnecessarily.

By following these simple steps, you can minimize the impact that genital psoriasis can have on your life (including your sex life) and build an even stronger relationship. Psoriasis doesn't need to be a secret. By concealing it and hiding it from everyone, it can increase your stress levels and actually deteriorate the skin even further.

All The Dirty Details Of Genital Psoriasis

The type of psoriasis normally found around the groin area is called "Inverse Psoriasis". It doesn't sound very nice, but this type of psoriasis usually breaks out in those moist areas hidden by underwear, where there's a lot of sweat, heat and where the skin is already sensitive and thin.

For a man, it can appear on the penis, including the tip/head, the scrotum (yes, this means itchy balls guys) and around the bum (be careful when wiping!), and for the woman, around the vulva on the outside of the skin, and very rarely - inside it. The skin here is very thin and vulnerable, which makes the whole affair much more uncomfortable.

On the statistical side, genital psoriasis is quite common and usually affects one out of three patients with psoriasis. Whilst 33% might sound like a lot, I think that the number is actually higher, maybe even much, much higher.

Many people develop genital psoriasis, and are too afraid to seek professional assessment because they think it might be a sexually transmitted disease! It doesn't blister like herpes, or cause ulcers like syphilis, but people don't know that. They think that somehow they caught something - even if they don't sleep around!

Other people just feel embarrassed about going to their family doctor, unzipping and saying "look - it's redder than a tomato!" Furthermore, some people go to their doctor, but then their psoriasis is misdiagnosed as a fungal infection instead! It's this combination of different reasons that means that genital psoriasis is most probably the most hidden type of psoriasis on the whole body.

All in all, genital psoriasis might be more prevalent than we think. If you have it, remember to consult a qualified professional, because it is treatable and you don't have to suffer in silence!

Cycling is regarded as one of the safest sports for avoiding injury. However is the world of cycling knee pain is fairly common.

As with most sports, the more mileage you do, the more close to perfect biomechanics you need to be in order to avoid injury. As cycling is a non contact sport knee pain from cycling stems from poor biomechanics, muscle imbalance, poor flexibility or poor bicycle set up.

The top three areas to examine when trying to fix your knee pain is training errors, technique errors or bike set up errors.

1) Training errors.

It is very easy to develop muscle imbalances around the knee. For example you may over

develop the quadriceps compared to the hamstrings.Hamstrings and calves commonly get tight and can adversely affect knee alignment. Some cyclists also develop imbalances within the quadriceps muscle resulting in a stronger lateral side versus medial side. It is essential you talk to your physiotherapist or coach about your training protocol and address any underlying imbalances. Further training will simply exacerbate the problem.

2) Technical errors

Pushing excessively high gears with slow cadence can place more stress on the knee cap. If this heavy power work is implemented too early in the season you will risk wearing out the back of the knee cap.

The other common error is cycling with the knee turned in which causes massive lateral force on the knee cap aggravating the knee pain. Get someone to cycle behind you to check your alignment as you ride along. Make sure the knee is moving up and down with the knee over the foot and not wobbling around or turning in.

3) Bike set up

Even if you are training correctly and have perfect cycling technique, knee injuries whilst cycling can still be caused by poor bike set up. If you have not had your bike fitted to you and are doing high mileage this is a good investment.

Check the crank is not too long, check the cleat alignment, check the distance of cross bar from seat to handlebars.

The seat height is important as well. The easiest way to check is to allow one pedal to drop to the 6 o'clock position and observe the angle of the knee joint. There should be a 25-30 degree flexion in the knee when the pedal is at the bottom most point. Another is to measure your inseam (in centimetres) and multiply this measurement by 0.883. This should be your distance from the top of the seat to the centre of the bottom bracket. If you place your heels on the pedals, have someone else hold the bike, and pedal backwards, your hips should not rock back and forth. Likewise if your hips rock when you are riding, then lower your saddle until you achieve a smooth pedal stroke.

The majority of people suffering knee pain whist cycling will need the seat position adjusting. Once this contributing factor has been corrected then treatment will be effective.

Physio treatment may be required to loosen off tight structures, knots or scar tissue within the muscles. A good sports physio will also advise you on specific strengthening exercises to address any muscle imbalances.

After having a knee replaced, many patients get anxious about the healing process. Everyone wants to get results as soon as soon as possible and are looking for ways to speed the process up. Though you may have gone through pre-operative training at your local hospital, retaining the information learned from class can be short lived. I have listed three common mistakes most people will make after knee surgery.

1. Trying To Speed Up The Healing Process: A majority of the time this seems to affect the men. Most men will try and circumvent the time involved and get onto the fast track as if they have something to prove to someone. You will begin to start feeling like yourself in generally four weeks but, do not expect the knee to feel much better until six weeks out from the day of surgery. It will be temperamental for the first six weeks.

2. Not Using Ice: I would not recommend this. After you have completed your exercise session or just generally want to curb the level of pain or swelling apply ice to the knee. You cannot use too much ice. All rehabilitation professionals will agree with this. I have seen a few that never use ice but this is the exception rather then the rule. Ice is the best modality in my estimation to use after joint surgery. Please make sure you encase the entire knee however, throwing a bag of peas on the top of your knee will not get it done. Ice is great for pain relief and keeping the swelling do to a minimum.

3. Trying To Avoid Using An Assistive Device: Believe it or not there are some that will not want to use any device after surgery once they get home. In the hospital its mandatory but once you get home you may be tempted to see what you can do without the walker. This puts unnecessary stress on the knee and surrounding soft tissue setting you up for a sleepless night and a very painful knee. If you are receiving physical therapy at home or an outpatient clinic, you will be instructed as to when you can revert from using a walker to a cane.

The key is not to rush things. you can expect your new knee to calm down and swelling subside in six weeks. Of course some will progress faster then others but all in all your rehabilitation will work out if you give it time.

Thousands of people all over the world turn to Botox to halt the signs of aging. But did you know that this cosmetic procedure may also fight arthritis?

That's what a small, preliminary study is telling us and doctors are already excited about it. In that study, osteoarthritis patients who received Botox injections reported a 50 percent or more improvement in knee pain. If other studies can repeat those results, it won't be long before Botox becomes the next arthritis miracle cure.

"It works very well. We have patients where the pain comes down for three months, or it could be up to six months," said Dr. Gordon Ko, one of the investigators.

Ko has been administering Botox injections to arthritis patients who don't respond to conventional medications. The drug is injected into the gap between the joint and results have been promising.

The pioneering study lasted for six months and involved 37 patients with moderate to severe knee pain due to osteoarthritis. The participants (36 men and one woman) received either 100 units of Botox with lidocaine (a short-acting anesthetic) or a saline placebo with lidocaine.

They were analyzed after a month, three months, and six months. Their pain and ability to move were measured during these times. After a month, two placebo patients dropped out from lack of benefit. Of the 18 patients in the severe pain group (half on Botox and half on placebo), there was a significant decrease in pain and improvement in physical function for those who received Botox shots. The placebo group reported minimal improvement.

Doctors are hoping to duplicate these results in other studies but patients are already convinced that Botox works for arthritis. One of the patients, Jenny Breen, had every reason to be thankful. She claims the injections have changed her life.

"If I had to give up my Botox I don't think I could live. My quality of life would go right down. I know, for me personally, it changed my life and made a big difference," she told CTV News.

Although Botox is expensive, the shots are seen as an ideal solution for arthritis patients who can't undergo knee surgery because of old age or frailty. Since Botox is injected directly into the joint, it doesn't cause stomach bleeding, hypertension, and other side effects of other traditional painkillers.

"If Botox injections for refractory joint pain continue to prove beneficial, they offer a very welcome solution for fragile patients. Local joint treatment with Botox injections could replace oral medications that carry the risk of systemic side effects, and Botox injections may negate or delay the need for joint surgery," said Dr. Maren L. Mahowald, the Rheumatology Section chief at the Minneapolis VA Medical Center, and a principal investigator in the Botox study.

As we await more good news from Botox researchers, you can stop arthritis pain with a little help from Flexcerin. This powerful supplement rebuilds, lubricates, and soothes swollen and painful joints without the side effects of other prescription painkillers. Check out http://www.flexcerin.com for details.

If you are in your 20's, 30's, or 40s and have a knee cartilage defect the pain can be debilitating on a daily basis. The injury that resulted in the pain may have been a car accident, sports injury, really anything that could've led to a cartilage defect in your knee that is now causing pain.

Just let's say that you are a competitive basketball player. You play at a very high level, and in one particular game you twist your knee and tear your ACL. You fall over after the incident and while you are falling, you end up with a medial meniscal tear and a cartilage defect. What would be the end result of all of the injury?

Well for starters in this day and age ACL reconstruction technologically has gotten very sophisticated and effective. So you could end up with an extremely functional ACL reconstruction from your own tissue or harvested from a cadaver. Also, if the medial meniscal tear is not extremely large it can be shaved down and the pain would no longer be there while enough meniscus would remain for appropriate shock absorption. The result though would be that you have a good amount of pain deep in the knee from the cartilage defect which could shorten your career and lead to a life of chronic pain.

The first treatment that works fairly well for a cartilage defect is called a microfracture treatment. It is performed as an outpatient arthroscopic knee surgery where the area of the cartilage defect is drilled multiple times through the bone slightly to generate some bleeding. With the bleeding present, there's able to then be some more cartilage production from the healing process being started. The cartilage that is produced unfortunately is not Type one native cartilage. It is call fibrocartilage and is not a great permanent fix for the defect. It will function well for a period of time, but the cartilage produces is not what you were born with.

The next treatment that works pretty well for a cartilage defect is called articular chondrocyte implantation (ACI). ACI is a procedure that involves harvesting some of your native cartilage cells and sending them to a laboratory for culture. After a few weeks when a sufficient amount of cartilage cells have been cultures they are then sent to the surgeon for implantation in the defect and overlying that a patch is placed to keep them situated while they grow in properly. This procedure works well but the problem is it involves downtime for the patient and another surgery.

The third procedure that works really well for a cartilage defect is called an OATS procedure which is an Osteochondral Autograft Transfer Surgery. Essentially what this involves is taking cartilage away from the part of the knee that is not a weight-bearing area and shifting over to the area where the defect is that is painful. It is done in multiple punctures that are circular and then essentially placed in mosaic type pattern in the hope that they will grow together with subsequent pain relief.

These three procedures are all performed as an outpatient knee arthroscopy and may work well for alleviating pain from a cartilage defect.

Knee pain is one of the most common problems patients come in with to a rheumatologists office. There are multiple causes of knee pain ranging from arthritis to bursitis to tendonitis and so on.

One type of knee pain that is rarely mentioned is the pain from an inflamed medial plica. This is considered an arthritis condition.

In order to understand this type of knee pain, it's important to have an understanding of basic knee anatomy.

The knee is a joint consisting of four bones, the femur (upper leg bone), tibia (the larger of two lower leg bones), the fibula (the smaller of the two lower leg bones), and the patella (the knee cap).

All the articulating (interacting) surfaces of the knee bones are covered with a thin layer of hyaline cartilage, a tough type of gristle, that helps with cushioning and shock absorption.

This entire system is enclosed inside a joint capsule. The capsule is lined with synovium, a type of tissue that provides nourishment and lubrication for the joint.

On occasion, the synovium can form a fold of tissue. This fold can occur above the knee cap, below the knee cap, and between the knee cap and femur, along the inside part of the knee.

When the fold occurs along the inside part of the knee between the patella and the femur, it can cause problems. This is called medial plica syndrome.

Pain in the region of the patella is the most common symptom. A person may also note snapping, clicking, locking, and even a sense of instability. This latter symptom is relatively rare.

Inflammation of the knee capsule, as may occur with arthritis, or trauma can aggravate the pain. In addition, bending and straightening the knee (eg. Stair climbing) can also aggravate the pain of a medial plica.

The diagnosis can be suspected clinically by the history. On examination, the patient may complain of pain located over the medial (inside) part of the joint. A sensation of snapping may be felt when the knee is flexed and straightened.

The diagnosis can be confirmed by magnetic resonance imaging (MRI) scanning.

Usually, a patient will undergo arthroscopy (insertion of a telescope inside the knee joint). At the time of arthroscopy, the medial plica will appear to be thickened and inflamed. The treatment is also rendered arthroscopically.

By introducing a motorized trimmer, the arthroscopist can carefully trim the inflamed plica so it no longer becomes trapped. This procedure is usually curative. We have seen a number of symptomatic medial plica cases that were essentially cured by this arthroscopic approach.

Are you thinking about having a knee surgery?

Your doctor may have mentioned that you will be needing a knee brace for after surgery. So what kind do you get?

1.) Introduction

Knee braces are used by people to help ensure that their knee is supported and to alleviate the pain that they are feeling. Knee braces are constructed using a variety of materials. They are designed in a way to either cover your knee cap or allow for an open patella. The kneecap is left open in most knee braces available in the market. Remember, you do not always need to cover your knee to help provide stability to it.

It is important to make sure that the knee brace you are wearing is well designed. In reality, a well designed knee support will make a huge difference in the life of a sufferer of injured knees. One of the many benefits that they offer is to help you avoid painful movements that could probably lead to aggravation of the injury you have sustained. This is really important if you think about it. Why push a hurt knee? Why threaten a healing injury?

Right after a surgery you may be wearing a large knee brace that keeps your knee locked out in extension. This can be helpful because everything is very delicate after a surgery and your doctor will not want anything to disturb the procedures results.

2.) As Time Passes After a Surgery

This time period is still considered to be after surgery is done, but you will most likely heal as the days and weeks go by. A knee brace for after surgery now can be seen with different eyes. These braces can still provide you with maximum support, but often times you are allowed to move your knee around more and thus your physician will request that you are allowed more free range of motion to get the blood going.

3.) Your Brace Specialist

When it comes down to it, you may need a couple different knee braces depending on how long after the surgery you are. You will need to talk to your brace specialist with any questions and they can help guide you toward the best options. Do not just go to someone on the internet that does not know what they are talking about. Of course everyone claims to be experts, but you should be able to ask them questions and get some qualified answers when it comes to purchaing one of these supports.

* This is health information. We are brace specialists who have seen the benefits of bracing over the years, but we have to suggest that you speak to your doctor regarding medical advice.

Any doctor will tell you it's not recommended to run after a knee replacement, because one piece is metal and the other piece is non-metal. Wear will come at some point depending on how much you run. Perhaps take up another type of exercise program. Running is considered a high impact sport. You can walk just about all you want to replace running. However, it will take double distance of walking to burn up the same amount of calories of the distance you ran.

Not many runners want to walk because, that's one reason they run. Walking is time consuming. Some people have plenty of time to kill. I don't! Any sport that has a lot of side to side movement like tennis is a no-no! If you were a full blown runner most likely you'll return to running at some point. It took me two years before I could up grade from a walk to a run. Then another year before I could run a full mile. Mainly because the idea was put in my head to not do it!

It's really a personal choice of what it all boils down to. A 136 pound 10% body fat is where I was before the knee replacement. Afterwards, I gained a whopping 40 pounds! A 176 pounds on a 5' 7" guy is not good for your health! That alone was enough reason for me to start running again. I'm still not 136, but I'm a lean 145. I'm happy with that for someone not racing anymore. I'm not saying I'll never race again, I'm just not right now.

These days two miles every other day, then alternate that week with two miles every day. The following week go back to two miles every other day. Of course I walk a whole lot more than I use to. My walking is no piddling around! A good walk pace is one mile every fifteen minutes. In other words four miles in an hour. I've read of some world-class master and senior runners alternating running with walking is their new way of training. If you email me, I'll dig up that information for you.

Running or whatever activity you choose to do after knee replacement is a real personal choice type thing. Only you, will know that for sure. I've read about some runners returning to racing, but that's them. I personally don't want to take a chance of messing up my $50,000 knee. I was told if you do wear out the plastic piece, it's not that a big of a deal surgery, like the initial knee replacement surgery.

If running is a weight thing for you, then here's another idea. If your having a weight problem, a lot of that is due to what you eat! If you're a vegetarian then just go ahead full boat to being on a raw food diet. This is a diet good for your health anyway, regardless if your over weight or not. Less weight on your artificial knee is a good thing. Less weight on your whole body is a good thing! Live longer and with a healthier lifestyle wither you have an artificial knee or not! All this is my personal experience. Check with your doctor and attorney before you do anything!