Robotics-Assisted Knee Surgery

Providing the Latest Technologies in Knee Replacement Surgery

FACING KNEE REPLACEMENT?

Hospitality & Excellence in Knee Replacement Surgery

An essential step in deciding to have knee replacement surgery is talking to your healthcare provider about your needs, wants, and goals. Researching the technology used in surgery, being informed about your knees, and rehabilitation is also important. We have provided all the information for you here.

Part of our commitment to excellence in progressive healthcare is the use of robotics in our rural community. Patients will also continue to receive a continuum of care that FCMC is known for throughout Cache Valley; from your referring physician to the orthopedic surgeon that performs the replacement, all the way through your rehabilitation and recovery.

“There is nothing more rewarding than talking to patients, working with them, and getting them back to what’s important in their lives.”

ABOUT THE NAVIO SURGICAL SYSTEM 

The NAVIO Surgical System: Accuracy. Precision. Confidence.

HOW TRADITIONAL PARTIAL REPLACEMENT METHODS WORK

Using traditional surgical methods, cutting blocks or guides are placed on the thigh bone (femur) and shin bone (tibia) to help direct a surgical saw in removing the diseased bone and cartilage. This method has been considered technically challenging, as accurately placing these blocks can be difficult. In recent years, advanced surgical techniques using robotic assistance have been developed to provide a higher level of accuracy and precision.

NAVIO ROBOTIC ASSISTANCE PROVIDES ACCURACY AND PRECISION

The NAVIO system is an advancement in the way our orthopedic surgeons perform partial knee replacement. The system works in conjunction with our surgeon's skilled hands to achieve the precise positioning of the knee implant based on each patient's unique anatomy. This added level of accuracy can help improve the function, feel and potential longevity of the partial knee implant. Through an advanced computer program, the NAVIO system provides robotic assistance that relays precise information about your knee to a robotics-assisted handpiece used by our surgeons during the procedure. By collecting patient-specific data, boundaries are established for the handpiece so we can remove the damaged surfaces of your knee, balance your joint, and position the implant with greater precision.
 

PATIENT SUCCESS STORIES


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

Meet the NAVIO Surgical System, a robotics-assisted knee surgery platform that adds an extra layer of pre-surgical planning and improved precision for partial and total knee replacement procedures.

NAVIO Robotics-assisted knee replacement surgery

Your knee replacement surgery is unique, based on your knee anatomy and the implant used. Designed to help ensure your knee replacement is positioned and aligned correctly, surgeons use the NAVIO Surgical System. Proper positioning of the implant is important because implant alignment is a crucial factor in determining how long your implant may last.1, 2

Decades of innovation in knee replacement surgery

Surgical techniques have evolved considerably since the earliest knee implant procedures were performed in 1968. These procedures relied on manual guides, external pins and cutting jigs to remove damaged bone and place the prosthetic implant.

Eventually more advanced implant positioning techniques were introduced that used long rods drilled into the central canal of the femur (thigh bone). These rods provide an attachment point for surgical cutting guides. More recent improvements introduced CT (computerized tomography) scan/MRI image guidance to create an individualized computer-generated surgical plan for each patient.

The latest innovation is the NAVIO Surgical System, a robotics-assisted platform that uses CT-free technology for precise implant sizing and positioning without the need for rods. The NAVIO Surgical System can be used for either a partial or total knee replacement procedure.

NAVIO system benefits: accuracy, less exposure to CT radiation

The NAVIO system offers two important benefits for people undergoing a knee replacement procedure. First, it helps your surgeon create a highly individualized plan that is specific to the unique shape and motion of your knee. Traditional planning may require CT scans, a series of images similar to x-rays that shows cross-sections of your knee. While other robotic-assisted platforms require CT scans, the NAVIO system works without them, meaning you are not exposed to the potentially harmful radiation experienced with this type of imaging.

The second benefit is robotic assistance. This combination of advanced technology is designed to help your surgeon and may result in more accuracy, giving you better long-term outcomes.

The NAVIO system is used for both partial and total knee replacement, which are distinctly different procedures. Here's a bit more information on how the NAVIO system is used in these surgeries:

Partial knee replacement

In partial knee replacement, your supporting tissue and ligaments that help stabilize your knee are spared and only the damaged portion of the knee is replaced. This means that healthy cartilage and bone remain intact to help your knee joint move smoothly with the prosthetic implant. Patients with osteoarthritis in only one area of their knee may be candidates for partial knee replacement.

Patients who undergo partial knee replacement often report a 'more normal' feeling knee, less pain and quicker rehabilitation.3

Robotics-assisted planning and partial knee surgical procedure

Using the NAVIO system, your surgeon creates a 3D representation of the unique shapes and profiles of your knee without the need of a pre-operative CT scan.

Using all of this information your surgeon can then determine the correct size and position of the implant. Implant size and position is critical to knee alignment and stability.

Next, your surgeon uses robotic assistance of NAVIO to physically remove only the damaged bone, preparing the site for the prosthesis, before placing and adjusting your partial knee implant.

Total knee replacement

In total knee replacement, the entire knee joint is replaced with a prosthetic implant designed to replicate the shape, motion and stability of your natural knee joint. Total knee replacement is one of the most common procedures performed in all of medicine, with over 600,000 performed in the U.S. every year. Ninety percent of people who receive a total knee replacement experience a dramatic decrease in knee pain, and an improvement in their ability to perform daily activities. 4

Robotics-assisted planning, and total knee surgery guidance

Just as in the partial knee procedure described above, your surgeon creates a 3D representation of the unique anatomy of your knee without the need of a pre-operative CT scan.

Your surgeon uses your knee anatomy information to determine the correct size and position of the implant, and creates a surgery plan unique to your anatomy.

Important safety notes

Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.

Disclaimer

Individual results may vary. There are risks associated with any surgical procedure including NAVIO-enabled Knee Replacement. NAVIO is not for everyone. Children, pregnant women, patients who have mental or neuromuscular disorders that do not allow control of the knee joint, and morbidly obese patients and patients contraindicated for UKR, PFA and TKA should not undergo a NAVIO procedure. Consult your physician for details to determine if NAVIO is right for you.

  1. 1. Collier, Matthew, et al., "Patient, Implant, and Alignment Factors Associated With Revision of Medial Compartment Unicondylar Arthroplasty.", Jour of Arthro, Vol 21 No 6, Suppl. 2, 2006.
  2. 2. Hernigou, Ph, Deschamps, G., "Alignment Influences Wear in the Knee after Medial Unicompartmental Arthroplasty.", Clin Orthop Relat Res., Volume 423, June 2004, pp 161-165
  3. 3. Hall et al., "Unicompartmental Knee Arthroplasty (Alias Uni-Knee): An Overview with Nursing Implications," Orthopaedic Nursing, 2004; 23(3): 163-171.
  4. 4. American Academy of Orthopaedic Surgeons website, accessed March 7, 2017: //orthoinfo.aaos.org/topic.cfm?topic=A00389

All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

Partial knee replacement with the NAVIO Surgical System

For people suffering from knee pain caused by osteoarthritis, whose damage is limited to a single compartment or area of the knee, partial knee replacement may be an option because it preserves healthy bone and ligaments while replacing the damaged area.1, 2 The NAVIO Surgical System uses robotics-assisted technology to help tailor partial knee replacement procedures to the unique shape and motion of each patient's knee anatomy.

Robotics-assisted Planning for Better Surgical Outcome

While it may seem counterintuitive, replacing only part of a knee joint can be more challenging than replacing the entire joint. This is because partial knee replacement must achieve an exact balance between the new implant - made of metal and plastic components - and the remaining portions of your natural anatomy made of bone and cartilage. As a result, one of the primary challenges of all partial knee replacements is precisely positioning the implant for each unique patient. Even minor changes in an implant's size or placement can cause the knee to function poorly or result in early failure of the implant and the need for future surgery.

The NAVIO Surgical System addresses the challenge of partial knee replacement by using both computer and robotic assistance to accurately map the surface of your knee, align your implant to your anatomy, and physically remove the bone necessary to place your new implant.3 This added level of assistance is important because implant alignment is a crucial factor in determining how long the implant will last. 5, 6

Robotic Knee Surgery without Radiation

Other robotic knee replacement systems use computerized tomography, or CT, scans to help a surgeon visualize a patient's knee anatomy. While CT scans are effective at showing the layers of knee anatomy, they can expose the patient to potentially harmful radiation. In fact, a single CT scan is equivalent to the radiation exposure received in 48 chest X-rays.4

The NAVIO system eliminates the need for CT scans by using an advanced computer program (similar to GPS navigation on your phone) to collect anatomic and alignment information about your knee. Once captured, this information is used to build a precise, computer-rendered 3D model of your knee that your surgeon will use to plan your surgery.

NAVIO Robotics-assisted Partial Knee Replacement Surgery

After all of the information about your knee is gathered and your surgical plan is created, your surgeon will use a robotics-assisted surgical tool (the NAVIO handpiece) to physically remove the damaged surface of your bone so that your new implant fits properly. Using the same 3D model of your knee, the handpiece is able to differentiate between the damaged areas that need to be removed, and the healthy areas that will remain. The NAVIO handpiece uses a burr that removes damaged bone for your implant.

The NAVIO system doesn't replace your surgeon. Rather, it assists your surgeon by adding an extra layer of planning to the procedure.

Partial Knee Replacement with Traditional Techniques

By comparison, traditional surgical methods for partial knee replacement use mechanical cutting guides that help guide a saw blade as it removes the bone necessary to place the implant. The NAVIO Surgical System helps tailor your partial knee replacement procedure.

Important safety notes

Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.

Disclaimer

Individual results may vary. There are risks associated with any surgical procedure including NAVIO-enabled Knee Replacement. NAVIO is not for everyone. Children, pregnant women, patients who have mental or neuromuscular disorders that do not allow control of the knee joint, morbidly obese patients, or any other patients contraindicated for UKR, PFA, or TKA should not undergo a NAVIO procedure. Consult your physician for details to determine if NAVIO is right for you.

1. Willis-Owen, Charles, et al, Unicondylar knee arthroplasty in the UK National Health Service: An analysis of candidacy, outcome and cost efficacy, The Knee 16, 473-478, //www.academia.edu/22765713, January 3, 2009

2. Liddle, A.D., Pandit, H., Et al, Optimal Usage of Unicompartmental Knee Arthroplasty, The Bone & Joint Journal, //www.bjj.boneandjoint.org.uk/content/97-B/11/1506, November 3, 2015

3. Lonner, Jess, Moretti, Vince, "The Evolution of Image-Free Robotic Assistance in Unicompartmental Knee Arthroplasty." The American Journal of Orthopedics, May/June 2016, 249-254. Accessed June 7, 2016

4. Ponzio DY, Lonner JH, Preoperative Mapping in Unicompartmental Knee Arthroplasty Using Computed Tomography Scans Is Associated with Radiation Exposure a..., J Arthroplasty (2014)

5. Collier, Matthew, et al., "Patient, Implant, and Alignment Factors Associated With Revision of Medial Compartment Unicondylar Arthroplasty.", Jour of Arthro, Vol 21 No 6, Suppl. 2, 2006

6. Hernigou, Ph, Deschamps, G., "Alignment Influences Wear in the Knee after Medial Unicompartmental Arthroplasty.", Clin Orthop Relat Res., Volume 423, June 2004, pp 161-165


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

Total knee replacement surgery with the NAVIO Surgical System

More than 600,000 total knee replacement procedures are performed each year in the U.S. and more than 90% of these patients experience a dramatic relief in knee pain and are better able to perform common activities.1 The NAVIO Surgical System delivers robotics-assisted tools designed to help tailor your total knee replacement surgery to the unique shape and motion of your knee.

Robotics-assisted knee replacement planning with the NAVIO System

The total knee replacement procedure starts with your unique anatomy in mind. By the time your procedure is complete, the damaged bones and cartilage within your knee joint will be removed and replaced with new implant components. Each of these implant components must fit precisely and be aligned to your natural anatomy if they are to provide you with the best outcome possible. The challenge of aligning your implant and preparing your bones to accept it can be complex, invasive and time consuming because no two knee joints are exactly the same.

The NAVIO Surgical System is designed to help your surgeon not only plan your surgery based on your unique anatomy, but also position your total knee implant using a combination of computer and robotic assistance. The NAVIO procedure starts with an advanced computer system that gathers precise anatomic and alignment information about your joint that your surgeon will use to create your specific surgical plan.

This extra layer of data collection and planning is designed to help ensure your knee procedure is performed exactly as your surgeon intends and that your implant is positioned as accurately as possible for the best long-term outcome.

CT-free

Other robotic-assisted knee replacement systems use computerized tomography, or CT, scans to help a surgeon visualize a patient's knee anatomy. While CT scans are effective at showing the layers of knee anatomy, they can expose the patient to potentially harmful radiation. In fact, a single CT scan is equivalent to the radiation exposure received in 48 chest X-rays. 2

The NAVIO system eliminates the need for CT scans by using an advanced computer program to collect anatomic and alignment information about your knee. Once captured, this information is used to build a precise, computer-rendered 3D model of your knee that your surgeon will use to plan your surgery.

Total Knee Replacement Surgery without rods

Another method that can be used to determine the anatomic alignment of your new implants uses long, metal devices called intramedullary (IM) rods that are drilled into the central canal of the bone to show the alignment of the knee in relation to the hip. These rods are then used to attach the cutting guides necessary to guide the surgeon's saw blade as it shapes the bones to accept the new implants.

Because the NAVIO system has already gathered the anatomic alignment information about your knee, it eliminates the need for IM rods. Instead, your surgeon will use the system's handheld robotics-assisted tool (the NAVIO handpiece) to accurately position the NAVIO-specific cut guides which are held in place with a few small pins instead of the IM rod. This process leaves the central canal of your bone untouched. Implant alignment is a crucial factor in determining how long the implant will last 3, 4.

NAVIO Brings Robotics-assisted Precision to Total Knee Surgery

After removing the cutting guides, the prosthetic knee implants are implanted and your knee is checked to make sure it moves and is balanced correctly. It is important to understand that the NAVIO system doesn't replace your surgeon. The procedure remains in the skilled hands of your surgeon, with the NAVIO system providing extra layers of planning, accuracy and precision.

Important safety notes

Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.

Disclaimer

Individual results may vary. There are risks associated with any surgical procedure including NAVIO-enabled Knee Replacement. NAVIO is not for everyone. Children, pregnant women, patients who have mental or neuromuscular disorders that do not allow control of the knee joint, and morbidly obese patients should not undergo a NAVIO procedure. Consult your physician for details to determine if NAVIO is right for you.
  1. American Academy of Orthopaedic Surgeon website, accessed March 7, 2017 //orthoinfo.aaos.org/topic.cfm?topic=A00389
  2. Ponzio DY, Lonner JH, Preoperative Mapping in Unicompartmental Knee Arthroplasty Using Computed Tomography Scans Is Associated with Radiation Exposure a..., J Arthroplasty (2014)
  3. Collier, Matthew, et al., "Patient, Implant, and Alignment Factors Associated With Revision of Medial Compartment Unicondylar Arthroplasty.", Jour of Arthro, Vol 21 No 6, Suppl. 2, 2006.
  4. Hernigou, Ph, Deschamps, G., "Alignment Influences Wear in the Knee after Medial Unicompartmental Arthroplasty.", Clin Orthop Relat Res., Volume 423, June 2004, pp 161-165

All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

Rediscover your active life with the high performance

A New Chapter in Knee Implants

Recent advances in biomedical engineering software have opened a new chapter in high performance knee implants.

One remarkable breakthrough has been the creation of the JOURNEY II XR Active Knee System, which combines an implant designed to restore the stability and natural motion of the human knee with low-friction materials that may help extend the longevity of the implant itself.

While the longevity of a knee implant is heavily influenced by the materials used to make it, the natural feeling of the implant during physical activity is dependent upon the way the patient's muscles, ligaments and tendons are addressed during surgery and by the implant's shape within the body after surgery.

Every knee implant design is faced with two important challenges; how to recreate the normal swing-and-rotate motion of your natural knee, and how to restore stability to your joint after surgery.

For the first challenge, conventional knee implant designs have attempted to recreate the natural, fluid motion of the knee with either a rotating platform (a simple pivot point) within the implant or by requiring an angled alignment of the implant during surgery. Both of these options force the muscles around your knew joint to work harder as they adjust to the joint's new and unnatural shapes and movement patterns.

For the second challenge, most implants rely on design aspects within the plastic insert to provide the stability that is sacrificed after the anterior and posterior cruciate ligaments (ACL/PCL) within your joint are removed to accommodate the new implant.

JOURNEY II XR is Different

Fortunately, the JOURNEY II XR Knee Implant is different from most knee implants.

First, the JOURNEY II XR implant features an anatomically shaped femoral component and two plastic inserts designed to work together to reproduce the original internal shapes and forces of your natural knee as it goes through its full range of motion. This attention to anatomic detail means that the muscles and other soft tissues around your joint don't have to adjust to unfamiliar stresses and you may be able to return to a natural pattern of motion after surgery.

Second, the JOURNEY II XR uses a U-shaped tibial base plate that fits around your healthy ACL and PCL, allowing them to remain in place and function normally after surgery. In short, the function of these important ligaments doesn't have to be re-engineered because they were never removed.

Added Durability

The JOURNEY II XR implant addresses durability with VERILAST Technology, a combination of two wear reducing materials - the proprietary OXINIUM metal alloy and a highly cross-linked plastic insert - that were designed to address wear on both surfaces of the implant.

Because it is twice as hard as cobalt chrome, the most commonly used metal in knee implants, implants made with OXINIUM material have been shown in lab testing to reduce joint wear by more than 80% when compared to cobalt chromium components.1

VERILAST Technology was designed to address "wear and tear," which is only one of several reasons why a knee implant may need to be replaced. Each patient should listen carefully when his or her orthopedic surgeon reviews other risks that can shorten the life of a new knee - such as infection, weight gain or high impact sports.

The results of laboratory wear simulation testing have not been proven to predict actual joint durability and performance in people. A reduction in wear alone may not result in improved joint durability and performance because other factors can affect joint durability and performance and cause medical conditions that may result in the need for additional surgery. These other factors were not studied as part of the testing.

Not all patients are candidates for the JOURNEY II XR Knee Implant. Discuss your condition and implant options with your surgeon.

Disclaimer

Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.

1. jHunter, G., and Long, M., Abrasive Wear of Oxidized Zr-2.5Nb, CoCrMo, and Ti-6Al-4V Against Bone Cement. 6th World Biomaterials, Minneapolis, MN 2000, p. 835


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

GENERAL KNEE INFORMATION 

The knee is a complex joint made up of bones, muscles, tendons, ligaments, and cartilage. It may be described as a hinge joint, similar to the hinge on a door. The knee not only bends back and forth but also has a complex rotational component that occurs with flexion and extension.

Each knee has two crescent-shaped menisci, or cushion pads. The lateral meniscus lies at the outer side of the knee and the medial meniscus lies at the inner side of the knee. The strong but flexible menisci act as shock absorbers between the femur (upper-thigh bone) and the tibia (shin bone), especially during weight-bearing activities such as walking or stair climbing. The menisci also stabilize and evenly distribute your body weight across the knee joint.

The ACL is one of a pair of crucial ligaments that forms a cross in the center of the knee joint. Both the ACL and the PCL function to stabilize the knee from front to back. The ACL limits the forward movement of the tibia, and the PCL limits the backward movement of this bone. Additional ligaments provide stability to other movements at the joint, including angulation (left/ right motion) and rotation. Without such stability, you may feel that your knee is simply giving out from under you.


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

Osteoarthritis of the knee

What is Osteoarthritis?

Osteoarthritis of the knee is a condition commonly referred to as "wear and tear" arthritis.

Causes

Although the degenerative process may accelerate in persons with a previous knee injury, many cases of osteoarthritis occur when the knee simply wears out. Some experts believe there may be a genetic predisposition in people who develop osteoarthritis of the knee. Osteoarthritis of the knee is the most common cause for total knee replacement surgery.

Symptoms

The primary symptoms of osteoarthritis are pain in the knee, swelling and stiffening of the knee joint. In the early stages of osteoarthritis the pain may be mainly associated with activity. As the cartilage wears away and the bones of the joint rub against each other, pain can become more severe and constant, interfering with regular daily activities and disrupting sleep.

Treatment

In the early stages of osteoarthritis, treatment may involve several techniques. Behavioral and lifestyle changes including losing weight and changing routines to avoid painful situations can be very effective in relieving pain. Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen sodium may also provide relief from pain. Cox-2 inhibitors are also effective in providing knee arthritis pain relief. Physical therapy may improve muscle strength and joint mobility, reducing the symptoms of osteoarthritis in the knee. Joint fluid therapy may lubricate the knee and reduce the pain and swelling of the joint. Partial or total knee replacement surgery may be necessary as the disease progresses and daily functioning becomes more impaired.


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

What is Rheumatoid Arthritis?

Knee Arthritis

Rheumatoid arthritis is a form of inflammatory arthritis and an autoimmune disease. For reasons no one fully understands, in rheumatoid arthritis, the immune system - which is designed to protect our health by attacking foreign cells such as viruses and bacteria - instead attacks the body's own tissues, specifically the synovium, a thin membrane that lines the joints. As a result of the attack, fluid builds up in the joints, causing pain in the joints and inflammation that's systemic - meaning it can occur throughout the body.

Causes

The exact cause of rheumatoid arthritis is unknown. It's possible that a virus or bacteria may trigger the disease in people with a genetic predisposition to rheumatoid arthritis. Many doctors think rheumatoid arthritis is an autoimmune disease in which the tissue of the joint's lining is attacked by the body's immune system. It's also possible that rheumatoid arthritis is caused by severe stress. The onset of rheumatoid arthritis occurs most frequently in middle age and is more common among women.

Symptoms

The primary symptoms of rheumatoid arthritis are similar to osteoarthritis and include pain, swelling and the loss of motion. In addition, other symptoms may include loss of appetite, fever, energy loss, anemia, and rheumatoid nodules (lumps of tissue under the skin). People suffering with rheumatoid arthritis commonly have periods of exacerbation or "flare ups" where multiple joints may be painful and stiff.

Treatment

Treatment of rheumatoid arthritis may involve medications such as non-steroidal anti-inflammatory drugs (NSAIDs), aspirin and analgesics. Corticosteroids may be prescribed and are effective in decreasing the inflammation associated with rheumatoid arthritis. Side effects can occur with the use of corticosteroids, and close monitoring by a physician is essential. Researchers have made progress in the treatment of rheumatoid arthritis and newer prescription drugs are now available. If non-surgical measures fail, you and your surgeon may decide that total knee replacement is the best treatment option to relieve your pain and help you return to an improved functional level.


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

One form of arthritis in the knee joint occurs as a result of degeneration of the cartilage in your knee. Osteoarthritis is commonly referred to as "wear and tear" arthritis or degenerative arthritis, and is the most common cause for total knee replacement surgery. Due to osteoarthritis, the cartilage in the knee breaks down over time and the result is a severely damaged joint surface with bone rubbing on bone. This process may occur as a result of previous trauma to the joint, ligament instability, or abnormal stresses to the joint.

Rheumatoid arthritis is an inflammatory process that results in erosion of the articular cartilage and subsequent damage to the knee joint surface.

Listed below are several non-surgical, and surgical options to consider for treatment of the arthritic knee:

  1. Lifestyle Modification

    losing weight, avoiding aggravating activities, modifying exercise to low impact activities only

  2. Exercises

    specifically prescribed to improve strength and flexibility without exacerbating your pain

  3. Anti-inflammatory Medications

    designed to decrease swelling in the joint and provide temporary pain relief

  4. Corticosteroid Injection

    powerful anti-inflammatory agent injected directly into the joint

  5. Joint Fluid Therapy

    a series of injections directly into your knee, designed to improve lubrication in the joint

  6. Glucosamine/Chondroitin

    dietary supplement that may relieve arthritic pain

  7. Bracing

    used to provide external stability to the knee joint

  8. Arthroscopic Surgery

    minimally invasive procedure to remove debris or repair torn cartilage

  9. Total Knee Replacement Surgery

    surgical procedure that replaces all three compartments of the knee.


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

What is the Right Age for Total Knee Replacement Surgery?

Age for Surgery

Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total knee replacement are age 50 to 801, but orthopaedic surgeons evaluate patients individually. Total knee replacements have been performed successfully at all ages.

Important Safety Notes:

Knee replacement surgery is intended to relieve knee pain and improve knee functions. However, implants may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon's limitations on activity level. Early failure can happen if you do not guard your knee joint from overloading due to activity level, failure to control body weight or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.

1 American Academy of Orthopaedic Surgeon website, //orthoinfo.aaos.org/topic.cfm?topic=A00377

All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

reasonsforkneereplacement

Total knee replacement surgery is considered when all other conservative measures have failed to provide successful intervention, and may be performed for the following reasons:

  1. To relieve pain
  2. To improve joint stability
  3. To improve alignment and correct bone deformity
  4. To maximize quality of life
  5. To optimize activities of daily living

Total knee replacement surgery is a common procedure performed on more than 600,000 people worldwide each year. With recent advancements in surgical technique and implant design, patients have experienced dramatic improvement in knee pain, function, and quality of life. Furthermore, most patients can now expect their implants to last up to a decade or more, allowing for years of active, healthier, pain-free living.


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

This is a brief overview of the activities that typically occur on your surgery day:

  1. You will be admitted to the hospital or surgery center.
  2. Your vital signs, such as blood pressure and temperature, will be measured.
  3. A clean hospital gown will be provided.
  4. All jewelry, dentures, contact lenses, and nail polish must be removed.
  5. An IV will be started to give you fluids and medication during and after the procedure.
  6. Your knee will be scrubbed and shaved in preparation for surgery.
  7. An anesthesia provider will discuss the type of anesthesia that will be used.
  8. Your surgeon will confirm and initial the correct surgical site.

All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

How is Knee Replacement Surgery Performed?

Knee Surgery

During knee replacement surgery, the surgeon surgically removes the damaged bone and cartilage of the joint and replaces it with smooth, artificial implants - thereby eliminating painful bone-on-bone contact.

Almost all knee replacement implants consist of a four-part system:

  • The tibial (shin) side has two elements and replaces the top of the shin bone. This portion of the implant is made up of a metal tray attached directly to the bone and a plastic spacer that provides the lower half of the new joint's bearing surface.
  • The femoral (thigh bone) side is a single element that replaces the bottom of the thigh bone and provides the top half of the new joint's bearing surface. This component also replaces the groove where the patella, or kneecap, sits.
  • Finally, the patellar component replaces the surface of the kneecap, which rubs against the femur. The patella protects the joint, and the newly resurfaced patellar button will slide smoothly on the front of the joint

Important Safety Notes:

Knee replacement surgery is intended to relieve knee pain and improve knee functions. However, implants may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon's limitations on activity level. Early failure can happen if you do not guard your knee joint from overloading due to activity level, failure to control body weight or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

postop

After your surgery is completed, you will be transported to the recovery room for close observation of your vital signs, circulation, and sensation in your legs and feet. As soon as you awaken and your condition is stabilized, you will be transferred to your room. Below is an example of what you may see when you wake up:

  1. You will find a large dressing applied to your incision in order to maintain cleanliness and absorb any fluid.

  2. There may be a drain placed near your incision in order to record the amount of drainage being lost from the wound.

  3. You may be wearing elastic hose, and/or a compression stocking sleeve designed to minimize the risks of blood clots.

  4. Your doctor may prescribe a PCA (patient-controlled analgesia) that is connected to your IV. The unit is set to deliver a small, controlled flow of pain medication and is enacted when you firmly press the button on your machine. Press the button anytime you are having pain.

  5. You may have a catheter inserted into your bladder as the side effects of anesthesia often make it difficult to urinate.

  6. A continuous passive motion (CPM) unit may be placed on your leg to slowly and gently bend and straighten your knee. This device is important for quickly regaining your knee range of motion.

  7. When your leg is not in the CPM, you may be wearing a knee immobilizer to protect your knee when you stand up.


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

preventcomplication

    In a small percentage of patients, as with all major surgical procedures, complications can occur. Below is a list of potential complications and steps you can take to minimize their occurrence:

  1. Thrombophlebitis
  2. Also known as deep vein thrombosis (DVT), this problem occurs when the large veins of the leg form blood clots and, in some instances, become lodged in the capillaries of the lung and cause a pulmonary embolism. The following steps may be taken to avoid blood clots:

    • Blood-thinning medication (anticoagulants)

    • Elastic stockings (TED hose)

    • Foot and ankle exercises to increase blood flow and enhance venous return in the lower leg.

    IMPORTANT: If you develop swelling, redness, pain, and/or tenderness in the calf muscle, report these symptoms to your orthopaedic surgeon or internist immediately.

  3. Infection
  4. Although great precaution is taken before, during, and after surgery, infections do occur in a small percentage of patients following knee replacement surgery. Steps you can take to minimize this risk include the following:

    • Monitor your incision closely and immediately report any redness, swelling, tenderness, increased drainage, foul odor, persistent fever above 100.4 degrees Fahrenheit orally, or increasing pain.

      Speak with your physician for a complete list of potential complications. The information on this page is not intended to replace professional medical advice.

    • Take your antibiotics as directed and complete the recommended dosage duration.

    • Strictly follow the incision care guidelines your surgeon recommends.

  5. Pneumonia
  6. Because your lungs tend to become "lazy" as a result of the anesthesia, secretions may pool at the base of your lungs, which may lead to lung congestion or pneumonia. The following steps may be taken to minimize this risk:

    • Deep breathing exercises: A simple analogy to illustrate proper deep breathing is to, "smell the roses and blow out the candles." In other words, inhale through your nose, and exhale through your mouth at a slow and controlled rate.

    • Incentive spirometer: This simple device gives you visual feedback while you perform your deep breathing exercises. Your nurse or respiratory therapist will demonstrate proper technique.

  7. Knee stiffness
  8. In some cases, the mobility of your knee following surgery may be significantly restricted and you may develop a contracture in the joint that will cause stiffness during walking or other activities of daily living. The following steps must be taken to maximize your range of motion following surgery:

    • Strict adherence to the CPM protocol as prescribed by your surgeon

    • Early physical therapy (day one or two) to begin range of motion exercises and walking program

    • Edema control to reduce swelling (ice, compression stocking, and elevation)

    • Adequate pain control so you can tolerate the rehabilitation regime


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

rehabfollowkneereplacemensurgery

In order for you to meet the goals of knee replacement surgery, you must take ownership of the rehab process and work diligently on your own, as well as with your physical therapist, to achieve optimal clinical and functional results. The rehabilitation process following total knee replacement surgery can be quite painful at times. However, if you commit to following your program and overcome the challenges in rehab, you will succeed in meeting the goals you set when deciding on surgery. The following outline will summarize the process you will adhere to during rehabilitation:

  1. In the Hospital
    • CPM (continuous passive motion) beginning day one or two
    • Ambulation with a walker or crutches (weight-bearing status determined by your surgeon)
    • Range of motion exercises
    • Edema control (ice, compression, elevation)
    • Instruction in home exercise program
    • Discharge goals are as follows:
      1. Independent getting in and out of bed
      2. Independent in walking with walker or crutches
      3. Independent in walking up and down 3 steps
      4. Independent in your home exercise program
      5. Ability to bend your knee 90 degrees
      6. Ability to fully straighten your knee
  2. At Home
    • Begin ambulation with a cane as tolerated.
    • Continue CPM (if necessary) and range-of-motion exercises.
    • Keep incision clean and dry; watch closely for signs of infection.
    • Continue home exercise program.
  3. Outpatient Physical Therapy
    • Advanced strengthening program, adding weights as tolerated
    • Stationary cycling
    • Walking program
    • Aquatic therapy program
  4. Long-term Rehabilitation Goals
    • Range of motion from 100-120 degrees of knee flexion
    • Mild or no pain with walking or other low-impact physical activities
    • Independent with all activities of daily living

All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

(Consult your therapist regarding the number of reps)

Leg Lifts
Raise leg six inches above the mat, keeping knee straight.
leglifts

Knee Extension
Place a pillow under your knee. Lift your foot off the mat.
kneeextension

Ankle Pumps
Flex ankle up and down.
anklepumps

Quadriceps Sets
Tighten thigh muscles and hold contraction for five seconds.
quadricepsets

Heel Slides
Flex your hip and knee. Return knee to the straight position.
heelslides


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2018 Smith & Nephew, All Rights Reserved.

Contact Us

We work directly with the Willow Valley Medical Clinic providers or your preferred physician to schedule consults and services.

Contact Info

Physical Referral or Appointment: 208-852-3662

Physician Referrals (fax): 208-852-1295

Office Hours

Monday – Friday 8:00 am – 5:00 pm