What Should You Expect After Having A Total Knee Replacement Surgery?

Total knee replacement is a hospital-based surgery. Essentially, what the surgeons are doing is opening up your whole joint (requiring about a ten inch incision), flipping over your kneecap, and cutting out both ends of the bone. This is where the hyaline cartilage has been compromised from chondromalacia, which are little worn out or divot potholes. Think of cavities in a tooth enamel. The nerve endings exposed from the cavity hurt!

Knee replacement surgery is similar to a dental cap or crown procedure, where the surgeon is cuts and grinds down the ends of your bones to create a “post” and then fasten the titanium implant like a cap or crown. Then they flip the knee back over, staple the incision, and voila! Your surgery is done.

It’s not quite that simple – obviously that is a summary, as this takes a few hours and requires a certain level of expertise by the surgeon when it comes to choosing the right implant, etc. Of course, this is done in a hospital because this is a large surgery. There are risks associated with anesthesia, infection, and more. After the surgery, you have to undergo rehab therapy. There’s incisional healing; the wound has to heal. The tissue inside the joint that has been cut and replaced has to heal. The muscles and ligaments will need to heal, and time is depending on how fit or how weak you were prior to having this knee replacement.

The goal of the surgery is to replace the hinge of the joint, by removing the ends of the bone where the nerve endings have been compromised. Everything else that might be causing you pain (the weakness in your quadricep muscles or your hamstrings or the different muscles that help you move your knee around) isn’t just going to magically disappear. You have to work hard at rehabilitating and strengthening those muscles. And it takes hard work and a lot of time to make sure that the implant bends close to 90 degrees and straightens completely. Most of the orthopedic studies that look at function and pain improvement after replacement surgery will wait six months to determine what someone’s new baseline pain and function is going to be. Sadly, a significant percentage of people who have this surgery, even if everything goes perfectly, end up with chronic pain that requires interventional and non-interventional pain management for the life of that joint.

But a total knee replacement isn’t your only option. If there is pain and you are walking with no or minimal assistance then it is likely that your joint is still in good mechanical condition. Chondromalacia – the thinning of the hard cartilage protecting the bones in the knee joint. The unprotected sensory nerve endings are the reason for your knee pain. When this hard cartilage wears down, the nerve endings in your bone are exposed, and it hurts when you walk or put pressure on them. This pain fuels the arthritis inflammation by releasing inflammatory proteins, sort of how heat fuels a hurricane. Without this heat the hurricane dissipates. This is why there are not hurricanes in the winter months. Because your knee is an encapsulated joint (a closed space), the more inflamed the joint gets, the more pressure is put inside of the joint, further compressing the sensory nerve endings causing more pain, which leads to more inflammation. It’s a vicious cycle. However, cutting out the bones to remove these nerve endings entirely is an extreme solution. If you can find a way to turn off the pain, you can stop the osteoarthritis cycle and heal the joint.

That’s what AROmotion is – a FDA approved microprocedure that combines the technologies of radiofrequency neurotomy, orthobiologics, and physical reconditioning to stop the pain, promote healing, and restore your motion. Our minimally invasive procedures can help you avoid a large joint replacement surgery if you are a candidate. To learn more about our treatments and what we do here at AROmotion, and to discover whether you qualify for our procedures, contact us to schedule a consultation or visit aromotion.com

The first and most important thing to understand is that when possible a physician’s goal should always be to preserve and heal your natural joint. Knee replacement surgery is not able to accomplish that, and therefore should always be considered as a last resort (for reasons that we’ll explain later in this blog post).

The main reason someone has knee replacement surgery in the U.S. is to solve knee pain. Typically, knee pain is caused by something called “chondromalacia”. Chondromalacia is a medical diagnosis term used to describe the erosion of the hard cartilage that coats the surface of the bones making up the joint. This cartilage, which is made out of the same material you see on the end of a chicken bone, serves to protect the nerve endings and blood vessels that live inside of the bone underneath this hard, “Teflon like” coating.

When you have chondromalacia, it indicates that you have basically worn out parts of this hard cartilage, and the nerve endings are less protected or even exposed. Using your joint puts pressure on these nerve endings and results in pain, which in turn causes swelling and inflammation inside of the joint. This creates tightness and more pressure, causing even more pain….and this cycle or feedback loop is what we commonly refer to as “osteoarthritis”. Your knee joint is an encapsulated joint, so it actually becomes more and more tense as swelling and inflammation increases, and that puts more pressure on the nerve endings as well. This is a cycle that keeps going on and on for months and years, and pain is the driver – it’s not just a symptom, it is actually the underlying cause perpetuating the destructive “arthritis” inside of your joint.

Treatments for knee pain have included anti-inflammatory medication like Advil, Motrin, Aleve, Cortisone steroid shots, and maybe even hyaluronic acid viscosupplementation, but these solutions are band aids designed to treat the symptoms rather than break the underlying cycle of pain and inflammation.

The orthopedic solution to this problem is to remove and replace the joint. Total knee replacement surgery is essentially cutting out both ends of the bone and replacing or “capping” them with a titanium and Teflon hinge. That sounds like a really big jump, and it’s something that happens a lot in medicine. However, it’s really the only surgical option to treat it. Think about it…if you have a painful cavity in your tooth, you will likely be offered a filling or maybe a root canal. Grinding the tooth down to a post and placing a cap or crown is only used as a last resort if the tooth is beyond repair. Well, that’s essentially what joint replacement is – grinding the ends off of the bones, thus removing the painful nerve endings and creating a post, then gluing an implant like a dental cap or crown to reconstruct the joint.

Here’s why that is the only available surgical option: as you wear out little potholes in the hard and protective hyaline cartilage (the areas of thin cartilage) and put pressure on those nerve endings beneath, it hurts! Surgically, we have two tools we can use to resolve joint pain; 1) arthroscopy and 2) total joint replacement. An arthroscope is a cutting/grinding instrument. If you have a symptomatic torn meniscus, and the meniscus tear is flapping around and getting stuck like a rock in your shoe, it hurts. An orthopedic surgeon will use arthroscopy to trim away the tear. The way surgeons repair a symptomatic meniscus tear is by cutting out the piece that’s flip-flopping and getting stuck. If you have potholes, or worn out areas of the hard hyaline cartilage coating the surfaces of the bone in the joint, an arthroscopy won’t work. It’s a cutting/grinding instrument that cannot address the potholes. So there’s nothing you can do arthroscopically to treat chondromalacia, or potholes in this hard Teflon cartilage.

However, when total joint replacement is performed, the whole joint is cut out, removing the ends where the hyaline cartilage is and where the nerve endings live. So if your knee hurts, the only solution to fix your “knee pain”, in an orthopedic surgeon’s office, is to remove those nerve endings surgically and then place a new implant or “cap” on top so your joint can function.

Total joint replacement is a drastic solution, a major surgery to treat knee pain, and that’s why good orthopedic surgeons always attempt all other less invasive options first. However, once you have that surgery, your knee anatomy will be permanently changed. You’re going to have a mechanical implant sitting on top of the post created by grinding down the ends of the bone for a knee joint. If all goes well and you follow the restrictions published by the implant manufacturer, it should last 10-15 years. Remember, per the implant manufacturer, there are many restrictions on activities and how you can function with that joint: twisting, torquing, tennis (you’re not supposed to play tennis if you have knee replacement surgery) – and more!

There are other nonsurgical options, though. If for the most part you are suffering from knee pain and stiffness, then it is likely that your joint is mechanically functioning and chondromalacia is the only thing causing your knee pain. When that is the case, a total joint replacement is unnecessary; the good news is that you don’t have to cut out your joint and replace it with an implant! AROmotion is an FDA approved microprocedure that breaks the cycle of osteoarthritis by “turning off” the nerve pain. This helps normalize the environment inside of the joint capsule so you can begin healing.

When you come in for a consultation, you will see one of our Board Certified Physical Medical Doctors who will discuss this FDA approved microprocedure designed to mitigate the pain and break the cycle of arthritis. They will also review the different types of orthobiologics that can be used to augment this natural healing process.

After the AROmotion microprocedure, one of our Board Certified Physical Medicine and Rehabilitation Doctors will prescribe and supervise your customized reconditioning program, so that the muscles and ligaments which move the joint return to proper form and function.

Contact us today for a free consultation or visit our website, aromotion.com , to learn more!