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7/13/13 8:01 P

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READ ONLY..............DO NOT POST HERE
list of articles on this thread......
STARTING AT THE BOTTOM..........
article.......1-

Patellar Subluxation and Dislocation
Information about an unstable kneecap
By Jonathan Cluett, M.D., About.com

article..........2-
Study: Weight loss can have a big impact on knees

article..........3-
Water Exercise Tips

article..........4-

Low-Impact Aerobic Exercises
Low-impact aerobic exercise benefits those with knee problems by toning the muscles of the leg that support the knee joint - to absorb shock before it reaches the knee joint.

article........5-

seven week on-line course i took about ....the ins and outs of Knee Replacement Surgery ..........

week-1....subject
what is total knee replacement?
when is it necessary?

week-2.........
alternatives to knee replacement

week-3........
unicompartimental knee replacement/or partial knee replacement
arthroscopy,treatments for:
exercise guide

week 4 .........
how to find a surgeon
questions to ask?
second opinion
pre-op questions to ask

week 5.............
discussion with doctor
understanding procedure and risks
preperation for surgery
what to pack
post-op plans for returning home re:mobilty,food and medications

week 6..............
knee replacement implants
risks of surgery
infection and treatment
implant failure

week 7..........
day of surgery
hospitalization
discharge,rehab,recovery
post -op exercises
playing sports after replacement

article 6..............

Do I Need ACL Surgery?
and the ins and out of acl surgery...

article 7..................
synvisc injections

article 8.............
Quadricep Exercises: Complete with Images & Descriptions

article 9..............

Ice or Heat
Should you ice or heat an injury?
By Jonathan Cluett, M.D.,

article 10..............

Walk This Way for Happier Knees
article 11

Should I exercise before joint replacement surgery?

article 12

Glucosamine & Chondroitin Not Recommended for Knee Arthritis ??

article 13

Visual Knee exercises

article 14

IF YOU ARE STRUGGLING READ THIS....

article 15

Signs Your Thyroid
Is Out of Whack

article 16
Physical Therapy for Knee Pain

article 17
What is Nordic Walking and Why Should it Interest Me?

article 18
Several good videos for a variety of knee issues

Edited by: L*I*T*A* at: 1/25/2014 (18:56)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

pacific time


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7/13/13 7:59 P

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article 18
Several good videos about knee exercises....

1-The Best Cardio Exercises for Bad Knees

life.gaiam.com/article/best-cardio-e
xe
rcises-bad-knees


2-Knee Rehabilitation Exercises

www.pamf.org/sports/king/kneerehab.h
tm
l


3-Knee Strengthening Exercises

www.physioadvisor.com.au/8119350/kne
e-
strengthening-exercises-knee-rehabilR>itation.htm



4-KNEE EXERCISE PROGRAM

www.athleticadvisor.com/images/acrob
at
/knee%20rehab.pdf


5-Knee Arthroscopy Exercise Guide

orthoinfo.aaos.org/topic.cfm?topic=a
00
300


Edited by: L*I*T*A* at: 1/25/2014 (18:55)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

pacific time


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L*I*T*A*'s Photo L*I*T*A* SparkPoints: (370,525)
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7/13/13 7:44 P

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article 17


What is Nordic Walking and Why Should it Interest Me?

Quite simply, Nordic Walking could be described as WALKING PLUS, or even EXTREME WALKING.

Unlike walking, or even running, Nordic Walking, which is walking with especially designed poles provides you with a whole-body exercise - lower body, upper body, plus a great aerobic workout - comparable to Nordic, or cross-country skiing


Nordic Walking, or pole walking is really taking off in Europe. Millions are participating in this great, whole-body exercise. More and more people in the U.S. are also discovering it and wondering why they haven't started Nordic Walking before.
In most countries the English name - Nordic Walking - has been adopted and kept, but the Swedes have dubbed it stavgång, in Norway and Denmark it is stavgang, and to the Estonians it is kepikönd.

If you already walk, power walk, hike, run, or cycle, Nordic Walking will enhance your fitness level. In addition, walking with poles is a lot more interesting and engrossing than plain walking.

It also saves wear and tear on your legs and knees, while providing balanced exercise for both your lower and upper body.

Haven't you ever wondered if it would be possible to also exercise your arms, back, abs, shoulders and chest, while walking? As it turns out - you CAN and it isn't difficult to learn.

Nordic Walking poles are really a very portable gym - probably the most compact and efficient anywhere - with the added advantage of being able to exercise in the great outdoors, instead of in a stuffy and boring exercise facility. Imagine taking an elliptical trainer on the trail, to the mountains, or on the beach! That is what in fact you could be doing with a pair of Nordic Walking poles.

In addition, studies show that exercising outside can burn up to 30 percent more calories than doing the same workout indoors.

Exercise, such as Nordic Walking can help people deal with stress of everyday life much more effectively, safely and pleasantly than with prescription drugs.

click on the link below,to read more....


www.nordicwalkingus.com/nordic-walking-tec
hnique-it-is-really-quite-simple-but-y
ou-have-to-start-off-the-right-way/


here is another great link to some videos about the pole walking etc....

www.keenfit.com/about-poles/what-is-
po
le-walking.asp


Edited by: L*I*T*A* at: 1/25/2014 (18:53)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

pacific time


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2/16/12 11:54 P

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Article 16


Physical Therapy for Knee Pain
By Brett Sears, About.com Guide


The human knee is a hinge joint that is comprised of the tibia (shin) and the femur (thigh). The patella, or kneecap, is located in the front of the knee. The knee is supported by four ligaments. Two shock absorbers, each called a meniscus, are found within the knee.

Pain in the knee can be caused by repetitive trauma and strain or by injury. Occasionally it occurs for no apparent reason. When knee pain occurs, you may experience functional limitations that include difficulty walking, rising from sitting, or ascending and descending stairs.

If you experience knee pain, it is important to determine if the pain is acute, sub-acute, or chronic in nature. This can help guide proper diagnosis and treatment.

Acute pain is usually the most severe and occurs 1-7 days after injury. During this time, you should rest the knee and let the injured structures heal before initiating any motion.
Sub-acute pain occurs from 2-6 weeks after injury. This is a good time to initiate gentle motion around the knee to help regain mobility.
Chronic knee pain is pain lasting greater than 8-12 weeks. Knee pain that is chronic should be evaluated by your healthcare provider.
Location of Symptoms
The location of your knee pain can help determine which structures are at fault and can help ensure proper treatment. Remember to check with your physician, physical therapist, or healthcare provider if symptoms are severe or last more than a few weeks.

Pain in the front of the knee. If you feel pain in the front of the knee, there may be a problem with the tracking and position of the kneecap, often called patellofemoral stress syndrome (PFSS). The kneecap and the tendon between the kneecap and the shin may become inflamed and painful. Pain here usually limits the ability to kneel, ascend or descend stairs, or run and jump.
Pain on the inside of the knee. If you have pain on the inside portion of the knee there is likely injury to the medial meniscus or medial collateral ligament. These structures are usually injured during athletic activity when the foot is planted on the ground and the body twists over the knee. The medial meniscus is a shock absorber located inside the knee. Occasionally, it suffers from wear and tear or arthritis, and can be damaged with no specific injury.
Pain on the outside of the knee. Pain on the outside aspect of your knee can be the result of injury to many structures. There is a ligament there that may be injured during athletic activity. Pain here can also be caused by iliotibial band (ITB) stress. The ITB is a thick band of tissue that runs from the outside of your hip to the front of your knee. As it crosses the knee, the ITB can rub abnormally on the knee, and a burning pain can ensue. Also on the outside part of the knee is one of the three hamstring tendons. Strain to this tendon may be a source of knee pain.
Pain in the back of the knee. Pain in the back of the knee is rare, but can occur. One of the hamstring tendons attaches here, and pain here is likely due to a hamstring strain. Another possible cause of pain here is a Baker's cyst. This is an abnormal swelling of the knee joint that occupies space in the back of the knee and causes pain with excessive bending of the knee.
If you develop acute knee pain, immediately follow the R.I.C.E. principle. R.I.C.E. stands forRest, Ice, Compression, and Elevation. After a few days of R.I.C.E., you can begin using the leg, only gently. If pain persists for more than 2-3 weeks, you should visit a doctor, physical therapist, or other healthcare provider in order to rule out any major problem and to ensure proper diagnosis and management.

What to Expect From Physical Therapy for Knee Pain
If you are referred to physical therapy for knee pain, the initial visit is important to ensure correct diagnosis and proper management. During this visit, your physical therapist will interview you to gather information about the history of your problem, about the aggravating and relieving factors, and about any past medical history that may contribute the overall problem. From the information gathered during the history, a focused examination will be conducted. The examination may consist of several sections including, but not limited to:

Gait evaluation. A gait evaluation is an assessment of how you are walking. Physical therapists are trained to notice small changes in the motion around the knee during different phases of walking.
Palpation. This involves using the hands to touch various structures around the knee to feel for abnormalities or to assess if a structure is painful to touch.
Range of motion measurements. Range of motion refers to how far the knee is bending or straightening. The physical therapist may use special instruments to measure how your knee is moving to help direct treatment.
Strength measurements. There are many muscular attachments around the knee and a measurement of strength can help determine if muscular weakness or imbalance is causing your knee pain.
Girth or swelling measurements. Occasionally, swelling may be present in the knee joint after injury. A physical therapist may measure the amount of swelling to help direct treatment.
Special tests. Special tests are specific maneuvers performed around the knee to help determine which structure may be at fault and may be causing the problem.
After a focused examination has been completed, your physical therapist can work with you to initiate the correct treatment. It is very important for you to be active and engaged in the program. Often, exercises to help strengthen and improve mobility of the knee will be prescribed. You may be required to perform exercises at home as well.

Remember, if knee pain persists for more than 2-3 weeks or occurs as the result of major trauma, a visit to a physician, physical therapist, or health care provider is recommended.

The knee is a major joint in the body that is responsible for walking, climbing stairs, and rising from a seated position. Pain in the knee can limit one or all of these activities. By keeping the knee joint mobile and strong, problems with knee pain may be avoided and your mobility can be maintained.



physicaltherapy.about.com/od/orthop
edi
csandpt/a/PT_for_knee_pain.htm?nl=1



Edited by: L*I*T*A* at: 1/25/2014 (18:52)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

pacific time


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2/16/12 11:37 A

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Great info. (Oops ~ I read after posting that you're not to post here, but don't know how to delete the post. Sorry about that!)

Edited by: JLLYBN2 at: 2/16/2012 (11:48)
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2/25/11 2:03 P

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Edited by: L*I*T*A* at: 2/16/2012 (23:55)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

pacific time


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2/23/11 1:50 P

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Hi everyone!
Not been a good day...

Been to Dr everyone and the message isn't much better, have to go back in 4months afraid got most upset with them as nothing ever seems to get done, they say they would like me to loose some more weight which is fine but where I have felt they were doing nothing ...to them they are putting off the inevitable of having a knee replacement as they feel I am too young and if I don't loose the weight I may damage the new knee..anyway had another injection into the knee which should help me do a little more exercise which is a good thing so lets see how the next few weeks go!!

Lesley


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7/29/10 4:57 P

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article 15............

Signs Your Thyroid
Is Out of Whack

Weight gain or weight loss may be the most
well-known symptom, but that's not the only
hint your thyroid may be going haywire.


women.webmd.com/slideshow-thyroid-sy
mp
toms-and-solutions?ecd=wnl_wmh_092010


Edited by: L*I*T*A* at: 1/25/2014 (18:51)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

pacific time


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7/29/10 4:50 P

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article 14

IF YOU ARE STRUGGLING READ THIS....

For those of you that are struggling, those of you that are discouraged, those of you that are hurting, those of you that are frustrated... This is for you!

There is not a thing I need to add to this, it speaks for itself, kinda makes me think twice before feeling sorry for myself though.....

www.youtube.com/watch?v=MslbhDZoniY&
fe
ature=player_embedded


Edited by: L*I*T*A* at: 1/25/2014 (18:50)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

pacific time


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6/29/10 4:46 P

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article 13

variety of visual knee exercises on the knee guru web site and they a very visual too.....maybe they are more easily understood when seen.........thought it might be helpful..........


www.kneeguru.co.uk/KNEEnotes/node/11
25


Edited by: L*I*T*A* at: 1/25/2014 (18:49)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

pacific time


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6/29/10 4:41 P

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article 12...........

Glucosamine & Chondroitin Not Recommended for Knee Arthritis
According to the recently published guidelines from the American Academy of Orthopaedic Surgeons (AAOS), glucosamine and chondroitin should not be prescribed for the treatment of knee osteoarthritis. The guidelines attempted to gather the best research studies available and summarize the most significant findings of these research studies
to read more click on the link below

orthopedics.about.com/b/2009/11/02/g
lu
cosamine-chondroitin-not-recommendedR>-for-knee-arthritis.htm?nl=1


Edited by: L*I*T*A* at: 1/25/2014 (18:48)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

pacific time


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L*I*T*A*'s Photo L*I*T*A* SparkPoints: (370,525)
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6/29/10 4:39 P

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article 11...........

Should I exercise before joint replacement surgery?
By Jonathan Cluett, M.D., About.com Guide

Knee replacement surgery patients can benefit from exercises.
Joint replacement surgery is a treatment for severe arthritis of a joint. The most common types of joint replacements are hip-replacement surgery and knee-replacement surgery. Hip arthritis and knee arthritis can cause significant pain and disability. The thought of exercising before having surgery may seem counterintuitive — why would you risk worsening a sore and worn out joint? A recent study looked in to the effects of exercise before surgery on patients undergoing joint replacement.
Answer: Patients who participated in a pre-operative exercise program were shown to have several advantages:
• Stronger Before Surgery
People who have arthritis can still exercise. These individuals who exercise are able to feel better and alleviate some of their arthritis pain, if they strengthen their muscles. By strengthening, weight goes down and the joints are better supported by stronger muscles.
• Faster Recovery
It was much more likely a person would be able to return directly home after joint replacement if they participated in a presurgical exercise program. People who were less fit were more likely to need inpatient rehabilitation after surgery.
It is important to note that regardless of participation in this exercise program, all patients in this study had similar satisfaction with their joint-replacement surgery. If you want to do everything you can to improve the early results from your joint replacement, however, a preoperative exercise routine can certainly be helpful.

orthopedics.about.com/od/hipkneerepl
ac
ement/f/exercise.htm?nl=1Source:


Edited by: L*I*T*A* at: 1/25/2014 (18:45)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

pacific time


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6/29/10 4:38 P

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article 10............

Walk This Way for Happier Knees
By RealAge
Here's a good way to keep moving but take some of the pressure off your knees.
Just put one foot behind the other. Yep, walking backward puts less strain on your patellofemoral joint -- an important kneecap-to-thighbone connection.
Backward March
Okay, you won't want to do this in an area that is highly trafficked, unlevel, or unfamiliar. But under the right (read safe) circumstances, walking in reverse gear will make your quadriceps muscles contract differently than they do when you're walking forward. It will cause a concentric contraction -- a movement that's gentler on your anterior cruciate ligament, a knee ligament professional athletes routinely injure. Guess some NFL running backs could use this trick . . . (Need to sit it out today? This video shows you how you can work out from a chair.)
Backward Benefits
If you want to try backward walking, go slow until you get the hang of it. Maybe invite a spotter along. And don't try it for the first time on a treadmill. If you've got knee problems of any sort, check with your doctor first. And consider these other ways to stay active while staving off knee trouble:
Sweat it out. Cardio exercise can actually increase the amount of protective cartilage in your knees. Here's what we recommend.
Buffer your joints. Strength training bolsters more than your bones and muscles. Find out how it helps strengthen the connective tissue in your joints.
Move your hips. Hip muscles are key to helping prevent knee pain.
ps:has anyone tried walking backwards in their pool?????


www.realage.com/tips/walk-this-way-f
or
-happier-knees


Edited by: L*I*T*A* at: 1/25/2014 (18:44)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

pacific time


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3/19/10 12:15 A

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article............9


Ice or Heat
Should you ice or heat an injury?
By Jonathan Cluett, M.D.,

Ice packs and heat pads are among the most commonly used treatments in orthopedics.
So which one is the right one to use for your injury, ice or heat? And how long should the ice or heat treatments last?
Read on for information about treatment of injuries with ice packs and heating pads.
Ice Treatment
Ice treatment is most commonly used for acute injuries. If you have a recent injury (within the last 48 hours) where swelling is a problem, you should be using ice treatment. Ice packs can help minimize swelling around the injury.
Ice packs are often used after injuries such as an ankle sprain have occurred. Applying an ice pack early and often for the first 48 hours will help minimize swelling. Decreasing swelling around an injury will help to control the pain.
Ice treatments may also be used for chronic conditions, such as overuse injuries in athletes. In this case, ice the injured area after activity to help control inflammation. Never ice a chronic injury before activity.
Heat Treatment
Heat treatments should be used for chronic conditions to help relax and loosen tissues, and to stimulate blood flow to the area. Use heat treatments for chronic conditions, such as overuse injuries, before participating in activities.
Do not use heat treatments after activity, and do not use heat after an acute injury. Heating tissues can be accomplished using a heating pad, or even a hot, wet towel. When using heat treatments, be very careful to use a moderate heat for a limited time to avoid burns. Never leave heating pads or towels on for extended periods of time, or while sleeping.

Ice or Heat?
Ice or Heat?
Ice Heat
When To Use Use ice after an acute injury, such as an ankle sprain, or after activities that irritate a chronic injury, such as shin splints. Use heat before activities that irritate chronic injuries such as muscle strains. Heat can help loosen tissues and relax injured areas.
How To Do It Read through the information on how to ice an injury. There are several ways to ice an injury. Heating pads or hot wet towels are both excellent methods. Place a washcloth under hot tap water and then apply to the injured area.
For How Long Apply ice treatments for no longer than 20 minutes at a time. Too much ice can do harm, even cause frostbite; more ice application does not mean more relief. It is not necessary to apply a heat treatment for more than about 20 minutes at a time. Never apply heat while sleeping.

orthopedics.about.com/cs/sportsmedic
in
e/a/iceorheat.htm?nl=1


Ice or Heat? Maybe it Doesn't Matter...
Wednesday May 26, 2010
A new study has investigated the use of ice and heat application, and determined the use of either treatment helped, but it didn't matter which was used. Many doctors tell patients to use ice at one time, heat at another, but for acute low back strain injuries, the choice didn't seem to matter.
This study looked at patients who came to the emergency room after a back injury. All patients received oral anti-inflammatory medications, and then the patients were either given an ice pack or a heat pad, and this was applied to their back. The study researches then looked at how their pain changed. They found that ice or heat, it didn't seem to matter.
Bottom Line: Study authors recommended that patients or providers use either ice or heat, whatever their preference. So if you have back pain, and one feels more comfortable, then pick that treatment.
orthopedics.about.com/b/2010/05/26/i
ce
-or-heat-maybe-it-doesnt-matter.htm?R>nl=1



Edited by: L*I*T*A* at: 1/25/2014 (18:43)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

pacific time


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Lita~ I have a doctors appointment with a sports injury doc on March 26th. Is there anything I can do to start building up this leg to support my knee? I really can't bend it very much without pain. I guess I was hoping I could skip on the doctor if I get a lot better on my own.

Sorry I did not catch that we were not suppose to post here until after I already posted. emoticon

Edited by: RANEYDAY at: 3/17/2010 (20:00)
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below is a link to some exercises to help strengthen our knees

www.bigkneepain.com/knee-exercises.h
tm
l


Edited by: L*I*T*A* at: 1/25/2014 (18:40)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

pacific time


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article 8...............

Quadricep Exercises: Complete with Images & Descriptions


www.weight-lifting-workout-routines.
co
m/quadriceps-exercise.html#1


Edited by: L*I*T*A* at: 1/25/2014 (18:38)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

pacific time


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9/11/08 11:11 A

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article 7...........

Synvisc
From Jonathan Cluett, M.D.,
Your Guide to Orthopedics.

About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD


What is Synvisc?
Treatment of arthritis has focused on surgery for severely arthritic joints. The non-operative treatments have been less extensively investigated, and there has only been limited success with these treatments. The current mainstay of non-operative treatment for arthritis is focused on the reduction of pain, primarily with the use of nonsteroidal anti-inflammatory (NSAID) medications. Unfortunately, these medications are not ideal for many patients because of side effects; furthermore, there is a suggestion of possible progression of disease with these medications (1).
What is the probelm with arthritis?
Arthritis is one of the most common diseases in the world today. The total cost of this condition has been estimated to be as high as 1% of the gross national product in the United States (2).



Rheumatoid Arthritis (RA)
Find Info On Rheumatoid Arthritis Symptoms, Treatments And More Now.
RheumatoidArthritisFacts.info


The knee is among the most commonly involved joints with arthritis, and can be one of the most serious affecting many aspects of an individual's quality of life. Patients with arthritis of the knee are susceptible to complications from other medical conditions, as they are more likely to live a sedentary lifestyle and are more often obese. Effective treatment for knee arthritis is a priority of orthopedic surgeons.

How does Synvisc fit in to arthritis treatment?
One possible method for treating arthritis of the knee without performing surgery has been with an injectable medication called Synvisc (the generic name is Hylan, and sold under the trade name "Synvisc"). Hyaluronan, the name of the substance in Synvisc, is secreted by cells in the cartilage of joints. Hyaluronan is one of the major molecular components of joint fluid, and it gives the joint fluid, also called synovial fluid, its viscous, slippery quality. The high viscosity of synovial fluid allows for the cartilage surfaces of joints to glide upon each other in a smooth fashion. By injecting Synvisc in a knee, some people consider this a so-called joint lubrication. This is why you may hear of Syvisc as a 'motor oil' for the knee joint.

Does Synvisc help knee arthritis?
Numerous studies have been performed in the past decade to assess the effectiveness of Synvisc as a treatment for osteoarthritis. However, no clear understanding of how well Synvisc injections perform has emerged. Early studies of Synvisc were performed on too few patients and the follow-up period was limited to a short time. Some studies showed a benefit of Synvisc injections, primarily in reduction of pain as assessed by patients, when compared to patients getting a placebo-a saline injection (2,3). But to contradict these studies, other trials showed no benefit to the Synvisc injections (4,5).




Should I have a Synvisc injection?
So where does this leave patients? Essentially, the jury is still out. No study has shown that Synvisc injections are an effective treatment in a large number of patients over a long period of time. Osteoarthritis, like other chronic conditions, has a course that naturally waxes and wanes. Because of this, it is impossible to determine from a short study of Synvisc injections whether or not a treatment is having a reproducible effect, or if the benefit shown is part of the natural variation in disease severity.
That said, Synvisc injections have been shown to be of benefit in some patients. Most promising, a recent report announced by the American Academy of Orthopaedic Surgeons, states that Synvisc injection treatment offers a delay in surgical treatment in patients needing total knee replacement (6).



This study found that almost 75% of patients were able to delay knee replacement surgery after using Synvisc injections. Furthermore, no study to date has found serious adverse side effects associated with the use of Synvisc injections in the knee joint. While there have been concerns about potential allergic reactions to Synvisc, this has not been demonstrated. Therefore, treatment has been shown to be safe, and there is potential that patients can benefit from Synvisc injections.

Final Word on Synvisc
What should you do? This is a difficult question to answer. As stated in the previous page, there is no definitive data to find that a Synvisc injection is either effective or not. Patients who are most likely to benefit from Synvisc injections are older than 60 years of age, and have severe arthritis symptoms (2). Research is continuing to examine exactly what role Synvisc injections will have in the future management of osteoarthritis.




Edited by: L*I*T*A* at: 10/29/2009 (23:30)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

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article 6..........



Do I Need ACL Surgery?

By Jonathan Cluett, M.D., About.com

About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

Ligament injuries may require ACL reconstruction


What is an anterior cruciate ligament tear?
The anterior cruciate ligament is one of four primary ligaments around the knee joint. It is an important stabilizer of the knee. The ACL can be injured by trauma or sporting activities. If the ligament is completely torn, it will not heal. Some individuals elect to leave the knee without an anterior cruciate ligament, and some choose ACL reconstruction of the ligament. If the knee has a deficient anterior cruciate ligament, the individual relies on the other three ligaments (as well as the inherent stability of the joint and surrounding muscles) to stabilize the joint. This is not always sufficient, and may lead to recurrent episodes of instability--a sensation that the knee may "give out."

Pros

Allows return to high-level athletic activity
May protect future damage to the knee cartilage
Offers a near-normal knee

Cons

Surgery is not 100% effective -- some people don't improve
Many activities can be accomplished without an ACL
There are complications that may occur
Current Recommendations
ACL reconstruction surgery should be considered for all individuals who desire a return to sports or activities that require lateral pivoting of the knee, or those who experience recurrent instability of the knee.

Who needs ACL surgery?

Most people expecting to return to high-level athletic activities in sports such as soccer or basketball
Individuals who experience recurrent episodes of knee instability due to anterior cruciate ligament deficiency
Patients who do not want to attempt conservative therapy

What is an ACL reconstruction?
Although people (including doctors) often refer to the surgery as an "ACL repair," it is better called an "ACL reconstruction." The anterior cruciate ligament, once completely torn, cannot be repaired. The options for ACL reconstruction are:

Using the central 1/3 of the patellar tendon, the tendon connecting the knee cap (patella) to the shin bone (tibia), to fashion a new ligament. When the graft is 'harvested,' a piece of the bone of the patella and tibia is also taken. Thus the attachments of the tendon to the bone are not disturbed. When the graft is placed into the knee, this allows for 'bone to bone healing.' This is felt by many surgeons to be the most secure graft type. The primary disadvantage is knee pain following the surgery; this may persist for years.
Using a portion of the hamstring tendon. The hamstring muscle group (in the back of the thigh) has tendon to spare. Some of the tendon can be harvested to create a graft. The advantage of the hamstring tendon is that there is less disturbance in harvesting the graft, and a much lower incidence of knee pain after surgery. However, many surgeons question the stability of this graft.
Finally, many patients now opt for donor tissue grafts. These usually use the patellar tendon of a cadaver, similar to using your own as described above. The problem with this is the sterilization process that kills the living cells of the graft. This means the healing time of the graft is longer and less reliable. There is a very small risk of infection or rejection, as is the case with any donor tissue. The advantage is that this procedure can be done entirely arthroscopically, and there is much less post-operative pain.

The best decision for ACL surgery varies from person to person and surgeon to surgeon. It is important to discuss the ACL reconstruction options with your doctor. Your surgeon may have a preferred technique and it is important to take that into consideration. Most studies show little difference between the patellar tendon and hamstring grafts in the long run. The donor tissue grafts are slightly less reliable, but because it involves a smaller surgery, and none of the complications associated with graft harvesting, many patients still prefer this method for ACL reconstruction.



What are the risks of ACL surgery?

There are risks--be sure to discuss these with your doctor. There are risks associated with the graft. These include failure of the graft, loosening of the graft, and a chance that the graft does not provide optimal stabilization of the knee following ACL surgery. All of these may require a revision reconstructive surgery.

There are complications associated with ACL surgery that are risks of all surgical procedures. The most significant is the risk of infection. This is especially concerning in patients who receive a donor graft. Recently, there have been several reports of patient deaths because of infected donor grafts after ACL surgery. These cases have been addressed, and the provider of the graft has been shut down, but this is a potential risk with a donor graft. There are also risks of anesthesia. These should be discussed with the anesthesiologist before ACL surgery.

All that said, the chance of a successful ACL surgery is about 90%. It is important, however, that patients understand this is a big procedure. Most importantly, for the ACL surgery to have any chance of success, a significant effort is required post-operatively by the patient. Without adherence to a proper rehabilitation protocol, the ACL surgery failure rate increases dramatically!

What if I choose not to have ACL surgery?
That's fine--ACL surgery can always be done in the future. Many patients opt to try physical therapy to strengthen the muscles around the knee in an effort to avoid ACL surgery. Many sports do not require an anterior cruciate ligament. The ACL comes into play when you are pivoting, or making lateral movements suddenly. For example, running in a straight line shouldn't be a problem without an anterior cruciate ligament. Many sports such as jogging, cycling, swimming, and others do not always require a functional ACL. Often people who participate in these sports, or those who are not physically active, choose to try rehabilitation alone. Some doctors also prescribe a sports brace to help support the knee. Most studies show these have only a small impact (if any at all), but they certainly don't hurt.

What are the risks of not having ACL surgery?
This is also very important to consider. While no one dies because they don't have a good ACL, there may be a significant downside to not having ACL surgery. One important factor is quality of life. Many patients rely on certain activities to maintain their mental health. If an individual cannot find satisfaction without being able to participate in sports that require a function ligament, then ACL surgery is an option. Also, new studies have shown that degenerative (arthritic) changes in the knee may be accelerated in patients without an ACL. This means that every time the knee "gives out," you may be damaging the cartilage. This is especially important for younger patients who will need good knees for many years. Many surgeons recommend that if a young patient attempts non-operative treatment, and they have a repeat episode of instability (after the initial injury), then they should have the reconstructive surgery.




My knee feels better after an ACL tear, should I still have surgery?

The anterior cruciate ligament (ACL) is one of four major knee ligaments. ACL tears are a common sports-related injury, and often requires surgical reconstruction. Without surgery, athletes with an ACL tear may have recurring problems with knee instability.

Answer: After an ACL tear, the knee is usually swollen and painful. Patients who sustain this injury are uncomfortable and know they have a serious problem with the knee joint.

These patients are often seen by their physician, who diagnoses the ACL injury, and helps to treat the acute symptoms. Once the swelling improves, and the pain subsides, patients often feel "normal."

Do I still need ACL surgery?

One common question of patients who sustain an ACL tear, and then start to feel much better, is if they still need surgical reconstruction of the ligament. It can be hard to accept the rehabilitation needed after ACL surgery if the knee starts to feel good again.
Unfortunately, if the ACL is completely torn, there is no chance of the ligament healing properly. While not everyone needs a functional ACL to perform activities, athletes who participate in certain sports that require pivoting maneuvers are unlikely to be able to return without a properly working ACL.


ACL Reconstruction and Rehabilitation:
Rehabilitation after surgery for an ACL tear is a lengthy process. Return to sports and activities takes months. There are many variations of ACL rehabilitation, and the information provided here is simply an overview. Specific rehabilitation must focus on each individual athlete, and you must adhere to your own protocol. It is also important to note that timelines are a guide -- progression depends on completion of one step, before advancing to the next step.

The First Days:
The goals of the first days after ACL reconstruction are to minimize swelling and prevent discomfort. This can be accomplished with:
Icing frequently
Elevating the affected knee
Using crutches
Some surgeons recommend the use of a brace after ACL surgery. This is controversial, and many surgeons choose not to use a brace at this time.
Another controversial subject is the use of a CPM, or motion machine, after surgery. Again, some surgeons will use the CPM despite a lack of evidence that it helps your recovery.

Weeks 1-2:
Range of motion exercises can begin immediately after surgery. The initial focus is to regain full extension (the ability to fully straighten) of the knee. In general, flexion (ability to bend) is much easier to regain than extension.
Patients will work with physical therapists to work on gait training (walking), gentle strengthening, and aerobic work. I like to get patients on a stationary bicycle as soon as possible after surgery as this improves strength, motion and aerobic activity.

Weeks 3-6:
Work is continued with physical therapy. As motion increases, emphasis is shifted to strengthening. Specifically balance and proprioceptive exercises.
Once normal motion has been achieved, some sport-specific activities can be started. Before beginning these activities, motion must be near normal and the swelling in the knee gone.

Weeks 7-12:
Early sports activities can be started and patients can often begin light jogging, cycling outdoors, and pool workouts. Side-to-side, pivoting sports -- such as basketball, soccer and football -- must be avoided.
Toward the end of this phase, some athletes can begin shuttle runs, lateral shuttles and jumping rope.

Months 4-7:
Continued progression with sports specific activities. This phase of rehabilitation is often the most difficult, because patients may have a knee that "feels" normal, but is not ready for the stresses of some sport activities.
Emphasis of rehabilitation should be on sport simulating activities. These will include figure-of-eight drills and plyometrics, and over time will include sport drills. For example, a tennis player may start light hitting, a soccer player some controlled dribbling, etc.

Return to Sports:
Deciding when to return to unrestricted sports activities depends on a number of factors:
Functional Progression
The decision to return to sports must be based on each individual's progression through their therapy.

Graft Type
Some surgeons may delay return to sports if the graft used to reconstruct the ACL came from a donor. Because these grafts are sterilized and frozen, there is a belief that they take longer to heal well inside the patient.

Surgeon Preference
Your surgeon will guide your rehabilitation, and the ultimate decision about return to sports.
Bracing After ACL Surgery:
There is also controversy about the use of braces during sports after ACL reconstruction. Studies have shown no benefit in preventing re-injury to the ACL. However, some athletes feel more comfortable in a brace, and there is no harm in wearing a sports brace.





Edited by: L*I*T*A* at: 9/11/2008 (11:09)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

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week............1 and..........2


i have started an on=line course for 7 weeks about knee replacement surgery and i will post what i get from the course here..............just hope it is worth while!!!??????...........

Knee Replacement Surgery

What Is Total Knee Replacement?

Who Needs Knee Replacement Surgery? | When Is Knee Replacement Necessary?


So you just found out that you may need total knee replacement surgery... Perhaps you've heard about knee replacement surgery, from friends, from doctors, on the news, but what is the actual procedure? What is replaced? Why is knee replacement necessary? Why do I need a knee replacement?



Who Needs Knee Replacement Surgery?

Wear-and-Tear Arthritis
Knee replacement surgery is most commonly performed on patients who have osteoarthritis, also called degenerative joint disease or wear-and-tear arthritis. Patients with this type of arthritis do not have the normal protective lining of cartilage remaining on the ends of the bone. Therefore, when the knee is bent, raw bone is irritated and causes pain.


Rheumatoid Arthritis
Rheumatoid arthritis causes a different type of joint destruction. Rheumatoid arthritis is a systemic disease that can cause a number of problems. Among these, rheumatoid arthritis can cause inflammation of the lining of joints. This link will connect you to a number of useful resources to help you understand the diagnosis of rheumatoid arthritis.


When Is Knee Replacement Necessary?

What Are Signs I Do/Don't Need A Knee Replacement?
Usually patients 'know' when they are ready for knee replacement surgery. If you have tried more conservative treatments for knee arthritis and you have persistent knee pain, it may be time for a knee replacement. If you are unsure, look through these signs that you may be ready for knee replacement surgery.


How Young Can Patients Have Knee Replacement?
Once reserved for elderly patients who have no other options, total knee replacement is now being performed in younger patients with excellent results. Rather than using age to determine when a knee replacement is performed, doctors look at symptoms and treatment response to determine if knee replacement is appropriate.


Worried You're Too Young?
More information to help you decide if now is the right time to consider knee replacement surgery. This article includes some excellent "indicators" that will let you know when the time is right to consider a knee replacement.



Week............ 2 ..........

Alternatives to Knee Replacement?

Medications | Joint Supplements | Exercise & Therapy | Other Considerations

Patients rarely need a knee replacement when they first develop symptoms of knee pain. More often, patients are seen in earlier stages of knee arthritis, and the symptoms can be managed with more conservative treatments.



Medications

Anti-Inflammatory Medications
Anti-inflammatory pain medications (NSAIDs) are prescription and nonprescription drugs that help treat pain and inflammation. Swelling and inflammation can be significant problems in patients who have knee arthritis. The anti-inflammatory medications can help to control these symptoms.




Cortisone Injections
Cortisone is also an anti-inflammatory medication that works to decrease swelling and inflammation within the joint. Cortisone is administered as an injection, and therefore the medication works very powerfully within the joint.


Synvisc
Synvisc is an injected substance that is given weekly as a series of three to six injections. Synvisc may be effective against pain in some patients with knee arthritis and may delay the need for knee replacement surgery.


Joint Supplements

Glucosamine & Chondroitin
Glucosamine and chondroitin appear to be safe and might be effective for treatment of knee arthritis. Some patients swear by these joint supplements and credit them with curing knee arthritis pain. However, research investigating these supplements has been limited, and results do not appear to be as significant as the companies selling these supplements claim.


Exercise & Therapy

Physical Therapy
Strengthening of the muscles around the knee joint may help decrease the burden on the knee. Preventing atrophy of the muscles is an important part of maintaining functional use of the knee. Whether or not you end up having knee replacement performed, a strong knee will be better either way.


Weight Loss
Probably one of the most important, yet least commonly performed treatments. The less weight the joint has to carry, the less painful activities will be. There are countless reasons for patients who are overweight to try to lose even a modest amount of weight--reducing knee pain is just one of those reasons.


Activity Modification
Limiting certain activities may be necessary, and learning new exercise methods may be helpful. Aquatic exercise is an excellent option for patients who have difficulty exercising. Limiting impact forms of exercise will help to minimize knee pain.


Other Considerations

Walking Aids
Use of a cane or a single crutch is the hand opposite the affected knee will help decrease the demand placed on the arthritic joint.


“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

pacific time


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week .....3.....

Unicompartmental Knee Replacement
From Jonathan Cluett, M.D.,
Your Guide to Orthopedics.

About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

Minimally invasive partial knee surgery
Partial knee replacement, also called a unicompartmental knee arthroplasty,' is a surgery that may be considered for treatment of osteoarthritis of the knee joint. Traditionally, patients have undergone total knee replacement for severe arthritis of the knee joint. In a total knee replacement, all cartilage is removed from the knee joint, and a metal and plastic implant is substituted.
The partial knee replacement surgical procedure has generated significant interest because it entails a smaller incision and faster recovery than traditional total joint replacement surgery. Partial knee replacement, also called unicompartmental knee replacement' and 'minimally invasive knee surgery,' removes only the most damaged areas of cartilage, and replaces these surfaces.
Who is a good candidate for partial knee replacement?
The minimally invasive partial knee replacement is indicated in patients who have severe arthritis of the knee that have failed conservative treatments may consider this procedure. Conservative measures may include, but are not limited to, medications (such as Advil, Naprosyn, Celebrex, and Vioxx), cortisone injections, strengthening exercises, and weight loss. If these treatments are not adequate, and you as a patient are not satisfied, then surgical procedures may be considered.
The partial knee surgery may be possible if the arthritis in the knee is confined to a limited area. If the arthritis is widespread, then the partial knee replacement is NOT appropriate, and should not be considered. In addition, the partial knee surgery is recommended in patients who are:
· Older than 55 years
· Not obese
· Relatively sedentary
· Have intact ligaments (specifically the ACL)
If these qualifications are not met, then the minimally invasive partial knee surgery may not be as successful. Unfortunately, many patients are therefore ineligible for this minimally invasive procedure.
What is the problem with most patients for the partial knee replacement?
Most patients who seek surgical management have arthritis that is too advanced for the minimally invasive partial knee replacement procedure. Because surgical treatment is considered a 'last-resort' by most patients, by the time surgery is necessary, their arthritis is too advanced to consider this minimally invasive procedure. If partial knee replacement is done in a patient who is a poor candidate, failure rates can be high, and conversion to a traditional total knee surgery may be more difficult.
What is the benefit of the partial knee replacement?
· Smaller Incision
A traditional knee replacement surgery involves an incision about 8 inches over the front of the knee. There is more significant dissection necessary to complete the procedure compared to the unicompartmental knee surgery. In the minimally invasive partial knee replacement, the incision is about 3 inches, and the amount of dissection and bone removal is much smaller.
· Less Blood Loss
Because of the extent of dissection and bone removal necessary for a total knee replacement, the need for a blood transfusion is relatively common. With the unicompartmental knee procedure, a blood transfusion is infrequently needed, and patients do not need to consider giving blood preoperatively.
· Shorter Recovery
Both the time in hospital and the time to functional recovery are less with the partial knee replacement. Patients are known to have been discharged on the day of the procedure, although most often patients are discharged on the first or second post-operative day. With traditional total knee replacement, patients seldom leave before three or four days in the hospital, and often require a stay in an in-patient rehabilitation unit.

Minimally Invasive Knee Surgery
Partial knee replacement
What is known about long-term results with partial knee replacement?
The long-term results are very good when the minimally invasive partial knee replacement is done in the right patients. Older studies showed very poor results of the partial knee replacement, but these results are thought to be due to poor patient selection. If the minimally invasive procedure is done on a patient with too widespread arthritis, the results are very likely to be less than satisfactory. If your doctor does not recommend a partial knee replacement, you may be in this situation. If this is the case, further conservative treatment (e.g. injections, physical therapy, medications, etc.), or total knee surgery are the best options.
Will I need surgery again after having a partial knee replacement?
Hopefully not.

When patients with a partial knee replacement are properly selected, the minimally invasive procedure is quite successful. That said, some patients continue to develop arthritis in other areas of the knee. Also, some patients wear out the unicompartmental knee implant, or it may come loose within the knee. All of these situations would require additional surgery, and possibly the conversion to a total knee surgery. Conversion from a partial knee replacement to a total knee can be more difficult because of the prior surgery, but it is not uncommon and results of conversion are good.
Other potential complications that should be discussed with your doctor prior to a partial knee replacement include infection, blood clots, and problems with anesthesia. It is important to have a long discussion with your doctor about the risks of this minimally invasive surgery, or any other procedure, prior to your operation.


What is arthroscopic surgery?
Arthroscopic surgery is a common orthopedic procedure that is used to diagnose and treat problems in joints. The word "arthroscopy" comes from two Greek words: 'arthro,' meaning "joint," and 'scope,' meaning "look." Simply put, arthroscopic surgery is a means to look inside a joint. But arthroscopy is much more than that!
What parts of the body can undergo arthroscopic surgery?
Arthroscopic surgery is most commonly performed on the knee and shoulder joints. Less commonly arthroscoped joints include the wrist, elbow, ankle and hip. The reason the knee and shoulder are the most commonly arthroscoped joints is that they are large enough to manipulate the instruments around, and they are amenable to arthroscopic surgery treatments.

Technically speaking, any joint can be arthroscoped.
However, the practicality and the instrumentation available limit our ability to arthroscope every joint for all types of problems. The most common arthroscopic procedures include repairing cartilage and meniscus problems in the knee, and removing inflammation and repairing rotator cuff tears in the shoulder.

How is arthroscopic surgery performed?
When a knee arthroscopy is performed, a camera is inserted into the joint through a small incision (about one centimeter). The arthroscopic surgery camera is attached to a fiberoptic light source and shows a picture of the inside of the joint on a television monitor. The surgeon uses water under pressure to "inflate" the knee allowing more maneuverability and to remove any debris. One or more other incisions are made to insert instruments that can treat the underlying problem. For example, a shaver can be inserted to trim the edges of a meniscus tear.

What is arthroscopic surgery a good treatment for?
Many common knee and shoulder problems are amenable to arthroscopic surgery. As mentioned above, some common arthroscopic procedures include:

Trimming a torn meniscus

Repairing a torn meniscus

Treatment of shoulder bursitis

Repair of the rotator cuff

Treatment of cartilage damage in the knee

Treatment of labral tears in the shoulder
However, not all conditions are best treated with arthroscopic procedures. A recent controversy arose in the past several years about the effectiveness of arthroscopic surgery in treating arthritis of the knee. The study, from the New England Journal of Medicine, reported that arthroscopic surgery for treatment of moderate arthritic changes of the knee is no more effective than 'sham surgery,' where incisions are made but no surgery is performed. Talk to your doctor about why arthroscopy may or may not help your condition.
Is arthroscopic surgery safe?
Understand that arthroscopic surgery is a surgical procedure and involves risks. These may include infection, blood clots, problems with anesthesia, etc. These are serious risks and the decision to undergo arthroscopic surgery should be taken seriously. That said, arthroscopic surgery is a "less invasive" procedure, and when performed for the right indications (meaning the right problems) it is often very successful. Ask your doctor for more information about arthroscopic surgery, and talk about the possible risks of undergoing the procedure.


I FOUND THIS ON THE WEB SITE FROM ORTHOPEDIC SURGEONS..........
WWW.ORTHOINFO.ORG

WAS HOPING FOR THE PICTURES TO COME WITH THE ARTICLE AS THEY WERE VERY GOOD........


THERE IS A LINK AT THE BOTTOM OF THE ARTICLE HERE TO TAKE YOU TO THE EXERCISES.......

Knee Arthroscopy Exercise Guide
Importance of Exercise
Before You Start
Initial Exercise Program
Intermediate Exercise Program
Advanced Exercise Program
Importance of Exercise

Regular exercise to restore your knee mobility and strength is necessary. For the most part, this can be carried out at home.

Your orthopaedic surgeon may recommend that you exercise approximately 20 to 30 minutes two or three times a day. You also may be advised to engage in a walking program.


Before You Start
Your orthopaedic surgeon may suggest some of the following exercises. The following guide can help you better understand your exercise or activity program that may be supervised by a therapist at the direction of your orthopaedic surgeon.
As you increase the intensity of your exercise program, you may experience temporary set backs. If your knee swells or hurts after a particular exercise activity, you should lessen or stop the activity until you feel better.

You should Rest, Ice, Compress (with an elastic bandage), and Elevate your knee (R.I.C.E.). Contact your orthopaedic surgeon if the symptoms persist.

Initial Exercise Program

Hamstring Contraction
Repeat 10 times.
No movement should occur in this exercise. Lie or sit with your knees bent to about 10 degrees. Pull your heel into the floor, tightening the muscles on the back of your thigh. Hold 5 seconds, then relax.


Quadriceps Contraction
Repeat 10 times.
Lie on stomach with a towel roll under the ankle of your operated knee. Push ankle down into the towel roll. Your leg should straighten as much as possible. Hold for 5 seconds. Relax.

Straight Leg Raises
Repeat 10 times.
Lie on your back, with uninvolved knee bent, straighten your involved knee. Slowly lift about 6 inches and hold for 5 seconds. Continue lifting in 6-inch increments, hold each time. Reverse the procedure, and return to the starting position.
Advanced: Before starting, add weights to your ankle, starting with 1 pound of weight and building up to a maximum of 5 pounds of weight over 4 weeks.


Buttock Tucks
Repeat 10 times.
While lying down on your back, tighten your buttock muscles. Hold tightly for 5 seconds.


Straight Leg Raises, Standing
Repeat 10 times.
Support yourself, if necessary, and slowly lift your leg forward keeping your knee straight. Return to the starting position.
Advanced: Before starting, add weights to your ankle, starting with 1 pound of weight and building up to a maximum of 5 pounds of weight over 4 weeks.


Intermediate Exercise Program

Terminal Knee Extension, Supine
Repeat 10 times.
Lie on your back with a towel roll under your knee. Straighten your knee (still supported by the roll) and hold 5 seconds. Slowly return to the starting position.

Advanced: Before starting, add weights to your ankle, starting with 1 pound of weight and building up to a maximum of 5 pounds of weight over 4 weeks.


Straight Leg Raises
Perform 5 sets of 10 repetitions.
Lie on your back, with your uninvolved knee bent. Straighten your other knee with a quadriceps muscle contraction. Now, slowly raise your leg until your foot is about 12 inches from the floor. Slowly lower it to the floor and relax.
Advanced: Before starting, add weights to your ankle, starting with 1 pound of weight and building up to a maximum of 5 pounds of weight over 4 weeks.


Partial Squat, with Chair
Repeat 10 times.
Hold onto a sturdy chair or counter with your feet 6-12 inches from the chair or counter. Do not bend all the way down. DO NOT go any lower than 90 degrees. Keep back straight. Hold for 5-10 seconds. Slowly come back up. Relax.


Quadriceps Stretch, Standing
Repeat 10 times.
Standing with the involved knee bent, gently pull heel toward buttocks, feeling a stretch in the front of the leg. Hold for 5 seconds.


Advanced Exercise Program


Knee Bend, Partial, Single Leg
Repeat 10 times.
Stand supporting yourself with the back of a chair. Bend your uninvolved leg with your toe touching for balance as necessary. Slowly lower yourself, keeping your foot flat. Do not overdo this exercise. Straighten up to the starting position. Relax.


Step-ups, Forward
Repeat 10 times.
Step forward up onto a 6-inch high stool, leading with your involved leg. Step down, returning to the starting position. Increase the height of the platform as strength increases.


Step-ups, Lateral
Repeat 10 times.
Step up onto a 6-inch high stool, leading with your involved leg. Step down, returning to the starting position. Increase the height of the platform as strength increases.


Terminal Knee Extension, Sitting
Repeat 10 times.
While sitting in a chair, support your involved heel on a stool. Now straighten your knee, hold 5 seconds, and slowly return to the starting position.


Hamstring Stretch, Supine
Repeat 10 times.
Lie on your back. Bend your hip, grasping your thigh just above the knee. Slowly straighten your knee until you feel the tightness behind your knee. Hold for 5 seconds. Relax.
Repeat with the other leg.
If you do not feel this stretch, bend your hip a little more, and repeat.
No bouncing! Maintain a steady, prolonged stretch for the maximum benefit.


Hamstring Stretch, Supine at Wall
Repeat 10 times.
Lie next to a doorway with one leg extended. Place your heel against the wall. The closer you are to the wall, the more intense the stretch. With your knee bent, move your hips toward the wall. Now begin to straighten your knee. When you feel the tightness behind your knee, hold for 5 seconds. Relax.
Repeat with the other leg.


Exercise Bike
Start pedaling for 10 minutes a day.
If you have access to an exercise bike, set the seat high so your foot can barely reach the pedal and complete a full revolution. Set the resistance to "light" and progress to "heavy."
Increase the duration by one minute a day until you are pedaling 20 minutes a day.


Walking
An excellent physical exercise activity in the middle stages of your recovery from surgery (after 2 weeks).


Running
Running should be avoided until 6 to 8 weeks because of the impact and shock forces transmitted to your knee. Both walking and running activities should be gradually phased into your exercise program.


Knee Osteotomy

Alternatives to total knee replacement surgery
In patients with degenerative arthritis, or osteoarthritis, of the knee joint, deformities of the knee are common. These deformities include a bow-legged or knock-kneed appearance. More technically, these deformities are called genu varum (bow-legged) or genu valgum (knock-kneed).
What causes a bow-legged or knock-kneed deformity?
As arthritis progresses, the cartilage of the joint wears thin. The meniscus, or joint cushions, are also damaged and wear away. If the damage is more on one side of the joint than the other, as is usually the case, then the knee will take on a deformed appearance. When the inside, or medial side, of the joint is worn thin, a varus deformity (bow-legged) will result. When the outside, or lateral side, of the joint wears thin, a valgus deformity results (knock-knees).

What is the problem with this type of deformity?
When the knee is worn more on one side, the forces transmitted across the joint are altered.

then the inside (medial side) wears thin, the force of your body weight becomes more centered on the worn out part of the joint. Therefore, the healthier part of the knee is spared the burden of your body weight, and the damaged portion gets the brunt of your weight. This becomes a vicious cycle that leads to progression of the arthritis.


How does an osteotomy of the knee help?
The idea of an osteotomy is to shift the weight-bearing forces to "unload" the worn out side of the joint, and place the forces on the healthier side of the joint.

Who is an ideal candidate for a knee osteotomy surgery?
The problem with knee osteotomies is that finding the right patient is very difficult. Knee replacement surgery is very successful, and unless there is a good reason not to perform a replacement the total knee replacement is usually favored. Some patients, however, are not good candidates for knee replacement, especially patients who are young. Because knee replacements wear out over time, younger patients should be evaluated for alternative procedures.

The ideal patient for a knee osteotomy is a young, active person, who has arthritis limited to one side of the knee joint. The patient must have significant pain and disability such that surgery is warranted. The patient must understand that rehabilitation from this surgery is lengthy and difficult. Finally, osteotomies around the knee, tend to last less than one decade--then something more, usually a knee replacement, needs to be done. Some patients may find lasting relief with an osteotomy, but the majority of patients use a knee osteotomy surgery as a means to delay eventual knee replacement surgery.

Good candidates for this surgery must fit the following criteria:

Significant pain and disability
X-rays showing involvement of only one side of the knee joint
The ability to cooperate with physical therapy and rehabilitation
Who is not a good candidate for a knee osteotomy?
Unfortunately, performing this surgery in the wrong patient can have poor outcomes. Therefore, you should discuss with your doctor the potential risks of this surgery. While many people want to avoid knee replacement surgery, the knee osteotomy is not right for everyone.

Patients generally should not consider this surgery if they have:

Widespread arthritis of the knee (not confined to one side)
Instability of the knee or tibial subluxation
Significant limitations of knee motion
Such a significant deformity it would be difficult to correct
Inflammatory arthritis (such as rheumatoid arthritis)


Knee Osteotomy
How is an osteotomy done?
An osteotomy uses is a procedure where the surgeon cuts the bone and then reorients the bone. There are two basic types of osteotomies: closing wedge, where a wedge of bone is removed to change the alignment of the bone; and, opening wedge, where bone is gapped open on one side to realign the bone. Depending on the type of deformity and the location of your osteotomy, your surgeon will choose one of these options.
Once the bone is cut and subsequently realigned, your surgeon may choose to use a metal plate and screws to hold the bones in the new position.

How long is the recovery from a knee osteotomy?
The recovery from a knee osteotomy can be difficult. Because the bone is cut, it needs time to heal. The total healing time is at least 8 weeks, and can take longer.

Most patients need physical therapy to regain their knee motion.

What are the complications of knee osteotomy surgery?
The most common problem with this surgery is that it almost always fails over time. Now, if you can feel better for nearly a decade, and delay knee replacement surgery, it may be well worth it. However, it is not uncommon for patients to require conversion to knee replacement within a few years of the surgery.

Orthopedic surgeons also face the problem of performing the surgery in a manner that will not make a subsequent knee replacement surgery more difficult. Finding a doctor experienced in this procedure is a good idea.

Other potential complications include problems with healing of the osteotomy (a nonunion), continued pain from arthritis, blood clots, and infection.

How successful is this surgery?
When done in the right patients, knee osteotomies are usually successful at decreasing pain caused by arthritis. They surgery tends to last about 8 to 10 years, and after that time, many patients will require total knee replacement. In a large group of patients, knee osteotomy gives good to excellent results in about:

80% of patients for 5 years
50% of patients for 10 years
30% of patients for 20 years
Because of this, knee osteotomy is generally reserved for young, active patients, who want to delay the time until knee replacement.


Rotating Knee Replacements

Are there advantages with a rotating knee replacement implant?

Total knee replacement surgery is a procedure done to replace worn-out cartilage of the knee joint with a metal and plastic implant. New research is constantly taking place to design a knee replacement implant that will be both reliable and last a long time.
Part of designing a knee replacement is a keen understanding of the materials used to replace the normal knee joint surfaces. Second, the design attempts to create an implant that will replicate a normal knee as best possible. By doing so, the patient will be able to participate in the same activities before and after surgery.


Rotating Knee Replacements
The rotating knee replacement implants not only swing back and forth (like a hinge), but the knee can also rotate inwards and outwards (a twisting motion).


Because a normal knee joint rotates a small amount, the rotating knee replacements are intended to more closely replicate normal knee motion.
You may have seen magazine or television advertisements about rotating knee replacements. Several companies are marketing these implants as the next step in knee replacement design. These advertisements would lead you to believe that rotating knee replacements are much better. But is this true? Do the rotating knee replacements work better and last longer than traditional knee replacements?

Why does this rotation matter?
We really don't know that it will matter, but the hope is that by acting more like a normal knee joint, the rotating knee replacements will have less stresses on the implant than traditional knee replacement implants. With less stress on the implant, the plastic part of the knee replacement may last longer.

All joint replacements are limited in that they tend to wear out over time. Knee replacements usually last at least 20 or more years, but they do not last forever. This is a problem for all patients, but especially for patients who have knee replacements at a younger age (less than 60 years old). These patients will likely wear out their knee replacement during their lifetime.

The rotating knee replacements may have less wear on the implant, and may last longer than traditional knee replacements. Unfortunately, this is just a theory. No one really knows that the rotating knee replacements are better than traditional knee replacements, and some surgeons will argue that they are worse. Some surgeons believe that the additional motion can lead to faster wear of the implant over time. The problem is, the rotating knee replacements have not been around for long enough to determine who is correct. No one knows with certainty the long-term results with the rotating knee replacements.

So what should I do? Should I have the rotating knee replacement?

This is a question you need to discuss with your doctor. There are some good data, mostly from studies in Europe, that show the rotating knee replacements work as well as traditional knee replacements. However, there are not any long-term studies that show these rotating knee replacement implants are much better over long periods of time (25 years or more).

Fortunately, rotating knee replacements look and act much like traditional knee replacement implants. The surgery is the same, and the recovery is the same. Some surgeons feel that ligament balancing of a rotating knee replacement is more difficult than a traditional knee replacement, but this is not agreed upon by all surgeons. There may be a difference between the rotating knee replacements and traditional knee replacements, but it is likely a small difference. You can discuss with your surgeon if this is a difference that should matter to you.



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How To Find an Orthopedic Surgeon
By Jonathan Cluett, M.D., About.com


ACL Reconstruction

ACL Knee Surgery

Joint Replacement
Finding an orthopedic surgeon can be a difficult task. Here are a few steps to complete if you don't know where to turn to next.
Difficulty: Easy
Time Required: 15 minutes
Here's How:
Talk to your primary care doctor.
Here or she will know the best doctors in your area, and will have experience referring other patients to local orthopedists.

Talk to your friends.
For common conditions such as arthritis, ACL surgery, etc., surely you'll have co-workers, friends, or family who know the local orthopedists and will have first hand experience.

Check your doctor out online.
The American Medical Association and the American Academy of Orthopaedic Surgeons both have databases that can be accessed online.

Ask tough questions.
Don't be afraid to ask about your doctor's credentials and experience. For some ideas of questions you can ask about your doctor, your surgery, and other issues, click here.

Consider a second opinion.
Did you not find what you were looking for? Want to be sure of what you heard? Don't hesitate to seek a second opinion, just to make sure.

Trust your instincts.
If a meeting with a doctor does not go well it doesn't mean they're a bad doctor or you're a bad patient, but it may mean the two of you don't work together optimally.

Tips:
Don't try to find the 'best' doctor.
There are too many definitions of 'best' and too many great doctors. Sure, look for an experienced, well-regarded surgeon, but also look for someone you work well with and who you trust.

Stick with it.
While seeking a second opinion is useful, too many opinions can cloud your thinking. Also, working with a doctor may require many visits over months or years. Moving around will hinder this process

Who is "the best" orthopedic surgeon?
By Jonathan Cluett, M.D., About.com

About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

See More About:find a doctorquestions to ask your doctordoctor biographies
Question: Who is "the best" orthopedic surgeon?

Answer: It all depends how you want to define best. Some surgeons devote more time to research, and they're often quite well known. Some surgeons perform specific, unusual procedures that they have been specially trained to do. Some orthopedic surgeons gain notoriety by being the physician of politician or professional sports team or player. There is no simple way to define the best surgeon.

First, it is very unusual that you would have to travel a great distance to find a very good orthopedic surgeon. There are thousands of well-trained, experienced orthopedic surgeons throughout the United States.

Second, surgeons who perform the most common procedures the most frequently, may not be particularly well known by the above criteria.

You can use the Find An Orthopedic Surgeon tool to screen physicians, and ask other doctors in the area which surgeons have been good to work with in the past.

It is my personal belief that the best surgeon must not only be competent, but you must work well with him or her. Determine the ability of your surgeon from reputation and recommendations from other physicians, but also make sure you are comfortable working with this doctor as you may well be working together for years to come. In order to have a successful outcome, finding someone you work well with can be of utmost importance.

How do I know if I have found the right orthopedic surgeon?
By Jonathan Cluett, M.D., About.com


Question: How do I know if I have found the right orthopedic surgeon?

Answer: The are a few places to go to check on your orthopedic surgeon.

The American Academy of Orthopaedic Surgeons has a search capability to search its database of members. The AAOS directory can be accessed at the following location:
AAOS Directory

The American Medical Association also has a membership directory which can be accessed at the following site:
AMA Directory

The American Board of Medical Specialties has a list of certified physicains in all specialties at the following site:
ABMS



Do I Need A Second Opinion?
There's no good answer to this question, but if you an unsure about your options, or still unclear about what is best for you, then seek another doctor's opinion. However, never, ever, feel bad or deceitful for seeking another physicians opinion. Your doctor should be perfectly comfortable with you going to discuss your condition with another doctor. Be honest with your doctor, but do not feel badly that you are asking another doctor to have a look at your condition.


Pre-Operative Questions
Questions to ask your doctor before surgery
By Jonathan Cluett, M.D., About.com


The following list of questions, compiled and adapted from the American Association of Hip and Knee Surgeons, offers some very good suggestions:

Do you have written materials or videotapes about this surgery that I can review?

How much improvement can I expect from this surgery?

What is your experience doing this type of surgery, and how many have you done?

Are you Board Certified?

Approximately how many of these surgeries are done each year at this hospital? Is there outcomes data available?

What are the risks involved? How likely are they?

What type of anesthesia will be used?

What are the risks?

What type of implant will be used? What is the track record for this type of prosthesis?

Will I have to stop taking any of my medications before surgery?

What options are available to avoid a blood transfusion?

How long will I have to stay in the hospital?

How much pain is normal to expect and how long will it last? Will I receive medication for the pain?

When will I start physical therapy? Will I need home or outpatient therapy?

Will I need to arrange for some assistance at home? If so, for how long?

What limits will there be on activities - such as driving, bathing, climbing stairs, eating, sex?

How long will I need to be out of work?

How often will I need to return for follow-up visits?

What complications can arise after surgery? What are the signs of complications?

.............week 5.......................


Finding A Doctor: The first step after deciding that surgery is necessary is to find the right doctor. Finding someone you trust is of utmost importance. You should find a surgeon who is competent, has a good record of performing the procedure you are having done, and is someone you enjoy working with and trust. There are steps you can take and questions you can ask to determine if a doctor would be good for you.

Get A Second Opinion: Some surgical procedures are always necessary, while others are not. The decision to have surgery must be well thought out by you and your doctor. You should understand what to expect, how successful the procedure is, what the risks are, and how long the rehabilitation will take. Often a second opinion can help you better understand your options -- you should never hesitate to ask for another opinion, even if you plan on returning to your current doctor.

Understand Your Procedure: Understanding the procedure is important because it will help you improve the chance of a successful outcome. Knowing what to expect at the time of surgery, during your hospitalization, and during the rehabilitation will help you achieve appropriate goals at each step along the way.


Discuss The Risks Of Surgery: While everyone hopes their surgery will proceed smoothly, there are potential risks of a joint replacement that needs to be understood. Every surgeon knows that some risks are unavoidable -- even if everything is done properly, there are potential problems. Patients need to understand risks of infection, wound problems, nerve injury, blood clots, anesthesia complications and others. If your doctor hasn't specifically addressed the risks of surgery, ask him or her about these potential problems.
Gather Your General Medical Information: You can gather your medical information to ensure your primary physician, orthopedic surgeon, and anesthesiologist all have up-to-date information. Collect information about your medications (names, dose, when taken, why taken), allergies, and other medical conditions. It is helpful to have these written down, and have extra copies for you to give to doctors and nurses.

Obtain Preoperative General Medical Evaluation: You will be seen by your primary care physician prior to joint replacement surgery. The purpose of this visit with your primary physician is to determine if there are any aspects of management of your current medical health that can or should be modified prior to surgery. To determine this, your doctor will obtain blood tests, an EKG, and possibly other tests such as a chest x-ray or echocardiogram.

Prepare For The Day of Sugery: Last minute preparations for surgery should include packing your belongings for your hospitalization. You should shower before the surgery and wash the area you are having surgery to minimize the chance of infection. Do not shave the area; your doctor can perform this if necessary. Do not wear make-up, jewelry, or nail polish. Do not eat or drink prior to your surgery. If you take regular medications, ask your doctor if you should continue or stop these medications.

What to take (and not take) to the hospital

Prepare For Your Return Home: It is of utmost importance to remember about your return home prior to going to the hospital for your joint replacement surgery. After surgery, you will be happy if steps have already been taken to ensure your comfort and safety once home.
Prepare for your return home

What to pack for your surgery day
Essentials:
Medications - in original containers
Recent x-rays, MRIs, or other scan you have had done
Any crutches, braces, or other devices needed after surgery
Insurance documentation
Documents requiring your doctors signature
Any other preoperative documents (some hospitals keep on file, others have patients keep these)
Identification
Clothing:
Nightgown/Pajamas
Robe
Comfortable clothing (sweatpants, loose shirts)
Slippers
Shoes
Toiletries:
Toothbrush/Toothpaste
Razor
Soap/Shampoo
Feminine Hygiene Products
Tissues
Other:
Book
Pen/Paper
Do NOT Bring:
Cellular phones (cannot be used around hospital monitoring equipment)
Personal computer
Jewelry/Valuables

Planning For Your Return Home From Joint Replacement Surgery
From Jonathan Cluett, M.D.,

Planning For Extra Help: Everyone will need some extra help after joint replacement -- some more than others. Patients who need extra assistance may require a stay at an inpatient rehabilitation facility.

If you will be returning home, make sure you can have someone stay with you for at least several days. This person staying with you should be physically able to assist you. It is important to have someone around almost all of the time for at least a few days. You can consider hiring help, if needed.

Planning For Mobility Concerns: After surgery, you will want to have an area where you can live without having to navigate long hallways, stairs, or other obstacles. Before you go for your surgery, try to find a place (even if temporary) where you can have a bed, bathroom, and kitchen on one level. Practice using crutches or a walker, and make sure these ambulatory aids fit within the spaces of your home. You may want to clear some spaces to make the house more easily navigable.

Planning Your Food: Make sure you have plenty of food that can be easily prepared. Preparing food ahead of time and freezing it is a good option. In the kitchen, make sure any appliances and cutlery you need are easily within reach. Have foods available that are easy on your stomach, such as soups, crackers, and soda.

Planning Your Medications: Be sure you have an ample supply of your medications, and know which, if any, you may be told not to resume after surgery. Ask your doctor for new prescriptions ahead of time, or during your hospitalization, so these can be obtained prior to returning home. Most patients will be prescribed a blood thinner and pain medication after surgery.

Make Your Home A Safer Place: Some simple steps can be taken to ensure safety hazards are addressed in your home. Performing a home safety check-up is a good thing to do anytime, but it's especially important after a major surgery. A fall in the house could be a serious setback to your rehabilitation.

Home Safety Checklist
Plan Some Activities: Recuperation after a major surgery can be a very boring time. Plan for some activities you find entertaining. Get a few books you have been meaning to read, gather some materials to start a scrapbook of your family vacation momentos, or get some games you can play with visitors. You may not feel up to activities, but you will want relief from boredom.


“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

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week...................6...........

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pictures and story of one persons experiences.........


Knee Replacement Surgery
Over time the knee can suffer structural damage from supporting the body's weight. If the damage is severe enough, knee replacement surgery may be necessary. Here's more information on knee replacements.

IMPORTANT: the link below will only take you to the site and not directly to the video...........you must write in the search box "knee replacement video" and click on it and it should get you there......


http://video.about.com:80/orthopedics/Kn
ee-Replacement.htm

video.about.com:80/orthopedics/knee-repl
ac
ement.htm


Q. What type of knee replacement implant is best?
From Jonathan Cluett, M.D.,
Your Guide to Orthopedics.

About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

There are many orthopedic manufacturing companies that produce different implants used in knee replacement surgery. Most of these companies make several different knee replacement prostheses. Is there a way to determine which knee replacement implant is best?

A. Asking orthopedic surgeons what knee replacement is best is like going to a car show and asking people which is the best car. You'll find lots of different answers, and each person thinks they've got the right answer.
One of the most important aspects of knee replacement surgery is determining the proper implant to be used in the operation. However, people disagree on what criteria are most important to select the best knee replacement implant.

Do you use the implant with the newest design, or the implant with the longest track record?

Does a surgeon use many different implants depending on each patient, or become most comfortable with one implant for every patient?

Should a surgeon use implants suggested or asked for by their patients?
Orthopedic supply companies have begun to advertise directly to consumers.

Better Knee Replacement
the amazing Oxford or CustomFit total replacement, Houston, Texas
DrLikover.com

Causes of Hip Pain
Symptoms, Causes & Treatments For All Kinds Of Hip Pain.
personalhealthguide.info
The advertisements might make you believe that their implant has been shown to be better than other implants. This has been seen recently with 'gender-specific knee replacements' and 'rotating knee replacements.'
The truth is that no one know what the 'best' implant is. The ideal knee replacement implant will allow for normal activities, normal motion, and last the patient's lifetime. The only way to know if these goals will be met is to use the implant in people doing normal activities, and follow their results for decades. Therefore, implants designed recently do not have long-term track records that prove their longevity.

Bottom Line - What Knee Implant Is Best?
I recommend patients and surgeons select an implant that fits the following criteria:
Has a reasonable track record of use (minimum of 5-10 years)

The surgeon has used the implant before

Is appropriate for the patient's condition
If you have questions about a specific implant, ask your doctor about the knee replacement prosthesis. Ask your surgeon to compare it to the implant he or she usually uses. If you want more information about an implant, you can read more from the company web sites.
Sources:

Surgery TimeLine

An example schedule for a knee replacement surgery

The following is a sample schedule for a knee replacement surgery. The specific times given are one possibility, and may vary substantially at different hospitals. This is intended to give the reader an idea of about how long they will be in different areas, and who they will see there. While this example is given for a knee replacement surgery, it can be used as a general guide for any procedure.

6:30 AM Arrive at Hospital
Check in to inpatient surgery
Change into gown
Who you will see: Secretary, Nurse

7:00 AM Meet with anesthesiologist
Discuss anesthesia, have questions answered
Inform anesthesiologist of medications you have taken and food eaten
Who you will see: Anesthesiologist

7:30 AM Meet with surgeon
Discuss procedure, have questions answered
Complete consent form
Who you will see: Surgeon, Assistants

8:00 AM Go to operating room
Begin anesthesia
Who you will see: Surgeon, Assistants, Anesthesiologist, OR Nurses

8:30 AM - 11:30 AM Procedure
After the case, the surgeon will update the procedure to anyone you designate

12:00 PM Wake up in operating room or recovery room
Family members are usually not allowed here, they will see you in your room.
Who you will see: Recovery Room Nurse

1:00 PM Move from recovery room to hospital room
Who you will see: Floor Nurse, Family and Friends


RISKS OF SURGERY........

Infection of a Joint Replacement

Problems due to infection after joint replacement surgery
The most commonly performed joint replacements are knee replacements, hip replacements, and shoulder replacements. Much less commonly, other joints, such as elbows, wrists, and ankles, are being replaced as well. One of the problems with joint replacements, is that infections of these implanted joints can become a very serious problem.

Why do joint replacement infections cause problems?
Bacteria are usually well controlled by our immune system. Once an infection is detected, our immune system rapidly responds, and attacks the infecting bacteria. However, implanted materials, like those found in a joint replacement, can allow infections to persist.

Our immune system is unable to attack bacteria that live on these implants, and these infections can become serious problems. If an infection of an implant goes untreated, the problem can worsen, and the bacteria can gain such a foothold that they can become a systemic problem.
The reason infections are such a significant problem is that bacteria cannot be easily eliminated from a joint replacement implant. Despite excellent antibiotics and preventative treatments, patients with a joint replacement infection often will require removal of the implanted joint in order to cure the infection.

What is done to prevent infections of total joint replacements?
At the time of surgery, there are several measures taken to minimize the risk of infection of a total joint replacement. Some of the steps are known to lower the risk of infection, some are thought to help but not known. Among the most important, known measures to lower the risk of infection after total joint replacement are:

Antibiotics before and after surgery
Antibiotics are given within one hour of the start of surgery (usually once in the operating room) and continued for a short period following the procedure.

Short operating time and minimal OR traffic
Efficiency in the operation by your surgeon helps to lower the risk of infection by limiting the time the joint is exposed. Limiting the number of operating room personnel entering and leaving the room is thought to decrease risk of infection.

Use of strict sterile technique and sophisticated sterilization techniques
Care is taken to ensure the operating site is sterile, the instruments have been autoclaved and not exposed to any contamination, and the implants are packaged to ensure their sterility.
After the operation, the risk of developing an infection from an outside source is reduced, but there is still a risk of developing an infection from the blood stream. Because of this, patients with a joint replacement implant should take antibiotics before invasive procedures such as dental work, colonoscopies, etc. It is known that these procedures may cause a transient risk of bacteria entering the blood stream. Antibiotics will help control this and prevent joint infection.

What happens when a total joint replacement becomes infected?
When a total joint replacement becomes infected, it may loosen, become painful, and need to be removed. Unfortunately, even if the implant is washed clean during surgery, most types of infections require removal of the implant to cure the infection.

Why did I get an infection after joint replacement surgery?
There are several risk factors for developing an infection after a total joint replacement, but most patients have no identifiable cause for developing an infection. Some of the risk factors include:

Immune deficiencies (e.g. HIV, lymphoma), or immune suppressive treatments (e.g. chemotherapy)
diabetes
Rheumatoid arthritis
Obesity

What is the treatment for an infected joint replacement?
Joint replacement infections should be divided into early and late infections to understand this subject. So-called early infections, that occur in the weeks following surgery, may sometimes be cured with a surgical washout of the joint and IV antibiotics. Exactly how long this is true for is debated, some surgeons say only in the first 3 weeks, others believe in the first 8 weeks. What is known, is the longer away from surgery, the harder to cure an infection without removing the implant.
Late infections, usually occurring months or years after the joint replacement surgery, almost always require removal of the implant, placement of an "antibiotic spacer," and IV antibiotics. Patients who undergo this surgery will need at least 6 weeks of IV antibiotics, possibly more, before a new joint replacement can be put back in the joint.

Once an implant is removed for an infection, can a new one be put back in?
Yes, but not until the infection is cleared.


Your orthopedic surgeon, in consult with a infectious disease specialist will determine the optimal treatment schedule, and obtain periodic blood work studies to determine when the infection is likely cured. After that time, a revision replacement (replacement of a joint replacement) may be considered.

What are blood clots?
Blood clots in the large veins (deep venous thrombosis, or DVT) of the leg and pelvis are common after orthopedic surgery, especially joint replacement surgery. The risk of developing a blood clot depends on several factors including the type of surgery, other medical problems, medications you may be taking, smoking history, as well as other factors.

Medication to Lower the Risk of Blood Clots
If the risk of developing a blood clot is thought to be high, your doctor may start you on blood thinning medication after your surgery. This is standard following joint replacement surgery such as total knee replacement and total hip replacement surgery.

Blood thinning medication may also be used following other procedures, especially large surgeries of the lower extremities.
Other modalities used to decrease the risk of blood clot formation include compression stockings to keep the blood in the legs circulating and pumps around the legs to stimulate blood flow through the veins. Early mobilization after surgery is also very important and will help prevent blood clot formation.

Blood Clots In The Lung
The concern of a DVT is that if a blood clot develops, it is possible that it can travel to the lungs (called a pulmonary embolism), which can potentially be fatal. If your doctor finds evidence of blood clot formation, you will likely be given a higher dose of blood thinning medication for a longer period of time.
Why aren't all patients given blood thinning medication?
The problem is that there are risks of blood thinning medication, such as a stroke, gastrointestinal bleeding, and other problems. While the risk of developing a stroke from blood thinning medication is small, only patients who are at high risk for developing a blood clot should be started on blood thinning medication

Stiffness
When surgery is performed, you body's natural response is to make a scar. This is true both on the skin, and deep down inside the joint as well. Because scars contract, this can cause a tightening of the soft-tissues around the knee joint. If this occurs after a knee replacement procedure, you may have difficulty bending your knee, sitting in a chair, or walking up and down stairs. Because of this, it is important to begin bending, and fully straightening the knee, as soon as possible after surgery. Aggressive physical therapy must be continued for months following the surgery. If stiffness persists despite physical therapy, a manipulation under anesthesia may be performed. This breaks up scar tissue, but it will require you to again be aggressive with physical therapy.


Implant Failure
Over time, implants wear out and may loosen. New technology has helped this problem, but it still happens. Most knee replacements last an average of about 20 years. Some last less than 10, some more than 30. But every implant eventually wears out. This is more of a problem in younger patients, who live longer, and typically place more demands on the implanted joint. If the joint wears out, a revision replacement (replacement of a replacement) may be performed. This is a more complicated surgery, and with each revision surgery, the life-span of the implant decreases. This is one reason why physicians often delay joint replacement surgery as long as possible.

partial knee replacement...........

just found this article and thought i'd add it here.........

About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

Minimally invasive partial knee surgery
Partial knee replacement, also called a unicompartmental knee arthroplasty,' is a surgery that may be considered for treatment of osteoarthritis of the knee joint.
Traditionally, patients have undergone total knee replacement for severe arthritis of the knee joint. In a total knee replacement, all cartilage is removed from the knee joint, and a metal and plastic implant is substituted.
The partial knee replacement surgical procedure has generated significant interest because it entails a smaller incision and faster recovery than traditional total joint replacement surgery.
Partial knee replacement, also called unicompartmental knee replacement' and 'minimally invasive knee surgery,' removes only the most damaged areas of cartilage, and replaces these surfaces.

Who is a good candidate for partial knee replacement?

The minimally invasive partial knee replacement is indicated in patients who have severe arthritis of the knee that have failed conservative treatments may consider this procedure. Conservative measures may include, but are not limited to, medications (such as Advil, Naprosyn, Celebrex, and Vioxx), cortisone injections, strengthening exercises, and weight loss. If these treatments are not adequate, and you as a patient are not satisfied, then surgical procedures may be considered.

The partial knee surgery may be possible if the arthritis in the knee is confined to a limited area. If the arthritis is widespread, then the partial knee replacement is NOT appropriate, and should not be considered. In addition, the partial knee surgery is recommended in patients who are:
· Older than 55 years
· Not obese
· Relatively sedentary
· Have intact ligaments (specifically the ACL)
If these qualifications are not met, then the minimally invasive partial knee surgery may not be as successful. Unfortunately, many patients are therefore ineligible for this minimally invasive procedure.

What is the problem with most patients for the partial knee replacement?
Most patients who seek surgical management have arthritis that is too advanced for the minimally invasive partial knee replacement procedure. Because surgical treatment is considered a 'last-resort' by most patients, by the time surgery is necessary, their arthritis is too advanced to consider this minimally invasive procedure. If partial knee replacement is done in a patient who is a poor candidate, failure rates can be high, and conversion to a traditional total knee surgery may be more difficult.

What is the benefit of the partial knee replacement?
· Smaller Incision
A traditional knee replacement surgery involves an incision about 8 inches over the front of the knee. There is more significant dissection necessary to complete the procedure compared to the unicompartmental knee surgery. In the minimally invasive partial knee replacement, the incision is about 3 inches, and the amount of dissection and bone removal is much smaller.
· Less Blood Loss
Because of the extent of dissection and bone removal necessary for a total knee replacement, the need for a blood transfusion is relatively common. With the unicompartmental knee procedure, a blood transfusion is infrequently needed, and patients do not need to consider giving blood preoperatively.

Shorter Recovery
Both the time in hospital and the time to functional recovery are less with the partial knee replacement. Patients are known to have been traditional total knee replacement, patients seldom leave before three or four days in the hospital, and often require a stay in an in-patient

Partial knee replacement
What is known about long-term results with partial knee replacement?
The long-term results are very good when the minimally invasive partial knee replacement is done in the right patients. Older studies showed very poor results of the partial knee replacement, but these results are thought to be due to poor patient selection. If the minimally invasive procedure is done on a patient with too widespread arthritis, the results are very likely to be less than satisfactory. If your doctor does not recommend a partial knee replacement, you may be in this situation. If this is the case, further conservative treatment (e.g. injections, physical therapy, medications, etc.), or total knee surgery are the best options.

Will I need surgery again after having a partial knee replacement?
Hopefully not.
When patients with a partial knee replacement are properly selected, the minimally invasive procedure is quite successful. That said, some patients continue to develop arthritis in other areas of the knee. Also, some patients wear out the unicompartmental knee implant, or it may come loose within the knee. All of these situations would require additional surgery, and possibly the conversion to a total knee surgery. Conversion from a partial knee replacement to a total knee can be more difficult because of the prior surgery, but it is not uncommon and results of conversion are good.
Other potential complications that should be discussed with your doctor prior to a partial knee replacement include infection, blood clots, and problems with anesthesia. It is important to have a long discussion with your doctor about the risks of this minimally invasive surgery, or any other procedure, prior to your operation.

video.about.com:80/orthopedics/Knee-
re
placement.htm


Edited by: L*I*T*A* at: 1/25/2014 (18:34)

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week 7..........article #5

Knee Replacement Rehab & Recovery
From Jonathan Cluett, M.D.,
Your Guide to Orthopedics.

About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD


Day of Surgery: The day of knee replacement surgery is mostly a day to recover from your procedure. But it is not just about rest. Depending on the time of day of your surgery, you may be asked to sit in a chair or on the side of the bed.
Patients will begin simple activities including ankle pumps, leg lifts, and heel slides. It is important for patients to take sufficient pain medication to allow them to participate in their rehabilitation exercises.

Some doctors will place you into a motion machine, called a CPM. The benefit of a CPM has not been clearly proven, and some surgeons choose not to use the device.

Hospitalization: During your hospitalization, you will meet with physical and occupational therapists. The physical therapist will work on mobility, strengthening, and walking. The occupational therapist will work with you on preparing for tasks such as washing, dressing, and other daily activities.
Therapy progresses at a different pace for each patient. Factors that will affect the rate of your progression include your strength before surgery, body weight, and ability to manage painful symptoms. The type and extent of surgery can also affect your ability to participate in physical therapy.

Discharge/Rehabilitation: Patients are usually discharged 3 to 5 days after knee replacement surgery. It is important that discharged patients be able to safely get in their homes and perform regular activities, such as getting to the bathroom and preparing food.
If patients are not progressing to the point that they can safely return to their home environment, in-patient rehabilitation may be recommended. This allows for further work with the therapists and 24-hour support services.

Patients who return home will have home services arranged as necessary. This may include a visiting therapist and/or nurse.


Walking: Most patients take their first steps after surgery with the aid of a walker. Patients with good balance and a strong upper body may opt to use crutches. Transitioning to a cane depends on two factors. First, restrictions from your surgeon -- not all surgeons allow full weight to be placed on the leg in the early weeks after surgery. Second, your ability to regain strength.

Usual time to return: 2 to 4 weeks with a cane; 4 to 6 weeks unassisted
Stairs: Many patients have to navigate stairs in order to enter or get through their homes. Therefore, your therapist will work with you to get up and down steps using crutches or a walker.

Usual time to return: 1 week with crutch/walker; 4 to 6 weeks unassisted
Driving: Return to driving depends on a number of factors, including the side of your operation and the type of vehicle you have (standard or automatic). Patients need to be able to safely and quickly operate the gas and brake pedals. Under no circumstances should patients drive when taking narcotic pain medications.

Usual time to return: 4 to 6 weeks
Work: Return to work depends on the activity that you have to do at your job. Patients who work in a seated position, with limited walking, can plan on returning about 4-6 weeks from the time of surgery.
Patients who are more active at work may need more time until they can return to full duties. Laborers should consider their work obligations before undergoing knee replacement. For example, patients may not be able to return to activities such as heavy lifting after knee replacement.

Usual time to return: 4 to 10 weeks, depending on work obligations


GuideEarly Postoperative Exercises
Early Activity
Advanced Exercises and Activities Regular exercise to restore your knee mobility and strength and a gradual return to everyday activities are important for your full recovery. Your orthopaedic surgeon and physical therapist may recommend that you exercise approximately 20 to 30 minutes two or three times a day and walk 30 minutes, two or three times a day during your early recovery.

Your orthopaedic surgeon may suggest some of the following exercises. The following guide can help you better understand your exercise/activity program, supervised by your therapist and orthopaedic surgeon.

Early Postoperative Exercises
Start the following exercises as soon as you are able. You can begin these in the recovery room shortly after surgery. You may feel uncomfortable at first, but these exercises will speed your recovery and actually diminish your postoperative pain.

Quadriceps Sets
Tighten your thigh muscle. Try to straighten your knee. Hold for 5 to 10 seconds.

Repeat this exercise approximately 10 times during a two minute period, rest one minute and repeat. Continue until your thigh feels fatigued.

Straight Leg Raises

Tighten the thigh muscle with your knee fully straightened on the bed, as with the Quad set. Lift your leg several inches. Hold for five to 10 seconds. Slowly lower.

Repeat until your thigh feels fatigued.

You also can do leg raises while sitting. Fully tighten your thigh muscle and hold your knee fully straightened with your leg unsupported. Repeat as above. Continue these exercises periodically until full strength returns to your thigh.

Ankle Pumps

Move your foot up and down rhythmically by contracting the calf and shin muscles. Perform this exercise periodically for two to three minutes, two or three times an hour in the recovery room.

Continue this exercise until you are fully recovered and all ankle and lower-leg swelling has subsided.

Knee Straightening Exercises

Place a small rolled towel just above your heel so that it is not touching the bed. Tighten your thigh. Try to fully straighten your knee and to touch the back of your knee to the bed. Hold fully straightened for five to 10 seconds.

Repeat until your thigh feels fatigued.

Bed-Supported Knee Bends

Bend your knee as much as possible while sliding your foot on the bed. Hold your knee in a maximally bent position for 5 to 10 seconds and then straighten.

Repeat several times until your leg feels fatigued or until you can completely bend your knee.

Sitting Supported Knee Bends

While sitting at bedside or in a chair with your thigh supported, place your foot behind the heel of your operated knee for support. Slowly bend your knee as far as you can. Hold your knee in this position for 5 to 10 seconds.

Repeat several times until your leg feels fatigued or until you can completely bend your knee.

Sitting Unsupported Knee Bends

While sitting at bedside or in a chair with your thigh supported, bend your knee as far as you can until your foot rests on the floor. With your foot lightly resting on the floor, slide your upper body forward in the chair to increase your knee bend. Hold for 5 to 10 seconds. Straighten your knee fully.

Repeat several times until your leg feels fatigued or until you can completely bend your knee.


Early Activity
Soon after your surgery, you will begin to walk short distances in your hospital room and perform everyday activities. This early activity aids your recovery and helps your knee regain its strength and movement.

Walking

Proper walking is the best way to help your knee recover. At first, you will walk with a walker or crutches. Your surgeon or therapist will tell you how much weight to put on your leg.

Stand comfortably and erect with your weight evenly balanced on your walker or crutches. Advance your walker or crutches a short distance; then reach forward with your operated leg with your knee straightened so the heel of your foot touches the floor first. As you move forward, your knee and ankle will bend and your entire foot will rest evenly on the floor. As you complete the step, your toe will lift off the floor and your knee and hip will bend so that you can reach forward for your next step. Remember, touch your heel first, then flatten your foot, then lift your toes off the floor.


Walk as rhythmically and smooth as you can. Don't hurry. Adjust the length of your step and speed as necessary to walk with an even pattern. As your muscle strength and endurance improve, you may spend more time walking. You will gradually put more weight on your leg. You may use a cane in the hand opposite your surgery and eventually walk without an aid.

When you can walk and stand for more than 10 minutes and your knee is strong enough so that you are not carrying any weight on your walker or crutches (often about two to three weeks after your surgery), you can begin using a single crutch or cane. Hold the aid in the hand opposite the side of your surgery. You should not limp or lean away from your operated knee.

Stair Climbing and Descending

The ability to go up and down stairs requires strength and flexibility. At first, you will need a handrail for support and will be able to go only one step at a time. Always lead up the stairs with your good knee and down the stairs with your operated knee. Remember, "up with the good" and "down with the bad." You may want to have someone help you until you have regained most of your strength and mobility.

Stair climbing is an excellent strengthening and endurance activity. Do not try to climb steps higher than the standard height (7 inches) and always use a handrail for balance. As you become stronger and more mobile, you can begin to climb stairs foot over foot.


Advanced Exercises and Activities
Once you have regained independence for short distances and a few steps, you may increase your activity. The pain of your knee problems before surgery and the pain and swelling after surgery have weakened your knee. A full recovery will take many months. The following exercises and activities will help you recover fully.

Standing Knee Bends

Standing erect with the aid of a walker or crutches, lift your thigh and bend your knee as much as you can. Hold for 5 to 10 seconds. Then straighten your knee, touching the floor with your heel first. Repeat several times until fatigued.

Assisted Knee Bends

Lying on your back, place a folded towel over your operated knee and drop the towel to your foot. Bend your knee and apply gentle pressure through the towel to increase the bend.

Hold for 5 to 10 seconds; repeat several times until fatigued.


Knee Exercises with Resistance
You can place light weights around your ankle and repeat any of the above exercises. These resistance exercises usually can begin four to six weeks after your surgery. Use one- to two-pound weights at first; gradually increase the weight as your strength returns. (Inexpensive wrap-around ankle weights with Velcro straps can be purchased at most sporting goods stores.)

Exercycling

Exercycling is an excellent activity to help you regain muscle strength and knee mobility. At first, adjust the seat height so that the bottom of your foot just touches the pedal with your knee almost straight. Peddle backward at first. Ride forward only after a comfortable cycling motion is possible backwards.

As you become stronger (at about four to six weeks) slowly increase the tension on the exercycle. Exercycle for 10 to 15 minutes twice a day, gradually build up to 20 to 30 minutes, three or four times a week.

Pain or Swelling after Exercise You may experience knee pain or swelling after exercise or activity. You can relieve this by elevating your leg and applying ice wrapped in a towel. Exercise and activity should consistently improve your strength and mobility. If you have any questions or problems, contact your orthopaedic surgeon or physical therapist.

What Sports Can I Perform After Knee Replacement?

The Knee Society recommends specific activities for patients with total knee replacement, these include:
Cycling
Calisthenics (gentle aerobics-style exercises)
Swimming
Low-resistance rowing
Skiing machines
Walking & hiking
Low-resistance weightlifting
Activities which The Knee Society specifically recommends to be avoided are:
Baseball
Basketball
Football
Hockey
Soccer
High-impact aerobics
Gymnastics
Jogging
Power lifting
One recent study on golf found that it places higher forces than jogging on the knee replacement implant

Specifically, the forward knee of the golfer is stressed significantly during the golf swing. Therefore, patients should be cautious about playing golf after a knee replacement.
These lists are meant to give patients an idea of what to expect if they undergo knee replacement surgery. Before you begin a new exercise program, it is important that you discuss this with your doctor. If there is an activity you do not see listed, and you are curious about your participation, ask your doctor.

CPM, also called continuous passive motion, is a device that is used to gently flex and extend the knee joint. The CPM machine can be used after surgery to allow the knee joint to slowly move. The initial thought was that CPM would improve motion following knee replacement surgery, as well as other knee procedures, and eliminate the problem of stiffness. By placing the knee in this device soon after surgery, scar tissue would not develop, and the problem of stiffness would not be a concern.

Latest Developments
Several recent studies have investigated the use of the CPM following knee replacement surgery and ACL reconstruction surgery. In nearly every study the results are essentially the same: there is some benefit in the first days and weeks following surgery, but there is no difference in knee motion after about six weeks. It does not seem to matter if the CPM is used, ultimately, the results are the same.


Knee surgery has come a long way in the past fifty years. However, orthopedic surgeons are always looking into ways to improve their results. One persistent problem following joint surgery is stiffness of the joint. Knees are especially problematic, because in order to resume our normal activities, we depend on excellent knee motion. The continuous passive motion, or CPM, was developed in an effort to begin motion as soon as possible following surgery, and hopefully alleviate the problem of post-operative stiffness.

Arguments For

The argument for a CPM is that patients do have an initial increase in motion following surgery that is more rapid than patients who do not use a CPM. Furthermore, patients who use a CPM following knee replacement surgery are less likely to require knee manipulation (where the patient is given general anesthesia, and the knee is forced into flexion) than patients who do not use a CPM. Also, patients often feel a strong desire to be "doing something" to help their recovery. While CPM may not actually alter the result of the surgery, it can give patients a sense that they are helping their recovery.

Arguments Against
No one has shown that a CPM makes any difference in the long run. Time and time again, studies show that within six weeks of knee replacement surgery, patients who use CPM and those that don't have the same range of knee motion. While there may be the psychological effect stated above, there has been no evidence to show that the use of CPM will ultimately improve the outcome of a knee replacement or anterior cruciate ligament reconstruction surgery. That said, there are some specific procedures, such as a release of contracture or adhesions, where a CPM can be an important part of the recovery from knee surgery.

Where it Stands
As stated previously, no one has been able to clearly demonstrate any long-term benefit to the routine use of CPM following a knee replacement or ACL reconstruction surgery. Many patients still use a CPM, but those that do not are at no disadvantage. As the studies clearly show, patients are likely to be at the same point within six weeks of surgery regardless of the use of a CPM.



Should you play sports after hip or knee replacement?
From Elizabeth Quinn,
Your Guide to Sports Medicine.

About.com Health's Disease and Condition content is reviewed by Medical Review Board

If you have had a recent hip or knee replacement you might question whether it is safe for you to participate in sports. While no randomized controlled trials exist that definitively answer that question, there are some collective opinions by experts in the field as to what activities are recommended or not recommended. The following recommendations are from a Bandolier [1] survey of consultant surgeons and fellows and senior residents involved in orthopaedic procedures at the Mayo Clinic [2].
The study asked the surgeons via a single page questionnaire whether they would recommend regular patient participation in 28 particular sports after hip or knee replacement surgery. Those recommendations are highlighted in the following table.

Recommended exercise includes: Golf, Swimming, Cycling, Sailing and Scuba
Not recommended exercise includes: Squash, Ice-hockey, Baseball, Running Water skiing, Karate, Basketball, Soccer and Rugby

To be recommended or not recommended required that more than 75% of surgeons agreed. Anything between these scores received a classification of intermediate. Cross-country skiing was recommended after knee but not hip replacement.

Recommended sports were supported by more than 75% of responders. A range of energetic and contact sports were not recommended by more than 75% of responders - including karate, soccer and water-skiing. Other activities, like tennis, ice-skating and aerobics had intermediate scores, and were neither recommended nor not. This paper had a literature search to identify reports on hip or knee surgical procedures and sports. In active golfers who had a knee replacement in the USA, the majority report a mild ache while playing, usually on the target side [3].

Obviously, there is a great deal of individual difference in ability to make a complete recovery after a major surgery. The decision to return to sport is one you must make along with the guidance of your surgeon and Physical Therapist.





Edited by: L*I*T*A* at: 5/31/2008 (16:01)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

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good ones Lita!

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ARTICLE # 4

TAKEN FROM WEB SITE:BIGKNEEPAIN.COM

Low-Impact Aerobic Exercises
Low-impact aerobic exercise benefits those with knee problems by toning the muscles of the leg that support the knee joint - to absorb shock before it reaches the knee joint.

Aerobic exercises also help in weight reduction. Losing weight reduces stress on the knee joint - the impact placed upon on the knees is three times the body weight while walking.

Aerobics also stimulate your the body to release endorphins - natural painkillers produced by one's own body.


Aerobic exercise is important for the health of the heart, lungs, and overall function of the body. However, high-impact exercises place extreme stress on the weight bearing joints. Those with knee problems should avoid high impact exercises. If you want to prevent future knee problems and knee pain you may want to replace high-impact activities with low-impact ones.

Warm up before aerobic exercise to slowly increase your heart rate and breathing rate. Five minutes of slow paced walking, and a few minutes of stretching are sufficient. Cooling down in the same manner is also important - be sure to stretch your quadriceps and hamstrings.

Know when to stop. Once your muscles are fatigued, they can't absorb as much shock, and the extra stress is offloaded to the joints, tendons, and ligaments. Taking every other day off will give your body a chance to repair itself and prevent overuse injury.

During pregnancy, hormones that allow the pelvic bones to become more flexible also cause the ligaments and tendons to loosen. This increases the chance of injury of a joint, especially during high-impact exercises. Check with your doctor or physical therapist (physiotherapist) as to the safety of an exercise

Recommended Low-Impact Aerobic Exercises
If you are experiencing knee pain, ask your doctor or physical therapist what exercises are appropriate.

Walking: Be sure to have proper shoes with adequate cushioning and support. Walk on even surfaces. Start with about 5 minutes of slower paced walking to warm up. Walk at a medium pace for about another 10 minutes per day and gradually build up to 30 - 60 minutes by adding a few minutes each time you walk. End your walk with 5 minutes of slower paced walking. After you get into better shape you can start walking at a faster pace to increase the intensity of your walks. You can increase the intensity level even more by swinging your arms as you walk. You should be about to talk while you are walking, otherwise you may be overexerting yourself.

Swimming and Water Exercises: If you have access to a swimming pool, swimming is an excellent no-impact exercise. Regular 'land' exercises can also be done underwater. The buoyancy of the water supports most of the body's weight while the resistance of the water make your muscles work harder to perform movements. You can use dumbbells and weights strapped to the ankles to intensify the workout without stressing the knees and other weight-bearing joints.

Overweight people in particular may find that walking aggravates knee pain. Walking underwater makes it possible for those with knee pain to get a good aerobic without stressing the joints. Most public swimming pools offer water exercise classes.

Many public pools offer water exercise classes specifically geared to people with arthritis The water is usually between waist-deep to chest-deep so one doesn’t have to know how to swim. Click here for warm water therapy.

Stationary bikes: Make sure your seat is high enough so that your knees are not bent beyond a 90-degree angle. Your knee should be slightly bent when your pedal is furthest away. An upright stationary bike (looks like a regular bike) gives you a higher intensity work out than a recumbent bike. A recumbent bike reclines and usually offers bucket seats and cushioned back support. It may lesson the strain on your knees and lower back.

Elliptical Trainer: Exercising on an elliptical trainer Is as low impact as walking but can provide a higher intensity cardio workout. The elliptical trainer is a cross between a stair climber and stationary bicycle. It is designed to use all of the body's main muscle groups and is a great way to get into shape and lose weight without sacrificing your knees.

Tips:

Proper Footwear helps absorb shock and provides support. Even with low-impact exercises, proper shoes are important.

Drink lots of water to prevent dehydration, drinking 2 cups of water before you start, and 1 cup for each 15 minutes of aerobic exercise



Arthritis and Exercise


There are over 100 forms of arthritis and other rheumatic diseases. These diseases may cause pain, stiffness, and swelling in joints and other supporting structures of the body such as muscles, tendons, ligaments, and bones. Some forms can also affect other parts of the body, including various internal organs.

Many people use the word "arthritis" to refer to all rheumatic diseases. However, the word literally means joint inflammation; that is, swelling, redness, heat, and pain caused by tissue injury or disease in the joint. The many different kinds of arthritis comprise just a portion of the rheumatic diseases. Some rheumatic diseases are described as connective tissue diseases because they affect the supporting framework of the body and its internal organs. Others are known as autoimmune diseases because they are caused by a problem in which the immune system harms the body's own healthy tissues. Examples of some rheumatic diseases are:

Osteoarthritis
Rheumatoid arthritis
Fibromyalgia
Systemic lupus erythematosus
Scleroderma
Juvenile rheumatoid arthritis
Ankylosing spondylitis
Gout
Arthritis and Exercise
Studies have shown that exercise helps people with arthritis in many ways. Exercise reduces joint pain and stiffness and increases flexibility, muscle strength, cardiac fitness, and endurance. It also helps with weight reduction and contributes to an improved sense of well-being.

Exercise is one part of a comprehensive arthritis treatment plan. Treatment plans also may include rest and relaxation, proper diet, medication, and instruction about proper use of joints and ways to conserve energy (that is, not waste motion) as well as the use of pain relief methods.

Experienced doctors, physical therapists, and occupational therapists can recommend exercises that are particularly helpful for a specific type of arthritis. Doctors and therapists also know specific exercises for particularly painful joints. There may be exercises that are off-limits for people with a particular type of arthritis or when joints are swollen and inflamed. People with arthritis should discuss their exercise plans with a doctor. Doctors who treat people with arthritis include rheumatologists, orthopaedic surgeons, general practitioners, family doctors, internists, and rehabilitation specialists (physiatrists).

The amount and form of exercise recommended for each individual will vary depending on which joints are involved, the amount of inflammation, how stable the joints are, and whether a joint replacement procedure has been done. A skilled physician who is knowledgeable about the medical and rehabilitation needs of people with arthritis, working with a physical therapist also familiar with the needs of people with arthritis, can design an exercise plan for each patient.

Types of Exercise
Three types of exercise are best for people with arthritis:

Range-of-motion exercises (e.g., stretching, dance) help maintain normal joint movement and relieve stiffness. This type of exercise helps maintain or increase flexibility. Range-of-motion exercises can be done daily and should be done at least every other day.
Strengthening exercises (e.g., weight training) help keep or increase muscle strength. Strong muscles help support and protect joints affected by arthritis. Strengthening exercises should be done every other day unless you have severe pain or swelling in your joints. The best type of strengthening program varies depending on personal preference, the type of arthritis involved, and how active the inflammation is. Strengthening one's muscles can help take the burden off painful joints. Strength training can be done with small free weights, exercise machines, isometrics, elastic bands, and resistive water exercises. Correct positioning is critical, because if done incorrectly, strengthening exercises can cause muscle tears, more pain, and more joint swelling.
Aerobic or endurance exercises (e.g., swimming, bicycle riding) improve cardiovascular fitness, help control weight, and improve overall function. Weight control can be important to people who have arthritis because extra weight puts extra pressure on many joints. Some studies show that aerobic exercise can reduce inflammation in some joints. Endurance exercises should be done for 20 to 30 minutes three times a week unless you have severe pain or swelling in your joints. According to the American College of Rheumatology, 20- to 30-minute exercise routines can be performed in increments of 10 minutes over the course of a day.
Most health clubs and community centers offer exercise programs for people with physical limitations.

Getting Started

Discuss exercise plans with your doctor.
Start with supervision from a physical therapist or qualified athletic trainer.
Apply heat to sore joints (optional; many people with arthritis start their exercise program this way).
Stretch and warm up with range-of-motion exercises.
Start strengthening exercises slowly with small weights (a 1- or 2-pound weight can make a big difference).
Progress slowly.
Use cold packs after exercising (optional; many people with arthritis complete their exercise routine this way).
Add aerobic exercise.
Consider appropriate recreational exercise (after doing range-of-motion, strengthening, and aerobic exercise). Fewer injuries to joints affected by arthritis occur during recreational exercise if it is preceded by range-of-motion, strengthening, and aerobic exercise that gets your body in the best condition possible.
Ease off if joints become painful, inflamed, or red, and work with your doctor to find the cause and eliminate it.
Choose the exercise program you enjoy most and make it a habit.
Overdoing It
Most experts agree that if exercise causes pain that lasts for more than 1 hour, it is too strenuous. People with arthritis should work with their physical therapist or doctor to adjust their exercise program when they notice any of the following signs of strenuous exercise:

Unusual or persistent fatigue
Increased weakness
Decreased range of motion
Increased joint swelling
Continuing pain (pain that lasts more than 1 hour after exercising)
It is appropriate to put joints gently through their full range of motion once a day, with periods of rest, during acute systemic flares or local joint flares. Patients can talk to their doctor about how much rest is best during general or joint flares.

Pain Relief
There are known methods to help stop pain for short periods of time. This temporary relief can make it easier for people who have arthritis to exercise. The doctor or physical therapist can suggest a method that is best for each patient. The following methods have worked for many people:

Moist heat supplied by warm towels, hot packs, a bath, or a shower can be used at home for 15 to 20 minutes three times a day to relieve symptoms. A health professional can use short waves, microwaves, and ultrasound to deliver deep heat to noninflamed joint areas. Deep heat is not recommended for patients with acutely inflamed joints. Deep heat is often used around the shoulder to relax tight tendons prior to stretching exercises.
Cold supplied by a bag of ice or frozen vegetables wrapped in a towel helps to stop pain and reduce swelling when used for 10 to 15 minutes at a time. It is often used for acutely inflamed joints. People who have Raynaud's phenomenon should not use this method.
Hydrotherapy (water therapy) can decrease pain and stiffness. Exercising in a large pool may be easier because water takes some weight off painful joints. Community centers, YMCAs, and YWCAs have water exercise classes developed for people with arthritis. Some patients also find relief from the heat and movement provided by a whirlpool.
Mobilization therapies include traction (gentle, steady pulling), massage, and manipulation (using the hands to restore normal movement to stiff joints). When done by a trained professional, these methods can help control pain and increase joint motion and muscle and tendon flexibility.
TENS (transcutaneous electrical nerve stimulation) and biofeedback are two additional methods that may provide some pain relief, but many patients find that they cost too much money and take too much time. In TENS, an electrical shock is transmitted through electrodes placed on the skin's surface. TENS machines might cost between $80 and $800. The inexpensive units are fine. Patients can wear them during the day and turn them on and off as needed for pain control.
Relaxation therapy also helps reduce pain. Patients can learn to release the tension in their muscles to relieve pain. Physical therapists may be able to teach relaxation techniques. The Arthritis Foundation has a self-help course that includes relaxation therapy. Health spas and vacation resorts sometimes have special relaxation courses.
Acupuncture is a traditional Chinese method of pain relief. A medically qualified acupuncturist places needles in certain sites. Researchers believe that the needles stimulate deep sensory nerves that tell the brain to release natural painkillers (endorphins). Acupressure is similar to acupuncture, but pressure is applied to the acupuncture sites instead of using needles.
Research
Researchers are looking at the effects of exercise and sports on the development of musculoskeletal disabilities, including arthritis. They have found that people who do moderate, regular running have low, if any, risk of developing osteoarthritis. However, studies show that people who participate in sports with high-intensity, direct joint impact are at risk for the disease. Examples are football and soccer. Sports involving repeated joint impact and twisting (such as baseball and soccer) also increase osteoarthritis risk. Early diagnosis and effective treatment of sports injuries and complete rehabilitation should decrease the risk of osteoarthritis from these injuries.

Researchers also are looking at the effects of muscle strength on the development of osteoarthritis. Studies show, for example, that strengthening the quadriceps muscles can reduce knee pain and disability associated with osteoarthritis. One study shows that a relatively small increase in strength (20% to 25%) can lead to a 20% to 30% decrease in the chance of developing knee osteoarthritis. Other researchers continue to look for and find benefits from exercise to patients with rheumatoid arthritis, spondyloarthropathies, systemic lupus erythematosus, and fibromyalgia They are also studying the benefits of short- and long-term exercise in older populations.

The information in this article has been made available by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health.








Edited by: L*I*T*A* at: 5/31/2008 (15:59)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

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ARTICLE # 3

Water Exercise Tips

A doctor's guidance is advised before you start an exercise program,
Water depth should be about chest high. There is more impact on your joints if you are standing in shallower water. Losing your balance and correct form will result if the water is too deep.
Exercising against the water can stress joints. Maintain proper form and don't over-exert your joints.
Wear water shoes to improve your footing and protect your feet.
Touching your heel to the floor each time your foot lands promotes correct form.
Stretch your muscles with a warm up before active exercise and a cool down afterward. Each stretching session should last 8-10 minutes.
Don't attempt to do too much too soon. If the movement hurts, don't do it. Water exercise should be painless.
Depending on your condition, you can exercise as slow or as fast as you desire.
Use barbells, noodles or gloves for additional resistance and increased intensity during your workout.
Use the Rate of Perceived Exertion to determine your intensity level during your exercise routine. These are your feelings of exertion, ranging from none to maximum effort. The "Talk Test" is even simpler - you should be able to talk with another person during your aquatic workout. If you can't, then you are working too hard and should slow down.
Workout with a friend for safety and encouragement.
Music is helpful to set your pace, to motivate, to avoid boredom or to soothe and calm.
Keep yourself hydrated before, during and after your workout by drinking plenty of water.

Benefits of Water Exercise
If you are reading this page, then you either want or need to exercise. We are living in a health and fitness era surrounded by a bombardment of facilities, programs, equipment, information, and options. Some of these attitudes focus on prevention, some on maintenance, and others on recovery. Whatever your reasons are for starting an exercise program, a doctor's initial guidance is advised.

Research has proven that, as the physical improves, so does the mental, emotional, and spiritual. Some of these benefits are:

Decreased: Stress, blood pressure, tension, weight, pain, body fat, impact on joints, risk of injury, and prescription drug requirements.

Increased: Strength, flexibility, energy, range of motion, muscle tone, oxygen/circulation, endurance, balance, coordination, fun, self esteem, safety, and enjoyment of life.

Enhanced: Feelings of well - being, sleeping patterns, recovery from injuries, social pleasures, and the reversing or slowing of ageing, both mentally and physically.

Success Factors

Your body is supported — making exercises easier and less painful while you are performing movements ranging from the simple to those that are nearly impossible on land.
The buoyancy provided by the water helps to protect your joints from the shocking impact usually associated with exercising on land.
Resistance of the water (hydrostatic pressure) against all of your motions resulting in higher workout intensities as compared to land exercises. A massaging effect is created when your muscles are surrounded by water.
Water provides twelve per cent more resistance than movements on land - without the gravitational stress and pain.
Water exercise is adaptable to everyone's desires, needs and abilities.
Non-swimmers can safely participate.
You are more likely to participate if you don't sweat or get your hair wet.
Water visually shields your body - for those participants feeling uncomfortable or awkward in normal exercise environments.
A variety of exercise equipment is available to assist with resistance and flotation.
High calorie burning during and after a workout.
In-door pools allow for year round exercise programs.
Your heart rate is slower making water exercise beneficial for pregnancy, obese, and heart disease participants.
Renews your energy level as it releases your stress and tension.
Water exercise is wonderful for participants with arthritis, back or other joint problems.


this is from the web site"about.com:physical therapy"

Aquatic therapy or pool therapy consists of an exercise program that is performed in the water. It is a beneficial form of therapy that is useful for a variety of medical conditions. Aquatic therapy uses the physical properties of water to assist in patient healing and exercise performance.
One benefit of aquatic therapy is the buoyancy provided by the water. While submerged in water, buoyancy assists in supporting the weight of the patient. This decreases the amount of weight bearing which reduces the force of stress placed on the joints. This aspect of aquatic therapy is especially useful for patients with arthritis, healing fractured bones, or who are overweight. By decreasing the amount of joint stress it is easier and less painful to perform exercises.

The viscosity of water provides an excellent source of resistance that can be easily incorporated into an aquatic therapy exercise program. This resistance allows for muscle strengthening without the need of weights. Using resistance coupled with the water’s buoyancy allows a person to strengthen muscle groups with decreased joint stress that can not be experienced on land.

Aquatic therapy also utilizes hydrostatic pressure to decrease swelling and improve joint position awareness. The hydrostatic pressure produces forces perpendicular to the body’s surface. This pressure provides joint positional awareness to the patient. As a result, patient proprioception is improved. This is important for patients who have experienced joint sprains, as when ligaments are torn, our proprioception becomes decreased. The hydrostatic pressure also assists in decreasing joint and soft tissue swelling that results after injury or with arthritic disorders.

Lastly, the warmth of the water experience during aquatic therapy assists in relaxing muscles and vasodilates vessels, increasing blood flow to injured areas. Patients with muscle spasms, back pain, and fibromyalgia find this aspect of aquatic therapy especially therapeutic.

It is important to know however, that aquatic therapy is not for everyone. People with cardiac disease should not participate in aquatic therapy. Those who have fevers, infections, or bowel/bladder incontinence are also not candidates for aquatic therapy. Always discuss this with your physician before beginning an aquatic therapy program.






Edited by: L*I*T*A* at: 5/29/2008 (23:49)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

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ARTICLE # 2

Study: Weight loss can have a big impact on knees


A pound of body weight always weighs a pound, right? Maybe not as far as your joints are concerned, a study published in the journal arthritis & Rheumatism shows.

In fact, researchers at Wake Forest University in Winston-Salem, North Carolina found that for overweight or obese adults with osteoarthritis of the knee, losing a single pound could result in a 4 lb reduction in pressure placed on the knee joint.

"Our results indicate that each pound of weight lost will result in a 4-fold reduction in the load exerted on the knee per step during daily activities," wrote lead researcher Dr. Stephen P. Messier and colleagues. "Accumulated over thousands of steps per day, a reduction of this magnitude would appear to be clinically meaningful."

Messier and colleagues tested the effect of weight loss on people's knee joints in a study involving more than 140 overweight and obese adults between the ages of 60 and 89. Most of the participants were women and all were considered sedentary prior to the start of the study.

Participants were enrolled in a weight loss program, some consisting of diet only, some of exercise only, and some of a combination of both and other healthy living habits. Weight and BMI were assessed at the start of the study and again at 6 and 18 months. At those times, participants also underwent gait (the manner of walking) analysis and a series of tests designed to measure pressure on the knees. They were also scored on a standardized scale of function and pain.

After 18 months, participants lost an average of 2% of their body weight and reduced their BMI by 3%. And when they analyzed those results in relation to the amount of force on participants' knees, they found the force reduction worked out to 4 times the amount of weight lost.

"The accumulated reduction in knee load for a 1-pound loss in weight would be more than 4,800 pounds per mile walked," noted Messier in a press release. "For people losing 10 pounds, each knee would be subjected to 48,000 pounds less in compressive load per mile walked."

Messier went on to add that while no long-term studies have yet demonstrated that weight loss could actually slow the progression of osteoarthritis of the knee, these results warrant further studies to determine whether slimming down could reduce the crippling complications of osteoarthritis.



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Edited by: L*I*T*A* at: 1/25/2014 (18:29)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

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ARTICLE #1


Patellar Subluxation and Dislocation
Information about an unstable kneecap
By Jonathan Cluett, M.D., About.com


About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD



Torn Knee Ligaments KNEECAP Problems Orthopaedic Surgery Knee Pains Sports Knee Injury
The patella, or kneecap, is one of three bones that come together at the knee joint. All of these bones have a layer of cartilage at points where their surfaces come into contact. The patella is also enveloped by a tendon. This tendon connects the quadriceps muscle of the thigh to the shin bone (tibia) below the knee.

What is patellar subluxation?
The kneecap slides up and down a groove on the end of the thigh bone as the knee bends. This groove is called the trochlea. The kneecap is designed to fit in the center of this groove, and slide evenly within the groove. In some people, the kneecap is pulled towards the outside of the knee. As this happens, the kneecap does not slide centrally within its groove.

Also called patellar subluxation, patients who experience an unstable kneecap have a kneecap that does not slide centrally within its groove. Depending on the severity of the patellar subluxation, this improper tracking may not cause the patient any problems, or it may lead to dislocation of the patella (where the kneecap fully dislocates out of the groove). Most commonly, the tracking problem causes discomfort with activity, and pain around the sides of the kneecap. Patellar subluxation is a condition that usually affects adolescent, and sometimes younger children.

What causes patellar subluxation?
There are dozens of factors implicated in the cause of patellar subluxation. The bottom line is that it is probably the contribution of several factors that lead to instablitiy of the kneecap. Possible factors include:

A wider pelvis
A shallow groove for the kneecap
Abnormalaties in gait
What else may be causing kneecap pain?
The most common cause of kneecap pain is chondromalacia, or an irritation of the cartilage on the undersurface of the kneecap. Patellar subluxation and chondromalacia can go hand in hand, but they should be considered separate entities. That said, if chondromalacia is being caused by subluxation, then the instability of the kneecap must be addressed for treatment to be successful. Other causes of kneecap pain include osteoarthritis, patellar tendonitis (Jumper's knee), and plica syndrome.

Is there any treatment for patellar subluxation?
Treatment of the unstable patella is first to ensure that the patella is not dislocated. Your doctor can determine by examining your knee and obtaining x-rays, to see if the kneecap is outside of its groove. In patients with a kneecap dislocation, the kneecap may need to be repositioned, or "reduced."

Treatment of patellar subluxation includes:

Physical Therapy
Traditionally, patients were sent to physical therapy to strengthen their VMO (part of the quadriceps muscle) to realign the pull on the kneecap. More recent research has shown that this is probably not the critical factor in eliminating kneecap problems. Focusing instead on strengthening of the hip abductors and hip flexors (so-called pelvic stabilization exercises) offers better control of the kneecap.

Bracing and Taping
Bracing and taping of the kneecap are also a conroversial topic in the rehabilitation of kneecap problems. These often provide symptomatic relief, but are certainly not a long-term solution. Caertianly if symptomatic relief is found with a brace or tape, it is certainly appropriate to continue with this as a treatment.

Better Footwear
Footwear contributes to the gait cycle. Motion control running shoes may help control your gait while running and decrease the pressure on the kneecap.
Is surgery ever needed for patellar subluxation or dislocation?
Some patients are not cured by conservative therapy, and it may be determined that surgery is needed, especially in patients who have significant pain or recurrent dislocation. By looking into the knee with an arthroscope, the surgeon can assess the mechanics of the knee joint to ascertain if there is an anatomic malalignment that could be corrected. One common malalignment is the result of too much lateral tension that pulls the kneecap out from its groove; this can place increased pressure on cartilage and lead to dislocation. For this problem, a procedure known as a lateral release can be performed. This procedure involves cutting the tight lateral ligaments to allow the patella to resume its normal position.

KNEECAP Pain

A dislocation of the patella occurs when the kneecap comes completely out of its groove, and rests on the outside of the knee joint. Kneecap dislocations usually occur as a significant injury the first time the injury occurs, but the kneecap may dilocate much more easily after the first injury.
Why do kneecap dislocations become a recurrent problem?
When the kneecap comes out of joint the first time, ligaments that were holding the kneecap in position are torn. The most commonly torn structure is called the medial patellofemoral ligament, or MPFL. This ligament secures the patella to the inside (medial) of the knee. When a kneecap dislocation occurs, something must fail to allow the kneecap out of the groove, and usually it is the MPFL.

Once the MPFL is torn, it often does not heal with proper tension, and the kneecap can subsequently dislocate more easily. That is why recurrent dislocation of the kneecap occurs in a high percentage of patients who have this injury.

What can be done to treat a kneecap dislocation?
Traditionally, kneecap dislocations were treated by bracing a patient, and allowing the MPFL to heal. Unfortunately, bracing does not seem to be terribly effective, and no matter how long a brace is worn after a kneecap dislocation, the redislocation rate is still quite high.

In patients who have recurrent (repeat) dislocations, there are surgical options. The usual treatment is to loosen the lateral (outside) ligaments that pull the kneecap; a so-called lateral release. At the same time, the muscle of the medial side of the knee (the VMO) is advanced to pull the kneecap more centrally.

What about surgery after a first-time kneecap dislocation?
Recent interest has developed in preventing these recurrent dislocations. Each time the kneecap dislocates, the cartilage can be injured, and the ligaments can become more stretched out. Some surgeons are trying to restore the normal anatomy by repairing the MPFL after a first-time dislocation. This surgery is controversial, because not all patients who dislocate their kneecap will have another dislocation. However, some patients would rather have the ligament repaired in an effort to lower the chance of having this become a repeat problem.





Edited by: L*I*T*A* at: 5/29/2008 (23:48)

“There's a difference between interest and commitment. When you're interested in doing something, you do it only when it's convenient. When you're committed to something, you accept no excuses; only results.”

When you get to a plateau, think of it as a landing on the stairway to your goal. And maintenance is a lifelong plateau, so a bit of "rehearsal" for maintenance isn't the worst thing in the world

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