Not to scare you but this is NOT a comfortable surgery to recover from. I frequently tell my patients who are planning this surgery to expect to be miserable for 1-3 weeks. Miserable is a very strong word yet very few of my patients say it wasn't as bad as they thought it was going to be. What surprises many of my patients is how long the knee remains uncomfortable after surgery, many of them think "I am tough" or "I am in good shape going into surgery" so it shouldn't be that bad. Unfortunately this is basically carpentry of the body and it hurts. Toughing it out for a few days isn't enough because it still hurts after week one and two. With that said, the outcomes are EXCELLENT and almost everyone is glad they had their surgery and often wish they had it sooner.
Fortunately the pain gradually subsides and the new complaint is STIFFNESS. If you leave your knee straight too long it hurts and if you leave it bent too long it hurts. Stationary bikes are really helpful at keeping the knee from getting too stiff and it is quite rewarding the first time you make a full revolution on the bike. Most of my patients will struggle to get knee extension (straightening) OR knee flexion (bending), rarely do patients have trouble getting both directions. Knee extension is the priority as it allows you to stand and walk properly. If you are fortunate enough to have your range of motion come back easily, your rehab is much more comfortable. The stiffer you are, the harder/longer it needs to be pushed on by the patient or therapist.
A total knee replacement or total knee arthroplasty is exactly what it sounds like. You are getting a "new" joint. Many patients have two "bad" knees by the time they are thinking about joint replacements. It isn't uncommon that the knee that looks worse on x-ray isn't the more painful knee. Most patients choose to have the more painful knee done first and it isn't long after surgery before your "bad" knee becomes your "good" knee. Your new knee will NOT look like your old knee, not only will you have a nice scar down the front of your knee, the knee itself will appear wider than your non-surgical knee, many of my patients think this is swelling that will subside and are disappointed when I tell them it is actually just the shape of their new knee. If you have both your knees replaced, you will then have a matching set! Swelling and bruising are common and frequently not a concern, if you have concerns about how your incision looks please contact your surgeon or PT. Your knee/leg often aren't too pretty in that first week but will improve quickly.
A Good Outcome
Orthopedic surgeons that specialize in joint replacements do a lot of them, some average 8 or more a day. That high volume allows the surgeon and their entire surgical team to be very good at them. The outcomes are generally EXCELLENT.
Total knee replacements are the most common surgery I see here at Altitude Physical Therapy and myself and our other therapists are very confident in treating patients afterwards. Some of those treated before surgery are able to delay surgery or eliminate the need entirely. Please don't hesitate to reach out to any of the Altitude clinics if you have further questions or concerns of what to expect.
Drew Sowyrda, PT, DPT
Total knee replacements -- or total knee arthroplasties (TKA) have become one of the most performed orthopedic surgeries in the world. According to the Agency for Healthcare Research and Quality, in 2017, more than 754,000 knee replacements were performed in the United States. In the PT clinic I treat as many patients after total knee replacements as any other orthopedic surgery. In orthopedic healthcare, total knee replacements are widely regarded as one of the most successful surgeries. The AAOS notes that over 90 percent of replacement knees are still functioning after 15 years.
Knee replacements are most often done when a person’s knee joint develops severe arthritis. This is when the cartilage in the knee joint -- at the bottom of the femur (“thigh bone”) and the top of the tibia (“shin bone”) -- degrades and the joint becomes painful and usually inflamed. Cartilage acts as padding in the knee joint and to decrease friction as the knee moves. When a person loses most of the cartilage in the knee this can be described as “bone on bone” arthritis and can require a TKA. Most of the time this loss of cartilage is due to wear and tear and is described as osteoarthritis. In some cases this can be caused by an inflammatory condition called rheumatoid arthritis or trauma like a motor vehicle accident.
Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Recently more and more surgeons are utilizing robotic guided surgical techniques and generally with excellent outcomes.
In a traditional TKA the surgeon uses preoperative x-rays, intraoperative anatomical landmarks, and manually positioned alignment jigs to guide bone cutting and implant positioning. These handheld techniques can lead to less reliable alignment-guide positioning, inadvertent sawblade injury to the knee muscles and ligaments, and limited ability to fine-tune the implant positioning. Suboptimal implant positioning may lead to poor functional recovery and reduced implant survivorship. (At this point I should note that I work with many surgeons who have done hundreds or thousands of these traditional TKAs with great clinical outcomes.)
Robotic TKA uses computer software to convert anatomical information into a virtual patient-specific 3D reconstruction of the knee joint. The surgeon uses this virtual model to plan optimal bone cutting and implant positioning based on the patient’s unique anatomy. An intraoperative robotic device helps to execute this preoperative patient-specific plan with a high level of accuracy. The action of the sawblade is confined to the preoperative surgical plan which limits soft-tissue injury and bone trauma.
A 2019 systematic review about robotic total knee replacement found the following:
If you are considering getting a TKA there is clearly a lot of evidence that robotic TKA are effective and in some ways superior to a traditional TKA. That being said, there are many other factors to consider when looking for a surgeon to do your TKA including:
Once you've made your decision don't forget the importance of rehab! All of our physical therapists are experts in both pre and post op knee replacement rehab. For more information about what to do once you've made this big decision, check out this informational page and reach out to one of our clinics to set up an appointment!
Eric Hanyak, PT, DPT
ANSWER: It depends
Yoga is a group of physical, mental, and spiritual practices or disciplines which originated in ancient India. Yoga is one of the six orthodox schools of Hindu philosophical traditions. There is a broad variety of yoga schools, practices, and goals in Hinduism, Buddhism, and Jainism. The term "yoga" in the Western world often denotes a modern form of Hatha yoga, yoga as exercise, consisting largely of the postures called asanas.
Is Yoga safe?
In order to teach Yoga you have to study five areas:
Studies have found the incidence of pain in Yoga practitioners caused by Yoga is more than 10% per year - which is comparable to the rate of all sports injuries combined among the physically active population.
There is some evidence that regular Yoga practice is beneficial for people with high blood pressure, heart disease, aches and pains - including lower back pain - depression and stress.
The National Center for Complementary and Integrative Health (part of the NIH) suggests the above findings, however they note "Although there has been a lot of research on the health effects of yoga, many studies have included only small numbers of people and haven't been of high quality. Therefore, in most instances, we can only say that yoga has shown promise for particular health uses, not that it has been proven to help".
Created by Joseph Pilates in the 19302, Pilates was first called Contrology and inspired during WWI while held in camp for four years. Joseph was a nurse-physiotherapist and his goal was to create lifelong sustainable exercise at a low cost. Pilates recognized that the brain controls mobility and stability of the body. Specific muscles are used in a functional sequence at controlled speeds - emphasizing quality, precision and control of movement. Complex movements are broken down step-by-step to internalize the pattern.
Regular practice should lead to:
Yoga and Pilates compared
Similarities: strength, flexibility, fitness, importance of breath
Differences: Pilates emphasizes core strength while yoga emphasizes flexibility
So should I do yoga or Pilates?
Depending on classification it may make sense for you to do one or the other, or both, or possibly neither!
How do I know my low back pain classification?
See an expert at Altitude! All our physical therapists are experts in identifying movement patterns and dysfunctions as well as classifying the best way to treat your low back pain!
Caitlin Barritt, PT, DPT, OCS
Bob Cranny, PT