June 23, 2021 - Manaaki Healthcare

What is a knee replacement surgery?

Knee replacement, also called knee arthroplasty or total knee replacement, is a surgical procedure to resurface a knee damaged by arthritis. Metal and plastic parts are used to cap the ends of the bones that form the knee joint, along with the kneecap. This surgery may be considered for someone who has severe arthritis or a severe knee injury.

Various types of arthritis may affect the knee joint. Osteoarthritis, a degenerative joint disease that affects mostly middle-aged and older adults, may cause the breakdown of joint cartilage and adjacent bone in the knees. Rheumatoid arthritis, which causes inflammation of the synovial membrane and results in excessive synovial fluid, can lead to pain and stiffness. Traumatic arthritis, arthritis due to injury, may cause damage to the cartilage of the knee.

The goal of knee replacement surgery is to resurface the parts of the knee joint that have been damaged and to relieve knee pain that cannot be controlled by other treatments.

Anatomy of the knee

Joints are the areas where 2 or more bones meet. Most joints are mobile, allowing the bones to move. Basically, the knee is 2 long leg bones held together by muscles, ligaments, and tendons. Each bone end is covered with a layer of cartilage that absorbs shock and protects the knee.

There are 2 groups of muscles involved in the knee, including the quadriceps muscles (located on the front of the thighs), which straighten the legs, and the hamstring muscles (located on the back of the thighs), which bend the leg at the knee.

Tendons are tough cords of connective tissue that connect muscles to bones. Ligaments are elastic bands of tissue that connect bone to bone. Some ligaments of the knee provide stability and protection of the joints, while other ligaments limit forward and backward movement of the tibia (shin bone).

The knee consists of the following:

Tibia. This is the shin bone or larger bone of the lower leg.
Femur. This is the thighbone or upper leg bone.
Patella. This is the kneecap.
Cartilage. A type of tissue that covers the surface of a bone at a joint. Cartilage helps reduce the friction of movement within a joint.
Synovial membrane. A tissue that lines the joint and seals it into a joint capsule. The synovial membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it.
Ligament. A type of tough, elastic connective tissue that surrounds the joint to give support and limits the joint’s movement.
Tendon. A type of tough connective tissue that connects muscles to bones and helps to control movement of the joint.
Meniscus. A curved part of cartilage in the knees and other joints that acts as a shock absorber, increases contact area, and deepens the knee joint.

Reasons for the procedure

Knee replacement surgery procedure is a treatment for pain and disability in the knee. The most common condition that results in the need for knee replacement surgery is osteoarthritis.

Osteoarthritis is characterized by the breakdown of joint cartilage. Damage to the cartilage and bones limits movement and may cause pain. People with severe degenerative joint disease may be unable to do normal activities that involve bending at the knee, such as walking or climbing stairs, because they are painful. The knee may swell or “give-way” because the joint is not stable.

Other forms of arthritis, such as rheumatoid arthritis and arthritis that results from a knee injury, may also lead to degeneration of the knee joint. In addition, fractures, torn cartilage, and/or torn ligaments may lead to irreversible damage to the knee joint.

If medical treatments are not satisfactory, knee replacement surgery procedure may be an effective treatment. Some medical treatments for degenerative joint disease may include, but are not limited to, the following:

Anti-inflammatory medications
Glucosamine and chondroitin sulfate
Pain medications
Limiting painful activities
Assistive devices for walking (such as a cane)
Physical therapy
Cortisone injections into the knee joint
Viscosupplementation injections (to add lubrication into the joint to make joint movement less painful)
Weight loss (for obese persons)

There may be other reasons for your doctor to recommend a knee replacement surgery.

Risks of the Knee Replacement Surgery Procedure

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

Bleeding
Infection
Blood clots in the legs or lungs
Loosening or wearing out of the prosthesis
Fracture
Continued pain or stiffness

The replacement knee joint may become loose, be dislodged, or may not work the way it was intended. The joint may have to be replaced again in the future.

Nerves or blood vessels in the area of surgery may be injured, resulting in weakness or numbness. The joint pain may not be relieved by surgery.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
If you are pregnant or suspect that you are pregnant, you should notify your doctor.
You will be asked to fast for eight hours before the procedure, generally after midnight.
You may receive a sedative prior to the procedure to help you relax.
You may meet with a physical therapist prior to your surgery to discuss rehabilitation.
Arrange for someone to help around the house for a week or two after you are discharged from the hospital.
Based on your medical condition, your doctor may request other specific preparation.

During the Knee Replacement Surgery Procedure

Knee replacement surgery procedure requires a stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.

Knee replacement surgery is most often performed while you are asleep under general anesthesia. Your anesthesiologist will discuss this with you in advance.

Generally, knee replacement surgery follows this process:

You will be asked to remove clothing and will be given a gown to wear.
An intravenous (IV) line may be started in your arm or hand.
You will be positioned on the operating table.
A urinary catheter may be inserted.
If there is excessive hair at the surgical site, it may be clipped off.
The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
The skin over the surgical site will be cleansed with an antiseptic solution.
The doctor will make an incision in the knee area.
The doctor will remove the damaged surfaces of the knee joint and resurface the knee joint with the prosthesis. The knee prosthesis is made up of metal and plastic. The most common type of artificial knee prosthesis is a cemented prosthesis. Uncemented prostheses are not commonly used anymore. A cemented prosthesis attaches to the bone with surgical cement. An uncemented prosthesis attaches to the bone with a porous surface onto which the bone grows to attach to the prosthesis. Sometimes, a combination of the 2 types is used to replace a knee.The prosthesis is generally comprised of 3 components: the tibial component (to resurface the top of the tibia, or shin bone); the femoral [thigh bone] component (to resurface the end of the thighbone; and the patellar component (to resurface the bottom of the kneecap that rubs against the thighbone).
The incision will be closed with stitches or surgical staples.
A drain may be placed in the incision site to remove fluid.
A sterile bandage or dressing will be applied.

After the procedure

In the hospital

After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Knee replacement surgery usually requires an in-hospital stay of several days.

It is important to begin moving the new joint after surgery. A physical therapist will meet with you soon after your surgery and plan an exercise program for you. A continuous passive motion (CPM) machine may be used to begin the physical therapy. This machine moves your new knee joint through its range of motion while you are resting in bed. Your pain will be controlled with medication so that you can participate in the exercise. You will be given an exercise plan to follow both in the hospital and after discharge.

You will be discharged home or to a rehabilitation center. In either case, your doctor will arrange for continuation of physical therapy until you regain muscle strength and good range of motion.

At home

Once you are home, it is important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.

To help reduce swelling, you may be asked to elevate your leg or apply ice to the knee.

Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Notify your doctor to report any of the following:

Fever
Redness, swelling, bleeding, or other drainage from the incision site
Increased pain around the incision site

You may resume your normal diet unless your doctor advises you differently.

You should not drive until your doctor tells you to. Other activity restrictions may apply. Full recovery from the surgery may take several months.

It is important that you avoid falls after your knee replacement surgery, because a fall can result in damage to the new joint. Your therapist may recommend an assistive device (cane or walker) to help you walk until your strength and balance improve.

Making certain modifications to your home may help you during your recovery. These modifications include, but are not limited to, the following:

Proper handrails along all stairs
Safety handrails in the shower or bath
Shower bench or chair
Raised toilet seat
Long-handled sponge and shower hose
Dressing stick
Sock aid
Long-handled shoe horn
Reaching stick to grab objects
Removing loose carpets and electrical cords that may cause you to trip
Avoiding stair-climbing until recommended by your doctor

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Disclaimer : This article has been sourced from https://www.hopkinsmedicine.org/ as it is. Click here to read original article.

What Is a Bone Marrow Transplant?

A bone marrow transplant is a medical procedure performed to replace bone marrow that has been damaged or destroyed by disease, infection, or chemotherapy. This procedure involves transplanting blood stem cells, which travel to the bone marrow where they produce new blood cells and promote growth of new marrow.

Bone marrow is the spongy, fatty tissue inside your bones. It creates the following parts of the blood:

red blood cells, which carry oxygen and nutrients throughout the body
white blood cells, which fight infection
platelets, which are responsible for the formation of clots

Bone marrow also contains immature blood-forming stem cells known as hematopoietic stem cells, or HSCs. Most cells are already differentiated and can only make copies of themselves. However, these stem cells are unspecialized, meaning they have the potential to multiply through cell division and either remain stem cells or differentiate and mature into many different kinds of blood cells. The HSC found in the bone marrow will make new blood cells throughout your lifespan.

A bone marrow transplant replaces your damaged stem cells with healthy cells. This helps your body make enough white blood cells, platelets, or red blood cells to avoid infections, bleeding disorders, or anemia.

Healthy stem cells can come from a donor, or they can come from your own body. In such cases, stem cells can be harvested, or grown, before you start chemotherapy or radiation treatment. Those healthy cells are then stored and used in transplantation.

Why You May Need a Bone Marrow Transplant

Bone marrow transplants are performed when a person’s marrow isn’t healthy enough to function properly. This could be due to chronic infections, disease, or cancer treatments. Some reasons for a bone marrow transplant include:

aplastic anemia, which is a disorder in which the marrow stops making new blood cells
cancers that affect the marrow, such as leukemia, lymphoma, and multiple myeloma
damaged bone marrow due to chemotherapy
congenital neutropenia, which is an inherited disorder that causes recurring infections
sickle cell anemia, which is an inherited blood disorder that causes misshapen red blood cells
thalassemia, which is an inherited blood disorder where the body makes an abnormal form of hemoglobin, an integral part of red blood cells

What Are the Complications Associated with a Bone Marrow Transplant?

A bone marrow transplant is considered a major medical procedure and increases your risk of experiencing:

a drop in blood pressure
a headache
nausea
pain
shortness of breath
chills
a fever

The above symptoms are typically short-lived, but a bone marrow transplant can cause complications. Your chances of developing these complications depend on several factors, including:

your age
your overall health
the disease you’re being treated for
the type of transplant you’ve received

Complications can be mild or very serious, and they can include:

graft-versus-host disease (GVHD), which is a condition in which donor cells attack your body
graft failure, which occurs when transplanted cells don’t begin producing new cells as planned
bleeding in the lungs, brain, and other parts of the body
cataracts, which is characterized by clouding in the lens of the eye
damage to vital organs
early menopause
anemia, which occurs when the body doesn’t produce enough red blood cells
infections
nausea, diarrhea, or vomiting
mucositis, which is a condition that causes inflammation and soreness in the mouth, throat, and stomach

Talk to your doctor about any concerns you may have. They can help you weigh the risks and complications against the potential benefits of this procedure.

Hyperbaric oxygen therapy, or HBOT, is a type of treatment used to speed up healing of carbon monoxide poisoning, gangrene, stubborn wounds, and infections in which tissues are starved for oxygen.

If you undergo this therapy, you will enter a special chamber to breathe in pure oxygen in air pressure levels 1.5 to 3 times higher than average. The goal is to fill the blood with enough oxygen to repair tissues and restore normal body function.

Facts about hyperbaric oxygen therapy

Hyperbaric oxygen therapy was first used in the U.S. in the early 20th century. This was when Orville Cunningham used pure oxygen to successfully treat someone dying from the flu. He developed a hyperbaric chamber, but dismantled it after his use of the therapy for other conditions failed.

The therapy was tried again in the 1940s when the U.S. Navy used hyperbaric oxygen to treat deep-sea divers who had decompression sickness. By the 1960s, the therapy was also used to combat carbon monoxide poisoning.

Today, it’s still used to treat sick scuba divers and people suffering from carbon monoxide poisoning, including firefighters and miners. It has also been approved for more than a dozen conditions ranging from burns to bone disease:

Carbon monoxide poisoning
Cyanide poisoning
Crush injuries
Gas gangrene (a form of gangrene in which gas collects in tissues)
Decompression sickness
Acute or traumatic inadequate blood flow in the arteries
Compromised skin grafts and flaps
Infection in a bone (osteomyelitis)
Delayed radiation injury
Flesh-eating disease (also called necrotizing soft tissue infection)
Air or gas bubble trapped in a blood vessel (air or gas embolism)
Chronic infection called actinomycosis
Diabetic wounds that are not healing properly

Medicare, Medicaid, and many insurance companies generally cover hyperbaric oxygen therapy for these conditions, but may not do so in every circumstance. Check with your insurance plan before treatment.

How does HBOT work?

HBOT helps wound healing by bringing oxygen-rich plasma to tissue starved for oxygen. Wound injuries damage the body’s blood vessels, which release fluid that leaks into the tissues and causes swelling. This swelling deprives the damaged cells of oxygen, and tissue starts to die. HBOT reduces swelling while flooding the tissues with oxygen. The elevated pressure in the chamber increases in the amount of oxygen in the blood. HBOT aims to break the cycle of swelling, oxygen starvation, and tissue death.
HBOT prevents “reperfusion injury.” That’s the severe tissue damage that happens when the blood supply returns to the tissues after they have been deprived of oxygen. When blood flow is interrupted by a crush injury, for instance, a series of events inside the damaged cells leads to the release of harmful oxygen radicals. These molecules can do damage to tissues that can’t be reversed and cause the blood vessels to clamp up and stop blood flow. HBOT encourages the body’s oxygen radical scavengers to seek out the problem molecules and allow healing to continue.
HBOT helps block the action of harmful bacteria and strengthens the body’s immune system. HBOT can disable the toxins of certain bacteria. It also increases oxygen concentration in the tissues. This helps them resist infection. In addition, the therapy improves the ability of white blood cells to find and destroy invaders.
HBOT encourages the formation of new collagen (connective tissue) and new skin cells. It does so by encouraging new blood vessel formation. It also stimulates cells to produce certain substances, like vascular endothelial growth factor. These attract and stimulate endothelial cells necessary for healing.

Types of hyperbaric oxygen chambers

Hyperbaric oxygen therapy uses 2 types of chambers:

Monoplace chamber. This is a chamber built for one person. It’s a long, plastic tube that resembles an MRI machine. The patient slips into the chamber. It is slowly pressurized with 100% oxygen.
Multiplace chamber. This chamber, or room, can fit two or more people at once. The treatment is largely the same. The difference is that people breathe pure oxygen through masks or hoods.

What happens during HBOT

Only a healthcare provider should prescribe hyperbaric oxygen therapy. A number of hospitals offer hyperbaric oxygen chambers. People relax, sit, or lie comfortably in these chambers and take deep breaths in sessions that last up to 2 hours.

Your ears may feel plugged as the pressure is raised, like when you’re in an airplane or the mountains. Simple swallowing or chewing gum will “pop” the ears back to normal hearing levels.

Your blood carries the extra oxygen throughout the body, infusing the injured tissues that need more oxygen so they can begin healing. When a session is complete, you may feel lightheaded. Mild side effects include claustrophobia, fatigue, and headaches.

Several sessions may be needed, so check beforehand to see whether your insurance company, Medicaid, or Medicare covers the cost.

Precautions

Hyperbaric oxygen therapy is not for everyone. It should not be used by people who have had a recent ear surgery or ear trauma, a cold or fever, or certain types of lung disease.

The most common complication after HBOT is trauma to the middle ear. Other possible complications are eye damage and sinus problems. In rare, severe cases, a person can get oxygen poisoning. This can lead to seizures, fluid in the lungs, lung failure, or other problems. Considering the possible risks and benefits, the decision to use hyperbaric oxygen therapy must be carefully made after a detailed discussion with your healthcare provider.

Disclaimer : This article has been taken from https://www.hopkinsmedicine.org/ as it is. Click here to read original article.