Patient Information And Rehabilitation Guidelines ...
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This booklet aims to improve your understanding of Atlas knee surgery and the rehabilitation afterwards. Osteoarthritis can affect any joint in the body but is more common in joints in the lower limb weight-bearing joints, eg hip and knee. A joint is formed where two bones meet. The ends of the bones, which form the joint, are covered in articular cartilage. This provides a smooth, slippery and low friction surface that also cushions the joint. Healthy cartilage absorbs stress and allows the bones to glide across each other smoothly. The word arthritis means joint inflammation. Also known as ‘degeneration’ or ‘wear and tear’ arthritis, osteoarthritis is the most common type of arthritis and develops over a long period of time. It affects the articular cartilage, which can start to wear away causing bone to rub against bone. Sometimes this affects one side of the knee joint more than the other, usually the inside side of your knee. Patient Information And Rehabilitation Guidelines Following Atlas Knee Surgery Anatomy Osteoarthritis
Transcript of Patient Information And Rehabilitation Guidelines ...
ThisbookletaimstoimproveyourunderstandingofAtlaskneesurgeryandtherehabilitationafterwards.
Osteoarthritiscanaffectanyjointinthebodybutismorecommoninjointsinthelowerlimbweight-bearingjoints,eghipandknee.
Ajointisformedwheretwobonesmeet.Theendsofthebones,whichformthejoint,arecoveredinarticularcartilage.Thisprovidesasmooth,slipperyandlowfrictionsurfacethatalsocushionsthejoint.Healthycartilageabsorbsstressandallowsthebonestoglideacrosseachothersmoothly.
Theword arthritismeans joint inflammation. Also known as ‘degeneration’ or‘wearandtear’arthritis,osteoarthritisisthemostcommontypeofarthritisanddevelopsoveralongperiodoftime.It affects the articular cartilage,which can start towear away causingbone torubagainstbone.Sometimesthisaffectsonesideofthekneejointmorethantheother,usuallytheinsidesideofyourknee.
PatientInformationAndRehabilitationGuidelinesFollowingAtlasKneeSurgery
Anatomy
Osteoarthritis
Researchshowsthatkneearthritiscanbeginorprogressifthe joint is exposed to excess stress or load, which canresult in pain and loss of motion. Several conditions canleadtojointoverloadincludinganatomy,injuryorobesity.Whentoomuchloadisplacedonthejoint,theprogressioncan lead to painful knee arthritis. Restoring the joint tonormal loading conditions may relieve the pain whilemaintaininghealthycartilage.Thegoalsoftreatmentincludeminimisingpain,restoringnormalactivitylevels,and slowing disease progression. While drugs and certain cartilage repairproceduresmaytemporarilyrelievepain,theyoftendonottreattheunderlyingproblems that led to arthritis.Although some invasive surgicalprocedures caneffectively reduce joint stress, they often involve permanent changes to thejoint’snaturalanatomy,whichmaylimitfuturetreatmentoptions.
TheAtlasSystemoffersanoptionbetween injection treatmentsandhigh tibialosteotomy treatment, and can provide pain reliefwith the preservation of thepatientsownkneeandcontinuationofimpactactivitiesandheavymanualwork,unlikepartialortotaljointreplacementwheresuchactivitiesmayleadtoearlyfailureofthereplacementandtheneedforrevisionjointreplacement.The Atlas system is an implantable joint unloader that works like a shockabsorberforyourknee.Theconcepthasbeenvalidatedtoprovidepainreliefforpatients since it’s predecessor, TheKinespring Systemhas been in clinical usesince2008withoverathousandcasesdoneworldwide.ThelessonslearntfromthisexperiencehavebeenincorporatedintotheAtlassystemwhichhasbeeninclinicalusefor18monthsandimplantedover100times.TheAtlassystemisspecificallydesignedtoallowarthritissuffererstomaintainhigh activity or productivity levels. The Atlas System is manufactured fromadvancedbiomaterialsandhaspasseddurabilityandbiocompatibilitytesting.
WhatistheAtlasSystem?
TheAtlassystemmaybeappropriateifyou:
§ Sufferfrompainonthemedial(inner)sideofyourknee,especiallywithactivity
§ Desiretobemoreactiveagain§ Havemedialcompartmentkneeosteoarthritis(OA)
TheAtlasSystemwillnotcureyourosteoarthritis,butitmayprovidepainrelief.
TheAtlasSystemisimplantedundertheskin,alongsidethekneejoint.Nobone,ligament or cartilage is removed. The implant and procedure are specificallydesignedtofacilitatequickrecoverywhilemaintainingfuturetreatmentoptions.AstheSystemisimplantedoutsidethejointcapsuleitwillbestraightforwardtoremove if needed and leave other options such as high tibial osteotomy,unicompartmental knee replacement or total knee replacement open to thepatientandtheirsurgeon.The implant and procedure are specifically designed to facilitate quickrecoverywhilemaintainingfuturetreatmentoptions.The Atlas System is carried out under general anaesthetic. The procedurerequiresonemedialapproximately10cmincisionontheinsidepartoftheleg,aboveandbelowthekneejoint.TheAtlasSystemisinsertedviathisincisionandsecuredwithbonescrewstothefemurandtibia(themajorbonesinyourupperandlowerleg).Nobone,ligament,orcartilageisremoved.X-rayimagesmaythentakentoensurethattheAtlasSystemiscorrectlypositionedandfunctioningproperly.FurtherinformationabouttheAtlassystemcanbefoundon:www.moximed.com
Treatmentforkneeosteoarthritisisbasedonindividualsymptoms,activityleveland other medical conditions. The goals of osteoarthritis treatment includeminimising pain, restoring normal activity levels and slowing diseaseprogression.Some treatments such as a high tibial osteotomy, a unicompartmental kneearthroplastyoratotalkneereplacementcanreducethestressonyourkneeandrelievepain,buttheyinvolvemoreinvasivesurgery.
Theprocedure
Otheroptionsforkneearthritis
High tibialosteotomy is a surgicalprocedure to realign the legand reduce thepainyouhavefromyourkneebytransferringthebodyweighttothepreservednormaloutersideoftheknee.Unicompartmental knee arthroplasty is a surgical procedure used to relievearthritislimitedtoasinglepartcompartmentsofthekneeinwhichthedamagedpartsofthekneearereplaced.Atotalkneereplacementisasurgicalproceduretoreplacebothsidesofthekneeandthekneecapjointtorelievepainanddisability.In contrast the Atlas Knee Implant System is designed to absorb excess kneeloads whilst preserving your natural joint anatomy in a less invasive surgicalprocedure.
Complicationsdooccur.Someareminorandsomerequirefurthersurgery.Itisimportant you understand this before proceeding with surgery. Examplesinclude:Complication RecordedinliteratureAnaestheticrisks(discussedwithyouranaesthetist)
Infection Deepveinthrombosis(clotintheleg)
Pulmonaryembolism(clotinthelung)
Furthersurgerytotheknee Fracture Damagetovesselsornerves Any surgical intervention can theoretically result in mortality (death), it isextremelyrareforthistohappenforthisprocedurebutrecentlegalrulingshavemandatedthisbementioned.
Anassessmentof your fitness toundergo surgery includingadetailedmedicalhistory, height, weight, blood pressure and pulse will be performed beforesurgery.Bloodtestsandahearttrace(ECG)mayalsobeneeded.
Complications
Pre-operativeAssessment
You are asked not to drink or eat anything for at least 6 hours before youroperation.You will be seen by Professor McNicholas and your Anaesthetist before youroperation.In the anaesthetic room, youwill have aneedleput into your armandwill beplacedonananaestheticmachine.Surgeryusuallytakesaround30–60minutes.Youwillwake-upinthetheatrerecoveryroom.Onreturntothewardyouwillhavethefollowing:
§ Dressings–woolandcrepebandageonthekneeandasplint§ Dripsanddrains–theremaybesmalltubesinthebackofyourhand.You
mightalsohaveatubeintoyourbladder(catheter).§ Analgesia– thismaybeoralmedicationorpatient controlled analgesia
(PCA),whichlookssimilartoadrip.
You can be discharged from hospital if progressing well, managingexercises,andsafeonthestairs.
Thewoundistobekeptdryuntilhealedandthedressingisnottobedisturbedunlesssoiledandacleanoneapplied.Regulariceapplication(10-15minsevery1-2hours).Youwillbegivenpainrelievingmedicationstotakehomewithyou,pleasetakethese asprescribed topreventpain frombuildingup to a level that is hard tocontrol.Physiotherapy appointment arranged. Expect bruising in the thigh and lowerleg.Rememberyourscarishighlysusceptibletothesun,anduseofahigherfactorsunblockisadvised.
TheDayoftheOperation
DischargeInstructions
Returntoworkwilldependgreatlyonthejobthatyoudo(desk-basedjobs2-4weeks;manualjobs6-12weeks;jobsrequiringladdersetc.3-4months).Returntodrivingat6weeksformanualgearedcarsandautomaticcarsifitistherightlegthathasbeenoperatedon.Ifitistheleftlegthathasbeenoperatedon,youmaydriveanautomaticcaroncethewoundsarehealedat2weeks.You should notify your insurance company of the procedure that has beenundertakentoensurethatyourcoverisvalid.Forfurtherinformationfollowthisweblink:https://www.gov.uk/driving-medical-conditionsFlying is not permitted for 8weeks following surgery due to a higher risk ofdevelopingabloodclot.Forfurtherinformationfollowtheweblinkbelow:http://www.nhs.uk/chq/Pages/2615.aspx?C%20ategoryID=69
Youwillbeseenat2weeks,3,6,12weeksand3,6,9,12months,2,5,10yearsannually after that. There will be an internet database used to collect youroutcomesscoresandrecorddetailsofyourkneeoperation.
Physiotherapyprogrammetofollow.
VTEisacollectivetermfortwoconditions:
§ DVT (deepveinthrombosis)–thisisabloodclotmostcommonlyfoundinadeepveinthatblockstheflowofblood.
§ PE(pulmonaryembolism)–apotentialfatalcomplicationwhereabloodclotbreaksfreeandtravelstothelungs.
Whilstyouarelessmobile,especiallyduringthefirstfewweeksfollowingyourprocedure,theriskofVTEishigherbecauseofyourimmobility.ProfessorMcNicholasmayprescribeyouadailyinjectionofClexanetohelpthinyourbloodand these should last approximately14days. If this isneeded, youwillbeshownhowtoinjectthisdrugyourself.
GeneralAdvice
Follow-up
Rehabilitation(Physiotherapy)Programme
VTE(bloodclots)
Symptoms:
§ Swelling – youwill have some swelling due to your surgery but if youhaveanyconcernspleasecallforadvice
§ Pain–anynewpainwewanttoknowabout§ Calftenderness§ Heatandrednesscomparedwiththeotherleg§ Shortnessofbreath§ Chestpainwhenbreathingin
ThingsyoucandotopreventVTE
§ Movearoundasmuchaspossible.Besensiblethough,shortandregularmovementisbest
§ Drinkplentyofwatertokeepyourselfhydrated§ Westronglyadviseyounot to smoke– thiswillhavebeendiscussed in
preopbutwecanalsoreferyoutooursmokingcessationteamwithintheHospital.
§ Move your ankle around asmuch as possible to keep your calfmusclepumping
Smallpreventativemeasurescanhaveahugeimpactonyourrecovery.Writtenby: MoximedInc.
MissFRashid,OrthopaedicRegistrarMrRichardNorris,OrthopaedicPhysiotherapistSpecialistProfessorMJMcNicholas,ConsultantOrthopaedicSurgeon
Datelastreviewed: April2016
