Knee Rheumatoid Arthritis
Rheumatoid arthritis of the knee
What is rheumatoid arthritis?

Rheumatoid arthritis is a form of inflammatory arthritis and an autoimmune disease. For reasons no one fully understands, in rheumatoid arthritis, the immune system - which is designed to protect our health by attacking foreign cells such as viruses and bacteria - instead attacks the body's own tissues, specifically the synovium, a thin membrane that lines the joints. As a result of the attack, fluid builds up in the joints, causing pain in the joints and inflammation that's systemic - meaning it can occur throughout the body.
Causes
The exact cause of rheumatoid arthritis is unknown. It's possible that a virus or bacteria may trigger the disease in people with a genetic predisposition to rheumatoid arthritis. Many doctors think rheumatoid arthritis is an autoimmune disease in which the tissue of the joint's lining is attacked by the body's immune system. It's also possible that rheumatoid arthritis is caused by severe stress. The onset of rheumatoid arthritis occurs most frequently in middle age and is more common among women.
Symptoms
The primary symptoms of rheumatoid arthritis are similar to osteoarthritis and include pain, swelling and the loss of motion. In addition, other symptoms may include loss of appetite, fever, energy loss, anemia, and rheumatoid nodules (lumps of tissue under the skin). People suffering with rheumatoid arthritis commonly have periods of exacerbation or "flare ups" where multiple joints may be painful and stiff.
Treatment
Treatment of rheumatoid arthritis may involve medications such as non-steroidal anti-inflammatory drugs (NSAIDs), aspirin and analgesics. Corticosteroids may be prescribed and are effective in decreasing the inflammation associated with rheumatoid arthritis. Side effects can occur with the use of corticosteroids, and close monitoring by a physician is essential. Researchers have made progress in the treatment of rheumatoid arthritis and newer prescription drugs are now available. If non-surgical measures fail, you and your surgeon may decide that total knee replacement is the best treatment option to relieve your pain and help you return to an improved functional level.
When is knee replacement surgery recommended?
What is the right age for total knee surgery?
Your surgeon's recommendation for knee replacement is based mainly on your level of pain and disability; there are no absolute restrictions on age or weight. Most of the people who have knee replacement surgery are between the ages of 50 and 80. The procedure has a high success rate and is considered relatively safe and effective.1 Women are more likely to undergo the procedure; in 2009, the rate of knee arthroplasty for female patients was 57 percent higher than for males2.
How do I know when it's time to consider surgery?
There are several reasons why your doctor may recommend knee replacement surgery.
People who benefit from knee replacement surgery often have:
- Knee pain that limits everyday activities, such as walking or bending
- Knee pain that continues while resting, either day or night
- Stiffness in a knee that limits the ability to move or bend the leg
- Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports
Important safety notes
Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.
References
- American Academy of Orthopaedic Surgeons website, accessed March 7, 2017: https://orthoinfo.aaos.org/topic.cfm?topic=A00389
- HCUP Facts and Figures: Statistics on Hospital-based Care in the United States, 2009. Accessed March 7, 2017: https://www.hcup-us.ahrq.gov/reports/factsandfigures/2009/TOC_2009.jsp

Total knee replacement surgery is considered when all other conservative measures have failed to provide successful intervention, and may be performed for the following reasons:
- To relieve pain
- To improve joint stability
- To improve alignment and correct bone deformity
- To maximize quality of life
- To optimize activities of daily living
Total knee replacement surgery is a common procedure performed on more than 600,000 people worldwide each year. With recent advancements in surgical technique and implant design, patients have experienced dramatic improvement in knee pain, function, and quality of life. Furthermore, most patients can now expect their implants to last up to a decade or more, allowing for years of active, healthier, pain-free living.
Knee replacement recovery

Your knee replacement: recovery
Knee replacement is most commonly performed as an inpatient procedure in a hospital. However, as healthcare options expand and surgical techniques continue to improve, alternatives including outpatient surgery and shorter hospital stays are becoming more common. Whatever is the best option for you, your medical team will help manage your pain following surgery, and your recovery and rehabilitation will begin shortly after your release from the surgical recovery area.
Remember, the information in this section is not intended to replace professional medical advice. If you have questions or concerns, turn to your doctor for answers.
Post-operative care
After your surgery, you will be transported to a recovery room for close observation of your vital signs, circulation, and sensation in your legs and feet. After you awaken and your medical team is comfortable with your progress, you may be transferred to your room or, in the case of outpatient surgery, discharged to go home. Here are some things you may notice as you recover from your surgery:
- A large dressing may be applied to your incision. This bandage helps to maintain cleanliness and absorb any fluid that seeps from the incision.
- A drain may be placed near your incision in order to record the amount of drainage from the wound.
- You may be wearing elastic stockings, or a compression stocking sleeve to help minimize your risk of blood clots.
- A PCA (patient-controlled analgesia) device that delivers a small amount of pain medication may be connected to your IV. The unit is designed to deliver a small, controlled flow of pain medication; it This device is button-activated activates when you firmly press the button on the machineand delivers a controlled amount of pain medication. Follow the instructions of your care team on how to use the PCA device.
- A catheter may be inserted in your bladder as the side effects of anesthesia can make it difficult to urinate.
Post-surgical pain management

It is natural and normal to feel some pain after your knee surgery. Your doctor and care team will work to reduce your pain, which may help speed the healing process and make it easier for you recover more quickly.
Short-term pain relief after surgery is usually accomplished using prescription medications. Pain relief medicines that might be used include opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics for pain at the surgical site. You may be prescribed a combination of medicines for the most effective pain relief, as well as to reduce the need for opioids.
It is important to note that opioids are a narcotic and can be addictive. If you are prescribed opioids, be sure to use them exactly as your doctor instructs. The aim is to stop taking opioids as your pain level of pain begins to improve. If your pain doesn't improve within the timeframe discussed with your care team, be sure and tell this to your doctor.
Recovering from knee replacement surgery
Successful recovery from your surgery greatly depends on you, the patient. How quickly and how completely you recover depends on a number of factors including how thoroughly you follow your surgeon's instructions as you begin rehabilitation (usually the day after the surgery). Equally important to your recovery time is how well you stick to your therapy and rehab plan at home in the weeks immediately after surgery.
Physical therapy and rehabilitation

Depending on how quickly you recover in the hours following your surgery, it is not uncommon to be asked to begin moving your knee on the same day as your operation. Most patients will also begin working with physical therapists as early as the day after surgery, lifting, stretching and flexing their legs and bending the new knee joint. The therapist will help you learn specialized exercises to strengthen your leg and restore a full range of knee motion. The aim is to help you return to walking and other normal daily activities as soon as possible after your surgery. Once you are home, you may be prescribed a series of physical therapy sessions to take place in the weeks following your surgery.
While every patient's recovery is different, many patients are able to resume most normal activities within about 3 to 6 weeks after surgery. You should expect some pain during activity and at night for several weeks after the procedure; you should alert your doctor if the pain is severe or if it persists beyond a few weeks.
Post-surgery exercise
Your care team's post-surgical activity program may include:
- A walking program that gradually builds up your mobility, in your home to begin with, and outside as soon as practical
- Getting back to normal household routines - sitting, standing, climbing stairs, getting in and out of bed and so on
- A series of prescribed exercises repeated several times a day will to help you regain your maximum range of movement and build strength in your knee.
You'll likely be able to return to driving once your knee is flexible enough to let you enter and sit comfortably in your car, and your muscle control allows you to accelerate smoothly and brake safely.
Important safety notes
Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.

This is a brief overview of the activities that typically occur on your surgery day:
- You will be admitted to the hospital or surgery center.
- Your vital signs, such as blood pressure and temperature, will be measured.
- A clean hospital gown will be provided.
- All jewelry, dentures, contact lenses, and nail polish must be removed.
- An IV will be started to give you fluids and medication during and after the procedure.
- Your knee will be scrubbed and shaved in preparation for surgery.
- An anesthesia provider will discuss the type of anesthesia that will be used.
- Your surgeon will confirm and initial the correct surgical site.
How is Knee Replacement Surgery Performed?

During knee replacement surgery, the surgeon surgically removes the damaged bone and cartilage of the joint and replaces it with smooth, artificial implants - thereby eliminating painful bone-on-bone contact.
Almost all knee replacement implants consist of a four-part system:
- The tibial (shin) side has two elements and replaces the top of the shin bone. This portion of the implant is made up of a metal tray attached directly to the bone and a plastic spacer that provides the lower half of the new joint's bearing surface.
- The femoral (thigh bone) side is a single element that replaces the bottom of the thigh bone and provides the top half of the new joint's bearing surface. This component also replaces the groove where the patella, or kneecap, sits.
- Finally, the patellar component replaces the surface of the kneecap, which rubs against the femur. The patella protects the joint, and the newly resurfaced patellar button will slide smoothly on the front of the joint
Important Safety Notes:
Knee replacement surgery is intended to relieve knee pain and improve knee functions. However, implants may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon's limitations on activity level. Early failure can happen if you do not guard your knee joint from overloading due to activity level, failure to control body weight or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.
ASK THE EXPERT

Dr. Gregory Lauro is available to answer any questions patients or their families may have regarding hip and knee conditions.
TESTIMONIALS

Dr. Lauro just did my left knee on July 2016,,,did my right knee on March of last year. He took great care of me,, I always felt that I could ask him anything and get a direct answer. His staff can’t be beat..they are courteous, and always ready to help you with any inquires you might have…What more can you ask for in a doctor. He gave me excellent care.

Dr. Lauro was recommended by Dr Hennesy. He was encouraging and focused. I am very happy with the results of my hip replacement and recovery time has been very rapid. Would recommend this Dr. and procedure very highly.

Dr. Lauro was wonderful. I had many orthopedics problems that arose from another doctor and Dr. Lauro handle all of them without a problem. It has been a long year but I do not know what I would have done without Dr. Lauro’s expertise in his field and his great care the he provided me.

Replaced left hip. remarkable results! Appointment dates/time convenient and office wait minimal. Respects active life style. Honest, forthright advice.

Dr. Lauro replaced my hip 7 years ago. His office staff is wonderful to speak with and he takes his time during office visits. Never rushes you through and answers any questions thoroughly and honestly.

Dr. Lauro has been doing partial knee replacements for 25 years and worked wonders for me. After only 3 months I no longer need my cane and my scar looks amazing. His office staff is as friendly as you could want. Very clean environment. Little to no waiting both in and out of the waiting rooms. He is very attentive and explains things very well. He listens more than he talks and is dedicated to his practice. I would and have recommended him a lot. A true professional who knows what he is doing.
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