patient information and rehabilitation guidelines
TRANSCRIPT
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