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- Welcome back to The Art of Medicine.
The diagnosis for a total knee replacement
depends on severity of your symptoms,
especially pain,
and especially how this pain
affects your lifestyle.
- The most common symptoms
with knee osteoarthritis are pain,
stiffness, and swelling.
In the early stages of arthritis,
your symptoms aren't typically constant or severe.
Symptoms often come and go,
depending on your activity level.
As your arthritis worsens,
your symptoms become more constant and severe.
These symptoms limit your ability
to do your normal activities
on a daily basis.
As your knee becomes stiffer and more painful,
the function of your knee
is significantly altered.
As your arthritis worsens,
the function of your knee becomes severely limited.
Your pain gradually shifts
from an intermittent activity-related pain
into a constant aching pain.
Even simple tasks can be aggravating.
Any weight-bearing activities
are also a significant source of discomfort.
As your arthritis worsens,
you may notice that your knee fatigues faster
than it used to, or it feels weak or unstable.
You have the feeling you don't trust your knee
to support you.
As a result, you may need to use a cane or a walker
to help take the pressure off your knee
and relieve some of your pain.
Positional changes are an additional source of pain.
This could mean stiffness and pain
when you get in and out of bed,
getting up from a chair,
or getting up and down stairs.
Finally, you may notice your pain
is so severe at night that it wakes you up
or keeps you from falling asleep.
- There are several key questions
your doctor should ask you
about the history of your knee pain.
The answers to these questions
help us determine the next step in your treatment.
Your doctor will want to know
how long you have knee pain,
what treatment you've had so far,
and how much it affects the quality of your daily life.
Once you answer the questions
about the history of your knee pain,
your doctor will perform a physical exam
to evaluate the severity of your arthritis.
There are several specific finding we're looking for.
We look to see if your knee is swollen.
This can help us to determine
the severity of your arthritis.
We also evaluate your knee for stiffness,
which is evident by a loss of motion of the knee.
May notice the knee does not fully straighten
or bend like it used to.
We look to see if you develop a knock knee
or bow leg deformity of your knee.
This deformity indicates
the abnormal alignment of your knee,
which gives us an indication
of how severe your arthritis is.
Weakness of the muscles surrounding your knee
indicates a lack of use.
This occurs over time
as you stop relying on your knee to support your weight.
Instability is caused by pain,
abnormal alignment,
and muscle weakness.
This results in an overall loss of trust
in your knee to support your weight.
- [Doctor] Here we have a lady
that is having pain in her right knee.
In her left knee, she doesn't have any pain.
Well, in the left knee,
we see that the space between the bones
is present and equal on both sides.
But if we go to the right knee,
where she's having pain,
we can see that, although she has space
that's present on the inner side of the knee,
on the outer side, it's completely collapsed.
This is the reason she's having pain,
this advanced arthritis on the outside of the knee.
Now, when the space collapses
on the outside,
we develop a knock-kneed deformity.
On the left side,
her knee is straight.
This gentleman has no pain
in his right knee,
but has severe pain
in his left knee.
In his right knee,
we can see that the spaces between the bones
are normal on the outside
and normal and present on the inner side.
On the left knee, he has a normal space
between the bones on the outside,
but look.
The space is completely gone.
The bones have collapsed on the inner side.
This is the reason for his knee pain.
On the right knee,
he has a straight knee.
On the left knee,
he has developed a knock-kneed deformity.
Here is a lady that's had
both knees replaced.
If we look at her right knee,
she's had the ends of the thigh bone
replaced by a metal component.
White is the metal component.
The top of the leg bone
has also been replaced
by a metal component,
the metal component having a stem
that is cemented down into the bone.
Between the two components
is a plastic sleeve
that is invisible on the x-ray.
Again, if we look at this x-ray,
this is the metal component
that covers the end of the thigh bone,
this is the metal component
that covers the top of the leg bone,
and this is a stem of that metal component
that reaches down into the bone.
In this space in here
is a plastic component
that allows both metal pieces to glide smoothly
on one another.
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