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The most common joint replacements are the hip and knee, with shoulders becoming more common. As humans live longer, our joints tend to wear down. Of the over one hundred types of arthritides, the most prevalent is OA: osteoarthritis - the degenerative form. How much joints wear down is not well understood, since even young people can have arthritis and old people may have very little. In other words, inherent predispositions for joint degradation is probably a factor, added to the "microtrauma" of living over decades, and of course joint trauma itself. Besides living longer, humans are working and "playing" longer and harder. Increasing incidence of obesity adds yet another complication.
If conservative treatment (rehabilitation, medication, lifestyle modification...) does not control the pain and the pain becomes intractable - affecting daily living - an orthopedic surgeon may suggest joint replacement. This is a very significant and final surgery, with a long and arduous rehab. Since the joint is replaced, the pain that used to stem from the arthritic joint is gone. Incision and swelling pain abates over a time.
In the case of the knee, the single most important aspect of rehab is regaining as much range of motion (ROM) as quickly as possible. Most critical is the ability to straighten the knee fully. If it doesn't, one will walk with a bent knee, which can affect gait, the hip or back. Of nearly equal importance is regaining functional bend of the knee. A minimal goal for bending the knee is 120 degrees, which allows for the descending of stairs without limping. Concurrently, intensive muscle strengthening is emphasized, the quads (front thigh muscle) being the most important. Normalizing gait is stressed immediately.
The end result should allow for resumption of full normal activities of daily life. Some sports are not recommended, as this will wear down the prosthesis. Discussing realistic goals before surgery is important. A total knee is not a normal knee. What is predominantly gained from this surgery is pain relief. Revision of primary Total Knees is not a solution without significant risks, as the base of bone into which the prosthesis sits is diminished with each revision. Choosing your sports carefully post-operatively will ensure longevity of the prosthesis. Cycling, hiking and swimming are relatively gentle on the joint, yet can be done at a intensive level ensuring maintenance of good muscular, aerobic and functional levels.
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