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To understand total knee replacement, you should be familiar with the structure of the knee, a complex joint consisting of three bones: the femur (thigh bone), the tibia (shin bone), and the patella (kneecap).
Clinical and biomechanical research has steadily refined knee replacement methods and materials. Total knee replacement can enhance your quality of life by providing many years of improved mobility and reduced pain. Before, during, and after your hospital stay, the Ranawat Orthopaedic Center (ROC) and Lenox Hill Hospital are committed to your well-being and satisfaction. In bringing you the latest advances in total knee replacement, Lenox Hill Hospital, a major teaching affiliate of NYU Medical Center, combines world-class professionalism with personalized care. The ROC staff will make an appointment for you for pre-surgical testing fourteen (14) days prior to surgery. Before your surgery, the ROC Staff will make an appointment for your examination with an internist at Lenox Hill Hospital. Unless you are told otherwise, continue to take medicines already prescribed by your own physician. Before your admission, please complete the Health Care Proxy form authorizing another person designated by you to make decisions with your physician about your care, should this become necessary.
To obtain your admission time and location, please call Same Day Surgery Admissions at (212) 606-1489 between 2pm and 4pm one business day before your scheduled surgery. EXTREMELY IMPORTANT: PLEASE BRING A LIST OF YOUR CURRENT MEDICATIONS AND THEIR DOSAGES SO THAT THE CORRECT MEDICATIONS AND DOSAGES CAN BE ORDERED FOR YOU WHILE YOU ARE IN THE HOSPITAL. DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT ON THE NIGHT BEFORE YOUR SCHEDULED SURGERY, UNLESS OTHERWISE INSTRUCTED. The hospital is located at 535 East 70th Street on the Upper East Side of Manhattan, between York Avenue and the East River.
You and your family, or the person accompanying you, should come to the Same Day Surgery Admission Unit on the 10th Floor of the hospital.
The anesthesiologist will see you before the surgery to discuss the appropriate anesthesia, either epidural or general. Though the actual knee replacement procedure usually takes approximately one hour, the actual elapsed time, from operating room to recovery room, could be two hours or more. In the Recovery Room, you may be given oxygen, your heart will be monitored, and an intravenous (IV) line will be attached.
When the anesthesiologist determines that you are ready, approximately 4 to 5 hours after surgery, you will be transported to an inpatient unit. If you wish to have a private nurse during your hospital stay, the hospital can arrange this service for you. After surgery, your IV (intravenous) line will remain in your arm for approximately 48 hours. At the bandaged surgical site, a thin tube inserted into the site and attached to a drain that prevents blood from accumulating under the muscles and bones of the knee. The day after surgery, your knee will be placed in a continuous passive motion machine (CPM), which helps it to regain flexion and extension.
Because anesthesia may temporarily inhibit urination after surgery, a catheter may be inserted into the bladder to remove urine. In collaboration with you and your family, the hospital staff, including a physician, physician assistant, nurse, physical therapist, and social worker will plan, provide and monitor your care. Gentle exercises to improve your range of motion can help prevent circulation problems as well as strengthen your muscles. After surgery, regular deep breathing, to rid your air passages of mucus, is vitally important.
To ensure that you breathe deep daily, the nursing staff will provide you with a device called an Incentive Spirometer, along with instructions on its use. Pain management after total knee replacement will be decided by the surgeon and the surgical team.
Epidural anesthesia, for one to two days post-surgery, will keep your pain at a low level on the pain scale.
Approximately 24 to 48 hours after surgery, as pain decreases and your activity level increases, you will be given oral or injectable pain medications, which control discomfort without restricting activity or mobility.
During your hospital stay, ice packs applied to the surgical site by the nursing staff while you are at bed-rest, will aid in reducing swelling and pain. Your participation in a physical therapy program is essential to the success of your surgery.
The day after surgery, a physical therapist will visit you with an exercise program to increase your increase range of motion and strength in your leg muscles. Before leaving the hospital, most patients progress to forearm crutches and can get in and out of bed unassisted. After total knee replacement surgery, clots, called deep vein thromboses (DVT), may form in the leg veins.
Before your discharge from the hospital, you will receive a noninvasive test to detect blood clots.
For the first month after your operation, sitting, which tends to worsen the swelling, should be 30 TO 45 MINUTES ONLY. Try to spend an hour in this elevated position in the early afternoon to help diminish the swelling that may have developed during your morning walks. During your hospital stay, eat balanced, nutritious meals with adequate calories and protein to enable your body to replenish proteins depleted by surgery, and to reduce the risk of complications such as infection or poor wound healing.
During your hospitalization, your physician is responsible for ordering the appropriate diet for you.
After surgery, most patients will be placed on a liquid diet for 3 or 4 days, as appetite may be poor and the effect of anesthesia on intestinal function can last a few days. The Food Guide Pyramid outlines daily nutritional needs and helps you choose a healthy diet.
The Food Guide Pyramid emphasizes foods from the five food groups shown in the lower three levels of the Pyramid. As soon as you decide to have a total knee replacement, you must look ahead, and plan for discharge and home recovery.
You and a family member or companion should consult with a social worker BEFORE YOU COME TO THE HOSPITAL. The majority of patients who undergo a total knee replacement are usually discharged from the hospital within four to five days after the surgery. The social worker will discuss your post-discharge needs in consultation with your internist and other members of your primary healthcare team. Please ask your social worker for more details on the range of services that can help in planning your discharge. Please do not hesitate to contact the Ranawat Orthopaedic Center (ROC) with any questions you have about the following instructions. Consult with your internist about duration and dosage of iron (ferrous sulfate) after your discharge. If your pain medication seems weak, or if you are experiencing unpleasant side effects, do not hesitate to call the Ranawat Orthopaedics.
If you experience discomfort during your ongoing physical therapy, take your pain medication at least 45 minutes prior to your subsequent therapy sessions. Tell your internist and dentist that you have an artificial joint so that they can prescribe antibiotics.
Patients should adhere to this regimen for the first two years following joint replacement. You may experience skin numbness around your incision, and knee stiffness, particularly with excessive bending activities, such as getting in and out of a low chair or a car.
Our specially-designed Home Recovery Program, a series of basic instructions and exercises, will help you regain your mobility and, thus, speed your recovery.
The Home Recovery Program allows you to choose from the four exercises you were taught in the hospital.


Continue to follow precautions outlined by your physical therapist until told otherwise by your surgeon. The following questions, answers and illustrations respond to the common concerns of patients and their partners after knee replacement surgery. The vast majority of patients are able to resume safe and enjoyable sexual intercourse after knee replacement. Total knee replacement precautions need to be observed during all activities, including sexual intercourse. Most patients, male and female, prefer 'passive' intercourse in the 'bottom' position, an option some find less fatiguing. As good communication is essential, you may want to share information in this booklet with your partner.
The three hamstring muscles located at the back of the thigh, are important to address when treating knee pain.
Place your heels on the seat of the chair and bend your knees so that your hips and knees are now at a right angle. The hamstrings mimic the stabilizing duties of the anterior cruciate ligament of the knee (the ACL). Don't forget that the benefits of hamstring strengthening will be minimized if you do not also stretch the hamstrings. Generally speaking,  a lot of people have muscle imbalances between the front of the thigh (quadriceps) and back of the thigh (hamstrings) in combination with the support of inner thighs, outer thighs, and Glutes can cause the kneecap to track incorrectly.
Sometimes if part of the quadriceps muscle (either inner or outer portion) pulls stronger it can pull the kneecap to either the inside or outside of the thigh, which can cause the grinding and miss-aligned tracking issue. Weak inner thighs (adductors), weak outer thighs (abductors), and weak Glutes affect the stability of the knee when standing on one leg or bending and straightening the knees. If the knee locks when you are standing or doing any type of exercise, the hamstrings are weak, and locking jams the kneecap against the leg bones in not a good way!
If you have had serious knee injuries or surgery, scar tissue & adhesions may limit the range of motion for your knee and knee cap.
I would recommend that you consider seeing your primary care doctor, a sports medicine physician, or get a referral to a physical therapist to rule out any serious knee issues, and ask them about the exercises you are doing, if they are OK for you, or what other exercises you can be doing to safely improve things. Hope this helps you make a wise decision on if the Knee Cap Dance exercise is appropriate for you to help keep your knees safe & healthy!
Posted by Aliesa George in Exercise and Fitness, Pilates Exercises, Techniques & Teaching Tips, Videos and tagged Aliesa George, Centerworks, knee cap exercise, Knee Exercise, knee exercise tips, knee exercise video, knee pain, knee stability, knee strength, Patella Exercise. I examine your post after i test products on the net, I anxious wether the very helpful material is offered.
Knee joint is the weight bearing joint and so if there is any discomfort in that joint it affects the entire standing and walking mechanism. I Lie on your back and keep a towel roll under the knee and press your knee down on the towel and squeeze your thigh muscle ( you can see the knee cap going up).Hold it for 5 seconds and then release it.
II Above position, keep a folded pillow under the knee and lift the lower portion of the leg in level with the thigh and hold it for 5 seconds and lower it. III Above position, lift one leg straight without bending the knee and hold it for 5 seconds and then lower it.
IV Above position, above exercises and then move the outwards and then inwards and put it down. V Above position, lift your leg and rotate clockwise and then anti clock wise and then put it down.
VIII Sit at the edge of the bed or on a high chair, keep a towel roll under the knee and then lift one leg up in level with the thigh and hold it for 5 seconds and lower it down. Side-lying leg lift, cross over: Lie on your injured side with your top leg bent and your foot placed in front of the bottom leg. Once it is easy to do the leg lifts, start strengthening your thigh muscles and groin muscles with the following elastic tubing exercises. Resisted hip abduction: Stand sideways near a door with your injured side further from the door.
Resisted hip adduction: Stand sideways next to a door with your injured side closer to the door. When you bend or straighten your knee, the end of the femur rolls against the end of the tibia, and the patella glides in front of the femur. A femoral component covers the end of the thigh bone, a tibial component covers the top of the shin bone, and the patellar component covers the underside of the kneecap. Prosthesis durability can vary from patient to patient because each patient's body places slightly different stresses on the new knee. The hospital's outstanding diagnostic, surgical, and rehabilitation sections offer a complete array of services.
If the donation is required, the Ranawat Orthopaedics staff will make an appointment for you at Lenox Hill Hospital's Blood Donor Center.
The Home Care staff will help you plan your home care and physical therapy needs following discharge from the hospital. When you arrive at the hospital, use the main entrance at 535 East 70th Street, between York Avenue and the East River. ALSO BRING MEDICAL INFORMATION FROM YOUR PHYSICIAN, INCLUDING DETAILS ABOUT ANY PAST REACTIONS TO ANESTHESIA. If you have questions or concerns, please discuss them with your surgeon or call the Ranawat Orthopaedics at (646) 797-8700.
For your arrival time, please call Same Day Surgery Admissions at (212) 606-1489 between 2pm and 4pm one business day before your scheduled surgery. The majority of our patients receive epidural anesthesia, in which a narrow catheter (tube) inserted between the shoulder blades allows a continuous flow of anesthetic medication to block all pain during the surgery. While most patients are discharged to in-patient units, some remain overnight in the Recovery Room for observation.
The IV line delivers fluids, antibiotics and other medications, and can also deliver blood, if necessary.
The tube and drain are removed the day after surgery, and the bandage is removed the second post-surgical day. When the patient regains function, usually within one or two days after surgery, this catheter is removed. As soon as you are able after surgery, a physical therapist will teach you the necessary exercises.
Normally, you take deep breaths almost every hour, usually without being aware of it, whenever you sigh or yawn. The hospital's team approach to pain management can help reduce your discomfort and thus speed your recovery. Since no objective tests exist to measure what you are feeling, you must help the staff by describing the pain, pinpointing its location, and judging its intensity, as well as reporting any changes in these.
After the epidural is discontinued, your pain can be managed by oral or injectable medication. THIS INFORMATION SHOULD ALSO BE INCLUDED IN THE MEDICAL INFORMATION YOU BRING TO THE HOSPITAL. In the first few days after surgery, you may benefit from taking pain medication one hour prior to your physical therapy session.
Although the amount of swelling can vary from patient to patient, the swelling itself in the leg, knee, ankle or foot is normal, and will usually resolve gradually over several weeks. Being adequately nourished is an important component of your overall health and promotes your recovery. Based on the recommended dietary guidelines for Americans, the pyramid recommends a varied diet, which provides the necessary nutrients you need and the right amount of calories to maintain a healthy weight. Immunocompromised patients, including those with inflammatory arthropathies, rheumatoid arthritis, drug or radiation-induced immunosuppression, insulin-dependent diabetes or any other major medical problem should follow this antibiotic routine indefinitely. Preventing infection must be the concern of all the healthcare professionals who treat you.


Activities you can enjoy after total knee replacement include walking, bicycling, bowling, swimming, golf and doubles tennis. Tested and refined at the Ranawat Orthopaedics, the program is straightforward and effective.
The number of times you do each exercise depends on your capacity, which will increase as you progress towards recovery.
Patients whose sexual function had been impaired by preoperative knee pain and stiffness welcome their new pain-free mobility.
Though individual recovery time varies greatly, this timeframe allows the incision and the muscles around the knee to heal. In general, follow the do's and don'ts on pages 26-27 and the positions illustrated on page 29. In addition, you can discuss the knee precautions that the hospital staff reviewed with you.
Knee muscle exercises are the best way to protect the knee joints and provide knee pain relief. You should feel most of the work happening at the area where the hamstring muscles attach, just behind the knee.
It will be more difficult on a ball as your abdominals will have to work to keep the ball from roll off to the side.
This is the most commonly injured knee ligament and hamstring strengthening will decrease the everyday demands on the ACL, thereby, reducing your risk for ligament injury. Pain in the knee could be due to several reasons- ligamental strain, arthritis, knee cap problem (chondromalacea patella), old fracture in and around the knee joint to name a few. Tie a loop in one end of a piece of elastic tubing and put it around the ankle on your injured side. Tie a loop in one end of the tubing and slip the loop around the ankle on your injured side. Please notify us if you have a change of name, address, telephone number or insurance carrier.
The femoral component is made of a super alloy (chromium cobalt ) and is held in place by a cement methylmethacrylate). However, the average patient can expect to obtain greater mobility and freedom from pain, which will, in turn, improve ability to walk. In the last decade remarkable advances in technology have transformed total knee replacement into an efficient and widely performed procedure. Help us help you; any medical concerns should be discussed with your surgeon, and unresolved aministrative issues with our office manager. If you wish to consult a social worker or a member of the Home Care staff to help plan for your return home, you may call the Social Work Department or the Home Care Department before your admitting date to the hospital. Also, anti-inflammatory medications and anti-oxidant vitamins such as C and E should be discontinued ten (10) days prior to your surgery.
In addition, a sedative is administered to dull sensation and awareness, while keeping the patient awake.
If you remain overnight in the Recovery Room, parents, guardians and other family members can coordinate limited visiting hours with the Recovery Room nursing staff.
When you are in pain, or are drowsy from anesthesia or pain medication, your breathing may be shallow. To prevent and reduce the incidence of clot formation, mechanical devices are used to squeeze the leg muscle, thus maintaining blood flow in the veins. No one food group is more important than the other; for good health you need to eat a balanced diet. To help you plan for discharge and home recovery, the Social Work Staff or Home Care Department of the hospital is available at your request. Your social worker will address any concerns you may have about your discharge from the hospital.
MAKE SURE YOU INFORM YOUR PHYSICIAN AND DENTIST THAT YOU HAVE HAD A TOTAL KNEE REPLACEMENT.
Recovery doesn't happen overnight, so don't be discouraged, and don't try to do too much too soon. If you recuperate rapidly, you will be able to resume sooner, as long as you are free of pain. As advised in the discharge instructions, you should avoid excessive knee flexion (knee toward chest), adduction (leg towards center of body), and internal rotation (toes turned inward).
Knee strengthening, such as hamstring exercises creates a shock absorption effect around the knee joints.
Commonly, both inflexibility of the hamstrings and weakness of the hamstrings contribute to knee pain.
Once we understood the problem and take right treatment then doing knee exercises on a regular basis becomes mandatory. Tighten the thigh muscle on your injured side and lift your leg about 8 inches off the floor. Cartilage acts as a cushion between the femur and tibia and is lubricated by synovial fluid. A patient's active participation in treatment, with full understanding of all issues, is vital to a patient's full and uneventful recovery.
You will also meet our physician assistant who will take your history and perform a physical exam. Once you have arrived in the Recovery Room, the Ranawat Orthopaedics's office staff or physician assistant will update your family and friends about your operation. We understand your need to stay informed and will make every effort to keep you and your familyin the know. Also, a medication to minimize clot formation, such as Coumadin, Heparin, Aspirin or Persantine, is prescribed. You should lie with one pillow under your head and four to five pillows under your foot and leg to elevate your leg above your chest. He or she will review the alternatives available to you based on your medical condition, home and healthcare needs, care giving arrangements you have already made, geographic location and financial situation. Though you do not have to follow a particular order, doing the lying exercises in sequence is easier and more convenient. Tighten the front of your thigh muscle and bring the leg with the tubing forward, keeping your leg straight.
Bring the leg with the tubing across your body sideways, crossing over your other leg and stretching the tubing. A nurse, ensuring your readiness for surgery, will arrange to transport you to the pre-operative waiting area, where you will be introduced to the surgical team. To maintain patient privacy, as well as to reduce the risk of infection, Recovery Room visits are restricted. The benefits of total knee replacement usually become fully evident 6-8 months after surgery.
Unless instructed otherwise, relatives wait in the Surgical Atrium on the 4th floor or at Ranawat Orthopaedics on the 6th floor.
If we exercise our knee musculatures (quadriceps and hamstring) properly then we can reduce undue stain on our knee joint there by reducing the pain to a remarkable extent. This exercise can be made easier by starting with your knees and hips flexed toward your chest.



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