How to delay TKR, TKA, (Total Knee replacement / arthroplasty) Surgery?
However, studies have found out that osteoarthritis, per se, does not cause pain. Then, what is it that is the culprit of this excessive pain that one leads to go for total knee replacement surgery.
Osteoarthritis is like a collection of conditions, which includes fat pad irritation, muscle imbalance, patellar maltracking and joint malposition. It has been found out that fat pad irritation is one of the major causes that leads to pain. Fat pad is like a pad/cushion that contains many nerves which makes it susceptible to pain and discomfort.
Whenever there is pain, there are huge chances that it is due to fat pad irritation. So, fat pad irritation can be treated by manual therapy, i.e. by proper, specific and guided tibiofemoral and patellofemoral joint mobilisations along with muscle strengthening and stretching exercises. And in some cases, it may need taping techniques which gives magical and instant results in reducing the fat pad irritation.
Another reason that causes pain and improper gait pattern is muscle imbalance in and around the knee joint. Muscle imbalance is common in the knee joint, where inside structures tend to weaken, and outside structures tend to tighten. Therefore, it is important to stretch outside structures and strengthen inside structures, thereby improving balance of muscles around the knee joint. Strengthening and stretching specific muscle groups can improve muscle alignment and thus, can reduce musculoskeletal pain.
If muscle imbalance is not treated or dealt with properly, it causes patellar maltracking. That is, the patella, which is the most anterior oval shaped bone of knee joint shifts towards the outside of the knee joint, that means laterally. Why does lateral tracking of patella occurs? This occurs because, as already discussed, the outside structures become tighter and inside structures become weaker; so, the muscles present laterally tend to exert a pulling force on the outside of the patella causing it to shift, tilt or rotate externally or laterally. This condition cause pain in the lateral retinaculum as it becomes tight, in addition to pain and tenderness along the iliotibial tract. This also causes pain in the inside of the knee joint, i.e. at the medial aspect of the knee, due to weakness of vastusmedialis oblique. Thus, strengthening the VMO and stretching the ITB and lateral retinaculum pays a substantial role in decreasing pain, stiffness, thus reducing the severity of osteoarthritis, thereby helping to delay TKR surgery.
Concludingly, what all are the factors that play a key role in delaying.
First, leading a healthy lifestyle which includes regular walks/ jogs are crucial. Secondly, proper strengthening and stretching
exercises play a vital role in decreasing the symptoms of pain, stiffness, thereby delaying osteoarthritis. And, thus, ultimately delaying TKR. Osteoarthritis is a condition in which the knee joint loses its cartilage and there is excessive wear and tear of joint, leading to reduced or no joint spaces in the knees. It is believed that this causes excessive pain. TKR is mainly done when there are severe limitations and pain in knees while walking, standing, moving, etc. When the knee doesn’t respond to any conventional methods of treatment like painkillers, steroids, physiotherapy etc. These limitations are mainly caused due to severe stage of osteoarthritis.
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In this video we have discussed
1. Internal rotation glide for knee
2. Anterior Glide to Gin Knee Joint Extension
3. Release of Lateral Retinaculum of Patella
4. Patellar Mobilisation
5. Glute Squeeze in Standing
6. VMO training
7. Clamshells
8. Hamstring Stretch
9. Calf Stretch
10. TFL Stretch
We have also discussed about the various dos and donts one should follow in order to have a better and pain free life.