Patient Information And Rehabilitation Guidelines

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