In or sitting for a long period of time.

In the early 1970s, the condylar knee was
created in the United States and overseas. The purpose of replacing the
tibiofemoral condylar surfaces with cemented fixation, along with preservation
of the cruciate ligaments, was created and refined. After many years and many
people initially attribute knee soreness or discomfort to lack of exercise or
getting older. Many do not take their early knee arthritis symptoms as “no
big deal” until they get worse and start to interrupt one’s ability to enjoy and do
everyday activities.  Bone friction and inflammation in the knee joint
makes the knee stiff and less adjustable. Knee range of motion can become very
hard on a patient life. A patient with common to advanced knee osteoarthritis
may find it is difficult to make their knee straight. Some people may only
experience stiffness in the knee in the morning. To correct severe knee
malformation, the condylar knee with posterior cruciate-sacrificing design was
initiate, also in the early 1970s. By 1974, rearrangement the patellofemoral
joint or sacrificing the cruciate ligaments had become standard practice. Thereafter,
condylar knee designs were upgraded to include better and safer fixation, with
use of universal instrumentation. Today, over 19 companies in the United States
circulate total knee implants of three different types: cruciate-preserving,
cruciate-substituting, and TC-III (Garret Hyman, 2011). Future developments
already in place, such as navigation-guided surgery, and wear-resistant bearing
surfaces with better fixation, promise a consistent evolution for the total
knee replacement (Lenox Hill Hospital, Department of Orthopedic Surgery). Identification
of the best method for post-operative pain control after total knee replacement
is a main objective in patient care.


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According to
(Garrett Hyman) Knee pain and stiffness are the most frequent signs of knee
osteoarthritis. These symptoms can to progress gradually over, while standing or after
sitting for a long period. Stiffness may or may not be accompanied by swelling.
Inactive lifestyle makes it worse, gaining weight is also a major problem. Knees
can become stiff after sleeping, walking or sitting for a long period of time.
People with knee osteoarthritis often find stiffness and pain are most
noticeable when they try to get out of bed in the morning or out of a chair
after a long period of sitting. In most but not all cases, the symptoms of knee
osteoarthritis come and go, becoming worse and more regular over months or
years. Knee osteoarthritis pain maybe intense after high intensity activities,
such as jogging or tennis, or simple weight-bearing activities that add weight
to the knee joint, such as squatting or stair climbing.  While adults of
any age may develop knee osteoarthritis, the currency of symptomatic knee osteoarthritis
increases very fast starting at the age of 45 and continues to increase
thereafter. The prevalence increases with age because with age the knee joints
experience wear and tear and cartilage thins and becomes less flexible, making
it more prone to osteoarthritis. The degeneration of the joints that is
characteristic of osteoarthritis is why the condition is also called
“degenerative joint disease”. Knee swelling is also a major problem, when
getting older the cartilage wears off and sometimes the femur and the tibia can
rub together. Two years ago, when my mother started to have those unbearable pain
she used to cry like a baby, she thought she was going to die. Many patients
including my mother usually have the felling of the knee popping or crunching
like eating a bag of chips. Feeling the knee popping or crunching (Garret, 2011)
explains that, those are signs that the cartilage is no more there, it is only
bone rubbing into each other.


Physicians diagnose osteoarthritis using a combination
of medical history, evaluation of symptoms, and various imaging scans that can
help assess the progression of the disease. They may also do a series of
physical evaluations to examine the alignment of the hips or knees and to
determine the extent of joint immobility. My Mother used to go to therapy and I
was always saying why would the physicians do therapies when knowing the
patient is in pain. I was wrong, because (Grant, 2010) said that physical
therapy is the first method used before surgery to strengthen the muscles and
make walking, sitting, and bending more easy. Knee arthritis can also be
diagnose using X-Rays and MRI. An X-ray is used to provide a picture of
potential joint damage, but is not the most reliable tool. Most patients over
the age of 60 display joint degeneration associated with osteoarthritis, but
only a third or this population report actual symptoms. For this reason, an
X-ray is usually used to confirm a suspected diagnosis made through a physical examination
and medical history (Grant Cooper, 2010).

resonance imaging techniques can be used to provide a more accurate picture of
damage to the joint and remaining cartilage.                                                                                                             Patents
diagnosed with rheumatoid arthritis will be referred to a rheumatologist – a
specialist with specific training and skills to diagnose and treat RA. In its
early stages, RA may resemble other forms of inflammatory arthritis. No single
test can confirm RA. To make a proper diagnosis, the rheumatologist will ask
questions about personal and family medical history, perform a physical exam
and order diagnostic tests. Rheumatoid factor (RF) is an antibody found in
about 80 percent of people with RA. Because RF can occur in other inflammatory
diseases, it’s not a sure sign of having RA. But a different antibody –
anti-cyclic citrullinated peptide (anti-CCP) – occurs primarily in patients
with RA. That makes a positive anti-CCP test a stronger clue to RA. But
anti-CCP antibodies are found in only 60 to 70 percent of people with RA and
can exist even before symptoms start (Arthritis Foundation).

Treatment                                                                                                                  According
to (Grant, 2010) drug therapy is used to manage physical symptoms, with a focus
on relieving pain and slowing progression of the disease. In most cases drug
does not help a lot, patients seem to always end up in the process of the knee
surgery. Some commonly used medications include analgesics or pain reliever such
as acetaminophen (e.g. Tylenol) or tramadol, but those medications have some
side effects. Analgesics are recommended for patients having little pain to
moderate pain. Non-steroidal anti-inflammatory drug are used on patient with moderate
to severe pain because they can reduce swelling and inflammation. Physical
therapy is strongly recommended after the surgery to get better results, three
days a week for six weeks. Steroid injections are often used for moderate to
severe pain especially patients that do not have the ability to participate with
exercises. Cortisone injections also called steroid injections are simply a miracle
because they work like a charm, it is an injection used to ease pain. Patients can
have this injection in their knees also in theirs hands, my mother had this
shot and it works great. The only problem was that the injection wear off
quickly and it is not covered by insurance, and my mother had to pay it out of