Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
A total knee replacement generally requires between one and a half to three hours of operative time. After surgery, patients are
taken to a recovery room, where vital organs are frequently
monitored. When stabilized, patients are returned to their hospital
room.
Passage of urine can be difficult in the immediate postoperative
period, and this condition can be aggravated by pain medications.
A catheter inserted into the urethra (a Foley catheter) allows
free passage of urine until the patient becomes more mobile.
Physical therapy is an extremely important part of rehabilitation
and requires full participation by the patient for optimal outcome.
Patients can begin physical therapy 48 hours after surgery.
Some degree of pain, discomfort, and stiffness can be expected
during the early days of physical therapy. Knee immobilizers are
used in order to stabilize the knee while undergoing physical
therapy, walking, and sleeping. They may be removed under the
guidance of the therapist for various portions of physical
therapy.
A unique device that can help speed recovery is the continuous
passive motion (CPM) machine. The CPM machine is first attached
to the operated leg. The machine then constantly moves the knee
through various degrees of range of motion for hours while the
patient relaxes.
Patients will start walking using a walker and crutches.
Eventually, patients will learn to walk up and down stairs and
grades. A number of home exercises are given to strengthen thigh and
calf muscles.
How does the patient continue to improve
as an outpatient after discharge from the hospital?
It is important for patients to continue in an outpatient physical-therapy program along with home exercises for optimal outcome of
total knee replacement surgery. Patients will be asked to continue
exercising the muscles around the replaced joint to prevent scarring
(contracture) and maintain muscle strength for the purposes of
joint stability.
The wound will be monitored by the attending physicians and their
staff for healing. Patients also should watch for warning signs
of infection including abnormal redness, increasing warmth, swelling,
or unusual pain. It is important to report any injury to the joint
to the doctor immediately.
Future activities are generally limited to those that do not risk
injuring the replaced joint. Sports that involve running or contact
are avoided, in favor of leisure sports, such as golf, and swimming.
Swimming is the ideal form of exercise, since the sport improves
muscle strength and endurance without exerting any pressure or
stress on the replaced joint.
Patients with joint replacements should alert their doctors and
dentists that they have an artificial joint. These joints are
at risk for infection by bacteria introduced by any invasive
procedures such as surgery, dental or gum work, urological and
endoscopic procedures, as well as from infections elsewhere in the
body.
Patients are recommended to take antibiotics before, during, and
immediately after any elective procedures in order to prevent
infection of the replaced joint.
Though infrequent, patients with total
knee replacements can require a second operation years later.
The second operation can be necessary because of loosening, fracture,
or other complications of the replaced joint. Re-operations are
generally not as successful as the original operation and carry
higher risks of complications. Future replacement devices and
techniques will improve patient outcomes and lead to fewer
complications.
Patients with severe destruction of the knee
joint associated with progressive pain and impaired function may
be candidates for total knee replacement.
Risks of total knee replacement surgery have
been identified.
Physical therapy is an essential part of rehabilitation
after total knee replacement.
Patients with artificial joints are recommended
to take antibiotics before, during, and after any elective invasive
procedures (including dental work).
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
The knee joint is composed of three compartments and ligaments which stabilize the joint. Causes of knee pain may include injury, degeneration, infrequently infection and rarely bone tumors. Although routine x-rays do not revel meniscus tears, they can be used to exclude other problems of the bones and tissues. The knee joint is the most commonly involved joint in rheumatic disease, as well as immune diseases that affect various tissues of the body.
Osteoarthritis is a type of arthritis caused by inflammation, breakdown, and eventual loss of
cartilage in the joints. Also known as degenerative arthritis. Osteoarthritis
can be caused by aging, heredity, and injury from trauma or disease.
Aseptic necrosis (avascular necrosis or osteonecrosis) is a condition that develops when blood supply diminishes to an area of bone and causes bone death. Though aseptic necrosis may be painless, pain is often associated when the degenerating bone is used. If caught early, aseptic necrosis may be treated by grafting new bone into the degenerating area. In later stages, joint replacement surgery may be required.
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