January 13, 2017

Joint deterioration (osteoarthritis) can affect every aspect of a person's life. In the early stages, it is common for people to ignore these symptoms, but as the disease progresses activities like walking, driving and standing become painful and difficult.

The Knee:

It is a complex joint consisting of bone, cartilage and ligaments. The end of the femur( thigh bone ) can be compared to a rocking chair. It has two distinct surfaces called compartments which rest on the tibia( shin bone). The third compartment is found behind the knee cap and all three compartments are covered with cartilage to help cushion and lubricate the bones during movement.

Osteoarthritis is a wear and tear condition that affects the joint cartilage and it develops after years of constant motion and pressure on the joint. As the cartilage continues to wear away, the joint becomes increasingly painful and difficult to move. If medicines and physiotherapy fail to provide relief, one might consider a total knee replacement.

There are two types of osteoarthritis – primary and secondary.

Primary osteoarthritis is generally associated with aging and the “wear and tear” of life. The older one is the more likely one is to have some degree of osteoarthritis. Secondary osteoarthritis, in contrast,tends to develop relatively early in life, typically around 10 years after an underlying cause.

Signs and Symptoms:

Joints affected by osteoarthritis ache or become painful more on bearing weight and on activity. On rest the symptoms subside except in advance joint degeneration. On examination by a clinician, tenderness might be present along with clicks on moving the joints.

X-rays are the gold standard to diagnose this condition. Occasionally, an MRI might be required to see the early cartilage damage and associated ligament degeneration.

Initially, conservative treatment consisting of medication, physiotherapy, exercises are tried. In early to moderate degeneration this might help in relieving the symptoms. But In advanced degeneration it might not help where one might have to consider to undergo a total knee replacement.

What is knee replacement surgery?

It is a surgery where the damaged bone and cartilage are resurfaced with an artificial implant. The implant mainly consists of metal and polyethylene which allow the bones to smoothly glide against each other,much like natural cartilage.

It is performed under spinal or epidural anaesthesia. The length of the surgery is approximately one-and-a-half hours. Care before surgery and time spent in the recovery room can add an additional two to three hours to the surgery.

The implant acts as a barrier between two exposed bone surfaces devoid of cartilage and relieve pain.

Who needs knee replacement surgery?

Patients with arthritis of any form with unbearable pain, severe deformity which hamper the day to day activities need this surgery.

What is the right age to undergo a knee replacement surgery?

One needs to understand that this surgery is done for joint deterioration which happens only in advanced age. Around 65 years would be the right age to undergo a knee replacement surgery. However if need arises it could be done at any age.

What are the implants used during surgery?

Now a days there are a wide variety of implants which might be manufactured abroad or in India as well. Usually the implants are made up of cobalt chromium and ultra high molecular weight polyethylene. The newer ones include oxinium, zirconium and ceramics in case of hip replacements.

After surgery, what next?

A CPM machine is used to improve the range of movement following a knee replacement surgery.

The patient would receive pain medication and physical therapy. Physical therapy is important following a knee replacement surgery especially to gain range of movement. The patient is allowed to walk within 24 to 48 hours with a walker following surgery.

What are the benefits of knee replacement surgery?

The primary benefit that a knee replacement offers is relief from pain. Almost 90-95 % of the knee pain disappears following the surgery and physical therapy. Deformity can also be corrected by surgery though this isn't the primary indication. Range of movement of the knee also improves though this depends on the extent of movement a patient had before surgery.

What is a successful knee replacement surgery?

It is one where the patient's lifestyle has improved significantly after surgery. The usual mistake that patients do is compare their results with the other. One needs to understand that every human being is different and factors such as the weight of the patient, pain tolerance, flexibility, activity and mental effort play a role in the ultimate outcome of this surgery just like any other procedure.

One other point that the patient needs to understand is that only the knee pain associated with the arthritis would reduce and not any other aches or pains.

It would roughly take around 2-3 months to appreciate the final outcome of the surgery.

What are the complications expected following surgery?

While uncommon, complications can occur during and after surgery. Some complications include, but are not limited to, infection, blood clots, implant breakage, loosening. Although this surgery is successful in most cases, some patients still experience stiffness and pain. No implant lasts forever and factors such as patients post operative activities and weight can affect the longevity.

What is the cost of the knee replacement surgery?

It may vary with the kind of implant used and the hospital ward chosen during surgery. Roughly the cost would be between Rs 80,000 to Rs 2.5 lac.

How long would the patient need hospital admission?

This depends on the preference of the surgeon. Roughly a patient is discharged 3-7 days following surgery.

Recovery

Exercise is necessary for proper healing. The home physical therapy roughly continues for around 4-6 weeks. Diligent physical therapy, proper diet and willingness to follow the advice given is important in the final outcome of the surgery.

Most patients are typically not allowed to participate in high impact activities or contact sports. These types of activities place extreme amounts of pressure on the joints which could lead to complications.

Complications can occur due to implants, so one needs to follow up regularly with his or her knee surgeon.

Decision to have a surgery is difficult. Millions of people around the world have made the choice to undergo this surgery to return to more active lifestyles. Hence one needs to understand the benefits, pro s and cons of this procedure and then arrive at a decision to go ahead with it or ignore it.

Dr Vivian Roshan D'Almeida
MBBS, MS (Ortho), MRCS (Eng), MRCS (Ire), MRCPS (Glasgow),
Fellow in Knee Surgery, Arthroscopy and Sports Medicine (USA, South Korea)
Consultant orthopaedic, knee and arthroscopy surgeon,
Ortho 1 Speciality Clinic.
Mobile: +918147421567
Email: v_dal1981@yahoo.com