Posted by: wockhardthospitals | August 12, 2009

Knee Replacement : Frequently asked Questions

1.Evolution around knee surgeries in India over the years.

This decade has been very progressive for orthopaedics in India to the extent that we can call it an orthopaedic decade. A lot is now on offer to improve quality of life to those with arthritis and joint injuries. As late as 1980s most people with worn out joints had no choice but to lead an invalid life. There are very few surgeons in our country with resources to provide reconstructive joint surgery. Also to those few who could afford, the treatment options were limited as well as expensive. In late 80s Arthroscopic or keyhole surgery started gaining popularity in India. This was a boon to youngsters involved in sports. Around the same time Joint replacements became more readily available. This is when Indian companies started coming up with reliable prostheses. As we rolled into the third millennium standard knee and hip replacements were optimised in a number of cities and centres across the country.

2.Percentage of Indian undergoing Knee Replacements every year

This varies greatly compared to western countries. Reliable figures are not available but a vast majority of Indian patients tend to procrastinate on knee arthritis rather than having surgery. Knee tends to be most commonly replaced joint in India because of higher incidence of knee arthritis compared to hip in our subcontinent.

3.Who is a candidate for knee replacements?

Any person with a painful and irreparably worn out knee joint can be a candidate. There has been a classic approach to do it after the age of 60 because older prostheses tended to last only 10 to 15 years and revision surgery was difficult. But now the contemporary designs are long lasting, techniques are more refined and revision surgery facilities have been developed optimally. Therefore we contemplate doing joint replacements at much younger ages.

4.What advancements have been made in total knee replacements? Advancements in surgical methods and how it has been revolutionized over the years

Advances as follows as detailed-

  1. Advances in materials- Harder alloys like Oxynium, long lasting synthetics like ‘highly crosslinked UHMWPE’ and ceramics

  2. Advances in design – better understanding of mechanism of knee joint has led to designs like ‘rotating platform’, ‘high flex knee’ , ‘gender specific knee’, ‘uni compartmental and bicompartmental knees’

  3. Better instrumentation has made the operation more precise hence we can guarantee better long term outcome. Lot of engineering has been applied to this development. Computer navigation has provided icing on the cake by providing a further tool to get ultimate precision.

  4. Advanced surgical evolution has brought forward minimally invasive techniques to conserve the soft tissues and in effect provide a faster and much quicker recovery.

  5. Advanced surgical and anaesthetic protocols have ensured much better patient safety, infection control and pain relief. This has further ensured world class results and final outcomes allowing our patients to enjoy a normal lifestyle for years to come.

5.What is a partial vs. total knee replacement?

The terms are almost self explanatory. The knee joint has 3 compartments. A. MEDIAL B. LATERAL C. PATELLFEMORAL.

A partial knee replacement only replaces the worn out compartment whereas TKR replaces the entire surface of knee joint.

6.What is the recovery period typically like?

Short term recovery takes 10 days. This the time required for the wound to heal and patient is walking fairly comfortably at this stage. Long term recovery takes around 6 to 8 weeks by which time the patient is back to normal day to day activity including driving and work.

7.What are the short- and long-term outcomes of knee replacements? What is the success rate and how many years a patient can sustain a successful Knee Replacement?

Typically when a good quality proven prosthesis is used the 97% knees should last for 10 years. This percentage goes down by 4% every 5 years. With current advances this survival will get better. We are keen to improve the post 10 year survival.

8.Post operative treatment for a patient who has undergone TKR

The preparation begins before surgery. I advise the exercises to be started while the patient awaits surgery. Various means like epidural catheter, injections and painkillers are used for pain control following surgery. Antibiotics are used for appropriate duration.

Exercises and walking starts on day 2 or 3

Special exercise aids are used by physiotherapists. E.g. CPM machine

Patient is free to go home when wound swelling is settled and knee is bending well.

Typically my patients go home 4 to5 days after surgery.

Stitches are taken out on 10th day

Exercises continue for at least a month

9.Is there a certain age that is considered too old for a knee replacement? Can you be too young?

Barring extremes there is no exception on theoretical grounds. Naturally a child with growing skeleton or an extremely old medically unfit patient will be a contra-indication. Circumstances are evaluated on individual basis. Certain young patient are so disabled because of the disease that there is no other option to go for the surgery.

10.What type of activities patient can participate in after a knee replacement?

A standard knee replacement allows painless walking, climbing stairs, and sitting in most positions. A high flex knee allows cross-legged sitting and squatting in addition to above. Activities like swimming, cycling, golf can be taken up unhindered.

What a knee replacement does not allow are impact sports and contact sports like football and badminton. However low level doubles tennis may be allowed.

11.How should a person choose an orthopaedic surgeon?

A chosen surgeon should be adequately experienced and trained with a good track record.

Not only is the surgeon important, the setup where the surgery is done should be equipped and advanced enough to be able to give worl class results and success rates.

Above is original material drafted by

Dr. Sachin Bhonsle, Consultant Orthopedic Surgeon, Wockhardt Hospitals, Mumbai


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