Knee Replacement Simplified!

Osteo-arthritis of the knee is a common stay problems in adults of elderly age group. The most presentation of which is knee pains and restricted range of movements. Patients have a variable degree of symptoms ranging from some discomfort or heaviness to inability to perform daily activities. The most important differentiating questions between a surgical and a medical candidate remains the following:

  1. The frequency of analgesic use:
  2. Presence of night symptoms:
  3. Comfortable ambulatory distance:
  4. Patient’s ability to maintain self-hygiene:

In cases where the answer to the fore said questions is positive with respect to frequent analgesic use, night awakenings due to pain, walking restricted to household only and inability to maintain personal hygiene, the answer to the pain remains surgical(knee replacement).  Patients who have mild symptoms or a sudden aggravation of symptoms in younger age, the condition is treated medically after investigating the cause of pain.

Knee replacement has been considered a “big” surgery and patients are often afraid of it. The fear is mostly secondary to the lack of knowledge about the procedure. The article focuses on the commonly feared myths about the surgical procedure.

What is Total Knee replacement??

Knee replacement or total knee arthroplasty is basically a resurfacing procedure where the bones of the thigh and the leg are shaped in the way as to accommodate the metallic plates on both surfaces. The reshaping of these bones takes of the 6-8 mm of the superficial bone which has lost the cartilage over it.

The components include a Femoral component, a tibial tray and an Insert between these two components. The patella is also resurfaced in cases with severe patello-femoral involvement.

Why is a layer of bone shaved off ?

This hard (sclerotic) bone should be removed so as to be able to place the implant with a good hold on the bone surfaces. The implants on both thigh and leg bone are usually fixed with cement which gives a firm hold and prevent loosening of the implant. A conventional thought that a “new” knee is fixed taking out the old one is a popular myth. The original joint is kept is place and the surfaces of bone is just replaced by a metallic plate contoured in shape of the bone.

What is the average life of the new knee?

The life of the implant depends on the wear tear of the plastic component that is inserted between the two metallic plates. This “spacer” functions like the cartilage in the knee. It is usually said to last for about 15 years’ time if patient understands the limitations post-surgery. The patients are usually advised to exercise regularly and to not bend the knee beyond 100 degrees of flexion. The group of patients regularly doing exercises have much shown much better results as compared to patients who discontinue exercises early on.

What exercises are advised after the surgery?

The few set of exercises have been demonstrated in the links below for the patients who have undergone or are planning to undergo replacement surgery in future.

Why is early surgery considered better?

 It is always considered better to seek surgical help early in the disease so as to prevent worsening of co-morbid conditions like diabetes, hypertension and hypothyroidism due to lack of exercises. Also the equality of bone is usually compromised with increase in age and deformity (bending) at the knee. The Implant rests on the bone stock only and for the implant to have a good fixation, it is recommended to get it done early.

How much time does it take for my replacement surgery?

Your doctor will advise an array of tests before you are deemed fit for undergoing the surgery. These tests are a part of pre-anesthesia checkup and indicate the functions of vital organ systems. After clearance is done, the patient is admitted a day before surgery. Nursing staff and your team of doctors will visit you and re-educate regarding the procedure on the following day. The surgical time in each knee is about 1 hour and anesthesia administration takes about 45 minutes time. The total time from shifting the patient from and back to the room is about 2 and a half hours.

Post Knee replacement Implant placement where the metal plates have a plastic insert in between.

What is the post-surgical course in the hospital?

Usually the patient is instructed to lift their heads up for 24 hours post-operative.  The patient is made to walk on day 1 after surgery after a change in the dressing. There is usually a urinary and an epidural (pain-relieving) catheter in place. These are removed before ambulating the patient and as per pain scale respectively. The patient is usually discharged on day 3 and advised a follow up at 2 weeks for suture removal. Knee brace and ambulatory support is used as per patient pain tolerance only.

Should I undergo a single sided or both sided replacement?

The patients profile and deformity is the first guide for decision making. The more is the deformity, it is advised to undergo both sides simultaneously so as to balance and align the body weight on both knees equally. On the other hand, to keep surgical stress to the minimum, unilateral replacement is described as per the risks involved due any co-morbidity (diabetes, hypertension, hypothyroid etc.) in elderly patients. It is primarily the decision of the anesthetist and the surgeon to decide on keep patient safety as first priority.

Knee Replacement Simplified!

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