Joint replacement surgery has become very successful with advancement of technology and instrumentation. The old school regarding knee replacement has been revolutionised with introduction of Robotic surgery, Patient Specific Instrumentation(PSI) and Patient controlled analgesia (PCA). The patients are made to walk next day after surgery and pain control is regulated by the patient himself. The use of expert techniques and instrumentation has evolved the surgical technique.
The choice of undergoing a surgery is completely a decision of the patient and their attendes and depends mainly on symptoms of the patient. Age is no bar, as frequently mistaken for undergoing a replacement surgery. Mostly the patients are councelled to start with conservative treatment in all cases even despite symptoms of any severity. Patients who fail to have any relief with medical treatment and rehabilitation are councelled for a surgical intervention and usually asked these questions:
- Do you use analgesics on a daily basis? If yes, what and how much?
- Do you have difficulty in doing activities of daily living?
- Do you have frequent awakenings at night due to the knee pain?
- How much is the distance that you can walk upto symptom free?
- Do you have any radiological documentation of your problem?
- Do you have pain while resting also?
A set of similar questions may be asked by your orthopedic which will guide him to provide you with the options that can help you do better.
The main treatment depends on patient symptoms and X ray findings along with a clinical profile of the patient. With advancement of technology, we also provide several non surgical and surgical treatments before a Replacement surgery. These depend upon the stage of the disease and disease activity.
Main Indications of undergoing a Replacement surgery include:
- Osteo-arthritis (Degenerative)
- Rheumatoid and associated arthritis
- Post Traumatic/Surgical Arthritis
- Oncological pathology around knee
The procedure basically involves a resurfacing of the thigh bone, leg bone and the knee cap and insertion of metal and plastic prosthesis.
Pre-procedural evaulation requires:
- Complete medical examination
- Complete hematological(blood) and urine examination
- Radiological examination of both knees
- A pre- anaesthesia checkup for all associated comorbidities
- Control of metabolic derangements with medical treatment
- Home and Social planning and councelling
No Surgery stands free of risks and one of the most important FAQ is how much is my patient going to benefit from surgery?
The answer to this question is indivisualised and depends on symptomatic status of the patient. The more the patient is symptomatic, the better is the pain relief post procedure. The risks associated with the procedure include:
- Blood Clotting (thrombosis)
- Mechanical complications: Loosening & subsidence
- Delayed wound healing
- Immunosuppression in cases of Rheumatoid arthritis
- Chest Infections
- Painful restricted range of motion post surgery (unhappy knee)
There always exists a difference between the expectations and result with most patients meeting the two by end of 6-8 weeks if there is no associated complication. The patients may have a restricted range of motion with flexion not reaching more than a 110 degree and inability to squatt and sit cross-legged post surgery.
Post-surgical precautions include regular physiotherapy as advised, protected weight bearing, good nutritional status and protecting wound from any contamination.
Most patients do well with excellent functional rehabilitation at 6 weeks time. Achieving quadricep strength after range of motion is achieved remains imperative. Exercises might need to continue for a year post surgery.
For any related querries please feel free to contact our orthopedic team. A personal consultation with the patient and records is essential for tailoring the needful treatment for the patient.
Basic regime for post operative rehabilitation remains same with addition of exercises at each visit. The last set of exercises are added up with the new ones. Here are a few exercise videos for post replacements
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