Knee arthritis – What to do ?

Wednesday, 12 February 2014

 Osteoarthritis is a crippling disease which involves degeneration of the cartilage and usually affects the knee and the hip joints. With advancing disease, the functional limitations start to set in with increasing difficulty in day to day activities.
A few decades ago, this was tackled mainly by pain medications and non-surgical intervention was the accepted treatment modality in major parts of the world leading to pain and suffering for millions of elderly throughout the world. However With the advent of total knee arthroplasty and the ever improving design and technical improvements, a sigh of relief has been provided to those who were unable to cope up with their daily activities due to pain and deformity of their knee joints.
Knee replacement surgery, also known as knee arthroplasty, is regarded as a modern surgical procedure that can accurately be described as "knee resurfacing". This procedure entails restoring the weight bearing portion of the knee joint that is damaged, worn out, or diseased to relieve pain and movement disability. It is performed through the implant of an orthopedic metal and polyethylene component shaped as a joint so that the knee can move properly.
Arthroplasty is a field of medicine which deals with the surgical reconstruction and total replacement of degenerated joints. Arthroplasty uses artificial body parts (prosthetics). Arthroplasty literally means "the surgical repair of a joint".
When the articular cartilage of the knee becomes damaged or worn out, it becomes painful - the patient finds it extremely hard to move the knee. The bones, rather than sliding over each other with the minimum of friction, rub and crush together.If an artificial prosthesis is surgically implanted, the patient will feel much less pain, possibly none, and his knee will move properly.
Replacement surgery in a damaged knee joint by placing an artificial prosthesis will alleviate pain and help better movement of the knee.Today, every year, millions of knee replacement surgeries are carried out throughout the world. Most patients are seniors - aged over 55 years.
For most patients, a replacement knee surgical procedure will last for at least 15 to 20 years, especially if cared for properly and not put under too much strain. More than 90% of people who have total knee replacement surgery experience a dramatic decrease in knee pain and a significant improvement in their ability to perform common activities of daily living.

Reasons to perform knee replacement surgery

Today, a knee replacement surgery is considered a routine operation. Below are the three most common reasons for the procedure:
  • Osteoarthritis- This type of arthritis is age related - caused by the normal long wear and tear of the knee joint.
  • Rheumatoid arthritis- also called inflammatory arthritis, occurs when the membrane surrounding the knee joint is inflamed and thick.
  • Post-traumatic arthritis- this type of arthritis is due to a severe knee injury. When the bones around the knee break or the ligaments tear, this will affect the knee cartilage
  • When is knee replacement surgery recommended?

    Knee surgery is recommended for older people, although adults or teenagers of any age can be candidates for the procedure, since they are physically active and will more rapidly wear the joint out. The weight, gender, or age of the person is never a factor when considering knee replacement surgery. Whether or not to perform surgery is nearly always based on the severity of pain and degree of disability of the patient.
    If should be noted that knee replacement surgery that occurs earlier in life usually means further surgery later on. However, several studies have proven that knee replacement surgery performed before severe stiffness and pain set in is associated with better outcomes.
    When considering the option of knee replacement surgery, doctors take into account a number of symptoms:
    • Severe knee pain or stiffness.
    • Moderate but continuous knee pain.
    • Chronic knee inflammation and swelling.
    • Knee deformity.
    • Nothing else worked.
    • Preparing for a knee replacement surgery procedure

      The preparations for a knee replacement surgery are started way before the actual day of surgery. The blood investigations and urine examination is done to rule out any possible source of infection, which if present is a contraindication to surgery. The patient is kept fasting overnight before the day of surgery and the procedure is carried out under spinal anesthesia. The procedure lasts for about 30 to 45 minutes.
      The patient is mobilized the same day and weightbearing is started by next day. The patient is made to walk with support by next day and after stitch removal at 10-12 days weight bearing without supports can be done. The patient is usually discharged in 3 to 4 days.

      What are the risks of surgery?

      Experts say that total knee replacements have extremely low complication rates - and occur in fewer than 2% of patients. Complications may include stroke, DVT (deep vein thrombosis), infection in the knee joint, or heart attack. Nerve damage occurs in 1 to 2% of patients.
      Persistent pain or stiffness occurs in 8-23% of patients.About 1 in every 50 patients will experience prosthesis failure within five years of their operation.

      Recent Advances in Total Knee Replacement -

      • Mini-incision surgery (MIS) - Still considered a new surgical technique, the difference is that the orthopedic surgeon performs a very small cut in front of the knee rather than the standard large opening. New specialized instruments are inserted in the small opening to maneuver around the tissue rather than cutting through it. Since the procedure is less harmful to the joint, the recovery time is much quicker and less painful.
      • Image-guided surgery - Although considered as a very accurate alternative in positioning the new knee joint, it is still not a common surgery. As a matter of fact, only 1% of all operations are done through image-guided surgery.
      • Autologous chondrocyte implantation (ACI) - This procedure is when new cartilage from the patient´s own cells matures artificially in a test tube and is later introduced into the damaged area. It is a common procedure used when the patient has injured his knee in an accident. A more common procedure for patients with accidental injuries, rather than those with arthritis.
      • Custom knee Replacement Surgery -

        It is the most recent development in this fiend where CT Scan of the patient’s knee is taken and custom pre-operative alignment blocks are made , as shown in below diagram.
        Since the knee is accustomed to the patient’s knee , it provides an exact fit for each patient undergoing surgery . It also lowers the operative time and number of steps involved in the surgery.
        Pre – Operative Post Operative
        Steps involvedin a custom Total Knee Replacement Surgery
        Thus this technique allows improvements in speed, cost,access, reach and flexibility which benefits both the surgeon and the patient.

        Summary and Conclusion: -

        Pain and suffering from osteoarthritis are soon going to be a thing of the past and elderly can achieve a near normal life, made possible with increasingly affordable surgery and improving designs and new innovations.

        For More Information 

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