Total knee replacements are one of the most successful medical interventions ever, improving the lives of millions of patients. Over the last 50 years these surgeries have evolved into one of the commonest surgical procedures being performed across the globe with increasing frequency. The most common reason to perform a total knee replacement is arthritis. Arthritis is a condition which can affect all joints but most commonly afflict the knee and hips.
Joints have articulating surfaces which are covered with a smooth cartilage which allows for smooth and painless movement. This cartilage can be lost or damaged due to many conditions – age (osteoarthritis), injury (post traumatic arthritis) and various types of inflammation (inflammatory arthritis like rheumatoid arthritis, psoriasis, ankylosing spondylitis etc).
Most patients in my busy practice as a joint replacement surgeon almost 3/4 the of the patients are females and commonly between 55-65 years old. This is unlike my surgical practice in the Uk where most patients were in their 70s. However it is not uncommon to perform surgery in very elderly patients (my oldest surgical patient for TKR being 92) .
Most patients will present with complaints of pain. Pain is commonly felt when starting to move or when getting up from a sitting position. Pain is also worsened by activity, going up and down stairs and also on walking a certain distance. In severe cases pain can be felt at rest and can also disturb sleep.
Stiffness: Patients can also notice loss of the range of movement and struggle to bend and fully straighten the knee. In advanced cases the patients lose a significant range of movement.
Most patients will have a limp which increases with the symptoms. Pain and deformity are the main contributors to the limp.
In long standing cases of arthritis of the knee can lead to various types of deformities which can make the condition worse and mobility more challenging. The most common deformities are the knee bending outwards (Bow legs or varus) or keeping the knee in a slightly bent position (fixed flexion deformity). Increasing deformity can also pose a challenge to surgery increasing the complexity of the surgery with increasing deformity.
Pain, deformity, limp and decreasing ability to walk leads to gradual decline of the patients health. The limp can very commonly lead to increasing back pain and degeneration of the spine. Lack of mobility and activity leads to various medical conditions like diabetes and heart conditions which is also contributed too by chronic painkiller use.
All of the above problems lead to falling quality of life. Most patients are distressed not only by the symptoms they face but also because most patients gradually lose their independence and in severe cases become dependent even for simple tasks like personal hygiene, going to the toilet etc, which adversely affects not only their quality of life but also their dignity.
The decision to proceed with a total knee replacement is made mainly on the basis of the impact the symptoms of arthritis have on a patient’s life. The diagnosis is usually confirmed by a simple xray and further scanning is usually most required unless there is some complexity. Most patients will have simple blood tests and occasionally some patients may require a cardiac work up.
Total Knee replacement has become a very routine surgery and despite its complexity the surgery itself is no longer considered challenging in most cases, unless there is a large deformity or any other factors.
Several patients will be suitable to have both their knees replaced at the same time. Some patients (with advanced age, uncontrolled or severe medical conditions, and need for complex surgery) would benefit from one knee at a time.
The surgery is commonly performed under spinal anaesthesia where the patient remains awake but numb from the waist down. We frequently leave a thin catheter in the back (epidural catheter) which provides excellent pain relief to patients post surgery for the next fe days in the hospital.
Surgery is performed using minimally traumatic techniques and standards jigs and occasionally computer assisted. Normally I don’t use any external stitches which allows for easy recovery and less follow up.
The patients after surgery are kept in our special high dependency unit overnight. and are shifted to the ward the next morning of the surgery when their dressings are reduced and they are made to walk.
My patients undergo an enhanced rehabilitation program and most patients are encouraged to walk and are given physiotherapy. Patients usually go home on the 4th or 5th day of the surgery. At this point most patients are walking with the aid of a walker or crutches. The patients can discard the dressing on their own on the 7th day and can start washing the operated area soon after. There are no stitches to be removed. In two weeks most patients would have discarded their walking aids though i am not pedantic about time scales as all patients have different abilities.
I encourage most of my joint replacement patients to get an X-ray every year, and see me. If physical visits are not possible as several patients are international i tell them to send me their X-rays electronically for my review. Based on current science, published literature and advancements in medical science, we postulate that over 90% knee replacements should last 20 years and 70% or so for more than 30-35 years. But this would require periodic follow up, and measures to ensure that the bone quality does not deteriorate. For this we encourage good diet, exercise and certain medication.
Published literature reveal high satisfaction rates following knee replacements and in my own practice this is reflected by a high positive feedback from patients who have undergone knee replacements. Get the best knee replacement treatment and surgery in Noida and get instant relief from knee and joint pain.
Dr Gaurav Rathore is a senior orthopaedic surgeon and additional director for Orthopaedics and joint replacement at the Magenta Clinic and Max Super Speciality Hospital ( Previously known as Jaypee Hospital), Noida. He has nearly 25+ years experience in Orthopaedics with 11 years in some of the best centres in the UK, including Wrightington hospital, England, the pioneering hospital for joint replacements in the world.
He also has experience of practising in few of the Premier Hospitals in UK including University Hospitals of Morecambe Bay NHS Trust, John Radcliffe Hospital, Oxford, Chesterfield Hospital, SWELOC, London etc.
In 2013, he moved to India bringing world class Orthopaedic care to Delhi NCR. He has worked at a senior level at Sant Parmanand Hospital, Civil Lines; Fortis Escorts, Okhla and Fortis Hospital, Noida. He has been heading an orthopaedic unit at Max Super Speciality Hospital ( Previously known as Jaypee Hospital ), Noida since 2015.
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