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1. What is arthritis?
Arthritis is a group of conditions where there is progressive damage to one or more joints. The most common type of arthritis is osteoarthritis, where there is progressive wear and tear of a joint. Some other types of arthritis are associated with inflammation of the joints. Arthritis eventually wears away the normal cartilage covering the surface of the joint and the bone underneath becomes damaged. This causes pain and stiffness in the joint.
2. What causes knee pain?

The knee is the most used and therefore stressed joint in the body. The common causes of pain in the knee are injury, arthritis and infection.

3. Is there a cure?

This depends entirely on the nature of the problem. Sometimes knee pain can be treated through rehabilitation, and on occasion surgery may be required. It is important to consult a doctor for proper advice as soon as the symptoms are evident.

4. What is Total Knee Replacement?

Total Knee Replacement is a procedure in which the parts of the bones that rub together are resurfaced with metal and plastic implants. Precision instruments are used to remove and replace damaged parts of the bone with implants. The surface of the femur is replaced with a rounded metal component that matches closely the curve of your natural bone. And the surface of the tibia/leg bone is substituted with a smooth plastic component.

5. How to tell if you need a knee replacement?

If your knee pain is so severe that it causes difficulty in walking and performing daily activities, knee replacement might be called for. However it is mandatory that these symptoms be taken to a doctor for an accurate diagnosis. Doctors try and delay the procedure for as long as possible by using non-invasive treatment. However if the disease is in an advanced stage, knee replacement is a means to achieve relief from pain as well as return to daily activities.

6. How do you prepare for Total Knee Replacement surgery?

A complete physical check-up is required to rule out any medical problems that may interfere with your surgery. At this time the doctor will also review your medical history. Do not forget to inform the doctor about any medication that you may be taking. A few routine pre-surgery tests will also be performed. The surgery can result in blood loss which will require transfusion. So you might be asked to donate a few units of your own blood prior to surgery.
7. What happens during Total Knee Replacement surgery?

Prior to surgery an IV line will be inserted into your arm to administer medication during the operation. Thereafter anesthesia is administered in the OT. Once anesthesia has taken effect, the knee is scrubbed and sterilized. The surgery then begins with an incision to expose the knee joint. The surgeon then uses precision guides and instruments to remove damaged surfaces. The ends of the bones are then shaped to accept the implants. The implants are then fixed, and the incision closed. A sterile bandage is applied to the wound and routine post operative care will follow as anesthesia wears off.

8. How is the implant affixed in the body?

Bone cement is used to secure the knee implants.

9. What can you expect after the surgery?

A specially designed rehabilitation routine will be started to help regain strength, balance and movement in the knee. 24 hours after surgery, you will be asked to stand. And in 48 hours, you will start to walk with support. You can expect to stay in hospital for 3 days after surgery. Your sutures will usually be removed before discharge, and you will be advised on exercises to continue at home.

10. How soon can you return to normal activities?

On an average, patients walk with a cane in 6 weeks, and start to drive in 2 months. While the surgery will relieve you of pain and allow you to resume most normal activities, this does not include contact sports and activities that put excessive strain on your knees.

11. How long will a joint replacement last?
Longevity of the prosthesis depends on the patient's activity levels, weight as well as the accuracy of the implant placement. Recent studies have found common implants to be functional in 96% patients even after 20 years. However it must be understood that implants are not as durable as the natural knee, and will eventually wear out and no assurance can be given about its longevity.
Risk & Complications:

What are the risks and complications associated with this surgery?

As with any other major surgery, there are some potential risks after knee replacement surgery. Overall the incidence of complications after knee replacement surgery is fortunately quite low. The possible complications are:

1) Deep venous thrombosis (DVT)

DVT is common after any major surgery on the lower limbs or pelvis including joint replacement surgery. Though DVT is quite common after joint replacement surgery it does not cause any symptoms in majority of the patients. In a small proportion of patients (less than 1%) the clot can dislodge and cause blockage of major blood vessels in the lungs (pulmonary embolism) or in the brain (cerebral embolism). In such an eventuality patients need supportive therapy in the intensive care (ICU). After total knee replacement surgery, patients are usually put on low molecular weight heparin (LMWH) injections which function as blood thinners and reduce the incidence of DVT and its consequences. Additionally patients are also given elastic stockings (TED stockings) in the post-operative period. After the surgery, all efforts are made to minimize the risk of DVT. The followings methods are commonly employed:

1. Low molecular weight heparin (LMWH) – Blood thinning injections
2. Warfarin or Aspirin – Blood thinning tablets
3. Elastic stocking – TED stockings
4. Intermittent pneumatic compression pumps – Flowtron pump
5. Early mobilization – getting a patient out of bed as soon as possible
Usually a combination of methods is used to prevent clot formation.

2) Infection
As with any other major surgery, there is a potential risk of infection with any joint replacement surgery. The overall risk of infection with modern techniques is quite low (about 1-2 %). Every effort is made to prevent infection after a joint replacement surgery.

How does one reduce the chances of infection after joint replacement surgery?

Every patient is assessed carefully before surgery for risk of infection. Patients with pre-existing diabetes have a higher chance of infection and need good control of their blood sugar levels. Patients with urinary tract infection, bad teeth or with any other infection in the body should wait until their infection is treated and cleared. Patients are given higher antibiotics during and immediately after surgery as a precautionary measure (prophylactic antibiotics). These surgeries are performed in clean air operating theatres with laminar airflow and body exhaust suits.

What happens if a patient develops infection after joint replacement?

The treatment of infection after joint replacement depends on whether the infection is superficial or deep. Most superficial infections can be treated with a prolonged course of antibiotics (6-8 weeks) given intravenously initially and later orally. Deep infections which present early (within 3-6 weeks after surgery) need immediate arthrotomy and wash out (opening of the wound and washing out of the wound with normal saline) followed by prolonged antibiotic therapy. When treated early it is possible to retain the patients’ prosthesis and expect control of infection. It is therefore very important to act swiftly once there is any suspicion of an infection. Deep infections which present late may need two stage surgeries whereby the existing prosthesis is removed in first stage followed by antibiotics for about 6-8 weeks to control infection. Once the infection is under control, a new prosthesis can be implanted during the second stage of surgery. In some instances where the infection is difficult to control, it may be necessary to consider arthrodesis of the joint (joint fusion).

3) Stiffness
Though most patients are able to bend their knees to beyond 100 degrees after a good rehabilitation program, some patients tend to have stiff knees despite proper rehabilitation. It should be emphasized that the range of movement (ROM) that a patient can expect after a knee replacement depends on the pre-operative range of movement in the knee. Most patients can expect to get 10-20 degrees more movement as compared to the pre-operative range. Some patients have a tendency to develop excessive scarring in the knee after surgery (arthrofibrosis) and these patients may have severe stiffness in the post-operative period. These patients should be considered for manipulation under an anaesthetic (MUA) to break down the adhesions followed by vigorous physiotherapy.

4) Loosening, Implant wear and Osteolysis
Loosening of the prosthesis is due to the bond between the implant-cement-bone becoming weak. This is long term complication which can be seen with any joint replacement surgery over a period of time. Patients who are overweight, those who have had an infection in the post-operative period, patients with severe osteoporosis, patients who have residual instability or a deformity in the knee (like varus deformity) after surgery, and young and active patients who tend to load their joints excessively tend to develop implant loosening earlier.
Implant wear relates to wearing out of the polyethylene (plastic liner) between the femur and tibia. This again is long term complication with any joint replacement surgery especially where polyethylene is used. Patients who have persistent deformity after surgery (varus deformity) or those with some residual instability after surgery tend to have accelerated poly wear. This leads to release of microscopic debris being released in the joint which in turn stimulates the release of certain bio-chemicals in the joint which can cause osteolysis (eating away of bone around the prosthesis). This can lead to early loosening of implants or peri-prosthetic fractures (fractures around the implant).
Patients who progressive loosening, and those with excessive wear will require revision knee replacement surgery. Those with a peri-prosthetic fracture will need internal fixation or revision knee replacement using long stem prosthesis.
Knee Replacement Procedure:
Knee replacement surgery can be performed as a partial or a total knee replacement. In general, the surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee.
The operation typically involves substantial postoperative pain, and includes vigorous physical rehabilitation. The recovery period may be 6 weeks or longer and may involve the use of mobility aids (e.g. walking frames, canes, crutches) to enable the patient's return to preoperative mobility.
In a separate study, the same researchers also found that people who were good candidates for surgery — basically, they had really bad knees — benefited substantially from the surgery, reporting much less knee pain and much better physical functioning in the months immediately following the procedure and again two years later. On one commonly used measure of knee function, their scores improved by about 20 points on average. By contrast, subjects whose surgeries the scientists deemed inappropriate did not improve much. After a year, their scores on knee function had risen by only about two points.
Benefits of Knee Replacement Surgery:
Once your new joint has been completely healed, you will reap the benefits of the surgery. These include:
 Reduced joint pain (may be no pain!)
 Increased movement and mobility for e.g. Walking, stair climbing, etc.
 Stable Joint. Straight Joint (Correction of deformity)
 Increased leg strength (if you exercise)
 Improved quality of life-ability to return to normal activities and pastimes.
 Most likely, running, jumping, or other high impact activities will be discouraged.
Category : Health
Tags : knee surgery india, , knee surgeon, knee surgery cos
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Date Added : 8-1-2015