Dr Kevin Yip, is physician specializing in knee, disc problem and spinal pain treatment with 21 years of experience in treating various kinds of sports and Orthopaedic problems. Knee problem is a very common physical problem, affecting people from all age groups. There are different symptoms and causes of knee Problem and it is very important that you should consult your knee pain specialist immediately if Knee pain stay for more than one week.
The knee problems are found commonly in all sections and age groups of people, this is more so often in females after the age 50 years. About 15% of the populations is suffering from one or the other type of joint problem viz. arthritis. "Arthritis" is a general term describing the disease of any joint knee, hip etc. where the joint is damaged or destroyed by a disease or injury. The most common type of arthritis is called 'Osteoarthritis', which is degenerative in nature. It usually results from constant knees stress e.g. due to over weight. Heredity sometime also contributes. The second commonest type of arthritis is called 'Rheumatoid arthritis'. This disease usually affects multiple joint of the body like hand, elbows, shoulders, knees, hips and feet. The cause of it is not well known. However, there is evidence to suggest that it is an 'autoimmune' disease, where some tissues in the body (under the influence of some triggering agent) produce chemicals which attack the lining (synovium) of the joint, irreparably.
As an initial treatment of arthritis, conservative treatment in form of medicines, Physiotherapy is used. Even though modern medicines offer symptomatic relief from the agonizing pain and inflammation of the knee joint, their efficiency is limited and the symptoms reappear with withdrawal of medication. In early stages of resistant arthritis, key whole surgery (Arthroscopy) is useful. As the disease progress and tolerance to medicines develop, the patients become knee crippled and are unable to lead a normal life. Moreover, these pain killers are sometime harmful as they may cause gastric ulcers, kidney and liver damage. Repeated, progressive attacks of arthritis could lead to permanent damage and deformity of the knee joints. TOTAL KNEE REPLACEMENT (T.K.R.) is a highly successful treatment option available in this stage.
Total Knee Replacement is a boon to people having chronic, disabling arthritis. The success rate for such an operation is very high and it is now possible to need a life very close to normal. There is no lead to live with pain and immobility any more. Option for joint replacement surgery is like acquiring a new lease of like. T.K.R. is usually preferred after the age of 50 years, where all measures of relieving pain have become unsuccessful. The joint replacement surgery is going through the same initial phase as the open heart and by pass surgery had gone about a decade ago in India. As the heart operations have now become popular with the masses, the joint replacement surgery is bound is bound to follow soon.
The knee joint functions like a hinge of a door or window and can only move in one direction. It is formed by the articulation between 3 bones viz. femur (thigh bone), tibia (leg bone) and patella (knee cap). The artificial joints are made of a metal and plastic combination. The metals used commonly are Vitallium, Titanium and Stainless Steel. The plastic used is Ultra High Density Poly Ethylene (UHDPE). Artificial joint is technically called a 'prosthesis'. A prosthesis is designed to look and function in exactly the same manner as the natural joint. A prosthesis is made from a strong material capable of taking stress and is bio-compatible i.e. nontoxic and non allergic. Although, a prosthesis is designed to last for a life time but like our very own joints, some time it loosens or wears out, after 10-15 years of the operation. This problem can also be tackled satisfactorily through a 'revision surgery (re-operation)'.
Total joint replacement of the knee is mostly advised in elderly patients (except for some young patients suffering from bad rheumatoid arthritis), who have the last stage of arthritis affecting their knees. In these patients, at this stage, all the other measures of relieving the pain and disability have already been tried and failed. The arthritis could be due to osteoarthritis, rheumatoid, or post traumatic arthritis etc.
Total knee Replacement is being performed with increasing success rate. The goals of TKR are as follows:- 1. Relief of pain. 2. Restoration of stability of the knee. 3. Achievement of functional range of motion of the knee joint. 4. Maintenance of good operative result over the long term.
The procedure of TKR involves shaving off the damaged/diseased ends of the bone and fixing of a new artificial joint on the existing healthy bone either by bone cement (polymethyl methacrylate) or bone screws. One cut (incision) is required on the front of the knee to expose the joint & to do the operation. • If there is any infection in the body then a doctor should be consulted immediately and proper antibiotic cover should be taken, to avoid secondary infection in the artificial joint. What cannot be done after the Total Knee Replacement • Never squat on the ground. (This could damage the Prosthesis). • Do not use Indian toilet • Do not engage in competitive sports or intense activities. • Do not let your body weight increase, as this will increase wear and tear.
Like any major operations. TKR may be associated with a complication although rarely. There may be potential complications both during and after surgery. Generally, these include infection, blood clots (thrombosis), pneumonia, fat embolism, prosthesis loosening and nerve damage.
TKR not only offers pain relief but corrects the existing deformity and restores the stability of the damaged joint. It also helps in achieving the functional range of motion and thus improves the gait and mobility of the patients. Overall, the patients have a better quality of life and independence, which is so vital in elderly age.
The future of join replacement surgery is bright in India. TKR surgery has come here to stay forever, as it has proved worldwide over in the last 2 decades, through excellent result. A great amount of research is being carried out the further improve both the material used in the replacement parts and in their design to make them function smoothly and as 'normally' as possible. With more trained personal available in time to come and lower cost of prosthesis would certainly help in making the TKR to become extremely popular treatment option.
A joint replacement surgery is done under general or spinal/epidural anaesthesia. It is a major surgery which lasts for one two hours. The average blood loss during and after the operation is about 500 to 700 mls., and this loss is compensated by a blood transfusion. Before the surgery, a through physician and pre-anaesthetic check up is done. It is very important to exclude any active or hidden infection in the body at the time of doing T.K.R.
Patients are advised to do certain exercises for few days or weeks before the surgery. So that good results can be achieved.
Rest is given to the patients for 24-28 hours after the surgery. The patients are allowed to stand and walk with support. The knee bending is also started after 2 days, under the supervision of a physiotherapist. The sutures/clips are removed between 10-14 days. The patients are discharged home between 7-10 days. Follow-up visits are done 1, 4 & 12 months of the operation and thereafter once every year.