Health

By Dr Tejaz K. John, MBBS, MS (Orth) Joint Replacement Fellowship Consultant Orthopaedic Surgeon)

Knee replacement surgery can help relieve pain and restore function in arthritic and severely diseased knee joints in the elderly. During knee replacement, the surgeon clears away worn out bone and cartilage from your knee joint and replaces it with an artificial joint (prosthesis) made of metal alloys, high grade plastics and polymers.
The first artificial knees were little more than crude hinges. However, today, most knee replacement joints have advanced technology to replicate your knee’s natural ability to roll and glide as it bends.

Why is it done?

A knee replacement can markedly decrease pain and disability in people with knee problems caused by osteoarthritis, rheumatoid arthritis and traumatic arthritis.

Knee replacement may help if:

You have pain that limits activities such as walking, climbing stairs getting out of chairs, or have moderate to severe knee pain at rest.
You have limited function or mobility, such as chronic knee stiffness and swelling that prevents you from bending or straightening your knee.

You have tried other methods to relieve symptoms, for example, weight loss, physical therapy, a cane, medications, braces and surgery, but they have failed.
You have a knee deformity, such as a joint that bows in or out.
You are aged 55 or older. Knee replacement is typically performed in older adults, but it may be considered for adults of all ages. Young patients who are physically active may benefit from high flexion knee replacement that assists in significantly more knee bending ability than conventional knee replacement surgery.
You are healthy. Good candidates are typically without conditions such as reduced blood flow or pre-existing infections that can complicate surgery. Diabetes & high blood pressure is not a contraindication for surgery, as long as the sugars and blood pressure are controlled prior to surgery.
Risks

As with any surgery, knee replacement surgery carries risks, including:
Infection
Knee stiffness
Blood clots in the leg vein (deep vein thrombosis) or lungs (pulmonary embolism)
Heart attack
Nerve damage

Risks of serious complications are rare, as fewer than 2% of people experience serious complications after surgery. Methods to prevent some of these complications are antibiotic therapy, pressure washing of the knee joint before closing the wound and a sterile operation theatre environment to prevent infection; and blood thinning agents after surgery and the use of compression stockings to prevent blood clots. The incidence of pulmonary embolisms and heart attacks is extremely rare and has decreased after current changes in the technique and anaesthesia.
How you prepare for surgery?

Knee replacement surgery requires anaesthesia and your personal preference helps decide whether to use general anaesthesia, which renders you unconscious during surgery, or spinal or epidural anaesthesia, during which you are awake but can’t feel any pain. You’ll likely be instructed not to eat/drink anything 6 hours prior to surgery.
Plan ahead for your recovery after surgery

To make your home safer and easier to navigate during recovery, make the following improvements:
Obtain a stable chair with a firm back, and a footstool for your leg.
Arrange for a toilet-seat riser with arms if you have a low toilet.

Try a stable bench or chair for your shower.
Remove all loose carpets and electric cords.

What can you expect during surgery?

During the procedure, your knee is bent up to 90 degrees. The skin cut is 18 to 30 cm in length, the kneecap is moved aside and the damaged joint surfaces are removed by performing bony cuts through a pre-sized slot in the jig. Expect knee replacement surgery to last about two hours.

A newer and more advanced procedure is MIS Knee Replacement (Minimally Invasive Surgery), where the skin cut is very small, between 9.5 to 14 cm, where there is very minimal muscle injury, less blood loss, faster rehabilitation and very little pain after surgery. However, it is technically demanding and requires the surgeon to have a high level of surgical skill.
After knee replacement surgery

After surgery, you’re kept in a recovery room for some time. You’re then moved to your hospital room, where you typically stay for several days before going home. You may feel some pain, but nerve blocks and medications prescribed by your doctor will help control it. During the first few weeks after surgery, your physical activity programme must include:
knee-strengthening exercises performed several times a day
a graduated walking programme — first indoors, then outdoors, slowly resuming other normal household activities, including walking up and down stairs
Results

More than 95 % of people who have a total knee replacement experience significant pain relief, improved mobility and a better overall quality of life. Three to six weeks post surgery, you generally can resume most normal daily activities such as shopping and light housekeeping. Driving is usually possible in 4 to 6 weeks. However recovery and return to normal activities for MIS knee replacement is much faster than with conventional knee surgery.
After you’ve recovered, you can enjoy a variety of low-impact activities, such as walking, swimming, playing golf or biking. But higher impact activities, such as jogging, skiing, tennis, and sports that involve contact or jumping, may be out. For any queries, contact the author at the hospital, or email: arthritisfreeworld@gmail.com.