There are several types of arthritis that affect the knee
joint. Osteoarthritis is the commonest type. It is a degenerative joint disease
that affects mostly middle-aged and older adults. Rheumatoid arthritis,
Traumatic arthritis (arthritis due to injury) are the other common types.
What is Total Knee Replacement?
Knee replacement is a surgical procedure to resurface a knee
damaged by arthritis.
Though the procedure is called total knee replacement, we
are not removing or replacing the entire knee bones or all the parts seen in a
model of knee that you find on doctor’s table. Here we are removing only the
surface of the knee bones that comes into contact with each other and are
replaced by metal and plastic parts that cap the ends of the bones. This forms
the new knee joint. This newly placed metal and plastic parts prevent the bone
ends from touching each other and thus allows a pain free knee movement.
Does all the knee arthritis require Knee Replacement?
No. In the initial stages when the cartilage damage is less,
the bone ends touch with each other only when there is a heavy impact, like a
fall, jumping, a day of heavy work etc. In such situations the inflammation of
the bone ends can be controlled by anti-inflammatory medicines and adequate
rest. Once the pain subsides the patient can resume to their usual works
without any pain. Patient should avoid the high impact works which if done
again brings back the pain.
In cases of severe arthritis even walking become a heavy
impact work for the knee. In such cases patient may get a relief of pain on
taking medicines and rest. But the pain will again return soon after stopping
medicines so that patient needs medicines most of the days. These medicines are
good if taken for few days, but will create other problems if taken for long
time. These are the patients who will benefit from a total knee replacement.
What are the medicines that doctor usually prescribes in
cases of early arthritis?
The anti-inflammatory medicines can be either a Non
Steroidal Anti Inflammatory medicine(NSAID) like Diclofenac or a Steroid. Both
can be taken as tablets or injections directly to the joint. Both these
medicines are very effective in managing an acute episode of pain. But if taken
for long time (like a month) these can create a lot of problems like kidney
damage, uncontrolled blood sugar etc….
Are there any medicines that will help to grow back the
damage cartilage?
No. So far no medicines have proved to grow back the damaged cartilage. There are several medicines available in the market that claims to regenerate the damaged cartilage, but none have proved to be effective. The fun fact is that most of the so-called medicines (both allopathic and ayurvedic) that claim to regenerate the cartilage are not even licensed from government to sell as medicines, and are selling as food supplements (similar to Horlicks, boost etc.…). Next time you buy a medicine for knee arthritis, make sure to check the label whether it’s a food supplement or a medicine.
How Does TKR Help?
In Knee Replacement your doctor removes the surface of the
knee bones that comes into contact with each other. These surfaces are replaced
by metal and plastic parts that cap the ends of the bones. This newly placed
metal and plastic parts prevent the bone ends from touching each other and thus
allows a pain free knee mobility.
Care After Surgery
After the surgery, in our clinic we usually advise you to
get up and walk the next day of surgery. You have to use a walker support for 1
month after surgery (you will be able to walk without a walker as early as 1
week after surgery, but we usually advices to use walker for a month till the
cut bone and muscles heal well, just as a caution against any accidental fall
which can create problems if occurs before complete healing of tissues). A
physiotherapist, will meet you and teach some exercise & movements to
improve and strengthen the knee.
It really is perfectly common to experience initial
discomfort and pain while walking and exercising. Continue exercising and you
will reach normalcy soon. Follow the instructions set by your surgeon and follow
up on your visits.
Is it really painful after the surgery?
No. Gone are the days when the patients complain of severe
pain after a total knee replacement. Now most of the centres including ours
follow a multimodal pain management protocol that allows the postoperative
period absolutely comfortable. With todays advanced medicines and techniques
most of our patients do not complain of pain at all.
What is a “non muscle cutting” total knee replacement seen
in ads of some hospitals? Is there any benefits of doing so?
By the term “non muscle cutting” it usually refers to
subvastus approach to the knee. “Approach” means the way your surgeon reach
till the knee bones. The most commonly used approach is ‘medial parapattellar
approach’ where the surgeon cuts the muscle (and tendon) on the front of your
thigh to reach the knee bones. In the Sub-Vastus approach your surgeon will
retract the muscle to one side (without cutting the muscle) to reach the knee
bones. The cut on skin is same for both.
The subvastus approach allows you to walk earlier and more
comfortably compared to the other technique. Also, the patients for whom
subvastus approach was done, reports less pain. Simply speaking the subvastus
approach (or the non muscle cutting technique) makes the initial period after
surgery little more comfortable. Don’t worry you have already done the
replacement by the other technique; the results and function after a longer
time are similar for both techniques.
From the surgeon’s point of view the subvastus approach (or
the non muscle cutting technique) is little difficult to perform. Few centres
including ours are routinely performing this non muscle cutting technique in
most of the cases (except for the patients whose particular anatomy makes it
impossible to do so).
Its perfectly ok to ask your surgeon about which method he
is planning to do, and you can take your decision accordingly.
What is a cruciate retaining knee replacement?
A cruciate retaining knee replacement is the one in which
your posterior cruciate ligament(is a structure that connects your knee bones
together inside the knee) is preserved. This again is little difficult to
perform from the surgeon’s point of view.
This technique is claimed to produce a near normal knee
after a total knee replacement. Also, it may be little easier for both you and
surgeon if in case you need a repeated knee replacement on the same knee which
may occasionally happen. Other than these, the cruciate retaining knee
replacement has no proven benefits compared to the other.
Few centres including ours are routinely performing cruciate
retaining knee replacement in all the possible cases.
Its ok for you to ask about which technique your surgeon is
planning for you, and you can decide accordingly. But it’s better that you don’t
compel your surgeon to do the cruciate retaining replacement if he is
comfortable with the other technique. Cruciate retaining surgery needs
perfection and if not done perfectly, can create more problems than the minor
benefits.
Can we do knee replacement as a Key-Hole / Arthroscopic surgery? What is a
minimal access knee replacement that is seen in some hospital ads?
It’s not possible to do knee replacement as a key hole
surgery. The term ‘minimal access knee replacement’ in hospital ads is not a standardized
term and it means different things to different people. Some doctors use the
term for a smaller skin cut. Some others use the term for the subvastus
approach mentioned above and some others use the term when they are doing the
surgery with both subvastus approach and a smaller skin cut.
How much does it cost to replace a knee?
The cost varies from hospital to hospital and surgeon to
surgeon. Also, there can be variation in same centre and same surgeon depending
the hospital services that you choose (like the rooms you take) and the implant
that is used. The cost typically varies between 1.25 lakhs to 2.5 lakh. Most of
the hospitals will have a package and will be able to give you an approximate
cost before surgery.
It is a common practice (or malpractice) among the hospitals
to not include even the necessary medicines and essential consumable items in
the package to project a lower cost of surgery to attract patients to them.
Then you will have to buy these items at an additional cost which can go up to
50 thousand rupees. So, when the package is discussed with you make sure to
conform that these essential items are included in the package.
