It's generally believed that senior citizens or those above 70 years would require knee replacement. But arthritis could also descend over younger candidates, making knee replacement a necessity in the not so distant future.
A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with artificial components.
What happens in a Total Knee Replacement surgery?
The knee is a hinge joint (works like the hinge of a door). The thighbone abuts the large bone of the lower leg at the knee joint. During a total knee replacement, the end of the thigh bone is removed and replaced with a metal shell. The upper end of the lower leg bone is also removed and replaced with a channeled plastic piece with a metal stem. In severe conditions, a plastic "button" may also be added under the kneecap surface. The artificial components of a total knee replacement are called prostheses.
Who requires it?
Total knee replacement surgery is considered for patients whose knee joints have been damaged by either arthritis, trauma, or other rare destructive diseases of the joint. It may be suggested for patients with severe destruction of the knee joint associated with progressive pain and impaired function. Osteoarthritis is the most common reason for knee replacement operation in India.
Are there any risks associated with the procedure?
In total knee replacement surgery, knee ligament is either retained, sacrificed, or substituted by a polyethylene prosthesis. Every type of knee replacement procedure has its own advantages and risks.
Risks of total knee replacement include:
Blood clots in the legs that can travel to the lungs (pulmonary embolism). Pulmonary embolism can cause chest pain and even shock in the longer run.
Urinary tract infection, nausea and vomiting, chronic knee pain and stiffness, bleeding into the knee joint, nerve damage, blood vessel injury, and infection of the knee which can require reoperation. Furthermore, the risks of anesthesia include potential heart, lung, kidney, and liver damage.
A knee replacement surgery may not have a good long-term outcome if the patient's weight is greater than 200 pounds. Increased pressure on the prosthetic knee joint can cause it to dislocate.
Another group of patients that may encounter risks of dislocatig joints is children who may tend to be more active.
What precedes the operation?
Before knee replacement surgery, other joints of the body are also examined. This ensures optimal outcome and recovery from the surgery. Additionally, all medications that the patient is taking are reviewed. Blood thinning and anti inflammatory medications may have to be adjusted or discontinued prior to surgery.
Routine blood tests of liver and kidney function and urine tests are evaluated. Chest X ray and EKG are performed to exclude heart and lung disease that may cause complications in surgery or anesthesia.
What follows the operation?
Post surgery rehabilitation includes Physical therapy sessions.
Also, once the operation is successfully done, patients are required to take antibiotics even after minor elective invasive surgery, including dental work
Once the joint is damaged, regardless of the cause, the resulting progressively increasing pain and stiffness and decreasing daily function lead the patient to consider total knee replacement. Decisions regarding whether or when to undergo knee replacement surgery are life changing, hence not easy. Patients must understand the risks as well as the benefits of the procedure, and must trust an experienced and competent medical professional with it before making these decisions.
Dr Ameet Pispati is one of the best Orthopaedic Surgeon to consult in Jaslok Hospital and Research Centre, Peddar Road, Mumbai for Arthoplasty and Arthroscopy surgeries. There is also a specialized department of Orthopaedics-Arthroscopy having well experienced Orthopaedic surgeons that you can consult at Wockhardt Hospital, Mumbai Central, Mumbai.