Many patients have this question regarding their knee arthritis and ask us during their consultation. What is the right time to undergo a joint replacement surgery? The answer to this is determined by a couple of factors- age of the patient, severity of symptoms and most important how this has affected the quality of life.
Each of the points mentioned have a bearing on the outcome of surgery. Total knee replacement is an excellent and cost effective way in managing knee arthritis. The satisfaction rates after knee replacement is around 80% and age at surgery has a bearing on the outcome. Generally, knee replacement in younger patients has been found to be less satisfying and has more complications. Even if though there is no cut-off age, generally knee replacement should be opted after the age of 55-60 years. In younger patients if all the options have been exhausted,then one can opt for a knee replacement. Some patients will have severe arthritis on the X-rays but clinically they are able to do their ADL (Activities of Daily Living) without much hindrance. When such a situation arises it is always the patient’s symptoms that dictate the timing of replacement and can be postponed till pain becomes severe. The pain in the knee should be continuous and not well controlled, pain should be limiting simple normal activities like stair climbing, walking or using the toilet.
I am diabetic, is it OK to have a knee replacement?
The other factor to be considered during a joint replacement is the general health of the patient. If a patient has multiple medical problems-then those problems should be well controlled before undertaking a joint replacement surgery. Common medical problems like Diabetes, Hypertension, Thyroid problems, Anaemia all have a bearing on the ultimate outcome of a knee replacement. Many of our patients are obese and that can have serious repercussion regarding outcome after a replacement surgery. Weight reduction is generally difficult because patients are unable to exercise before knee replacement but when an individual’s BMI is more than 35 then the complications after a replacement increases. So, it is advisable to consult a dietician and reduce weight by dieting before going forward with a knee replacement.
What pain medications are safe to treat mild arthritis?
Medications like Paracetamol and Tramadol have a higher safety profile than Diclofenac or other NSAID’s (traditional pain killers). The problem with long term pain medication intake is the higher chance of kidney failure and stomach ulcer formation. The duration of treatment necessary makes it important to take safer medications and opt for surgical treatment if pain management is not adequate.
What injections are safe and effective in knee arthritis?
Basically, there are 3 types of injections that are currently available in the treatment of OA knee. They are corticosteroids, Visco supplements and Platelet Rich Plasma (PRP). Corticosteroids are cheap and give good pain relief the problem with steroid injections is that they worsen the degeneration. Visco supplements are expensive and need to be repeated and cost is a significant factor to consider when opting for Visco supplements. Visco supplements basically work by increasing the joint lubrication. Lastly, PRP is an exciting new option which is less expensive than visco supplements in some centers and is more effective than the visco supplements according to some studies. PRP reduces the inflammation in the knee joint and is patients own blood product injected into the knee joint. Please talk in detail with your surgeon regarding which is the best injection option for your knee arthritis.