This is a question that I face every day in my life:
With all the media and surgeons that advertising the “miracles of knee surgery” how their patients return to normal function within days of the surgery, I thought the aam aadmi would be more informed on this issue. However, this was not the case. Many misconceptions, some often fueled by doctors themselves have led to the confusion and queries in patients minds.
In India, certain words sell, computer, laser, robotic, minimal incision, injection, ozone. People love to imagine and hope that they will get better with a magic pill or with a small procedure.
My answer to them is, I do not wear orange robes and I do not manufacture pills. what is in the market I am aware of and what works in the market I am aware of newer trends come and go and the promise of making people better with drugs and ointments in knee pain has been around for many years, in fact, it’s the easiest way to make money. Sell your product for some time and then take it off the market. You will make a killing.
There are many locally made oils and products that claim success in treating knee pain. These, however, give only temporary relief. Even the so-called famous green lipped mussels from New Zealand that used to decorate the newspapers are no longer seen.
So coming back to knee arthritis. What is it in lay man's terms the most common form of arthritis is osteoarthritis or osteoarthrosis. Essentially meaning wear and tear of the joints or your joint has become old.
This is a natural process that will affect most of us as we get older genetics plays a role. The amount of activity that we have done too much or too little also affect. Women have a higher tendency of getting affected. The knee joint is the joint that gets affected the most amongst the others. Previous trauma, malaligned limbs and ankle and hip issues can load the knees too. Prevention is not possible but slowing the rate of progression is possible. Keeping your weight under control, if you lose one kg and your load on the knee lessens by 3-4 kgs:
- Lead an active life by going for moderately paced walks.
- Strengthen you knee muscles with exercise, if your age is above 55 or 60, reduce floor activities like squatting, cross-legged sitting and vajrasan or namaz like position.
- Stair climbing is gentler on the knees than descending. In advanced arthritis, stairs should be avoided.
There are many modern medicines and antioxidants that are available to help reduce the rate of wear and tear and your doctor will be able to suggest some. However, note that these are all slow acting drugs and need a couple of months to act.
There is no laser surgery that helps. Knee arthroscopy in osteoarthritis is a sham surgery, that is it gives at best temporary relief because your doctor will inject a steroid at the end of surgery, you cannot do anything to global cartilage loss with an arthroscope. There are selected procedures that help in younger patients with cartilage loss, not in elderly people.
The magic injection, people look for a fast safe and office procedure that will help relieve pain and avoid surgery. There are 2 kinds of injection available one asteroid and the other a gel-like substance that replicates the natural gel that has got depleted from our body. The steroid helps reduce pain temporarily and is useful in emergency situations. The gel-like injections are more expensive and are at best used in early arthritis.
So we come back to the question that started this discussion:
Q1. When do I need surgery?
Ans. The need for a knee replacement surgery is the need to improve one’s quality of life. When you have a gnawing pain and discomfort that affects your quality of life on a regular basis you need surgery. This is a personal decision depending on how active you currently are and how active you need to be. In India, we have plenty of people who modify their lifestyle to suit their pain, they walk less and sit at home because walking gives them pain, all this to avoid surgery. This is opposite to what people in the west do. People there undergo surgery so that they can play golf.
Knee replacement patients who are suffering from osteoarthritis are often elderly, above the age of 55, they may be having pain for many years and feel that it is getting worse and their ability to walk getting reduced. If you are diabetic and hypertensive surgery can bring in added benefits because once you become mobile and active these ailments come under control.
Q2. What is the ideal age?
Ans. There is no ideal age. Since this surgery is done for age-related knee pain it is usually done in the elderly. If you are younger and in terrible pain and all other options save for painkillers do not work then you are a candidate. Diabetes and blood pressure are not contraindications to a knee replacement. Well controlled heart patients can undertake the surgery as it is usually done in regional (local) anaesthesia and not under general anaesthesia.
Q3. What is the life of a knee replacement?
Ans. It will usually last you for 20-25 years. That is why if done after 55 it should last a lifetime because as you grow older the demand on the knee also reduces.
Q4. How long does recovery take and how long will the pain last me?
Ans. Usually, the pain is maximum in the first 2 days however with newer techniques such as quadriceps-sparing or subvastus knee replacements (where the muscle is not cut) along with intraarticular injections and root blocks the pain control is much better. You will be made to walk the same or next day after surgery depending on your pain. There are only does after the surgery and no don’ts.
Pain medication is needed in the first few weeks post surgery so that you can exercise well and recover fast. The more you exercise the faster you recover. The exercises post surgery are simple but need to be done the more movement you try and achieve the better it will be for you. You may need the assistance of a physiotherapist post surgery.
Do not compare yourself with your neighbour friend, we assure you that you will walk, sooner than later! People are different and behave differently post surgery. Knee strength recovery postoperative depends on the knee strength pre-operation, so the more exercise you do prior to surgery always helps in the recovery postoperatively
Q5. Can I sit on the floor and do namaz and vajrasan?
Ans. If you have a good range of movement pre-surgery you will get a good range of movement post surgery. Knee range of movement depends on your movement before, besides this, the design of the implant and exercise plays a major factor. Sitting on the bed cross-legged is allowed. Sitting cross-legged on the floor and in namaz position causes faster wear and tear and shortens the life of the knee and is avoidable. Use your joint wisely and it will last you a long time
Q6. What are the new developments in the field of total knee arthroplasty
- Implants-side specific and more sizing options: There are newer implants that are available in more sizing options and in more insert options. These come at an additional cost but ensure a better fit and better-optimized range of movement. These are also more expensive, so speak with your doctor about it.
- Computer-guided knee replacement: Available since 2006, so technically it is not new. This technique ensures better alignment and more accurate cuts during the procedure. Not a compulsion today except in certain cases. In fact, internationally there has been a decline in the use of this technology.
- CT and MRI guided patient cutting blocks: Hereafter doing a ct scan or MRI of the affected knee, special cutting blocks are made by the company that helps the surgeon do the knee replacement. The implants used are the standard ones. There is an additional cost of about 40000 in addition to the MRI costs for use of this technology. This too is nowadays less in use.
Q7. What is done in a knee replacement?
Ans. Well, the accurate term should be knee resurfacing. In knee replacement we just resurface the worn out part of the knee (the damaged cartilage and extra bone that forms) and replace it with metal on either side and a plastic (polyethene) is placed in between.
It is like your dentist putting a cap on your broken tooth. These prostheses are cemented in position with bone cement. Your muscles and ligaments are all preserved.
Q8. Care after knee replacement
Ans. Prevent infection in the body or if you get it treat it early especially hidden infections like a dental and urinary tract. Visit your dentist every 6 months.
Q9. How soon can I return to work?
Ans. Usually, if you are in an office job you can return after stitch removal which is 2 weeks after surgery. If you are in a job that involves travel then you may take longer. There is no definitive time as it depends on your recovery and comfort level.
Q10. Complications in knee replacement
Ans. As in any other surgery, the knee replacement surgery also has potential complications, the most dreaded one being an infection. Hence we make sure that we operate in bigger institutes and not in smaller nursing homes. Blood clots in the leg are also common and measures like stockings and blood thinners may be started on patients in the postoperative period.