Friday, June 15, 2012


Most patients with advanced knee arthritis are still looking for that elusive cure. They are unable to accept that they need surgery. They strongly believe that something or someone somewhere can solve the problem with some magic medicine. They will keep trying fancy treatments like acupressure, rope therapy, braces, etc. The list goes on and on.
In all joints like the knee, the bone ends are covered by a smooth lining called cartilage. Cartilage ensures smooth, painless knee movements. Damage to the cartilage marks the beginning of arthritis. In advanced cases the cartilage lining is completely eroded. The bone below the cartilage gets exposed and bone starts rubbing on bone. This leads to severe pain. The real problem here is that cartilage does not regenerate or grow back. No matter what you try or which medicine you take, the original cartilage doesn’t come back. As the disease progresses and more and more cartilage is lost, the leg starts getting deformed at the knee. This makes matters worse. A crooked leg condemns the patient to more pain and disability. This pain can never go till the cartilage comes back and the leg becomes straight. Both these goals are impossible with non operative treatment!
So why does knee replacement work when everything else is failing? To understand this we need to understand the history of knee replacement. Researchers, scientists and doctors worldwide were struggling to solve the issue of arthritis since centuries. Initially they tried to replace the cartilage with other substances from the patient’s body like fat, fascia etc. But none of the structures they used had the qualities of cartilage and they would breakdown very fast and the procedure would fail. Then in the 60’s a genius called Sir John Charnley made a few landmark discoveries. He invented an extremely strong plastic called high molecular weight polyethylene. This plastic resembled cartilage very closely. The friction between this plastic and metal was as low as between two bones lined by natural cartilage. In addition to its fantastic friction properties, this plastic was also extremely strong. The other landmark discovery was of bone cement. This cement anchored the artificial joint to natural bone so strongly that the union lasted many years. These two discoveries changed the face of replacement surgery. Sir John Charnley designed an artificial hip joint which lasted 10 to 15 years. This was the first successful replacement. Using these landmark discoveries scientists started working on knee replacement. Finally after many attempts they achieved success and durable artificial knee joints were designed.   
Knee replacement works because it achieves both the desired goals. Cartilage is replaced by a strong and durable ‘cartilage like’ plastic. Furthermore the deformity is completely corrected after the surgery. As the damaged cartilage is replaced, the patient gets complete relief of pain. And as the leg becomes straight, this relief lasts many, many years. 
So does knee replacement work? Yes! It is one of the most successful surgeries of modern medicine. But it is a complicated surgery. To work it has to be done properly. The surgeon has to learn the technique and spend an adequate time in training. A well trained, experienced surgeon will do a good job almost every time. Infection is a constant threat to any surgery. In replacement surgery, infection can ruin everything. So in addition to a good surgeon, you need a good operation theatre.
These two factors are the reason, this surgery fails. An inadequately trained surgeon in a poor operation theatre is a recipe for disaster. Because of these issues, this wonderful surgery has earned a bad name.
 Instead of avoiding surgery because of fear which stems from a lack of awareness, I encourage patients to educate themselves regarding the pros and cons of this surgery and gain benefits.
What you KNEEd to know...
What is knee replacement?
Knee replacement is a surgery in which around 1cm of diseased bone and cartilage is removed and replaced by artificial metallic caps. The new joint surface restores normal joint movements and eliminates pain.
When is a patient ready for knee replacement?
1.       When pain is unbearable and constant
2.       When walking even short distances takes a lot of time and effort
3.       When the patient needs a walker or stick support to walk
4.       When the patient stops going out of the house for recreation, work or to attend social functions in fear of pain
5.       When deformity or limp becomes very severe
What are the advantages of this surgery?
1.       Complete relief of pain
2.       Complete correction of deformity
3.       Patient walks independently without help of a stick
4.       Patient can walk as much distance as he/she desires
5.       Patient can climb stairs
How long will a knee replacement last?
Knee replacement typically lasts for 15 to 20 years after which it may become loose and need a revision surgery.
How long will a patient have to be in bed after a knee replacement?
A patient usually walks within a couple of days after the surgery. The patient is able to go to the toilet on his/her own whilst in the hospital itself.
Is this surgery painful?
Most patients experience postoperative surgical pain. This pain can nowadays be well controlled with modern pain management techniques.
How long is the recovery?
Most patients need 1 – 2 months to recover completely and experience a pain free joint
What are the complications of this surgery?
Infection is the most feared complication. With modern theatre setup and discipline, infection rate is less than 0.6%. All other complications are rare.
Armed with this knowledge, the arthritic patient need not suffer anymore!

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