​Life After Knee Replacement​

Lots of patients are advised knee replacement! But do you really need it? How to really know if you require a surgery? Knee Replacement is a major surgery which should not be taken lightly. It's a great success for those who actually need it and can be a disaster for a  patient who doesn't. The doctor is naturally the best person to make the decision. Sadly many doctors are doing unnecessary surgery for monetary gain. The time has come for patients to become smart! It is my wish that patients become aware enough to decide for themselves. Patients should be able to choose a good decision from a bad one. Enlightening patients has always been my sincere endeavour! 

 

Knee replacement is the final option for a patient with arthritis. It is chosen when all else fails. The patient should have tried all possible treatment methods before considering surgery. Surgery is done for a patient who has constant and severe pain. Pain on getting up from the floor or when going up and down stairs, is common and doesn't usually warrant a knee replacement. However pain during walking is far more serious. Patients who need surgery can barely walk a few hundred feet. Every step is painful. They limp and walk very slowly. Many need a walking stick for support.  Activities of daily living are affected. Such patients tend to remain at home. They will avoid social commitments that require them to leave the house. Getting up at night and going to the bathroom is a huge and painful effort. Painkiller medications are required to get through the day. If you are so disabled and have tried many types of treatments without much benefit, get a knee replacement done.It is a beautifully successful surgery after which you will become normal again. But if you are not so bad, then think again! Knee replacement may not be the best option for you. It may be wiser to wait a while and consider other options. 

 

What has been the experience of patients who have undergone this surgery? Is it really successful? Does it give long term relief? Is the surgery painful? Before surgery, the patients are screened for infection and assessed for fitness. This involves investigations like blood tests, chest X-ray, etc. A physician checks the patient and certifies him or her fit for surgery. The patient is admitted one day prior to surgery. The surgery is done most often under spinal anaesthesia. A small injection is given with a thin needle in the lower back of the patient which makes the legs numb. The actual surgery lasts for 60 to 90 minutes. When the anaesthesia wares off, the patient experiences postoperative pain. The pain is severe for the first 2 to 4 days. Doctors usually have pain management protocols in place to manage the pain like epidural injections, blocks etc. After that the patient gets pain while exercising the knee (lifting the leg, bending the knee) and during walking.  As time passes the pain reduces and completely disappears by 8 to 10 weeks. The patient starts walking on the second or third day after surgery.  Post surgery the patient's leg becomes weak (due to cutting of muscle during surgery). Initially the patient needs a walker to walk. As time passes the leg becomes stronger and the patient can walk independently. Surgery also leads to swelling of the leg and the knee. This is a normal reaction to surgical trauma. The swelling automatically subsides in 12 to 16 weeks. After this period of recovery is complete, the patient truly experiences the benefits of surgery. The Person stops being a patient and becomes normal. He/she has complete relief from pain. He/she can walk normally (and fast) without a limp or stick. He/she does not need pain killers.

 

Even though knee replacement is a major surgery and has a long recovery time, it is a truly gratifying surgery which gives a person spectacular and lasting results.         

...ANYTHING BUT SURGERY!! (PART 2)

In the last article, I discussed treatments for knee arthritis that have poor results but are aggressively marketed to make quick profits! These treatments are experimental or commercial, many are non scientific and most result in a huge waste of money for the patient.

So if these treatments do not work, which ones do? What does authentic scientific research say? Why is this scientific research so important? If a particular medicine works for one person without side effects, can it be recommended for all? You may think why not? We do it all the time! Most of us have seen some medicine or treatment work very well in our friends or relatives. Then we start recommending that treatment to everybody! What’s wrong with that?

The problem is that a treatment that works for one person may not work for another. A treatment that is safe for one person may not be safe for another. That’s where scientific trials and statistics come in! If there are hundred patients, scientific evidence tells us if a treatment works for all 100 or it works for 75 out of 100, or 50 out of 100 or for only 10 out of 100.

Now let’s consider the treatment that worked for our friend. What if that treatment worked only in 10 out of 100 and caused side effects in 80 out of 100? Our friend was lucky, wasn’t he? With this information, will you start recommending this treatment to everybody? I’m guessing – NO!

There are multiple scientific review committees all over the world who have formed recommendations for knee arthritis by looking at research, evidence and statistics. The effectiveness and safety of these recommendations has been solidly proven. So what are these recommendations? These recommendations are for osteoarthritis of the knee. They are not for arthritis affecting other joints or for rheumatoid arthritis which is different type of arthritis.

Recommendation – patient education. Education by the doctor, physiotherapist or counsellor or patient self education from books or internet tremendously helps patients with arthritis. One may wonder how? Most fear and anxiety is out of ignorance!  Patients who learn about the problem, how and why it has happened to them, what will make it worse, what will make it better etc are less anxious. And as anxiety goes down, so does pain. Patients with knowledge look after themselves better, are more likely to follow advice and treatment recommendations and stay away from quack therapies.

Recommendation – weight loss. Weight loss is strongly proven by multiple studies in different countries to help decrease pain in patients with knee arthritis. I have written about weight loss in a previous article. It’s not easy to lose weight! But it’s not impossible like most of my patients think. It is a full time job. It requires huge efforts and 100% commitment. A conscious effort to adopt a healthy diet, reasonably restrict quantity of food consumed and daily exercises will result in weight loss in 9 out of 10 people. The problem is that we are lazy. We don’t want to put in any effort. We want some magic medicine or some belt or some therapy to melt the fat away. Unfortunately none of these work!

Recommendation – exercise. Exercise is a recommendation that I give all the time. I have written extensively on exercise in the past. I have dedicated multiple articles on the subject. This recommendation is backed by solid scientific research! Exercise is the magic pill you are looking for. It’s cheap and has no side effects! And it works. And it will work in all patients. But a lot of my patients tell me ‘exercise didn’t work for me!’  Exercise does not work in 2 situations. First is when arthritis is very advanced. And the second and most common reason is that patients don’t do exercise properly. Exercise is something which is taken very lightly. People will go to driving school for a month to learn to drive their car but will refuse to go to a physiotherapist for 10 days to learn the right way to do exercise. People will research the internet thoroughly to find a good doctor but will not research to find the different types of exercise that will benefit them. Exercise is a gold mine, my friends. The physiotherapist and the doctor will only show you the way... they will only show you the tip of the iceberg. It’s up to you to dig deeper after that. 10 minutes of doing a few repetitions when you wake up in the morning doesn’t help. You have to spend effort and time to achieve results.

Recommendation – braces and footwear modification. There is no strong evidence in scientific literature for or against braces (knee caps and belts) and footwear modifications. There is no harm in trying braces! Patients who find benefit in braces should continue to use them.

Recommendation – assistive devices for walking. Again... a very effective recommendation. Using a walking stick decreases pain and increases the distance that the patient can walk. It would also decrease the requirement for medication, buy time and postpone surgery. But most patients refuse to use a stick because of some misplaced sense of shame! As a patient, I would give little importance to what other people think especially because I am suffering and others are not!

Recommendation – medication. So which medications are recommended for arthritis? Is there a medicine that will cure the problem? The answer unfortunately is NO. No medication, whether it is allopathy, ayurveda, homeopathy or Chinese has been conclusively proven to cure knee arthritis. Lot of them ‘claim’ to cure arthritis but there is no concrete scientific evidence. That means that the chances that a particular medicine will work for you are as good as the chances that drinking a glass of water will work! Another common misconception is to take calcium supplements for arthritis pain. Osteoporosis or weak bones is a problem that accompanies arthritis or joint inflammation. Calcium supplements are used to treat osteoporosis. They have no role in the management of arthritis.

Medications are however recommended to control the pain of knee arthritis. The main medication is Acetaminophen (Crocin). Acetaminophen is a mild analgesic with a very good safety profile. It does not cause acidity in majority of people and does not affect the kidney even with long term use. It has been scientifically proven to be safe even if used for a long period of time. Other analgesics (pain killers) can be used as short term treatment to control attacks of severe pain. Topical analgesics (pain killer ointments) are also strongly recommended and useful. They are also safe for long term use. What about Glucosamine? There have been extensive studies carried out on the effects of glucosamine. The results say that all it does is give relief of pain in some patients. It does not cure the problem or cause cartilage to grow back. It is safe. The recommendation is to use it (if you can afford it) only if it gives relief from pain.  

 To conclude, I recommend my readers to develop a scientific outlook while assessing treatments especially new miraculous cures promoted by aggressive marketing. Here Science, Statistics and Evidence all become your friends as they protect you from being cheated of your time, energy and hard earned money!

Recommendations from

•        AAOS 2008 (American Association of Orthopaedic Surgeons)

•       OARSI 2007 (Osteoarthritis Research Society International)

•       NICE 2009 (NHS, UK)

•       RACGP 2009 (Royal Australian college of General Practitioners)

•       NGC 2007 (Singapore)

•       EULAR 2003 (European League Against Rheumatism)