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February 2010
Replace Your Arthritic Knee
Dr K C Mehta
A painful knee can severely affect your ability to lead a full, active life. Artificial knee replacement surgery (also called knee arthroplasty) is becoming increasingly common as the population of our country begins to age. When pain, stiffness, knee swelling and limitation of motion in your knee keep you from your daily activities, you may need total knee replacement.

There are different causes of knee pain, the commonest being arthritis - an inflammation of a joint. Of the several types of arthritis, the following are the major culprits of joint damage:

The most common form of arthritis, which necessitates knee replacement, is osteoarthritis or degenerative arthritis. In this condition, the smooth gliding surface of the joint, called the articular cartilage, would have worn away. This makes the bones grind against each other, creating popping sounds, pain and loss of normal movement. This condition occurs primarily in people over 50.

Rheumatoid Arthritis
This is caused by dysfunction of the immune system. Trauma-related arthritis results when a joint is injured, either by fracture, dislocation or damage to the ligaments surrounding it, causing instability or damage to the joint surface.

In very early cases of osteoarthritis, or if you do not want to undergo surgery, strenuous and painful activities should be avoided. However, gentle exercise such as walking or swimming should be adopted. You will benefit from some moist heat and massage. Weight loss can be very helpful in reducing pain from arthritic knees by reducing the stress - and this is good for general health as well.

If your pain is not adequately controlled by these measures, knee replacement surgery would be the option.

Knee Replacement
In total knee replacement surgery, the parts of the bones that rub together are resurfaced with metal and plastic implants. Total joint replacement is a remarkably successful operation that has transformed the lives of many people by enabling them to be active and pain-free. The goals of total knee replacement are, in order of priority, to provide pain relief, to enable standing and walking that is not limited by the knee, for improved knee motion and knee strength.

The Process
The patient is kept under observation for about 24 hours. One plastic tube drains off excess blood from the knee; and of course, antibiotics, painkillers and a blood-thinning agent are given. The patient is made to sit up and walk with support the next day. The drains are removed after 24 hours. The sutures are removed between 15-21 days.

Both knees can be replaced together, if needed. A variable interval (few days to few weeks) is followed between each replacement though, to allow the patient to recover between the two surgeries. The typical hospital stay is four to five days for unilateral knee replacement and nine to 10 days for bilateral knee replacement.

You can also opt for a minimally invasive surgery where the incision is small, with lesser blood loss, shorter hospital stay, faster recovery and better motion.

Road to Recovery
Each patient recovers differently. After the surgery, you have to do routine walking, which will gradually increase your knee strength and mobility. You may experience some pain for 15-45 days. The pain is tolerable, treatable, and subsides gradually over a few days though. Injections, IV pain medication, patient-controlled anesthesia, pain pills and anti-inflammatory medications are used to keep your pain to the minimum. The hard work you do in the early weeks of rehab will pay off with improved strength and motion, which will help reduce stiffness in your knee.

In a study by the Arthritis Foundation, 90 to 95 percent patients were found happy and satisfied to have opted for total knee replacement. With their new knee promising to serve them a good decade and more of painless mobility, wasn't that always expected?

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6 Reasons for Total Knee Replacement

Total knee replacements are usually performed on people suffering from severe arthritis. Most patients who have artificial knees are over the age of 55, but the procedure is performed in younger people too. Though the circumstances vary, total knee replacement would be considered if:
  1. You have pain every day causing major disability.
  2. Your pain is severe enough to hamper routine work and activities of daily living.
  3. You have significant stiffness of your knee joint.
  4. You have significant deformity (knock-knees or bowlegs).
  5. If your X-rays show destruction of the joint, you and your surgeon will decide if the degree of pain, deterioration and loss of movement is severe enough for you to undergo the operation.
  6. When conservative methods of treatment fail to provide adequate relief

Dr. K. C. Mehta is Consultant Knee Surgeon at Apollo Hospitals, Ahmedabad

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