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Dr. J.Maheshwari
Arthritis is a disease
where a joint is damaged. There is a stage
in arthritis, when the joint is so badly
damaged that it becomes painful and deformed.
In case of the knee, taking even a few steps
becomes painful. Initially one tries to
pull on with pain-relieving medicines but
after sometime nothing works, and the only
way out is surgery.
Done at the proper time,
for a selected patient by a doctor who
knows it all, the operation brings almost
new life to the patient. Today, these
operations are no longer experimental,
and have a success rate of over 95 percent.
Let us first know what is possible without
operation.
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Ways to keep the pain at manageable level
without surgery |
The following may help: |
(a) Use of a good quality knee support
or a brace
(b) Use of a stick while walking
(c) Apply heat on your knee, ice in
acute stage
(d) Use pain-relieving oil/cream
(e) Do proper knee exercises, learn
from a physiotherapist
(f) Follow joint-protection advise
such as avoiding squatting, stairs,
etc.
(g) Have an injection in the knee,
if your doctor so advises.
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All these measures can give variable
relief for some time. In some cases
the relief may last for years while
in others it can be, at most, as time-buying
measure. If one does not get relief
in 6 months, surgery may be the only
option. Most patients in this stage
fear surgery and continue to suffer
hoping for magic relief, which does
not happen. Do not fall prey to false
claims, if there was any truth in
those claims, our prime minister will
not have accepted surgery as an option.
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Warning: Do not let your
knee get so much damaged that even
surgery will not help! It is well
known that the results of knee replacement
deteriorate if the knee is damaged
beyond a limit.
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When one has tries all non-operative
methods, surgery is the only options.
Operations are of two types - joint
saving operations and joint replacement
operation. Joint-saving operations
such as arthroscopy surgery (operating
on joints without cutting them open,
by endoscopic techniques) and an alignment
correction operation works in selected
cases. Joint replacement operation
may be a partial on total joint replacement.
We shall discuss these later.
Wherever required, knee replacement
operation is a wonderful opportunity
for a person to markedly improve
his quality of life - i.e. to continue
to enjoy life till the very end
of life. It is one of the most predictable
and successful operations. In U.S.A.
alone, over 300,000 knees are replaced
every year. Today, even a heart
operation has become predictable
and successful, and so has a knee
replacement operation.
This brochure is aimed at educating
you regarding issues connected with
knee replacement operation. The
following are some of the questions
frequently asked by the patient.
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| (a) Do I
need a knee replacement? |
| (b) What
is actually done in a knee replacement
operation? |
| (c) What
if I continue to live with a
damaged knee? |
| (d) Will
I be able to tolerate this operation
at my age? |
| (e) Is undergoing
the operation going to be painful
experience? |
| (f) How long
will I be hospitalized? |
| (g) How long
does it take to recover? |
| (h) How much
will it cost? |
| (i) Is it
possible that I may become worse
than what I am today? |
| (j) What
are the possible complications? |
| (k) Should
both knees be replaced together? |
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Q 1: Most patients want to avoid surgery, and are not sure whether their knee is bad enough to be replaced. So the first question is Do I need a knee replacement?
Ans 1: Knee replacement is considered
necessary when your knee is damaged beyond repair, and is severely limiting
your life style. It is a lifestyle operation. If your are happy leading
your life in bed on in the house you probably are managing with compromise,
but it is okay as long as you have happily accepted it. Knee replacement
is an opportunity to make a world of difference in your quality of life.
As doctors we can tell you that your knee is permanently damaged by evaluating
the patient and his x-rays. There is a scientific way of assessing the extent
of your disability.
Q 2. Some patients continue to manage reasonably well even with damaged knee with non-operative
treatment methods. Others develop
deformities, get intolerable pain,
and lose control over the knee and
tend to fall. Even if they have been
told about surgery as the only option,
patients are looking for ways and
means of postponing their operation,
which often leads them to more complications.
Hence the other question is how long
can I postpone the operation?
Ans 2: In some cases it is possible
to postpone the operation provided you are willing to make changes in your
way of living. This includes loosing weight, cutting down on your activities,
physiotherapy, regular doze of painkillers etc. But, this cannot go on for
long as the painkillers also have serious life-threatening side effects.
There are cases where waiting is, inviting trouble. These are cases where
there are deformities of the knees, where the x-ray shows that the gap between
the bones is not there, or where the patient may have already developing
fracture in the bones around the knee. Postponing the surgery is not without
price. As one continues to walk on arthritic knee, the legs get deformed,
the ligaments supporting the knee get stretched out, the muscles become
week and even the bones get worn out. If postponed beyond a limit, it may
not be possible to improve upon the condition even after knee replacement.
It is particularly disaster to postpone knee replacement if one of your
joint is still workable.
Q 3. Most patients are horrified by the
name ‘knee replacement’
and say, “I don’t want a
knee replacement”. This is mostly
because they have no idea what knee
replacement is all about. So, let
us know what actually is knee replacement?
Ans 3: In knee replacement operation,
it is not that the knee is removed and replaced with an artificial knee.
What is actually done is that only the worn out soft cartilage, which normally
covers the end of the bone, is replaced. It is like capping the bone ends.
This cap is made of high quality steel, and is fixed on the end of the bones.
Q 4. A lot of patients have apprehension whether knee replacement will work for them. Let us understand how does knee replacement operation benefits?
Ans 4: After the knee replacement,
your deformity will be corrected. Your pain will be reduced, and the knee
will regain strength. This improves your gait and you can go for walks,
go up and down the stairs, go for shopping, go for social functions etc.
Q 5. Patients also think that they may not be able to tolerate the operation due to old age, and ask will I be able to tolerate the operation at this age?
Ans 5: It is only in old age, that the knee replacement operation is done. It is rarely done before the age of 55 years. It is very natural that persons over 55 years of age will have some or the other disease associated with this age. Problems like diabetes, high blood pressure, some breathing trouble, heart trouble etc are common, and are considered ‘normal’ for this stage. A thorough body check up is done before surgery, and all care is taken during surgery. Most of the time the operation is done under local anaesthesia by just numbing your legs while you remain fully awake. Most patients tolerate this operation very well.
There are some other questions, which you may also have in mind. These are as follows:
Q 6. One worry every patient has is can I become worse than what I am?
Ans 6: The success rate of knee replacement is 95% in the hands of in most surgeons who have requisite experience and facilities. This means that in 95% of the cases, the knee will become pain-free, regain strength and look straight. There are those 5 % where the result may not be as good. These are usually patients who come for surgery a little too late. Also, some patients catch infection, and some loosen their knee before time. Such cases may take long to recover or may have to be operated again. The other significant complication is blood clotting in the veins of the leg, which can sometime lead to a serious lung and heart problem. Some of the minor complications are swelling of the leg, delayed wound healing, weakness of muscles, and lack of full control on the leg.
Although all efforts are made to keep these rather serious complications under control, but these are risks even in the best of hands. In most circumstances, the complication can be salvaged by timely care, which may mean a subsequent operation.
Patients are apprehensive about pain they might feel during surgery, hence the question, is the operation going to be painful?
Well, every operation is associated with some degree of pain & discomfort. Modern pain management techniques have made this operation practically pain free. Some of these techniques used are the same as used for ‘pain-less labour’. One can imagine, if the worst pain, that of labour can be controlled with these techniques, knee replacement pain is nothing.
Q 7. How long will I be hospitalized?
Ans 7: The usual period of hospitalization is between 5-7 days. Once discharged from the hospital, you will be able to take a few steps and walk to the toilet. It is at this stage of recovery that you can be safely sent home. In exceptional cases if any problem is noted, one may have to stay back in the hospital for a few more days.
Q 8. How long will it take to recover?
Ans 8: It varies from patient to patient. On an average, when both knees are operated upon together, the usual time to walk around without support is six weeks. When one knee is only replaced, it is half this time.
Q 9. What is the post- operative requirement?
Ans 9: Once you are discharged from the hospital, approximately 1 week after the surgery, you will not be required to come to the hospital early. This is because we have developed a knee care team who can take care of you at your home itself. Your stitches will be removed at home, 2 weeks after the surgery. Our specialist physio will help you learn exercises and walk for one month after surgery. This all shall be done at home. We shall ask you to come and show once you are up and about in the house. We have evolved this home-care programme considering the difficulty faced by the patients in repeatedly visiting the hospital.
Q 10. How much does this operation cost?
Ans 10: The total cost of hospitalization, which includes surgeon’s fee, anaesthesia charges, operation theatre charges, medicine use in the operation theatre, room rent and cost of the artificial parts etc. comes to about Rs 2 lakh per knee. The operation is expensive because the artificial parts which are fitted inside the knee are imported, and cost nearly Rs.70000 for one knee.
Q 11. What to expect during hospitalization?
Ans 11: You will be admitted a day before surgery. You will undergo medical check up to make sure that you are fit for surgery. Anaesthetist will examine you. On the day of surgery, you will be taken to the operation theatre in the morning. It takes about 1 hour for operation on one side. You shall be kept in the ICU for one day after surgery. When you come to your room you will find two plastic tubes fixed to the bandage around your leg. These bring the free blood out of the operated knee. You will be given painkiller medication and antibiotics. In case you are allergic to any medicines, do not forget to let the doctors know about it.
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Once you have understood these issues, you should take time to mentally prepare yourself for the operation. This involves the following:
- Think positive: You and your family, all must adopt a positive attitude to the success of the operation. It helps to meet people who have undergone the operation, and are feeling better. It makes a difference!
- 2. Lose weight: Get into the right eating habbit to check your weight, in preparation for walking slim and trim.
- 3. Start knee exercises: Get going right away. It helps in post-operative recovery.
- 4. Get a medical check up to make sure that you are not suffering from any other disease. Control of medical illnesses is required.
- 5. Stop smoking
- 6. Stop pain-killer drugs 1 week before surgery
- 7. Organise your home to receive you after surgery: This involves having a western commode or a chair, using a high chair for sitting, using a bed with height.
Common misconceptions about knee replacement
- The whole knee will be replaced
- It will be a very painful operation
- It cannot be done at old age
- I am too young to have the knee replaced
- It will take 6 months to be able to walk
- It lasts for only a few years
- One cannot climb up the stairs
- One cannot sit on the floor
- A lot of regular care and exercise are mandatory after the replacement
- Infection is a common complication
- It is not a successful operation
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