Easing Knee Woes

Despite the challenges posed by osteoarthritis, knee replacement surgery provides a promising pathway to restore mobility and enhance overall well-being. Through comprehensive rehabilitation programs and adherence to post-operative care guidelines, individuals can regain function and resume their daily activities, thereby improving their quality of life……
By Dr Shreyash Yadav

Maintaining healthy knees is essential for an active lifestyle. However, when injuries or conditions like arthritis occur, particularly osteoarthritis, one’s ability to bend and flex the knees can become restricted due to damage, inflammation, and pain. Over time, the damage progresses, making life more difficult and painful.
Deterioration of the joint and surrounding tissue can make it difficult to perform basic daily activities, even while sitting or lying down. As cartilage wears and bone rubs against bone, pain and reduced mobility follow.

While age is a major risk factor for osteoarthritis of the knee, young people can get it too. For some individuals, it may be hereditary. For others, osteoarthritis of the knee can result from injury or infection or even from being overweight. Here are answers to questions about knee osteoarthritis, including how it’s treated and what can be done at home to ease the pain.
Osteoarthritis is the most common type of arthritis. While it can occur even in young people, the chance of developing osteoarthritis rises after age 45. According to the Arthritis Foundation, more than 60 million people in India have osteoarthritis, with the knee being one of the most commonly affected areas. Women are more likely to have osteoarthritis than men.
The most common cause of osteoarthritis of the knee is age. Almost everyone will eventually develop some degree of osteoarthritis. However, several factors increase the risk of developing significant arthritis at an earlier age.

Today, knee replacement surgery has become a common solution that provides dramatic pain relief for more than 90 percent of patients. The vast majority of knee replacement procedures are used to treat osteoarthritis. The procedure—introduced in 1968—relies on a mechanical implant to replace severely arthritic or damaged knee joints. According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements took place in the United States last year, and that number is expected to grow into the millions within the next twenty years. Total knee replacement (TKR), also called total knee arthroplasty (TKA), is considered one of the safest and most effective procedures in orthopaedics.

Two different types of knee replacement exist: total and partial.

• Total Knee Replacement
Total knee replacement makes up about 90 percent of all knee replacement procedures. During TKR, a surgeon repairs the knee joint by covering the thigh bone with a metal covering and encasing the shinbone with metal and plastic. The prosthesis replaces the rough and irregular surfaces of the worn bone with smooth surfaces. In many cases, the surgeon also replaces the under surface of the kneecap with a plastic surface to further reduce pain and provide a smoother functioning joint. The procedure involves some removal of bone and cartilage.
After a TKR, one should expect to spend three to five days in the hospital. Weight-bearing therapy is started early following the operation. In addition, some combination of physical and occupational therapy is started at the hospital. In most cases, the patient is likely to be able to stand and walk, at least with the assistance of a cane or walker, before leaving the hospital. Starting in the hospital, and usually before exiting the operating room, the knee may be cradled in a knee brace, and medical staff will monitor the flexion (bending in) and extension (extending out) limits of the knee.

After discharge, the patient is likely to go home for recovery and rehabilitation. Some patients require home health care or assistance. The treating doctor will most likely prescribe physical therapy at a local clinic for continued rehabilitation, and the physical therapist there will then suggest exercises one can do at home. Most patients conclude rehabilitation within eight weeks—at which point they should be able to move around without assistance and resume their daily activities.

• Partial Knee Replacement
If one receives a partial knee replacement, the surgeon will replace only the part of the knee that’s damaged or arthritic. The advantage to this approach is that it requires a smaller incision, involves less bone and blood loss and consequently, produces less pain. Patients undergoing partial knee replacement tend to experience a faster recovery time than those who have TKR. However, there are disadvantages, including the possibility that he will have to eventually undergo further surgery if arthritis develops in the parts of the knee that are not replaced.

Risks, Complications, and Considerations in TKR
Today, knee replacements are safe. Very few patients experience complications. The most common surgical complication is infection, which has been documented to occur in fewer than two percent of patients. When complications do occur, they may include: infection, blood clots, a problem with the implant, or persistent pain and damage to the blood vessels surrounding the knee as a result of the surgery. You should thoroughly discuss the benefits and risks of TKR with the surgeon before making any decision about a procedure. You may also want to evaluate other considerations, such as: financial issues (the cost of surgery, follow-up care, and time off from work), hospital quality, and what to expect from your new knee.

TKR is an increasingly attractive and viable option if one is dealing with chronic knee pain or unable to participate in common activities. Approximately 90 percent of the replacement joints last 10 years and about 80 percent function for 20 years. There’s a high probability that one will once again participate in activities such as walking, bicycling, golf, tennis and swimming. As the pain subsides and the ability to use the knee returns, the quality of life will most likely improve dramatically.

Joint replacement surgery (arthroplasty) is a surgical procedure in which joints are replaced with artificial parts made from metals or plastic. The replacement could involve one side of the knee or the entire knee. Joint replacement surgery is usually reserved for people over age 50 with severe osteoarthritis. The surgery may need to be repeated later if the joint wears out again after several years, but with today’s modern advancements most new joints will last over 20 years. The surgery has risks, but the results are generally very good.