If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.
If medications, changing your activity level and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. By resurfacing the damaged and worn surfaces of the knee can relieve pain, correct leg deformity and help resume normal activities.
Is total knee replacement for you?
Whether to have total knee replacement surgery should be a cooperative decision made by you, your family, your family physician and your orthopaedic surgeon. Alternatives to traditional total knee replacement surgery that your orthopaedic surgeon may discuss with you include activity modification, weight reduction if you are obese or arthroscopic joint lavage.
Reasons that you may benefit from total knee replacement commonly include:
* Severe knee pain that limits your everyday activities, including walking, climbing stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker
* Moderate or severe knee pain while resting, either day or night
* Chronic knee inflammation and swelling that does not improve with rest or medications
* Knee deformity: a bowing in or out of your knee
* Knee stiffness: inability to bend and straighten your knee
* Failure to obtain pain relief from non-steroidal anti-inflammatory drugs. These medications, including aspirin and ibuprofen, often are most effective in the early stages of arthritis. Their effectiveness in controlling knee pain varies greatly from person to person. These drugs may become less effective for patients with severe arthritis
* Inability to tolerate or complications from pain medications
* Failure to substantially improve with other treatments such as cortisone injections, physical therapy, or other surgeries
Most patients who undergo total knee replacement are age 60 to 80, but orthopaedic surgeons evaluate patients individually. Recommendations for surgery are based on a patient’s pain and disability, not age. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.
Realistic expectations about knee replacement surgery
More than 90 percent of individuals who undergo total knee replacement experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement will not make you a super-athlete or allow you to do more than you could before you developed arthritis. You have to make sure certain things after surgery if you want to get full benefits:
* Participate in regular light exercise programs to maintain proper strength and mobility of your new knee
* Take special precautions to avoid falls and injuries. Individuals who have undergone total knee replacement surgery and experience a fracture may require more surgery.
Complications
The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, occur in fewer than 2 percent of patients. Total knee replacement done in a proper set up with good Operation theatre minimises infection rate to negligible. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery. Blood clots in the leg veins are the most common complication of knee replacement surgery. Your orthopaedic surgeon will outline a prevention program, which may include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings, and medication to thin your blood.
Although implant designs and materials as well as surgical techniques have been optimised, wear of the bearing surfaces or loosening of the components may occur. Additionally, although an average of 115° of motion is generally anticipated after surgery, scarring of the knee can occasionally occur, and motion may be more limited, particularly in patients with limited motion before surgery. You are recommended to discuss your concerns thoroughly with your orthopaedic surgeon prior to surgery.
Total Knee Replacement surgery is the only solution for Advanced Osteoarthritis and makes the patient enjoy life in a disease free manner and improves their quality of life in day to day activities.
Dr Nandkumar Katakdhond
Source: The Daily Star, June 27, 2009
