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Approximately five million joint replacement operations are done each year worldwide. Although most people who undergo this type of surgery are over the age of 65, but about a quarter are younger than 55. Damage to the knee joint can result from various reasons but the most common cause is Arthritis.
Surgery to replace all or part of a damaged knee joint can have a dramatic effect on the lifestyle of someone suffering from severe pain and disability, but it is a major operation which should not be undertaken lightly. Your consultant will advise you about the likely benefits of surgery, but the final decision to go ahead is yours, and before making it you should be sure that your expectations about its outcome are realistic and that you understand what is involved. It is hoped that this article will provide enough information to help you make an informed decision.
Knee replacement is a way of getting the joint back into shape. It involves cutting out the damaged portion of the joint and replacing it with a new one. This is a very common procedure, which has successfully brought back the mobility to the patients of knee pain and arthritis.
THE KNEE JOINT:
The knee joint comprises of a long thigh bone articulated with the upper end of shin bone along with a disc like knee cap. These bones are kept together by strong ligaments and muscles for normal functioning of the knee joint as it is the joint which bears the weight of the body.The ends participating in the joint are covered with cartilage, so that the surface of the bones should not rub with each other.The joint cavity is lined by a membrane called as the synovium, which secretes an oily synovial fluid into the joint and allows smooth movement of the thigh bone with shin bone and knee cap.
Ligaments and muscles help to move the knee. These structures do generally not stretch when the knee is bent or extended. However, if the ligaments and muscles are not healthy and flexible enough, the ligament and muscles are stretched to the point where they become weak and ineffective in moving the knee. When this happens, the person begins to experience pain in the joint.
When you exercise your knees, you strengthen the ligaments around the joint and allow the muscles to stretch further. Stretching the ligaments is like strengthening the muscles. The more ligaments you stretch, the stronger they become. Therefore your joints will support the weight and movement of the weight you put on them.
PROSTHESIS OF KNEE JOINT :
The doctor will decide about the best material to be used in your particular case.
This selection will depend upon factors such as –
Your Age and Normal Level of Activity.
Degree of Damage.
Deterioration of the Bones of your Knee Joint.
Femoral Component :It is the part which fits onto the thigh bone. It is made of highly polished alloy like cobalt, chrome, oxinium.
Tibial component :This is like a tray. It is also made of metal like Titanium. It comes with a highly cross linked plastic dish like structure together they make the tibial component.
Patellar Component :It fits on the patella. It is also made of highly cross linked plastic. All these components are fitted over respective bones with the help of bone cement.
Oxidized Zirconium :Is a tough Zirconium alloy metal substrate which decreases the wear as a result of which life of joint increases.
The following systems are helpful to the surgeon while performing surgery, which decreases duration of surgery & increases accuracy.
SYSTEMS USED DURING TKR SURGERY :
Computer Navigation :This system allows surgeon to take help of computer during surgery. This increases accuracy of surgery, which inturn increases the long term success of operation.
Patient Matched Technology :In this most modern technology, patients MRI Scan and X-rays are sent to Engineers in the United States.They prepare specific blocks for individual patients. This helps in making the surgery faster and more accurate. This also helps in increasing the long term results of surgery
There are several diseases which can damage the knee or hip joint as well as other joints of the body also. These diseases cause damage to the surfaces of the bones taking part in the joint formation resulting in severe pain and disability.
OSTEOARTHRITIS :
Osteoarthritis is the most common cause for destruction of most of the joints of the body including the knee & hip joint. As the age progresses the cartilages over the ends of bones degenerate due to friction caused by the use of the joint. Once the cartilage is lost the surface of the bones beneath gets exposed. Due to the continuous rubbing and friction while walking the surface of the bone gets worsened and the individual cannot take even a single step without pain. Osteophytes formed at the margins of the joint restrict the movement of the joint. Due to severe pain and destruction of the joint one may start limping while walking and that will cause problems to the spine.
For management of osteoarthritis one may use cane for support while walking, physiotherapy and take pain killer tablets or intra- articular injections.
The most common cause of Osteoarthritis is the degeneration of cartilage in the joints. As the cartilage deteriorates, it becomes thinner and becomes more easily wear and tear. This causes the cartilage to wear away at the joint causing pain and stiffness. Other common causes of Osteoarthritis are rheumatoid arthritis and osteoporosis.
Symptoms of Osteoarthritis vary between individuals. Most patients experience some degree of pain in the joint(s) of their knees or hips, although some may experience pain just inside their knee(s). Some patients may also experience swelling in the joint(s) due to fluid retention. Patients may also experience symptoms such as weakness and fatigue, in addition to pain. Many times the first symptoms of Osteoarthritis are not associated with any type of pain.
Osteoarthritis is often treated using medications. These medications are usually used to reduce the symptoms and reduce the pain of the disease. There are also lifestyle changes that can be made to help with the treatment of Osteoarthritis. One of the most common lifestyle changes to reduce the pain and decrease the risk of further damage to the joint(s) is to walk frequently. If a patient has pain only in their knee or hip, they should try to walk as much as possible. Some people also choose to get up and walk around more as well to reduce the pain. This can include using a heating pad in the home or a stairlift to help get them back to walking.
RHEUMATOID ARTHRITIS :
Rheumatoid arthritis is a disease of connective tissues which involves inflammation of several joints. It starts in early age and can affect both men and women, more often women. The affected joints become swollen and tender. The bones become demineralised and muscles weak and atrophied.
Rheumatoid Arthritis is an autoimmune disease that mainly affects the joints. It generally causes swollen, painful, and warm inflamed joints. The pain and swelling often become more pronounced after periods of rest. Most often, the hands and wrists are involved, as well as the back and abdominal areas.
Rheumatoid Arthritis is the most common type of arthritis, and it usually goes undiagnosed for years. To diagnose arthritis, a doctor will often want to take a biopsy of the joint tissue. If the doctor suspects that arthritis has set in, they may order more tests, such as an imaging study.
The cause of all types of osteoarthritis is not always known.Some people suffer from haemophilia which is a bleeding disorder in which repeated bleeding into the joint results in swelling and inflammation, with subsequent destruction of the articular cartilage. Infection of the joint , accidental injury, gout, death of the tissue of the bone due to alcoholism, long term use of steroids or pain killers are some of the known causes. Some people suffer from dislocation of the hip joint right from birth which puts pressure on the joint causing excessive wear and tear of the joint.
People suffering from severe pain and disability seek advice of the specialist. Firstly the patient is treated with pain killers and physiotherapy. When these measures fail to give relief from pain and disability the specialist may suggest you about the joint replacement surgery.
The joint replacement surgeon will examine you, will see your x-rays and eventually will suggest you about the joint replacement surgery. The possible outcomes and risks of the surgery and anesthesia are explained to you. Though the doctor suggests surgery to you, the final decision must be yours, depending upto which extent you suffer from pain.
There are some factors which should be taken into account before going for the operation.
Daily ActivityIf you are physically very active and relatively young you should consider other options like physiotherapy and pain killers. So that you can postpone the surgery as much as possible, as more strenuous activity may reduce the life of the implants.
The quality of your Bone and MuscleAs metal parts are to be inserted in your bone, your bone should have a good quality, that they fit into the bones for a fairly longer time. Also the quality of your muscles should be good, that you can carry out the post-operative physiotherapy programme to build your muscles.
Your general Physical ConditionIf you are suffering from arthritis in other joints, may your daily activities be restricted despite operation of knee or hip joint
Your medical problems might increase the risk of surgery and anaesthesia.
These are some common complications associated with each type of surgery & some are specifically related to hip replacement surgery. Most complications are minor but it is important to be aware & to seek medical attention.
Chest InfectionPossible following general anaesthesia and particularly in smokers.
Deep breathing is important
FeverIt can develop in the first 24-72 Hrs.after surgery.Its cause will have to be investigated and treated accordingly.
Thrombosis & EmbolismAfter surgery blood clot (deep vein thrombosis) may occur in one of the deep veins of the body.
We take precautions to prevent this from happening.
Wearing Anti-Embolism stockings : at least for 6 weeks.
Course of blood thiner Injections/Tablets.
Exercises & Early Mobilization after surgery.
InfectionIt is always a risk when materials are implanted into the body.
We use special precautions to avoid this
Operation theaters with laminar flow.
Operating Staff with disposable suits. (Space Suits)
Antibiotics in peri operative period.
SepsisSepsis may be caused by pus producing organisms. Main cause is contamination of the wound.
You need to take proper medical advice if you have pain, swelling, heat and redness around wound or with leakage of pus and high fever.
Nerve DamageThe small nerves supplying the skin over operation site are usually damaged. When an incision is made during surgery it can cause numbness around wound. This does not in any way affect the function following surgery
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