I remember an incident. One fine, busy day an elderly patient came over in an OPD with her son for a knee replacement consult, after her son left she asked me, “I am an active participant of my religious group, for the reason I need to sit on the ground which I am unable to, can you achieve this.” I did not want to answer her so I diverted the discussion. Having set the context, this write-up will more be about the common concerns of people who are planning to undergo the surgery so that realistic expectations can be set in terms of surgical outcomes.
You must be already aware of the magnitude of the person suffering from osteoarthritis for the knee which is 2.6 crore. Women are more prone to osteoarthritis than males, especially around age 50 and above.
Osteoarthritis is a condition where the joint gets inflamed thus eroding the protective cartilage that cushions the ends of involved bones. The ends thus wear down over time.
Let’s look at the common concerns of people:
- Why should I get surgery?
A patient need not choose surgery as the first option. There are strictly defined guidelines for surgical candidates:
- Pain in and around the knee that does not respond to medicines, physiotherapy, etc. Pain at rest.
- If the scans (Xray, MRI) show osteoarthritic changes.
- Restricted range of motion that interferes with daily living activities
- Deformed knees like bowing outwards, waddling gait.
- Severe swelling and inflammation
The decision of surgery is taken by your orthopaedician after an apt diagnosis of the condition has been established; you are informatively involved in the process in terms of other available treatment options and the output you want to achieve from surgery. The final call needs to be taken by you. If you need surgery, but you don’t want it, it’s your choice.
- Is now the right time for surgery for me?
Each patient is different in terms of degeneration, age, and complications, a proper case, and diagnosis help to decide if surgery is the right option for you. If your pain and deformity are interfering with your independence and daily activity in spite of physiotherapy and medication, it’s time for you to have surgery.
- What is the procedure like?
It is a major procedure under general anaesthesia. Both ends of the joint undergoing friction are removed (end of femur and top of the tibia) and replaced by an artificial joint. The surgery may take 2-4 hours for the entire procedure to complete.
- Will I experience pain during and after surgery?
Not during surgery due to general anaesthesia. After surgery pain may be felt at the incision site controlled by pain meds until healing takes place.
- Will I be able to sit on the floor after surgery/ what will I be able to do?
Sitting on the floor is not advisable after the surgery, prosthesis as close as possible resembles knee joint but has its limitation. You cannot sit and cross your knees. You will always have to sit in a high place like a chair or so. You will be able to sit, stand, carry out day to day activity, drive, dance, play, etc.
- Do I have to exercise after surgery too?
An exercise regimen for replacement rehabilitation awaits you. Even after the rehabilitation is complete, exercising to strengthen core leg muscles is always advisable.
- How long will the artificial knee last?
Approximately 90% of knee replacements last at least 15 years. The average life of a knee replacement is considered 18-20 years. In case the surgery is repeated after 20 years it is called revision knee replacement surgery and is extremely uncommon.
- How successful is the procedure generally?
Research has concluded that more than 90% of surgeries result in successful outcomes like
- Decreased pain
- Upgraded function
- Independent Ambulation
- What happens if I avoid surgery?
Worsening of Knee Deformity
In the case of osteoarthritis, the space between the bone ends keeps decreasing due to the thinning of protective cushions resulting in Joint Deformity. It mostly presents in the form of bowing of legs which shows in your gait making walking difficult.
Exceeding Joint Stiffness
Losing muscle strength
- Due to pain and Restricted movement muscle become atrophied and thin losing their tensile strength and becoming relaxed
- The chances of regaining strength in such muscles even after surgery are really little.
Compensatory Problems like:
- Pain in non-osteoarthritic Knee
- Sometimes shoulder pain
- Quality-Adjusted Life
- Difficulty carrying out daily activities
- Dependence on another person
- What should I expect after surgery?
- Ambulation the same day mainly through walker
- 1-2 more days of hospital stay
- 2 months of regular rehabilitation which includes:
- Knee strengthening exercises
- Range of motion regain
- Independent walking with the help of an assistive device
In most cases complete occupational and personal activities are achieved by 6 weeks.
Total Knee Replacement is not magic that will make you a super person but it is intended to achieve functional independence without pain.
Dr. Rajesh Verma, Director & Senior Consultant – Orthopaedics, Spine Surgery, Dharamshila Narayana Superspeciality Hospital, Delhi & Narayana Superspeciality Hospital, Gurugram