Total knee replacement – the recent perspective

Dr. Mohit Arora
Knee pain is a very common        problem in advancing age group. With increasing life expectancy, sedentary lifestyle and high incidence of obesity its prevelance in the society is further increasing. It is the        commonest cause of disability in the world amounting to 17.5 percent.
According to a study osteoarthritis is the No. 1  ailment in India. Approx 66 million people above 65 years suffer from oseoarthritis. In early stages arthritis can be treated with exercises, physiotherapy, dietary supplements, and temporarily with relatively safe painkillers. But when the problem increases to the extent that all the conservative measures fail then your doctor may suggest a knee replacement surgery.
Total knee replacement is one of the most successful orthopaedic surgery for treatment of symptomatic knee arthritis. The  success rate of surgery is approximately 95-99%. These days we are getting patients in early 50’s and late 40’s of age with advanced changes in knee and requiring surgery . Hence there was a need of specially designed durable implants and latest techniques to increase the life of the replaced joints joints.
Latest implants:  All the implant companies are focussing on knee  joints which give high flexion (better bending) and  better durability with low wearing rate. Joints which last for life and hence decreases the chances of re-surgery. These days joints have come with life of more than 30 years and which allow patients to sit crosslegged.
Technique of surgery: there was need of technique which will ensure proper alignment of implant. Hence high performance computerized instruments are used. They are designed for proper alignment with small cuts (~4 inches). Hence leads to less pain and less soft tissue cutting  less duration of surgery and early mobilization of patient.
How long the patient has to be bedridden: After the replacement surgery patient can be mobilized as soon as the patient is out of the effect of anaesthesia.  Patients start walking and toilet training is done on third post operative day. If patient’s muscles  can bear  we can even start climbing stairs on  4th day.
duration of surgery: These days doctors try to attract patients by claims of 10-15 min surgery. It is proved internationally that every surgery has a minimum average time if done properly without missing any steps. Done stepwise , a knee replacement surgery takes 30 minutes approximately. If attempted to do it fast by missing steps of surgery, results are inferior and joint durability decreases.
Complications : Chances of complications in TKR are rare (approximately1%). Patient can have infections, deep vein thrombosis and other medical and anaesthesia related problems. To avoid complications it is important to do the preoperative assessment properly and to take required precautions during, before and after the operation.
(The author is a M.S. M.Ch (Ortho) USA Senior Consultant and Head of  Department, Deptt of Orthopedics and Joint Replacement Fortis Escorts Hospital, Amritsar)