Introduction:
Every other person over the age of twenty suffers from some pain
in the body. Those with pain are most commonly affected with joint pain.
Joint pain due to arthritis restricts one’s activity and as a result
causes disability. Knee joint is the commonest major joint affected with
arthritis and is widely prevalent among the general population with one in five
adults affected.
World Health Organization (WHO) listed Arthritis as one of the
four major orthopedic problems affecting millions of people around the world.
Bone and Joint Decade 2000 to 2010 was followed by WHO to spread the awareness
of this disabling problem. The government of India through its participation in
this Bone and Joint Decade has shown its commitment in prevention and treatment
of these disabling conditions.
Fortunately advanced medical technology helps us to cure this
disabling condition. The purpose of this article is to present the facts and
myths of arthritis and total knee replacements.
Normal Knee Joint:
When the knee joint works well, you do not feel the importance of
this joint. It gives us stability and mobility when performing normal
activities However when it hurts and limits our activity; we understand the
role of this joint in our normal day to day life.
Why does our knee gives raise to pain causing inability to do what
are essential activities such as walking. We shall dwell into how a normal knee
works to understand about arthritis and treatment method of knee replacement.
Knee joint is one of the strongest joints in the body which is
vital to our normal mobility. It helps us to walk normally by bending the knee
to an angle of sixty degrees. It helps us to climb stairs by bending to right
angle. We can squat on the floor or sit cross legged by bending more of the
joint.
The knee joint is made of two main bones called Tibia (the
shin bone of leg) and Femur ( bone of thigh). It also has two small bones
called fibula and patella (knee cap). These bones are covered with a thick
coating called Cartilage. This cartilage is very smooth and allows gliding
without friction.
These bones are held together with tissue called capsule and
ligaments, yet allowing movement in certain directions and not others (like the
hinges of the door). It also has cartilage called menisci which helps the bones
transfer the load without undue stress at any one point. The lining of the
joint called Synovial membrane secretes fluid to lubricate the joint.
What is Arthritis:
Arthritis is the process where the normal knee starts swelling and
painful. This can happen either as one gets old or due to inflammation of the
lining of the joint. Arthritis does not always affect elderly. Some people are
as young as twenty or thirty needing surgery to cure this disabling condition.
The thick coating of the ends of the bone called cartilage begins
to lose its effectiveness. The cartilage starts to crack, delaminate and
disappear completely exposing the bare bone. The bare bone when rubbing against
the other bone in the joint, gives raise to the pain.
The body works harder by secreting more fluid as a futile attempt
to lubricate the damaged joint. Thus the swelling of the joint is more a result
of arthritis rather than the cause of pain.
How does arthritis affect
us.
Arthritis gives rise to
unpleasant sensation of pain. This restricts the activities of normal day to
day life of walking, sleeping and getting up from a seated position and
climbing stairs. The restriction from going out of the house, using public
transport, partaking in family and social engagements is often significant than
what is apparent. This disability is well known to affect the quality of our
life. The deterioration in our quality of life is measurable to help us to
offer a cure for this pain.
Cure for this pain is
available with Total joint replacements.
Total Knee Replacement is one of very successful Orthopaedic Operations. It is
quantified to be as successful as Bypass surgery and cataract surgery in
improving the quality of life. More patients are undergoing this surgery although
less than what is happening around the world. The reason is why it is not more
popular than it is at the moment is the awareness of this highly successful
treatment.
In this surgery, the ends
of the thigh bone and the shin bone are replaced with artificial material made
of metal. The implant often made of strong Cobalt Chrome alloy, though titanium
and ceramic are also used improving the
long term success.
Like a normal joint
artificial joints also wear with time. Any metal however polished, will have
surface irregularities if one looks under the electron microscope. The surface
finish and the material then become very important in reducing this
irregularity and thus help in reducing the wear of the material with which this
articulates.
The material with this
metal articulates is a specialized plastic called Ultra High Molecular Weight
Polyethylene. Newer Highly cross linked Polyethylene has come into use thus
ensuring the long term success. The
quality of the Plastic used is controlled in the way this plastic insert is
manufactured. This helps in the long term success of the knee replacement
surgery.
Successful Total Knee
Replacement Surgery
The long term success of
the knee replacement surgery is more important that looking at short term benefits
of this surgery. Any material placed between the end of the femur and tibia
will relieve the arthritic pain. What is more important however is the
durability of the material in staying without damaging the underlying bone!
The damage to the underlying
bone is the worst scenario when faced with the failed knee replacement surgery.
One fears this as the damage often starts without any warning such as pain.
When one faces a failed knee replacement, the surgical challenges becomes
daunting and more importantly becomes very expensive.
The quality of the total
joint replacement surgery has been shown to reduce the chances of revision
surgery in the long run. Revision surgery after total knee replacement is not
something an ordinary individual can tackle not only as a patient but also
financially. This also becomes technically challenging for the treating
Orthopaedic Surgeon.
Maintaining high
standards of Total Knee Replacement.
A dedicated team should
be involved in this surgery. The team will comprise of the surgeon,
Anaesthetist, Physicians, Physiotherapist and nurses. The team will helps us to
understand the parts of the new joint, benefits and risks in undergoing such a
surgery. Meeting and discussing the former patients will be arranged. Help in reducing
the excess weight and stopping smoking to help recovery will be explained.
The chances of infection
developing after such surgery should be kept to absolute minimum. This is
achieved by controlling the theatre environment and the personnel involved.
Ultra High Clean operating Suite with Laminar Air Flow helps in reducing the infection.
The implant or the
prosthesis used should have long term follow up data. The quality of these
implants has to be very high as they have to withstand many years of use in
normal activities.
The treatment given in
the period immediately following surgery is very important to getting the
patients achieve recovery back to normality. The pain control after surgery
helps the patients do the exercises which are essential. Specific Physiotherapy
Protocols are followed for these patients prior to, during and after surgery.
What to expect after
total knee replacement
There is misconception on
the outcome after this treatment. Most people believe that the disability and
pain will not be relieved. Pain relief after total knee replacement is
excellent. With the relief of pain, the patient is able to return to normal
life within few weeks. They become independent. He or She would be able to walk
distances without limitation. With the relief of pain, they are happier
engaging in the family and social activities.
Recent Advances:
Muscle Sparing surgical Techniques, Improvements
in the implants such as Ceramized metals, Porous coating of the prosthesis,
computer navigation in the surgery of implantation of the total knee
components, use of Space suite type of theatre attire for the surgeons to
reduce the infection, third and fourth generation cement techniques, pulse and
jet Bloodless technique before implantation of the components, post operative
pain and anaesthetic managements and many more can be listed as recent
advances. These techniques are available and used routinely in India and
locally in Trichy
Other Joint Replacements
The total joint
replacements are commonly done for other joints such as Hip joint and shoulder
joint with excellent outcome. Less commonly replaced joints are those of elbow,
wrist and ankle, though there are new joints available for practically all our
joints.
Summary;
Arthritis is a very
common disabling condition affecting majority of general population. There is
continuing lack of awareness of arthritis and the curative treatment options
such as Joint Replacement surgery. Hence the World Health Organization has
extended its mandate for the Bone and Joint Decade for another ten years from
2011 to 2020.
Let this herald
a new beginning in spreading awareness of the increasing number of Bone and
Joint problems. Arthritis may not be preventable at present and when affected,
many are certainly curable”
