Knee Replacement is never an emergency urgent operation like Bypass Surgery or Appendicitis. The surgery can be delayed as long as the patient desires provided patient is willing to suffer and bear the pain because of the arthritic knee.
If the patient has severe arthritis which has caused bending of the knee, deformity and difficulty in walking, It is not advisable to avoid the surgery because the pain would become worse and your activity (standing, walking, outdoor work) will become less & less over a period of time.
By reducing weight, doing regular knee exercises we can reduce the pain and we can avoid the operation for few weeks or few months. You cannot permanently avoid it if the knees are severely deformed or severely painful.
- When patient has pain every day
- Need for pain medication on a daily basis
- Pain at night preventing patient to sleep
- Pain during outdoor activities/ work
- If knees develop deformities and look crooked/bend
If any 2 out of 5 symptoms are present, Patient is better off with an operation of the knee.
With current advancement in technology. Patient can start knee movements on the same day of surgery and patient can walking full weight bearing walking the very next day of surgery with walker support. Patient can be discharged on 3rd or 4th day if medically stable.
Earlier discharge (Within 24hours) like “day care surgery” or “1 day surgery” is possible in only younger selective patients.
Walking is usually started the very next day after surgery with full weight on both the legs and walk with the help of walker under supervision of physiotherapist.
Stair climbing is usually started on 2nd or 3rd days after surgery.
Patients are usually discharged to home on 3rd or 4th days after surgery.
Selective cases of fit & young patients can be discharged within 24-48 hours if patient desires it & if medically comfortable.
60-70% patient can sit on the floor if they exercise regularly and achieve range of movement beyond 125 degree.
Usually by 6 weeks patient can join back at work. But if the job is sedentary, patient can join as soon as early as 3-4 weeks. If the job is heavy/physically demanding then patient may take 3-4 months.
Usually exercises are taught at the hospital so when they go home 90% patients do NOT require physiotherapist at home, Only people who are very old or who are not improving adequately or are not doing adequate exercises on their own will require physiotherapy at home and they comprise only 10-15% patients of the total operated population.
90% patients don’t require physiotherapy at home.
There are standard joints , high flexion joint which give capacity for more than 140 degree bending, there are joints with rotating discs, there are joints which can be used for a severely bad/deformed knee where ligaments are not good which are called constraint joints & there are joint for redo surgeries called Revision joint where a lot of bones are damaged and need to be replaced by metal objects like augments/sleeves.
The type of the joint is selected by the surgeon based on patient’s deformity, loss of bone and functional requirement.
Patient is assessed clinically and with weight bearing x-rays and various views of the knee joint. Depending on the amount of damage seen, surgeon will discuss with the patient whether full surgery or partial surgery is required in each case.
GOLD joint is a standard joint which has got coating of TiNbN which gives a gold like colour but it is not made of gold. It is supposed to increase the smoothness and reduce wear. However, these gold joints are only in the market for only last 2-3 years and whether they will last very well at 15-20 years from today it has not been tested.
30-year joint is a joint propagated by a company called Smith & Nephew. It has a coating of a special substance (Oxinium-Oxidised Zirconium) giving it a black colour. The coating claims to reduce the wear and it it is presumed that the reduction in wear will make the joint last longer. In lab studies it is shown that the joint can last up to 30 years although it has not been used for 30 years till now.
Usually knee/hip replacement is a very safe operation and 98% patients have no issue/complications. However certain things can happen just as in any other operation such as, Infection (0.5%), clotting of blood in calf/thigh (2-3%), Dislocation (1%). List of complication can be discussed with surgeon and he will tell you the pros & cons at preoperative counselling.
On an average in a standard patient with routine surgery we expect the joint to last anywhere between 15-25 years, It may last even longer than that if the patients take care himself/herself by reducing body weight, regular exercises, improving the quality & structure of the bones by taking necessary diet and supplements.
The joint may fail in rare cases. However, in most of these we can correct the cause of the failure. Sometimes we may need to change the joint and put a newer type of joint which may again last for 15-25 years as per today’s technology.
Usually Knee/Hip replacement is done in patients who are above the age of 55-60 years. Many of these patients have Diabetes, Blood pressure, Thyroid, Heart/Kidney/Liver problems etc.
All these medical problems have to be medically evaluated and patient will have to be medically optimised before going ahead with the surgery. So far, we haven’t had a reason to deny TKR surgery to a patient for medical issues.
Age is relative, many times young patient may have severe arthritic knee which make the patient difficult to walk, go outdoor and enjoy his/her life. In such cases replacement surgery can be done in younger people. We have patients as young as 16-18 years whose hip joint were so damaged that they were bed ridden and was not able to do any outside work. These people are very happy now, many have gone back to college, work. One of the female patients had actually finished her college, joined job, got married and had a normal delivery after the hip replacement surgery done at the age of 22 years.
Usually the joint is selected based on the quality of the bone. Patient who are elderly with severely osteoporotic bones can also be operated by using special type of joints called Long stem and or cemented Implants. With these implant patients can go on for next 10-15 years even up to 20 years. We have operated patients aged 105 who came with hip fractures and these patients can be made to stand next day and later go home walking in a matter of usually 8-10 days when their medical conditions are stabilised.