Walking on two limbs is what separates us humans from rest of the animals but this comes at a great cost. Our knees have to withstand forces anywhere between 3 times our body weight during climbing stairs to 7 times the body weight during squatting exercises. Doing this over and over again throughout our lifetime naturally causes wear and tear of knee joint and especially of the cartilage present between thigh and shin bone. This in initial stages causes inflammation of the joint casing pain but can progress to bowing of legs in severe cases.

Pain in knee not only hampers daily activity but also discourages oneself from exercising which leads to weight gain which puts more pressure on knees causing further damage to cartilage and bony surface and so goes on the vicious cycle. To treat the symptoms and the deformity, knee replacement is done.

During the initial stages of the disease the line of treatment consists of analgesics and anti-inflammatory, physical therapy, calcium and vitamin D supplementation. One often complaints that I went from doctor to doctor who game me certain medicines which relived the pain till I took medicines but pain came back the moment I stopped the medicines. Another common complaint is I’m taking calcium supplementation for too long. One must understand the disease process and the treatment given for the same, as the pain killers are giving temporary relief so as to facilitate the physical therapy and the calcium and Vitamin D supplementation is preventing further bone damage.

Alternatives:

  • Intra-articular Steroid Injection -With a small needle 1-2ml steroid is injected inside the affected knee joint which reduces inflammation inside the joint which in turn reduces pain. The effects last for 2-3 months.
  • Viscoelastic supplements -This consist mainly of hyaluronic acid which is a natural content of the fluid inside knee joint hence increasing the viscosity of joint fluid. It also reduces inflammatory chemicals which cause reduction in pain and to an extent; try to reduce the cartilage damage. These injections are costly and the effect last between 3 to 6 months.
  • High tibia osteotomy -It is a surgery done to change the angle of shin bone at the knee level with the help of a special metal plate to balance the weight at knee. This is done in a select few patients who mainly have Medial knee joint arthritis of early stages and preferably younger patients with better bone healing capacity. When all the other modalities of treatment fail and the pain has increased to an extent where daily activities are affected or the bowing of legs is extreme, a knee replacement surgery is indicated to break the vicious cycle of pain and disability and to improve quality of life.
  • How: With help of specialized instruments, in sterile conditions with laminar flow operation theatre, experience orthopedic surgeons and allied staff perform a surgery on the affected knee. The knee joint is opened from front, damaged cartilage and bony surface is replaced by specialized metal surfaces befitting to each individual and a polymer spacer is placed between two surfaces. Occasionally under surface of kneecap is also replaced.

Outcomes:

When the vicious cycle is broken by knee replacement one can do physical therapy much better as the pain is significantly reduced than before. One can also plan weight reductions goals and manage their lives for a better and pain free future.

With every surgery there are risks involved such as infection, prolonged hospital stay due to other illness hindering speedy post-operative recovery. Complications like fat embolism syndrome can also be seen in post knee replacement surgery but one must consider them as a rare outcome of the surgery as all the cases are handled with extreme caution and care as to avoid any such complications.

Men vs Women:

Degenerative knee osteoarthritis is more commonly seen in females compared to males and the deformities are often severe than males. Post menopause, level of a hormone called estrogen is reduced significantly which causes negative calcium balance, in simpler words, bone resorption is more than bone formation. Bones become weaker and hence more prone for bowing and fracture easily.

How much:

VishwaRaj Superspeciality Hospital is a vision of Shri Vishvanath Karad who has been who has founded many educational institutions in service of this great nation and its intended to serve people of weaker socio-economic class with best possible medical care at most affordable rates. Our knee replacement packages are cheaper by at least 20% than nearest cheaper competitor and at 1/3 rd the cost of main-stream hospitals of Pune. We do not compromise on any consumables used during the surgery or implants used for the surgery. We just keep minimum margin for us and want to pass on maximum benefit to the patient.

Robotics:

New inventions are made every day and health care is no exception. Not a day goes by when we not hear about robots replacing human or artificial intelligence making marvels but one must consider that we humans are the creator and not the creation. Given a chance will how many would want to be operated by a robot and how many will prefer being operated by an experienced surgeon with years of training?

In a competitive world and an age of marketing, we hear Robotic surgery and easily drawn towards it. But Robotic knee replacement surgery is nothing but a specialized computer helping the angles and precision needed for bony cuts to fit the metal implants properly. There is no harm in using technology to make a difference in human life but we feel it should not be used to make a difference in the patient’s bill.

By

Dr Ramprasad Dhrangutti

Consultant Orthopaedic Surgeon

VishwaRaj Superspeciality Hospital

Q: How long do I need to stay in hospital?

A: Patient is admitted one day prior to surgery and on average, patient is discharged 4 to 5 days after surgery.

Q: When can I start walking after surgery?

A: 24 hours after surgery walking is allowed, recommended and encouraged!