Who needs Total Knee Replacement?

If you are suffering from arthritis of the knee joints, then for sure you have been declared a candidate for knee replacement, may be now or after few years.

After 40 years of orthopaedic practice, following write-up is my opinion about total knee replacement surgery, . Other surgeons may have their own opinion and may not agree with my views.

Arthritis of knee affects almost every person after a certain age. It’s starting age, severity and progression varies widely and is influenced by many factors. The main causes are summarised below:

  • Age is the main reason. The problem is degenerative disorder and part of ageing hence it cannot be termed as disease.
  • Weight: The knee joints worn out early in obese persons.
  • Existing deformities like bow legs or knock knees. With these pre-existing deformities, one compartment of knee is loaded more than other and degenerates early.
  • Injury to the joint with fracture extending into the joint or even soft tissue injury resulting in bleeding in the joint cavity. Meniscal and cartilage injuries of knee also predispose to early arthritis.
  • Other joint diseases like rheumatoid arthritis (RA) results in early degeneration.
  • Some genetic factors which are still unknown. Many patients around 70 years have early arthritis and others around 50 have severe disabling arthritis. It is not explained by other factors.

The best plan for knee arthritis  is to have natural lifestyle with healthy balanced diet with ample vegetables and fruits. Walking is beneficial for all body systems, reduces weight and helps better nourishment of cartilages of joints. Medications for pain and walking aids as and when required do help in reducing symptoms. Corrective surgery of deformed limb bones results in balancing loads in knee compartments. “Total Knee Replacement” is usually the last option in treatment plan.

The main problems of knee arthritis are pain and disability. The patient has to consider when it is unbearable as all other options have been unsuccessful.  One has to consider benefits and expected complications of the procedure.

In knee replacement surgery, articulating ends of bones of thigh (femur) and leg (tibia) are sliced off and replaced by artificial material (metal and polyethylene). The main benefit is off course pain-free mobile joint.

With technical advancements in surgery and anaesthesia, complications are much less. Apart from complications during surgery and in early post-operative period, one has to consider long term problems as well. Financial burden for patient and the family is an important issue. For some this is the main reason for not having surgery even it is considered mandatory. The usual life of knee implant is 15 years. It may become lose or become painful later on. Infection, if occurs is a disaster for the patient, disappointment for the family and defeat for the surgeon.

My opinion: Generally speaking, in primary knee arthritis, replacement surgery is considered to be the last option in patients with advanced arthritis with pain and disability and aged around 65 years. Exceptions are always there.

Dr. Idrees Padela, Orthopaedic Surgeon

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