RECENT ADVANCES in Total Knee Arthroplasty :
Lately, joint replacement surgery in India has ushered into
a new era. Various aspects of arthroplasty have unfolded and many
myths trashed. The expectations of our patients force us to overcome
our limitations and provide better and better results. The major
issues in the world today are, the use of
Mobile
Bearing Knee Implants (because of their documented longer survival
rate), minimally invasive surgery, computer assisted surgery and use
of high flexion designs which provide near full
movements to the knee.
In Our country many patients of
primary arthritis of knee report for the treatment when their
disability is severe and deformity grotesque. These cases can be
divided as severe varus deformity, severe valgus deformity, severe
flexion deformity, stiff knees, with bone defects and gross
ligamentous laxities. The stability of implant is of paramount
importance in order to achieve good and lasting results. The
decision for whether one should opt for this surgery, should be a
co-opted one between you, your family and your joint replacement
surgeon. You should weigh the benefits of the surgery with respect
to the problems you are facing.
Knee Replacement
(Total of Partial) does have a definitive and almost a complication
free outcome in good hands. The Mobile Bearing Knee designs have
documented longer survival ( such as LCS design has a documented
survival up to 20-25 years). This longer survival of mobile
bearing joint designs is because of its better design and relative
mobility between the components, and larger contact area (1400 sq
mm) as compared to Fixed Bearing (200 sq mm). This is the most
suitable implant for relatively younger, active and obese patients.
These days we are doing knee replacement surgery with just 4”
incision (minimally invasive surgery) in suitable persons. One is
allowed to go to the bathroom on the second day of the surgery,
exercise on bed are started on day one of the surgery One needs to
use walker or elbow sticks for about 2 to 3 weeks. Usually in 3 to 4
weeks you may start performing normal routine like driving car,
going to market etc. Recovery depends upon the quality of surgery
done, determination of the patient and inputs of the surgeon.
Usually in our patients movement of 0° to 120°-140°
is achieved after surgery.
The age at which you should opt
for surgery is not relevant. Surgery is an option when you
have a significant problem and your surgeon confirms the same. There
is no substance is suggestion that one should carry on suffering as
long as one can and then go for surgery when the suffering is
unbearable, when options (mobile bearing high flexion knee) with
life span of 20-25 years are available.
Our vision needs
to be broadened, reality of aging has to be accepted and if needed
treatment must be undertaken. Our mission should be to make aging
graceful for all. Arthritis is a manageable challenge, a planned &
judicious treatment is important and early initiation is key to
success.
For more information you can log on
to my web site www.jointsindia.com
With Best Wishes
Dr. Rajeev K Sharma
M.S.
(Orth), D.N.B. (Orth)
Senior
Consultant Orthopaedics & joint Replacement Surgeon,
IndraprasthaApolloHospital,
New Delhi
