Recent Advances

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 of the knee.

In our country, many patients of primary arthritis of the 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 ligaments laxities. The stability of implant is of paramount importance in order to achieve good and lasting results. The decision of 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 in 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 in bed are started on day one of the surgery One needs to use a walker or elbow sticks for about 2 to 3 weeks. Usually in 3 to 4 weeks you may start performing a normal routine like driving a 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 patient’s 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 suggested 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 a 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.

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With Best Wishes

Dr. Rajeev K Sharma
M.B.B.S, MS (Orth) Gold Medalist, D.N.B (Orth), MCh (Orth)
Managing Director,
Primamed Super Speciality Hospitals,
New Delhi & Gurugram



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