As the geriatric population of India grows, the incidence of knee pain is bound to increase. Also, due to the change in lifestyle and expectations from the aging population, more and more elderly people are going to seek medical help for the management of their knee pain.
What is a Knee Joint?
The knee joint is a weight-bearing joint of our body which consists of three bones (femur, tibia and patella) held together with surrounding ligaments and joint capsule. Bone ends are covered with cartilage which obtains its nutrition and lubrication from synovial fluid. With aging water content inside the joint decreases considerably. Damage to cartilage can cause irregularity and thinning over the joint surface.
What Happens if Knee Joint Gets Damaged?
Subsequently joint fails to glide normally during locomotion. Debris from the bone surface in a degenerate joint can cause excessive fluid production in the joint leading to pain and swelling. Change in normal biomechanics of joint leads to instability. The body tries to control this “instability” by tightening the ligaments and producing excess bone but not so successfully.
Pain and stiffness in knee joint herald the onset of arthritis. People find it hard to get up from sitting posture and climb stairs. The normal walking distance also reduces in due course. These patients need support to stand and walk. Pain can be in the front of the knee, inside of the knee, back of the knee and diffusely all around. Knee movements are associated with crepitus. Sleep can get disturbed due to the pain.
Knee Joint Replacement
Knee joint replacement with prosthesis has remarkably changed the lifestyle and quality of life for the patients suffering from arthritis. Instead of being bed-ridden and crippled, these patients are leading near normal pain-free life and are able to carry on normal daily activity independently. Joint replacement was primarily designed for elderly population above 55 years. With new technological development in the field of joint replacement, age is no longer a restriction for undergoing this procedure. These operations have been successfully performed with an excellent outcome in young as well as old patients.
Patello-Femoral Joint Replacement
Patello-femoral joint replacement is done in patients who have knee pain mainly under the knee cap over the anterior aspect. Here the only anterior aspect of femur and under-surface of the patella is replaced.
Compartmental Knee Replacement
Technological advancement has led to the development of compartmental knee replacement which is primarily used for younger patients who have arthritis limited to one part of the knee. Once the diseased bone is removed and replaced with a metal prosthesis, the pain completely disappears and patients get back to the pre-arthritic stage. It also helps in restricting the progression of arthritis to the rest of the knee.
Medial and Lateral Compartment Knee Replacements
Medial and lateral compartment knee replacements are done in patients who are suffering from pain on inside or outside of the knee. Pain over the inside of the knee is more common hence more and more patients are undergoing medial compartment knee replacements. Over the years, medial compartment knee replacement has produced an excellent result and increased the overall longevity of the replaced joint.
Rehabilitation following a compartmental knee replacement is much easier and rapid and there is less surgical exposure to performing these surgeries. Also, it produces “near normal knee” as the rest of the bone and joint is intact.
Total Knee Replacement Can Help
Total knee replacement is one of the most common operations performed worldwide. It is mainly performed for advanced arthritis in the knee and has been successfully performed and reproduced over the last three decades. A distal end of the femur (thigh bone) and a proximal end of tibia (leg bone) is replaced with the metal prosthesis and in-between space is fitted with a plastic spacer.
There are plenty of designs for knee joint prosthesis in the market and these need to be individualized depending on patient selection and patient’s expectations. Patients with very severe arthritis or instability may require extra connecting rod in the stem of the implant to provide stability. More active patients may require mobile polyethylene spacer (mobile bearing implants) which changes its orientation with changing the motion of knee thus allowing increased longevity of replaced knee joint.
Can a Patient Walk Normally After Total Knee Replacement?
Following a knee replacement, the patient can start walking the next day after surgery with the help of walking aid. They can be discharged from the hospital within 3-4 days following surgery. Most of the patients are independently walking without any walking aid by the end of six weeks. It is very important that the patient continues physical therapy after discharge from the hospital. There is a dramatic reduction of pain in the knee following knee replacement and this allows patients to perform activities for daily living without any difficulty. Patients are advised not to indulge in high impact activities or else longevity of prosthesis may decrease.
Ever since knee replacement was first performed, technological advancement has allowed these operations to be performed successfully for patients suffering from arthritis in knee across the world. Arthritis of the knee is no longer an incurable condition. Knee joint replacement not only improves the pain but also the quality of life. Patients who have undergone knee replacement are independent, mobile and more confident of themselves. Knee replacement surgery is indeed a life-changing operation. It heralds a new era for patients who otherwise are crippled with arthritis.
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