Joint replacement surgery is one of the most successful surgeries in modern medicine, and has helped millions of patients crippled with disabling arthritis to live a painless and mobile life. Knee arthritis is quite common in India, due to high-flexion knee activities such as kneeling, squatting and cross-leg sitting commonly employed by our population for religious and social purposes. Max Institute of Orthopaedics & Joint Replacemenrs, Patparganj is the top orthopaedic hospital in the country, specializing in all sorts of joint replacements, including primary, complex and revision knee replacements.
The knee is the largest joint in the body and has an important function in most day-to-day activities such as walking, sitting and climbing stairs. The joint is made up of three bones- lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the kneecap (patella). The ends of these bones are covered with a smooth substance, called articular cartilage, which allows smooth gliding of the bones over each other for normal movements. The remaining surfaces of the knee are covered by a thin ‘synovial membrane’, which releases a fluid that lubricates the joint and reduces friction, similar to oils and greases in moving parts of a motor. Loss or damage of the articular cartilage is called as ‘arthritis’.
Pain: Pain is the most common symptom of arthritis, which is only occasional in the early stages, but becomes constant, felt during all walking activities, in advanced stages.
Swelling: Swelling in the knee often accompanies arthritis, and denotes inflammation/ thickening of the synovial lining, with an increase in the amount of synovial fluid (effusion).
Stiffness: With increasing arthritis, the knee becomes stiff and one might feel difficulty in bending or straightening it fully.
Crepitus: With loss of articular cartilage, the bones cannot smoothly glide over each other and produce a characteristic sound called ‘crepitus’ upon movements.
Deformity: With increasing arthritis, the knee joint gradually loses its shape and alignment, appearing as a ‘knock knee’ or ‘bowed knee’ deformity (Fig ).
Loss of function: Knee arthritis leads to difficulty in routine day-to-day activities such as walking, getting up from a sitting position and climbing stairs. The patient progressively loses the walking ability, with severely affected patients only able to walk for a few minutes, or even completely bedridden.
Rheumatoid arthritis and other autoimmune diseases
Metabolic e.g. crystal-deposition diseases like gout
Knee infection in childhood or adult life
Miscellaneous causes e.g. osteonecrosis
Diagnosis of knee arthritis is often not difficult, and just a visit and examination by your orthopaedics doctor might be all that is required. Various X-rays of the knee are then taken, in different angles and positions, to confirm the diagnosis and grade the severity of arthritis. Advanced investigations such as MRI scan might be required in some cases, or to assess the damage to the soft tissues like muscles and ligaments of the knee. Several blood tests might be needed to rule out inflammatory arthritis.
Max Institute of Orthopaedics & Joint Replacements, Patparganj offers comprehensive care for arthritis, with its team of highly qualified, experienced and world renowned doctors including joint replacement surgeons, orthopaedicians, physiotherapists and rheumatologists. The treatment of knee arthritis varies, depending upon the severity of the condition. In early stages, simple measures like anti-inflammatory medications, dietary supplements, physical therapy (exercises) and lifestyle modification might help to relieve your symptoms. Injections might be given in the knee to control joint inflammation and give temporary relief in some cases. When this ‘conservative treatment’ fails to relieve your symptoms, it is the time to think of surgery. Your doctor may offer you one of the following surgical options:
Arthroscopy (‘key-hole’ surgery)
In this, the joint is thoroughly washed out of the inflammatory mediators, the degenerated cartilage is shaved/smoothened, degenerative tears of the ‘meniscus’ debrided and any loose bodies in the joint removed, relieving the symptoms and increasing the movements.
Joint salvage surgery
In younger patients, some surgical procedures can be undertaken to correct the bony and soft tissue alignment of the knee, relieving the pain and improving function. Such procedures are called ‘osteotomies’, and preserve the natural cartilage and ligaments of the knee, with no activity restrictions following the surgery.
Joint replacement surgery
In the most severe cases, where other treatment options have failed, joint replacement is the only option. A joint replacement or ‘arthroplasty’ is actually a resurfacing surgery, wherein the worn out surfaces of the bones are shaved and replaced with artificial metallic components (prosthesis) fixed with a special cement. In advanced cases, all the three bone surfaces forming the knee might need to be replaced in a ‘total knee replacement’, whereas in less severe cases, only a part of the knee might need replacement as a ‘partial knee replacement’ (unicondylar or patellofemoral knee replacement). Several designs of prostheses are available in the market, and your surgeon would suggest you one best suited to your needs and anatomy. Max hospital boasts of the topmost joint replacement surgeons in the country, with an extensive experience of primary, complex and revision knee replacements. The hospital has world-class modular operation theatres using laminar air flow systems and body exhaust suites, to minimize the risk of infection.
With improvements in prosthetic designs, materials and surgical techniques, an ‘artificial knee’ can last for your lifetime. Modern research has shown that the prosthetic knees function continue to function well, without any significant pain or loosening, even after 25 years in more than 90% of the patients. Newer materials such as highly cross-linked polyethylene have further increased the survivorship of prosthetic implants. Modern techniques like computer navigation enable the surgeons to implant the new joint in accurate alignment to restore the biomechanics and kinematics of the knee. PINLESS computer navigation is the latest technology in navigation, and is available at our hospital. Do ask your surgeon about PINLESS navigation and its advantages.