The knee joint is the biggest joint in a human body. It bears maximum pressure since it holds the entire body together. Three bones come together to form a knee joint – Femur (thigh bone), Tibia (lower leg) and Patella (knee cap). Patella protects the knee joint and provides strength to the knee joint ligaments.
Articular cartilage covers the three bones that form the joint and helps in its smooth functioning and absorption of jerks. However, if there is inflammation of this cartilage, it cannot repair itself and needs medical care.
The knee joint is surrounded by a synovial membrane which secretes a thick fluid making the joint smooth and slippery. It also nourishes the joint and cartilages around the joint.
There are two types of Arthritis - Osteoarthritis and Rheumatoid Arthritis
OA is the most common arthritis and is also called as synovial arthritis. OA is an old age defect, mostly seen in 50+ people, which is caused by inflammation of the knee cartilage. Eventually the cartilage breaks and the knee joint bones start rubbing with each other. This results in stiffness, pain and non-functioning of the joint. Young patients who are diagnosed with OA are usually the ones who have suffered a knee injury or have gotten it due to some pathological reason.
Symptoms of OA
Pain in and around the knee joint, stiffness in the mornings, swelling of the joint, inconsistent pain during nights, problem during long walks or even in short distance walking, problem in standing for prolonged periods.
Rheumatoid Arthritis (RA)
RA is an autoimmune disease that can cause chronic inflammation of the joints and other areas of the body. It can affect people of all ages. It is a chronic disease characterized by periods of disease flares and remissions. In rheumatoid arthritis, multiple joints are usually, but not always, affected in a symmetrical pattern. Chronic inflammation of rheumatoid arthritis can cause permanent joint destruction and deformity. Damage to joints can occur early and does not always correlate with the severity of RA symptoms.
The ‘rheumatoid factor’ is an antibody that can be found in the blood of 80% of people with rheumatoid arthritis. Early RA treatment results in better outcomes.
Symptoms of RA
RA symptoms and signs include fatigue, joint pain, swollen joints, fever, loss of joint function, as well as joint stiffness, redness, warmth, tenderness, and deformity.
Care at various stages of Arthritis:
The treatment of arthritis optimally involves a combination of the following factors:
- Patient education:
- Rest and exercise:
- Weight loss:
One must consult an orthopedic doctor as early as possible once any discomfort or pain in the joint is felt.
Resting allows the body to self-heal. This lowers the need for a surgery. Exercising under the guidance of a physiotherapist also helps relieve the pain faster.
People with a heavy built must lose weight as early as possible to reduce pressure on the joint. Weight reduction allows the joint to function smoothly.
Medicines such as Non-steroid-anti-inflammatory-drug (NSAID), immunosuppressants, steroids are prescribed for pain relief.
In severe cases, surgery is required to provide permanent relief.
When medicines, exercise and other conservative methods fail to provide relief and the pain and immobility increases of the knee joint, your doctor may decide that you now qualify for a knee replacement surgery.
Knee replacement surgery or knee arthroplasty is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability. It is most commonly performed for osteoarthritis and also for other knee diseases such as rheumatoid arthritis.
Other major causes of debilitating pain include meniscus tears, cartilage defects, and ligament tears. Debilitating pain from osteoarthritis is much more common in the elderly. Knee replacement surgery can be performed as a partial or a total knee replacement. In general, the surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee.
Preparations for a knee replacement surgery
- Primary medical tests:
- Medication information:
- Improve your health:
- Discontinue aspirin:
- Get your home ready for your recovery:
A few weeks before your procedure, you must try to get a complete physical check up by your primary care doctor to rule out other medical problems that may interfere with your surgery. Your doctor will understand your medical history and order tests that must be performed before surgery, such as blood tests, urine analysis, chest X-rays and electrocardiograms (EKG or ECG).
Inform your orthopedic surgeon about all medications that you’re taking. Your doctor will advise you regarding medications that you should continue or stop taking prior to surgery. If you develop any infection prior to surgery, such as a cold or the flu, please notify your surgeon immediately.
You should be in the best possible health before your surgery. If you are overweight, your doctor may suggest that you lose weight. If you smoke, it is highly recommended that you stop because smoking can change blood flow patterns and delay healing and recovery.
Seven days prior to surgery, you should stop taking all aspirin or other non-steroidal, anti-inflammatory drugs.
Prepare for your return home from the hospital prior to your surgery so that you are as comfortable as possible. We recommend that you arrange for a family member or friend to be with you for 24 hours a day for the first week. Make sure you have your transport planned for return from the surgery as well as for follow-up visits, which generally are at three, six and 12 weeks after the surgery.
- Arrange for a care-giver:
- Arrange your meals:
- Fall-proof your home:
- Raised toilet seat
- Stable shower bench or chair for bathing
- Long-handled sponge or shower hose
- Reaching device that will allow you to grab objects without bending your hip
- Pack your hospital suitcase:
After surgery, you’ll need help and care for yourself at home. Plan who will assist you and talk with them about your concerns. If no one is available to care for you, a discharge-planning nurse can help make arrangements for skilled nursing or caregivers to help you at home.
Arranging meals that can be stored and frozen and stocking up on prepared foods will eliminate extra work for your caregiver.
Organize your home with safety features to prevent accidents. These include making pathways in crowded areas, eliminating all throw rugs, securing extension cords and telephone cords strung across the floor, securing handrails in your bathtub and stairways, and placing all needed items at a level so that you can easily reach them. You also should be sure that your house is equipped with the following:
Pack a small suitcase for your hospital stay that includes a list of your personal hygiene items, comfortable and loose clothing, a knee-length robe and slip-on shoes. Please leave all of your valuables, including jewelry, wallet and watches at home. It is not necessary to bring your medications, but please bring a list of your medications and their dosages, as the hospital will provide you with your medications.
Short Term Recovery
- Rehabilitation (rehab):
You will probably still be taking some medicines. You will gradually take less and less pain killers. You may continue medicines to prevent blood clots for at least ten days after surgery.
Most people who have knee replacement surgery start to walk with a walker or crutches the day of surgery or the next day. And most people can bear weight on the knee if it is comfortable. A physical therapist will help you gently bend and straighten your knee. Your therapist will also begin some simple exercises to help strengthen your leg muscles.
The main goal of rehab is to allow you to bend your knee at least 90 degrees-enough to do daily activities, such as walking, climbing stairs, sitting in and getting up from chairs, and getting in and out of a car. Most people can get considerably more bending than 90 degrees after surgery. But one of the things that affects how much bend you get after surgery is how much bend you had before surgery. To get the utmost benefit from your surgery, it is very important that you take part in physical therapy both while you are in the hospital and after you go home from the hospital.
Long Term Recovery
- Physical Therapy:
- Increasing mobility, strength and endurance in joints
- Gradually increasing your confidence and pace of walking
- To educate you about the care and protection required for the newly installed knee
- Caring for Surgery Site:
- Preventing Swelling:
- Taking Pain Medication:
- Protecting Your New Joint:
- Taking anticoagulant medication:
After complete knee replacement, physiotherapy is an important and crucial part of recovery. Its aim is:
You will continue to work on increasing the extent to which you can bend your knee and on building strength and endurance. Total rehab after surgery usually takes several months.
If your doctor has closed your wound with staples, you’ll get instructions on how to clean the area and change the dressing. Your doctor may want you to leave the dressing on as long as it is clean and dry or may want you to change the dressing. The staples will be removed by your doctor or your therapist.
Unless your doctor tells you otherwise, you can shower once you are home and can safely move in the bathroom. If you’re not steady, get help while showering so that you don’t fall.
Keep your leg elevated when you are sitting. Use an ice pack on the front and back of your knee. Your doctor or therapist will tell you how long to keep using ice packs.
Now that you’re home, it’s important to take your pain medication exactly as per your doctor’s instructions. This will help you get better faster and avoid complications.
Avoid certain positions and movements while your new joint is healing. Do not kneel on your operated knee or bend forcefully. Do not cross your legs. Do not twist toward the side of your surgery. Avoid stairs if you are unsteady or dizzy. Climb the stairs one at a time. Do not switch feet for each new stair. Use crutches if instructed by your therapist.
Following your surgery, your doctor would want you to take an anticoagulant medication to prevent your blood from clotting too easily while you are healing.
Preventing Blood Clots
Warning signs of possible blood clots in your leg include:
- Increasing pain in your calf
- Tenderness above or below your knee
- Increasing swelling in your calf, ankle and foot
Warning signs that a blood clot has traveled to your lung include:
- Sudden increased shortness of breath
- Sudden onset of chest pain
- Localized chest pain with coughing
For the first two years after your knee replacement, you must take preventive antibiotics before dental or surgical procedures that do not allow bacteria to enter your bloodstream.
Warning signs of a possible knee replacement infection are:
- Persistent fever (higher than 100 degrees)
- Increasing redness, tenderness or swelling of the knee wound
- Drainage from the knee wound
- Increasing knee pain with both activity and rest
If you are experiencing any of these symptoms, call your surgeon.
A fall during the first few weeks after surgery can damage your new knee and may result in a need for further surgery. Stairs are a particular hazard until your knee is strong and mobile. You should use a cane, crutches, a walker, hand rails or someone to help you until you have improved your balance, flexibility, and strength.
- Myth: Arthritis is just an ageing process. You have to learn to live with it.
- Osteoarthritis is a disease of the knee joint which affects millions of people worldwide. It is a chronic condition characterized by breakdown of joint cartilage which causes rubbing of bones against each other leading to joint pain, stiffness and loss of movement. There are various ways to alleviate arthritis and no one has to live with it.
- Myth: A knee replacement surgery leaves a large noticeable scar.
- With minimally invasive procedure, there is minimal scarring after knee replacement. The typical scar is of 3 - 5 inches long which gradually fades away becoming less noticeable.
- Myth: You cannot sit on the floor after knee replacement.
- It depends upon the type of surgery and the patient’s condition. If such activities are to be performed you must discuss with your surgeon prior to the surgery. Indus Knee Replacement System allows you to live a fairly routine Indian lifestyle.
- Myth: It takes months to recover after knee joint replacement.
- With modern techniques and technology available, recovery is quite fast. You would be advised to start taking few steps next day of the surgery itself. Most people return to routine activities within a few weeks.
- Myth: You should follow conservative treatment as long as possible even if it means bearing a lot of pain.
- You need not suffer knee pain until it becomes intolerable. Surgery is advised to people even at an early age if they have severe pain which is not relieved much with other conservative treatments.
- Myth: Rehab after knee replacement is hard and you cannot expect full range of motion after knee replacement.
- On the contrary, rehab after surgery is relatively easy. Once the implant is well settled inside your body, it should provide enough range of motion to carry out routine Indian lifestyle.
- Myth: Knee replacements don’t last long.
- Most knee replacements last as long as 20 years or more if properly taken care of. Moreover, the quality of life you achieve after a knee replacement is priceless.
- Myth: You can consider knee replacement only after 60.
- Not necessarily. If you are living with knee pain that is prohibiting you from carrying out daily activities and you still consider undergoing knee replacement only after 60, is not right thinking. The life of a knee replacement can last as long as 25 years or a lifetime. So you need not wait turning 60 for a knee replacement.
- Myth: Both knees should not be replaced at the same time.
- Both knees can be replaced at the same time if the patient’s health condition is good. In fact, many doctors prefer to do both the knee replacements simultaneously if they feel that patient can tolerate the procedure well. It not only saves money, but recovery & rehabilitation is done at the same time, patient gets back to work and thus saves a lot of financial burden on the patient.