Pain, in any form, is unpleasant. Those with knee osteoarthritis (degenerative joint disease) endure a debilitating kind of pain with many layers of suffering. To be dependent on another person for even normal activities such as moving about the house, taking the stairs or going to the washroom is frustrating.
Knee osteoarthritis is a condition where wear and tear and progressive loss of the articular cartilage present in the knee joint leads to stiffness, swelling and knee pain. The discomfort intensifies with time, hampering day-to-day activities.
It is in such advanced stages of knee osteoarthritis that doctors prescribe total knee replacement surgery as a solution.
“I had a bilateral knee replacement surgery done in November 2022,” says 65-year-old Shobha Gandhi, a homemaker and resident of Bengaluru.
READ MORE :
Writer’s cramp: causes, symptoms and management
Sprain or strain: how to manage your sports injuries
Shin splints: keeping your shin up and running
Gandhi had been trying to cure the excruciating pain, which spread from her knees to the calf muscles, glutes and the back, for the past ten years. The osteoarthritis-induced pain affected her mobility and eventually kept her confined to her home. She tried multiple treatments: physiotherapy for a couple of years, taking injections and painkillers, and aqua-therapy sessions. All of them helped and her X-rays did not show further deterioration, but the relief was temporary and the pain would come back.
Eventually, Gandhi went in for a bilateral knee replacement surgery. After getting all medical tests done, she went under the knife — and was back home in six days.
These days, a physiotherapist comes in every day. In the first week, Gandhi walked with the help of braces and a walker. By the end of two weeks, she could manage with either the braces or the walker. Next, she hopes to be able to walk unaided, and also climb stairs.
“The best thing about the whole journey is that the whole excruciating arthritic pain has disappeared,” says Gandhi.
Who can go for knee replacement surgery?
Not all individuals with knee osteoarthritis undergo surgery — it is preferred for those over 60-65 years because knee replacements have a finite lifespan, about 20-25 years. If done in younger individuals, another surgery might be needed later in life.
“The main criterion [while suggesting surgery] is the pain coming in the way of the activities needed for [a person’s] daily life,” says Dr Narayan Hulse, director, department of orthopedics, bone and joint surgery, Fortis Hospital, Bengaluru. “When the pain is not controlled with other simple measures — like painkillers, exercises, physiotherapy, lifestyle modifications, walking aid and other medications to control the pain — then we decide on a knee replacement. The X-ray must also show severe arthritis in the joint.”
The body weight, underlying conditions, metabolic syndromes and other health conditions are also to be considered. Generally, people with knee osteoarthritis tend to be on the heavier side because of reduced activity over the years.
“[We ask] anyone with a body mass index (BMI) of more than 30 to lose weight, but it’s challenging,” says Dr Ananya Puttaraju, senior consultant, robotic joint replacement and foot ankle surgeon, Hosmat Hospital, Bengaluru. “Hence waiting for them to lose weight, and then performing the surgery may not be practical. If the BMI is more than 40, we suggest bariatric surgery.”
Dr Hulse adds, “It is also advisable that their general health is optimised before they undergo the surgery.”
Knee replacement technique
The world’s first knee replacement surgery was performed in 1968. Over the past five decades, the technique of the surgery has been refined.
Dr Puttaraju says, “In the initial stages, we can manage with physiotherapy, analgesia, etc. If the cartilage is fully worn out — leading to one bone touching the other bone, causing immense pain — the only permanent solution is a knee replacement.”
According to Dr Hulse, “The operation involves making a vertical cut on the front of your knee and exposing the bones of the knee joint, which are the thigh bone and the leg bone. The end of these bones is smoothly reshaped using instruments on which a metal cap or metal components are placed, usually using bone cement. A polyethylene disc is placed in between these two metal components. As a unit it will allow bending of the knee from zero to about 130-140 degrees. Here the [thigh] bone and [leg] bone are not touching each other because of the intervening metal and polyethylene disk, which move but will not cause pain.”
Recovery after knee replacement
The recovery process is crucial. The healing and recovery should happen without any force or pressure, and under medical supervision.
“After a unilateral knee replacement surgery, the person’s joint mobilisation is done with a physiotherapist’s help, either on the same day or the next day,” says Dr Hulse. “Within the next three or four days, the patients can walk small distances on their own and then they are discharged home as early as the third day. Stitches on the joint are removed after about 15 days’ time, and in about three to four weeks’ time, patients are independent to walk inside and outside the house without the help of crutches. By around six weeks, most of the patients will start doing all the normal activities that they have been doing before the surgery.”
In comparison, the recovery process takes a little longer for a bilateral knee replacement surgery.
The first move is the hardest post-surgery. “A trained professional [physiotherapist] will help them and supervise them to get the range of movement and the balance right,” says Dr Puttaraju.
Though mostly done for the elderly, nowadays there are instance of even young individuals with intractable pain undergoing knee replacement surgery. Though after healing and recovery they can do most normal activities, including sports, it is advisable that repetitive-impact activities (such as skipping) and heavy-contact activities (football, rugby) are avoided. But most people can take part in low-impact sports (such as table tennis, light badminton, swimming) and recreational activities (driving, travelling).
“The primary goal of knee replacement is pain relief and to get back to daily activities,” says Dr Hulse.
Takeaways
- When performed right, knee replacement surgery can relieve a person from the pain of knee osteoarthritis.
- A physiotherapists intervention is necessary post-surgery, during the recovery stage, for mobilising the joint.
- Getting back to daily activities is one of the benefits of knee replacement surgery, but care must be taken to avoid activities that may jeopardise the implant.
