What is a TKR?
Who should go for Total Knee Replacement?
According to Dr Paul McNamara, consultant orthopaedic surgeon, Medcare Orthopaedics and Spine Hospital, Dubai, patients need knee replacement for a variety of reasons, which could be attributed to injury, osteoarthritis, sedentary lifestyles and so on. Knee joint is worn off when the cartilage cushion between the bones wears away and the patient’s articular cartilage in the knees is damaged, or when the patient finds it extremely hard to move as the bones rub and crush together causing pain. That is when the patient needs to be fitted with an artificial prosthesis to alleviate pain.
Evolution of TKR
The fear factor
Dr McNamara added, “The greatest deterrent to knee replacement is the fear that people have. In the West, we have up to 15-16 TK surgeries being conducted in a single unit of any hospital as knee replacement is all about independence. Patients do not want to go on wheelchairs and prefer to opt for TKR. While here, I have seen many people preferring family members to push a wheelchair and keep putting off the surgery. This is detrimental to the patient as once he is confined to the wheelchair and movement gets restricted, there is too much muscle loss, making knee replacement more challenging. We want patients to go in for TKR as soon as possible as average lifespan of the prosthesis is easily 20-25 years and one can have a revision surgery after that. But it is important not to lose your muscle tone and be active and TKR provides that privilege to the patient immediately.”
Step-by-step procedure in a TKR
Step 1: A longitudinal incision of about 15cm is made in the location where the kneecap is situated. The surgeon then uses that opening to go through the layers of tissue and reach the inner structure where he flips the patella to be able to reach the insides of the femur and tibia, where the portion is being damaged because of friction of bone on bone with thinning of the cartilage.
Step 2: The surgeon undertakes the resurfacing of the damaged parts of both the bones, shaving off a few millimetres of the diseased portions and releasing the tightened soft tissue around it.
Step 3: Once the space is created, the surgeon tests the flexion and extension with trial prosthesis. At this stage, the exact measurements are very vital. Once that is determined then the actual prosthesis is placed.
Step 4: The surgeon makes sure to infiltrate the layers with anaesthesia, which is given in the muscle and the back of the knee to keep it pain free.
Step 5: After the prosthesis consists of titanium on both ends is fitted well on both ends linking the femur with the tibia and the polyethylene cushioning is in between the two. Bone cement is used fill in the gaps and grouts. The cement, which is fortified with antibiotics, is first mixed well and the patty is used to fill in the gaps. The bone cement has a quick solidifying time of 12-13 minutes and the surgeon has to take care to see it is neither too soft nor too hard. It must be the right consistency and during that period, the knee is left alone so that the prosthesis does not move. In the last two or three minutes before solidifying the bone cement heats up. Once the period is over, the surgeon, snips of the excess cement around the joint.
Step 5: The soft tissues are reattached, layer-by-layer, and the surgeon closes the incision through the layers working his way up one layer after the other making sure to infiltrate the incision with enough local anaesthesia. The entire procedure takes about one hour and the patient recovery takes about 5-6 hours after which the patient is allowed to move a little. If everything is stable and patient is able to move without pain, he or she is discharged the second day after surgery.
Cost of knee replacement
Quick recovery key to knee health
Dr McNamara explained, “Now, during the surgery we use regional and local anaesthesia and minimise use of opioids as that confuses and disorients patients. I use a local anaesthesia at the site of the incision, another at the back of the knee and a third in the muscle towards the end of the surgery. These multilevel anaesthetics, help the patient feel less pain and he gets moving within hours of the surgery. That helps in preventing clots and also gets the joint mobile and is a great contributor to the rapid recovery. In a couple of years knee replacements will get to be day care procedures as we progress to more advanced techniques.”
Success rate and lifespan of a prosthesis
Types of knee replacement surgeries
Elaine Wolfenden, British expatriate in Dubai, underwent a surgery for replacement on her left knee and was able to resume movement within few hours of her surgery. Ten weeks after the surgery, she said her knee recovery was very good and she would be visiting Dr McNamara for a follow up after completion of three months.
10 common questions about knee health
• Why is the knee one of the most important aspects of our physique in terms of lending body balance and managing weight distribution?
The knee is a joint between the two major portions of our lower limb — the femur and the tibia and it is supported by cartilage, meniscus and However, if the knee is misaligned, injured or not in the correct groove, than this becomes the most major factor in affecting one’s gait, balance and be a pain trigger.
• At what age do our knees begin to trouble us and why?
• They say obesity is one big factor for knee health, how does it affect knees?
Studies have shown that the risk of developing knee osteoarthritis is 4 to 5 time more in obese compared to non-obese people and for a woman of normal height, for every 5kg weight loss, the risk of knee osteoarthritis dropped by 50 per cent.
• Is there a way to keep our knee health perfect for our entire life? Please share some top tips
a. Control weight: If you are at a healthy weight, maintaining that weight may be the most important thing you can do to prevent osteoarthritis. If you are overweight, losing weight may be your best protection against the disease.
b. Exercise: Low-impact exercise can improve joint health. Look for activities that include strength training and stretching in addition to aerobic exercise. Strengthen the muscles that surround the knee as strong muscles mean less stress on the joint itself.
c. Early treatment of knee problems: The presence of bow -legs or injury of a knee ligament or cartilage can all lead to progressive damage to the knee cartilage. Thus, early treatment of such conditions will help you preserve the cartilage.
• Is there a way to keep our cartilage in good health for life?
One must have an active lifestyle, be mobile and have a healthy diet rich in antioxidants that can help minimise the adverse impact of oxidation and neutralise the free radicals.
For better cartilage health, it is advisable to get hyaluronic injections, use Platelet Rich Plasma Therapy, which can help in slowing down the deterioration in Stage, One, two and three of osteoarthritis. Although not really ratified by the FDA, a regular use of glucosamine chondroitin can also help in knee health and slow down the wear and tear.
• At what age does it become important to get knee replacements and why?
If non-surgical treatments like medications and using walking supports are no longer helpful in relieving knee pain, you may need to have total knee replacement surgery. Most patients who undergo total knee replacement are age 50 to 80 years old but you need knee replacement whenever you develop problems of mobility due to knee damage, which can be earlier too. On average, a total knee replacement lasts about 20-25 years, so if you have the procedure in your 40s, you will most likely need to have another — or a revision — surgery later in life.
On the other hand, delaying surgery is not a good idea because osteoarthritis limits mobility and this can lead to other health problems physically and psychologically related to being sedentary. In addition, when knee replacement is delayed, people do not get as much function back as they would have if they had the surgery sooner.
• What is the difference between total and partial knee replacement and what is the deciding factor on which kind of replacement a patient needs?
Partial knee replacement tends to be performed if osteoarthritis affects only one-half of the knee joint. Because partial knee replacement retains most of your knee tissue, you are still susceptible to meniscal tears and progression of arthritis in the rest of the knee. When a partial knee replacement fails, it can be converted to a full knee replacement.
• Can an artificial knee replace a health knee joint completely or are there issues that will always be present with an artificial knee?
• Under what circumstances is the artificial knee contraindicated (or who cannot get the knee replacement)
Doctors do not recommend knee replacement to people who are bedridden and are not mobile due to neurological problems. Such individuals who do not use the knee replacement can develop clots and even infections with a lack of movement which can be life threatening. People who get knee replacements must be mobile and indulge in light to moderate exercises.
Original news source Credit: gulfnews.com