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Magazine
HEALTHWATCH
Advances in knee replacement
DR. S.K.S. MARYA
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Painful joints can impact an active life. A look at the corrective options available.
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Due to modern medical advances, more than 25 per cent of the population is older than 60 years but still looks forward to many decades of active life. Painful joints as a result of wear and tear or inflammatory arthritis can be a serious impediment t
o normal life.
Osteoarthritis of the knee is one of the most common disorders, mostly affecting those above 40. It affects more women than men and risk factors include obesity, knee injury and occupational loading.
Symptoms
Many people experience aches in and around the knee, persistent pain or attacks of acute stabbing sensation, morning stiffness and stiffness associated with pain. The disease is also associated with swollen knee joints, buckling or giving way due to weak knee muscles and tenderness in the knee area. In severe cases, the pain may confine a person to the house. Loss of mobility and dependence on others can be psychologically devastating. This is especially so in elderly people. Fortunately, recent advances in joint replacement surgery can help.
The symptoms depend on the severity of the disease. In mild cases, pain may be felt only at the end of the day or during strenuous activities. With increasing severity, the walking distance gradually decreases and it may be associated with swelling and warmth over the joint even during moderate activities.
In advanced cases, walking without support becomes impossible and pain may be present even when one is resting. Many patients spend sleepless nights for fear of pain even with the slight movement.
Surgical options
Knee replacement may be unicompartmental or involve total replacement of the knee. The surgeon will decide what is best after studying the severity of the pain, the degree of functional impairment and evidence of structural joint damage.
Arthroscopy is the simplest surgery. Carried out under local anaesthesia, the patient can be discharged in a day or two. It is minimally invasive and involves cleaning/debridement of joint, repair of damaged cartilage, removal of damaged bone and loose fragments of cartilage. It helps preserve the remaining healthy part and stimulates the regeneration of a new cartilaginous load-bearing surface. However, this is useful only in very early stages and is not applicable for patients who have very severe pain, instability or deformity of the joint.
Osteotomy or “bone cutting” helps prevent deterioration of joints with arthritis. It helps realign the loading axis of the knee to redistribute the static and dynamic loads on articular surfaces. This reduces pain and delays progression of the disease, but is rarely performed, as it is useful only in a few cases and does not eliminate the symptoms totally.
When pain is very severe, joint replacements can offer a dramatic cure with restoration of normal activities. Here, the superficial layers of the bone are removed and replaced with new gliding and load-bearing surfaces made of plastic, metal or ceramic. Deformities can be corrected and the joint becomes stable, allowing the patient to regain mobility.
Unicompartmental knee replacement is recommended for patients with partial knee damage. It involves insertion of small implants in place of the damaged tissue of the knee joint. It helps relieve pain and preserves function for as long as possible. It is usually recommended for patients less than 60 years of age.
Total knee replacement is recommended for patients with moderate to severe symptomatic knee arthritis affecting both the medial and lateral compartments. It involves resurfacing the worn-out parts of the knee surface with implants made of metal and plastic, placed on the joint surface of each bone.
Most ligaments and tendons remain intact with this process. It allows the smooth gliding of bones over each other, enabling the knee to bend and move.
Latest advances
Computer navigation is the latest advance in orthopaedic surgery. The anatomy of the operating area is assessed and displayed accurately and three-dimensionally.
As the surgeon uses an instrument during surgery, the IGS camera calculates its position and transfers the data to a computer. The whole system offers the surgeon a virtual 3D navigation support system. It allows very precise, safe and perfect surgeries.
Computer Navigation enables knee replacement surgery to be performed with greater precision and control. Surgical instruments are continuously tracked by the navigation system, enabling the surgeon to judge the precise position and alignment of the bone cuts.
The benefits to the patient are better alignment, early mobilisation and most importantly, decreased wear and tear of the prosthesis. As a result, the longevity of the joint replacements may be extended up to 25 years, which means that many patients may never need a revision surgery in their lives.
The writer is Director and Chief Surgeon, Max Devki Devi Institute of Orthopaedics and Joint Replacement, New Delhi.
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