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KNEE REPLACEMENT

Anatomy of the knee joint:

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To better understand how knee problems occur, it is important to understand some of the anatomy of the knee joint and how the parts of the knee work together to maintain normal function.
knee_img3 Let’s begin with the basics of knee anatomy. The knee joint is made up of three bones and a variety of ligaments. The knee is formed by the femur (the thigh bone), the tibia (the shin bone), and the patella (the kneecap). Several muscles and ligaments control the motion of the knee and protect it from damage at the same time.Two ligaments on either side of the knee, called the medial and lateral collateral ligaments, stabilize the knee from side-to-side.
The anterior cruciate ligament (ACL) is one of a pair of ligaments in the center of the knee joint that form a cross, and this is where the name “cruciate” comes from. There is both an anterior cruciate ligament (ACL) and a posterior cruciate ligament (PCL). Both of these ligaments function to stabilize the knee from front-to-back during normal and athletic activities. The ligaments of the knee make sure that the weight that is transmitted through the knee joint is centered within the joint minimizing the amount of wear and tear on the cartilage inside the knee. knee_img4
knee_img5 The weight-bearing surfaces of your knees are covered with a layer of cartilage (referred to by doctors as”articular cartilage”). There are also two shock absorbers in your knee on either side of the joint between the cartilage surfaces of the femur and the tibia. These two structures are called the medial meniscus and the lateral meniscus.
The menisci are horseshoe-shaped shock absorbers that help to both center the knee joint during activity and to minimize the amount of stress on the articular cartilage. The combination of the menisci and the surface cartilage in your knee produces a nearly frictionless gliding surface. The knee is an incredible joint. It is strong, flexible, and very tough.
 
Movement of the knee:

The main muscles that move the knee joint are the quadricep and hamstring muscles. The quadriceps attaches to the patella, and the patellar tendon connects this muscle to the front of the tibia. When the quadricep muscles contract the knee extends. In contrast, when the hamstring muscles contract, they pull the knee into flexion.

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Various problems with Knee Joint:
  • Malformation of the knee joint: Knocked knee (valgus) or Bow Legged knee (Varus).
  • Cartilage degeneration.
  • Arthritis:Secondary Osteoarthritis
    • Osteoarthritis
    • Rheumatoid Arthritis
  • Accidental damage of the knee joint

Arthritis

‘Arth’ means joint and ‘it is’ means inflammation. Therefore Arthritis means inflammation of joints. A joint is end of two bones covered by tough elastic tissue called cartilage. This cartilage helps the bones not to rub. There is fluid between two bones of a joint that lubricates the joint for smooth movement. The joints are protected by ligaments and tendons (muscles).In arthritis treatment in Jhansi, wear and tear of the tough elastic cartilage leads to direct contact of the two bones of the joint, leading to acute pain. Symptoms include swelling, redness, deformity, pain and loss of motion at the affected areas.

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 When Moving Hearts: Knee stiffness and pain have tendency to increase with the passage of time. Eventually, even simple activities, such as walking or going up and down stairs, can become extremely painful experiences.Osteoarthritis: It is one of the most common causes of problem knees. Osteoarthritis occurs when the cartilage in the knee joint begins to break down. When it wears down, the bones in the knee joint begin to rub against each other – resulting in acute pain. Injuries, wear and tear, rheumatoid arthritis, and poor leg alignment are another causes of painful knee problems.Pain and swelling are worse in the morning or after a period of inactivity. Pain may also increase after activities such as walking, stair climbing or kneeling. The pain may often cause a feeling of weakness in the knee, resulting in a “locking” or “buckling.” Many people report that changes in the weather also affect the degree of pain from arthritis.

Common Symptoms:
  • Knee pain that limits your everyday activities, including walking, going up and down stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker.
  • Moderate or severe knee pain while resting, either day or night.
  • Chronic knee inflammation and swelling that doesn’t improve with rest or medications.
  • Knee deformity-a bowing in or out of your knee.
  • Knee stiffness-inability to bend and straighten your knee.
  • Failure to obtain pain relief from non-steroidal anti-inflammatory drugs. These medications, including aspirin and ibuprofen, often are most effective in the early stages of arthritis. Their effectiveness in controlling knee pain varies greatly from person to person. These drugs may become less effective for patients with severe arthritis.
  • Inability to tolerate or complications from pain medications.
  • Failure to substantially improve with other treatments such as cortisone injections, physical therapy, or other surgeries.
  • Most patients who undergo total knee replacement are age 50 to 80, but orthopedic surgeons evaluate patients individually. Recommendations for knee replacement surgery in Jhansi are based on a patient’s pain and disability, not age.
  • Patients as young as age 16 and older than 90 have undergone successful total knee replacement.

Making the diagnosis :The orthopaedic evaluation consists of several components:A medical history, in which your orthopaedic surgeon gathers information about your general health and asks you about the extent of your knee pain and your ability to lead normal life/activities of daily living.A physical examination to assess your knee motion, stability, and strength and overall leg alignment. X-rays to determine the extent of damage and deformity in your knee. Occasionally blood tests, an MRI (Magnetic Resonance Imaging) or a bone scan may be needed to determine the condition of the bone and soft tissues of your knee. Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether total knee replacement would be the best method to relieve your pain and improve your function. Other treatment options including medications, injections, physical therapy, or other types of surgery also will be discussed and considered.Your orthopaedic surgeon also will explain the potential risks and complications of total knee replacement, including those related to the surgery itself and those that can occur over time after your surgery.

Treatment options
In its early stages, arthritis of the knee is treated with conservative, non surgical measures.

 

  • Lifestyle modifications can include losing weight, switching from running or jumping exercises to swimming or cycling, and minimizing activities such as climbing stairs that aggravate the condition.
  • Exercises can help increase range of motion and flexibility as well as help strengthen the muscles in the leg.
  • Using supportive devices such as a cane, wearing energy-absorbing shoes or inserts, or wearing a brace or knee sleeve can be helpful.
  • Other measures may include applications of heat or ice, water exercises, liniments or elastic bandages.Several types of drugs can be used in treating arthritis of the knee. Because every patient is different, and because not all people respond the same to medications, your orthopedic surgeon will develop a program for your specific condition.
  • Anti-inflammatory medications can be used to help temporarily reduce swelling in the joint.
Surgical Treatment
If your arthritis does not respond to these non operative treatments, you may need to have surgery.
  • Arthroscopic surgery uses fiber optic technology to enable the surgeon to see inside the joint and clean it of debris or repair torn cartilage.
  • An osteotomy cuts the shinbone (tibia) or the thighbone (femur) to improve the alignment of the knee joint.
  • A total or partial knee arthroplasty replaces the severely damaged knee joint cartilage with metal and plastic.

What is Total Knee Replacement: 

The smooth surface of the artificial implants just like normal knee, can allow for easy, painless movement. For many people the implantation of artificial knee joint is the.The Implants: The various parts of the implants are similar to your own knee. The tibial component sits on the top, and covers the tibia and similarly femoral component covers femur & patella component covers knee cap. The smooth surfaces of these components work together, as they glide and rotate and give pain free movements.

 Candidates for Knee replacement Surgery: Total knee replacement surgery is performed on people suffering from severe arthritic conditions. Most of the people in the world who have artificial knees are over 55 years of age, but this surgery can be performed on younger patients also. The following indications suggest for total knee replacement surgery;

  • You have daily pain
  • Your pain is severe enough to restrict normal work and ordinary activities of daily living
  • You have significant stiffness in your knee joint
  • You have significant instability of your knee
  • You have significant deformity (bow legs or knock knee)

 Preparing for Surgery Medical Evaluation

If you decide to have total knee replacement surgery, you may be asked to have a complete physical by your family physician several weeks before surgery to assess your health and to rule out any conditions that could interfere with your surgery.Tests
Several tests, such as blood samples, a cardiogram, and a urine sample may be needed to help your orthopaedic surgeon plan your surgery.Preparing Your Skin and Leg Your knee and leg should not have any skin infections or irritation. Your lower leg should not have any chronic swelling. Contact your orthopaedic surgeon prior to surgery if either is present for a program to best prepare your skin for surgery.Blood Donation You may be advised to donate your own blood prior to the surgery. It will be stored in the event you need blood after your surgery.

Medications Tell your orthopedic surgeon about the medications you are taking. He or she will tell you which medications you should stop taking and which you should continue to take before surgery.

Dental Evaluation Although the incidence of infection after knee replacement is very low, an infection can occur if bacteria enter your bloodstream. Treatment of significant dental diseases (including tooth extractions and periodontal work) should be considered before your total knee replacement surgery.

How long is the recovery after total knee replacement surgery? 
After your operation, the staff will be keen to have you move your new knee, so you should plan to be in hospital for few days. After four to six weeks, you will have a follow-up appointment and at that time it will be easier for the doctor to assess your progress and to determine how much weight you can put on your knee. Full recovery time from the surgery depends on many factors and physical and occupational therapy will play a role in the process too.

What is the hospital stay like? 
– You will be admitted the day of surgery and remain hospitalized for approximately 3 days. Immediately after your knee replacement you may place your full weight on your new knee. Doctor will begin your therapy the day of your surgery and emphasize walking, regaining your range of motion and strengthening exercises.

– Transfusions are occasionally needed during or after surgery.

– Your pain is controlled with injections and later by pain pills. Your discomfort should significantly decrease by the third day and only require pain pills before performing therapy.

How long will a knee replacement last?
Knee replacement implants can wear out over time. The implant is made of metal and plastic, and while these implants are designed to last many years, they all will eventually wear out. Studies have consistently shown knee replacement implants are functioning well in 90-95% of patients between 10 and 15 years after surgery.

Most knee replacements last more than 20 years and many will last much longer.

Benefit of Total Knee Replacement: 
– Decreased joint pain
– Increased mobility
– Increased strength
– Correction of deformity
– Restoration of leg length
– Improved quality of life

Realistic expectations about knee replacement surgery 
An important factor in deciding whether to have total knee replacement surgery is understanding what the procedure can and can’t do. More than 90 percent of individuals who undergo total knee replacement experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement won’t make you a super-athlete.

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With appropriate activity modification, knee replacements can last for many years.

Activity exceeding usual recommendations after surgery
  • Vigorous walking or hiking
  • Skiing
  • Tennis
  • Repetitive lifting exceeding 50 lbs
  • Repetitive aerobic stair climbing

 

Expected activity after surgery
  • Recreational walking
  • Swimming
  • Golf
  • Driving
  • Light hiking
  • Recreational biking
  • Ballroom dancing
  • Normal stair climbing
Call your Doctor if
  • You have any numbness or decreased motion of your foot or leg
  • You have excessive pain, swelling or drainage
  • The edges of your wound do not seem to be healing together
  • You have fever or any signs or symptoms of an infection

Physiotherapy:
Physiotherapy is an essential part of your recovery following a Total Knee Replacement.Following hospital discharge (or discharge from inpatient rehabilitation), patients who undergo total knee replacement will participate in either home physical therapy or outpatient physical therapy at a location close to home.The length of physical therapy varies based upon patient age, fitness, and level of motivation, but usually lasts for about six to eight weeks. Two to three therapy sessions per week are average for this procedure.At first, physical therapy includes range-of-motion exercises and gait training (supervised walking with an assistive device, like a cane, crutches or walker). As those things become second nature, strengthening exercises and transition to normal walking without assistive devices are encouraged.

 

Can rehabilitation be done at home? 
All patients are given a set of home exercises to do between supervised physical therapy sessions, and the home exercises make up an important part of the recovery process.

However, supervised therapy–which is best done in an outpatient physical therapy studio–is extremely helpful, and those patients who are able to attend outpatient therapy are encouraged to do so.

For patients who are unable to attend outpatient physical therapy, home physical therapy is arranged.

Usual response 
No two patients are alike, and recovery varies somewhat based on the complexity of the knee reconstruction, and the patient’s health, fitness, and level of motivation.

Most people walk using walker for 2 weeks, then use a cane for about 2-3 more weeks; sometime between one and two months post-operatively, most patients are able to walk without assistive devices.

Most patients obtain and keep at least 90 degrees of motion (bending the knee to a right angle) by the second week after surgery, and most patients ultimately get more than 110 degrees of knee motion.

Most patients can return to sedentary (desk) jobs by about 4-6 weeks; return to more physical types of employment must be addressed on a case-by-case basis.

Most patients are back to full activities–without the pain they had before surgery–by about three months after the operation.

What’s new in Total Knee Replacement?
  • Minimal Invasive Surgery                                                                                                              
  • Computer Assisted Surgery (Navigation) 
  • To know more about Computer Navigated Joint Replacement click here

These facilities are available in our hospital. TKR Results:

 

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Pre opeerative alingment of left knee. 02.pre operative residual deformity at knee jointPre operative residual deformity at knee joint. Pre operative standing posture (bow legs defformity).
04.pre operative Fixed flexion deformity at knee joint (L)Pre operative Fixed flexion deformity at knee joint (L). Pre operative walking pattern. 06.knee extension (straightning) range on 2nd day after knee replacementknee extension (straightning) range on 2nd day after knee replacement.
Knee flexion range on 2nd day after knee replacement. Patient walking on 2nd day after knee replacement. Patient climbing stairs with a stick on 4th day after knee replacement.
Patient climbing stairs with a stick on 4th day after knee replacement. Pre operative x ray. Post operative x ray.
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