Total Knee Replacement
Total knee replacement is a technique in which the diseased surfaces of the knee are replaced with artificial implants.
This is done when end-stage arthritis has totally destroyed the cartilage covering the joint surfaces of the knee. It is a successful and time-tested operation. It allows good knee bending with excellent longevity and stability. It corrects knee deformity and relieves the pain of arthritis. It is suitable for all group of patients where the muscles are satisfactory and patients functional level is such that he or she would benefit from a healthy knee. we offer all the latest in total knee replacement for primary and revision surgeries to our patients. We do the tissue preserving technique of total knee replacement which was developed by us. We were the first people to offer customized total knee replacements in this region and and also did the first gender-specific bilateral navigated knee replacement surgery. We offer our patients the latest techniques based on what is suitable for them including robo-computerized, customized TKR, special implants for allergic patients.
IS TOTAL KNEE REPLACEMENT THE ONLY WAY?
Total knee replacement (TKR) is the best surgical procedure to tackle end stage arthritis of the knees. It has stood the test of time and technical advances continue to improve results. This surgery is a powerful tool to correct damage in the knee but also has the ability to correct faulty biomechanics. Take the example of a patient ‘xyz’, whose knees have always been bowed inwards since childhood. He has now started to suffer significant arthritic pain in the knee. Total knee replacement will not only mend the damaged surfaces but also allow the surgeon to correct the bowing, the maltracking of the knee cap, the malrotation and other such “manufacturing defects” (as I prefer to call them). Hence TKR (total knee replacement) is an excellent operation when multiple things in the knee have gone wrong with end stage arthritis. It corrects everything in one go and works well. The “tissue preserving technique” of knee replacement which I developed has produced revolutionary results and accepted in the ‘Limca’ book of records for faster recovery. This technique allows surgery with less pain, better movement without the need for intensive physiotherapy, less blood loss ( we do not routinely give blood transfusions to even patients of knee replacement even when both knees are done in one sitting). My oldest patient of bilateral single sitting total knee replacement has been a gentleman of 91 yrs. Who walked four hours after surgery, thanks to this specialised technique. Combine this technique with customised surgery which I started 8 yrs. back and the result is totally unbelievable. Customised surgery allows virtual planning and execution even before the actual surgery. Customised instruments make the surgery more accurate and less invasive.
But is a total knee replacement suitable for all patients of arthritis?
Knee arthritis can be divided into patients who suffer from end stage disease and those who do not. The term end stage disease would imply that the cushion in the knee has completely worn out and obviously will need some form of intervention surgically to remedy the situation. End stage disease will be seen on an xrays as complete or nearly total loss of joint space. This loss of space may involve one, two or all three compartments of the knee ( the knee joint has three individual compartments the inner side, outer side and one in front)
Take the case of an individual who has not lost all the joint space on the xray and deformity is not severe. Such a patient will benefit significantly with exercises, activity modification, medication and visscosupplementation which involves putting artificial synovial fluid (the oily fluid in the normal knee) into the joint. This reduces the discomfort, reduces the wear and tear, and increases the life of the joint.
In case the joint space is completely lost but still not affecting more than one compartment of the knee with healthy ligaments and biomechanics, the patient need not go for a total knee replacement. These patients are more suitable for limited surgical options like “microplasty knee resurfacing” or UKR. This technique was pioneered in India by me nearly 13 years back and here surgical correction is done through a very limited surgical exposure. This procedure has also stood the test of time just like total knee replacement. It preserves the native knee joint and its biomechanics but changes the worn out surfaces. It preserves the patient’s own knee joint with a very natural result. The long term results equal that of total knee replacement with significant bone and soft tissue conservation. Such an option however has to be applied before extensive damage occurs. Correct assessment as to feasibility of this technique in a particular case is as important as good surgical technique. Specialised training is essential to prevent misuse of this powerful tool.
Since total knee replacement is a very good surgical option with predictable results it sometimes tends to be overused. Patients should be assessed correctly to see if they can be benefitted with a lesser procedure.