Published on June 8, 2024
By Admin
Total Knee Replacement: Who needs it? What are the risks?
Total knee replacement is surgery where the patients having severe pain in the knees due to worn out knee joints are replaced with artificial materials. The surgery is usually recommended in patients older than 60 years because the artificial joint has its own life which has been estimated to be around 10-20 years depending upon the activity level and body weight of patients. It has been seen that the patients who are very active and have heavy body weight, the life of the artificial joint is on the lower side.
In this surgery, the worn out surfaces are cut by the surgeon and resurfaced with the artificial materials. So actually, the better word for this surgery is resurfacing rather than joint replacement.
Traditionally, this surgery is performed with the help of mechanical jigs to cut the bony surfaces exactly according to the need of the patient. This has been given the name of restoring the mechanical alignment of the joint. In the last couple of decades, there has been use of robotics in cutting the joint surfaces, which has been given the name of restoring the kinematic alignment of the joint.
Many companies manufacturing the knee replacement implants came out with their own systems of robots. With the use of the robots, the cost of the surgery went up. But over the years till now, the research has shown that the results of robotic surgery are not superior to the traditional surgery in any manner.
The patient satisfaction rate of knee replacement surgery is around 80-90%. 10-20% dissatisfied patients may still get some pain and/or improper alignment or stiffness. These are not always in the hands of the operating surgeons. But patient selection is an important factor for avoid dissatisfied percentage of patients.
For the success of the surgery, patient needs to start physiotherapy exercises in the preoperative period so that his/ her muscles are strong and the patient becomes familiar with the exercises to be done by him/her in the post operative period. The exercises after the knee replacement surgery are to be mainly done by the patient under the supervision of an expert. Lack of exercises on the part of the patient after the surgery is a common cause of poor results.
The cost of the surgery is high due to the basic reason of high cost of the implants. A number of implant materials like oxinium/ gold surfaced joints are being advertised recently by various companies with the claims of better results. But as on today, there is no significant difference in the results between the standard materials and gold coated/ oxinium.
Whether one should undergo knee replacement of one joint or both the joints is another important factor that should be known to the patient. If the pain is in one joint only, one should get the surgery of only one joint. Some patients think that they should get the surgery of both the joints to avoid a second surgery in future is a wrong notion. We should never replace a joint which is not having significant pain. Moreover, the profile of surgery of a single joint replacement being lower than the two simultaneous joint replacement surgeries- the risk of complications is also reported to be somewhat low. however, if the patient is fit for surgery physically and he/ she has problem in both the joints, one can go for simultaneous replacement of both the joints.
The serious complications of the surgery included deep vein thrombosis (DVT) and infection. DVT is preventable to some extend by early mobilization of patient after the surgery, lots of fluids intake and some measures like blood thinner drugs (aspirin) and mechanical pumps for the legs for initial few days after surgery.
The infection is another serious complications which is again preventable to some extent by getting the surgery in a hospital following aseptic technique and standard operation theatre protocols, and also by using the prophylactic antibiotics in the perioperative period. But there are patient factors also like diabetes/ smoking/ obesity/ poor immunity etc which are beyond the control of the surgeon. If the patient gets infection, he/she may need multiple surgeries with the aim of curing the infection.
So, the patient selection and the hospital selection are important factors for the success of the surgery.
In totality, the knee replacement surgery has turned out to be boon for the patients who were earlier leading a life of immobility and crippling due to severe pain in the joints. The success rate of the surgery is quite high.