Knee arthritis and mini total knee replacement surgery

Sri Ramakrishna Hospital.


What is Knee arthritis?
Knee joint is made up of lower thigh bone, upper leg bone and knee cap. Large ligaments attached to these bones provide knee stability. The long thigh muscle (Quadriceps) provides the knee strength. This complex hinge joint is important for us to walk, run, pivot and climb up and down stairs. Arthritis develops when the protective lining of this joint cartilage wears out leading to raw bones rubbing against each other causing pain.

What causes arthritis?
Osteoarthritis and rheumatoid arthritis can cause the knees to become painful. Osteoarthritis can occur after an injury or can be caused by excess body weight, a genetic predisposition, or just normal wear and tear. Over time, the cartilage is damaged and worn away, and eventually, the bones rub directly against one another. This is what causes the pain and permanently damages the knee. Rheumatoid arthritis is an autoimmune disorder that causes inflammation of the joints throughout the body.

What are the treatment options?
Early stages of arthritis treated with Chondroitin and Glucosamine medications, few days of anti-inflammatory tablets, physiotherapy, joint injections and weight reduction.
Keyhole surgery is also beneficial in the early arthritis to remove loose pieces of bone, unhealthy tissues and to smoothen out the irregular bone surfaces.
Knee replacement surgery is performed in severe arthritis to provide pain free, functioning joint and also to improve the quality of life. The procedure involves resurfacing and replacing the damaged portions of the knee, including the lower end of the femur (thigh bone), the top of the tibia (shin bone), and the underside of the knee cap.
However, rehabilitation after traditional surgery can be lengthy and painful. People often postpone knee replacement, not wanting to be away from work and everyday activities for months. Others are concerned about pain after surgery and long surgical scar. Recently, a new alternative has emerged—Minimally Invasive Quadriceps-Sparing Total Knee Replacement often referred to as a “mini total knee replacement.”

What is “Mini total knee replacement” ?
It is a new surgical technique that utilizes shorter incision and avoids damage to the quadriceps muscle, which is the most important muscle around the knee. The recovery time is much quicker – often allows patients to walk with a support within two days of surgery.
Patient’s undergoing this procedure able to get muscle strength and control back more quickly than patients who have had traditional total knee replacement.The soft tissue preserving nature of the surgical approach also decreases post-operative pain and diminish the need for prolonged rehabilitation compared to traditional approach.
The Smaller incision also helps in quicker recovery and faster healing.The benefits of minimally invasive knee replacement include less damage to soft tissues, leading to a quicker, less painful recovery and more rapid return to normal activities.

What happens after the surgery?
Antibiotics are given to prevent infection for few days. Injections are usually given to prevent clot formation in the legs. Various medications are used to provide pain free recovery from surgery. Knee exercises will be started sooner and you will be able to stand and walk within two days after surgery.
Doctor and physiotherapist will review your progress regularly. You will be able to go home after 4 days and stitches will be removed on 14th day. Walking and exercising knee everyday helps quicker recovery. You will be able to resume normal activities like driving in six weeks.

Is artificial knee as good as Normal knee?
Artificial knee is not a normal knee nor is it as good as a normal knee. Therefore activities that overload the artificial knee must be avoided. Although implant designs and material, as well as surgical technique, have improved, wear of the weight-bearing surface or loosening of the components may occur after 25 years after surgery. Excessive activity or being over-weight may accelerate this wear process.

What else is new in knee replacement?

Unicompartmetal (partial) knee replacement. A partial knee replacement as the name suggests only replaces the worn part of the knee joint rather than the entire knee. This operation is only available if only part of the knee is worn.

High Flex knee
This special type of artificial knee helps to get maximum bending of the knee

High performance knee
Advanced artificial knee materials like Oxinium femur and cobalt chrome polished tibial trays produce less wear and lasts much longer. These high performance joints are suitable for younger patients.