Osteoarthritis and TKR

About Osteoarthritis and Knee Pain

If you are visiting this web site, chances are it’s because you or someone you care about suffers from the arthritis that causes knee pain. You are not alone. More than 20 million have the most common form of it, known as osteoarthritis (OA). In fact, OA is the number one of the most common cause of disability

But there is goodnews for OA patients. More than ever before, people are regaining their active lifestyles and continuing many of their favorite activities, despite theircondition. As you explore the rest of this , keep this in mind: There is hope, and help.

Osteoarthritis is a chronic disease. That means it will never get better, and is likely to get worse over time. Unlike some forms of arthritis that are due to a faulty immune system, osteoarthritis is a “wear-and-tear” disease: the knee pain and immobility are caused by wear-and-tear between the joints. This friction is due to worn out cartilage between the joints.

OA strikes three times as many women as men and most often occurs in people over 50. However,younger people who have been injured in sports or accidents can start having symptoms in their 30s and 40s.

If you have OA,everyday activities may be extremely painful or even impossible. Simple thingslike walking, driving, lifting, standing, and exercising may be causing you extreme pain. It may even hurt when lying down to sleep or rest.

In addition to physical symptoms, osteoarthritis takes an emotional toll. A survey by The National Council on the Aging sheds light on the way OA hampers the lives of people with the disease.OA is a progressive disease. While early treatment can slow things down, affected joints generally continue to get worse.

Remember, though,that while the disease is serious and painful, there is hope and help. lets,Explore for information on coping with knee pain and OA.

About the knee

Your knee has three parts: your thigh bone (femur), shin bone (tibia)and knee cap (patella). Where the bones meet, they are covered with asmooth substance called articular cartilage which helps them slide overeach other easily. The joint is held together with tough bands of tissuecalled ligaments and is lubricated with a special fluid.Arthritis is a process in which the articular cartilage is destroyed: oncecartilage has been damaged or destroyed it is gone for good as it cannotrepair or heal itself. Serious injury, wear and tear and a family history ofarthritis all seem to play a part. Arthritis can develop over many years orfairly rapidly and can follow serious injury.

What is a Total Knee Replacement (TKR)?

Total knee replacement, or TKR, is a surgical procedure in which the knee is resurfaced with artificial parts. Your knee replacement will consist of a metal shell on the end of the femur and a metal and plastic trough on the tibia. A plastic button will be used to resurface the back of the kneecap, if needed.

An artificial knee is not a normal knee but,aims to:

l. Provide pain relief

2. Allow you to walk a good distance again

3. Correct deformityi.e. give you a straight legl

4. Remove symptoms such as giving wayand locking

5. Improve your quality of life.

The consultant will recommend this operation, however it is your choice to have this operation and the outcome is reliant on the amount of work you do.After the operation your deep Osteo-arthritic pain should resolve, however,for a period of time this will be replaced with ‘Surgical pain’ from the trauma of the operation and it is important to take regular analgesia to allow you toperform your exercises.

A total knee replacement(TKR) is a large commitment and you must be motivated and prepared to spend time making the process a success.

How long will my knee replacement (TKR) last?

All knee replacements have a limited life expectancy dependant on an individual’s age, weight and level of activity. Their longevity will vary but all TKR will eventually wear out. Currently 10-20 years is the expected life span but up to 5% of knee replacements will not last 10 years. There is no guarantee that your particular implant will last a specific length of time. It is important to follow your Surgeon’s advice after surgery.

How long will I be in hospital?

The average length of stay for a TKR is 3-5 days, however this is dependant on your previous level of fitness, medical complications and home circumstances. If you are motivated you maybe able to get home sooner. You will only be discharged when the team is happy you can care for yourself at home.

Why do implants fail?

The most common reason for failure in a TKR is loosening or wear of the implant. This can usually be replaced with another one which is called a revision.

Will I have restrictions after surgery?

You will be advised against participating in high impact activities such as running, jumping, squash, singles tennis and contact sports.

Will I notice anything different about my knee?

You will notice some numbness on the outside of the scar. The area around your scar may feel warm for up to six months. In the initial post operative period you will find your knee becomes stiff, this will improve with regular exercises. Initial swelling in your knee should settle in 6 weeks, however your knee can continue to swell following activity for about a year. You may also notice some clicking as you move your knee due to the artificial surfaces coming together, this should improve in time.

When will I be able to return to work?

We recommend that most people will need at least six weeks off from work. Patients with more sedentary jobs may be able to return to work sooner. The timing of your return to work will depend on your progress and commitment.

When will I be able to drive?

Most people would not be fit to drive in the first six weeks. If you have had your right knee replaced you must be able to perform an emergency stop effectively. Driving will depend on your progress,commitment and individual circumstances.Please seek advice from a health professional or at your six week follow up.

You may find that gentle exercise (within your limits of pain) such as cycling,swimming, or walking with periods of rest in between are of more benefit than exercise which will result in excessive weight on your joints i.e. jogging.

Exercising the muscles around the joint will help to maintain or possibly improve the strength of your muscles and also the range of movement of the joint. This will also benefit you after your operation.

Partial Knee Replacement Can Also Treat Your Pain

Knee osteoarthritis sometimes only occurs on the medial side of the joint (the side closest to your other knee). In knees that are otherwise healthy, partial knee replacement can preserve the healthy bone, cartilage and ligaments. Whenever a patient comes to a point where the pain becomes unbearable and it does not respond to simple line of treatment, THE ONLY OPTION OFFERED TO PATIENTS IS TOTAL KNEE REPLACEMENT. But in patients where the only medial side of knee is worn off and rest of the joint surface and ligaments are intact, it becomes a very destructive option. Although TKR has been a proven safe procedure with data supporting its success rates, it still has got a limited life span of around 15 yrs. in such a case if only medial surface is replaced with a UKA, it gives patient a pain free joint with almost normal knee movement with a comparatively minimal surgery.

Partial knee replacement is being done since last 65 yrs in western world and has developed its design to give optimal results in carefully selected group of patients. In published data, the Partial Knee is the most widely used and clinically proven in the world. Published long-term clinical results on the Partial Knee demonstrated a 92.4% survivorship at 10 years, 94.0% at 15 years and 91% at 20 years.

New research reports that Partial Knee patients are more likely than total knee patients to be satisfied with their ability to perform activities of daily living, and to report that their knee replacement “felt normal”.

Patients receiving the Partial Knee at a minimum of one year post-operation were:

  • 1.81 times more likely than total knee replacement recipients to report that their knee felt normal.
  • 2.69 times more likely to be satisfied with their ability to perform activities of daily living.

Other advantages of partial knee includes short hospital stay, minimally invasive surgery, rapid recovery and almost no physiotherapy post operation.

It is a blessing for Indian patients for two reasons, one, it allows squatting and cross leg sitting to patients which is not possible with TKR and second, in most of the Indian patients the degenerative disease starts in medial compartment and if its treated with Partial knee the progression of disease also gets restricted.

There is no guarantee that any implant will successfully function for a specific length of time, as there are a multitude of variables that affect the life of an implant.

Not all patients suffering from knee osteoarthritis are candidates for Partial knee, hence its your surgeon who will decide whether it can be a choice for your patient.