BHUBANESWAR: At 92, Ishwar Chandra Mohanty was afraid and sceptical of undergoing surgery despite excruciating pain in both his knees. However, after learning that tech-assisted knee surgeries performed these days have a high success rate and improve patients’ quality of life and functionality, he agreed to total knee arthroplasty (TKA).
Mohanty underwent surgery in both his knees in a span of two months at a hospital in Bhubaneswar and is now walking on his own. At his age, he was the oldest patient in eastern India to have undergone total knee replacement surgery.
With advancements in surgical techniques and geriatric anaesthesia, knee replacement procedures have undergone a lot of technological changes in recent years. Surgeries are now being conducted with minimal blood loss, causing less injury to tissues.
As the arthritis burden in India is rising alarmingly with an increase in life expectancy, age-related degenerative arthritis, which involves degeneration (wear and tear) of cartilage and can affect any joint such as the knee, has become the most common.
While the average age for the onset of knee problems is 50 years in Indian women, it is 60 years in the case of men. There are four stages of arthritis. Arthritis prevalence increases with age, body mass index, physical inactivity and deteriorating physical and mental health. Orthopaedic and joint replacement surgeons go for procedures in case of stage III or IV arthritis.
Fortis Hiranandani Hospital (Mumbai) director (orthopaedics and joint replacement) Dr Pramod Bhor said total knee replacement surgery is the best option to get relief from chronic knee problems. This surgical procedure involves the replacement of the whole compartment of the knee with implants and treating the complications that arise due to osteoarthritis, rheumatoid arthritis and post-traumatic arthritis.
Latest trends
Massaging knees with treated oil or gulping painkillers to get rid of joint pains are now passé. Technology and quality surgical instruments have increased the effectiveness of knee replacement surgical procedures. Computer and robot-assisted surgeries for treating an entire range of knee problems are now available at affordable costs. There are four procedures available for knee-related complications - total knee replacement, partial knee replacement, kneecap replacement and complex or revision knee replacement. Diagnostic tests like X-rays and CT scans are required to help determine the extent of damage in the knees or joints.
“Latest technologies like robotic surgery, high flex knee joints, highly contoured polyethene inserts and latest instruments have increased the longevity of artificial knee joints. The selection of the replacement prosthesis and surgical techniques is done as per the patient’s age, weight, knee size, activity level and overall health status,” said Dr Nikhil Verma, consultant orthopaedic surgeon at Sant Parmanand Hospital, New Delhi. Robotic knee replacement techniques allow for greater precision and the replacement can be customised according to the anatomy of the patient. This can lead to a more natural feeling and normal lifestyle post-surgery.
“There are two types of robotic surgeries - active and passive. An active robotic system is better than passive surgery with various advantages including higher safety and greater precision. The robotic arm uses a 3D CT- based planning software to perform the procedure. Improved accuracy of the procedure also leads to better long-term results,” said Dr Bhor.
Things to keep in mind
Orthopaedic surgeons replace the damaged knee with implants in knee replacement surgery. These implants are made of metal alloys, ceramic or strong plastic. Implants differ greatly in their design, installation and materials. Commonly used materials for implants are metals like titanium, tantalum, trabecular, zirconium, oxinium oxidized zirconium and cobalt-chromium. However, titanium alloy is the preferred material. The most popular titanium alloy used in knee implants is Ti6Al4V.
“According to Indian conditions, we are using high flexion implants, which have a smaller femoral radius of curvature and thicker posterior condylar component. These are better congruent to Indian standards as compared to European implants. In terms of metal, pure titanium is mostly used in implants when high strength is not needed,” Dr Bhor said.
Depending on the type of surgery and the implant used, the average cost of knee replacement surgery ranges between Rs 2 to Rs 7 lakh for both knees. “The longevity of surgeries has now increased up to 20 years due to the latest advancement in implant designing and implant coating. Robotic-assisted knee replacement surgery helps the surgeon in precise implant positioning and bone cuts with zero human errors,” observed Dr Sunil Kumar Dash, director of orthopaedics and joint replacement at AMRI Hospitals, Bhubaneswar.
Non-surgical options
Non-surgical interventions during early-stage osteoarthritis include a change in lifestyle (avoid the habit of sitting down cross-legged, regular daily exercise), physiotherapy and medications (pain management and some dietary supplements for the knee joints like glucosamine and collagen peptides), maintaining a healthy body mass index (getting exercise and keeping the joints active) and massage therapy (a non-clinical intervention that can help you get temporary relief in case of the onset of osteoarthritis. Nutritional supplements also help maintain the cartilage, but not in the case of stage III or IV arthritis.
IMS and SUM Hospital HOD of orthopaedics Dr Aniruddh Dash said non-steroidal anti-inflammatory drugs, weight loss, intra-articular injections and physical therapy can be effective non-surgical treatment options. “But these options have some limitations and are best when used in conjunction with other options. Bracing for knee osteoarthritis is a non-invasive and non-pharmacologic option which can significantly reduce pain and improve function with minimal adverse effects....” he said.
Post-operative care
Traditional total knee replacement procedure requires a recovery time of four to six weeks. On the other hand, robotic knee replacement potentially cuts the recovery time in half and helps the patient get back to the daily routine in two to three weeks.
Knee replacement recovery begins at the hospital itself. While some patients can leave the hospital within a few hours of surgery, others have to stay for several days.
After surgery, the medical staff starts working on the recovery process. They ensure that patients take appropriate medications at the right time and engage in physical therapy by encouraging them to move their feet, get up and walk around in small steps, added Dr Dash.