Dr. Saurabh Rawall

Knee replacement is a surgery wherein an artificial joint is used to replace a diseased, damaged or worn out knee. This surgery is common among people who fall in the age group of 60-80, but recent trends seem to suggest that younger people are opting for this surgery as well. The lifetime of the artificial knee joint is around 20 years, provided the knee is well cared for.

Why do you need Knee Replacement?

Most common reason is “high grade osteoarthritis” due to wear and tear of the knee joint. The pre-hospital study of the Knee joint is mandatory and would decide what kind of Replacement is suitable to the patient. If there is diabetes or hypertension associated with this, then it should be controlled well before undergoing surgery. Hemoglobin of at least 10 gm% is required.

If the mobility in your knee joint is reduced leading to impaired functioning of the knee joint, then you might need a knee replacement surgery. You may experience pain while walking, sitting and, in some cases, resting as well.

Some of the common reasons why you may opt for this particular surgery are:

1. Gout, where, small crystals are formed inside the joint.
2. Rheumatoid Arthritis, an autoimmune disorder, wherein the immune system of the body attacks the body’s healthy tissues.
3. Hemophilia, wherein, the blood ceases to clot normally.
4. Injuries to the knee
5. Disorders that cause unusual bone growth (bone dysplasias)
6. Death of bone in the knee joint following blood supply problems (avascular necrosis)
7. Knee deformity with pain and loss of cartilage
8. Unusual growth of bones in the knee joint

Knee replacement surgery is classified into:

1. Partial Knee Replacement: In this surgery, only one part of the joint is replaced.

2. Total Knee Replacement: Total knee replacement surgery involves replacement of both sides of the knee joint.

The usual hospital stay period is around 2-3 days after the surgery is completed. Initially, you will require the help of crutches to walk for at least 2 months. You may also be asked to do gentle knee strengthening exercises. It may take up to two years to recover completely from a knee replacement surgery.

Do you remember the last time you had a searing knee pain in the middle of your morning run? It was probably because you did not warm up properly. The incidence of injuries in various sports has gone up in the recent times, and it is mostly due to the lack of proper warm up exercises. However, other factors come into play as well, such as the pressure of increased workload on the current batch of athletes, missing a trick or two with the proper technique to be followed, etc.

In order to reduce the risk of an injury, it is advised to follow these simple tips:

1. Set realistic goals for yourself: Don’t go overboard with anything that includes repetitively stressing and straining your body over a certain degree. If you are planning to go for a run or hit to the gym, make sure you set goals that you can sustain and find feasible. One example of this would be to not increase the amount of weight drastically while lifting weights as it can lead to serious injuries.

2. Follow the right technique: Proper technique is very important in sports, a lack of which can lead to injuries. Ask your trainer to observe your form when you perform any activity. Focus on your breathing and posture when you are exercising.

3. Warm up before you begin exercising: Warming up before you exercise or play a sport is important as it helps loosen your muscles and boost blood circulation. It drastically reduces the risks of sustaining injuries, and also prepares your body for the subsequent exercise.

4. Cool down: Similar to an essential warm up is the need to cool down; it is another aspect that should not be ignored. Cooling down usually consists of stretches and postures that promote flexibility. The muscles become sore after working out. Stretching can help reduce post workout pain and make the joints flexible. Cooling down also helps in eliminating lactic acid from the muscles, which means less pain after exercise.

5. Listen to your body: During an activity, if you feel that you can no longer carry on, terminate the activity. The chances of injury rise if you continue to push your body over your threshold limit. If you think that you can no longer carry on doing something without risking an injury, avoid doing it altogether. Listen to your body, and it shall never fail you. If you wish to discuss about any specific problem, you can consult an Orthopedist.

Most of us may not be aware, but the knee is the largest joint in the human body and contributes the maximum to a person’s physical movement from one place to another. The knees play a significant role in a variety of movements including squatting, supporting the weight, running, kneeling, sitting, etc.

Whether it is a severe accident, osteoarthritis that set in with age, or other reasons, the result could be stiff, painful knees. The first line of treatment would be exercise, physiotherapy, and medications. However, if these do not work, then surgical treatment is the choice. Though usually it is reserved for people over the age of 50, there could be exceptions.

Given the number of functions it is involved in, when a serious procedure like knee replacement is being considered, the pain that the person would go through and the recovery time are two important parameters to address. It is best that the patient has a detailed discussion with the doctor and gets all doubts clarified. This will help both the patient and the doctor have realistic and practical expectations about what to expect after the surgery.

So, when pain and stiffness make knee replacement inevitable, prepare for it. The following sequence outlines what happens right from surgery to recovery.

1. Under general anesthesia, the damaged portion of the knee is removed, and a prosthesis (metal or plastic) is used to replace the removed portion.

2. Hospital stay can range from 3 to 5 days.

3. In about a month, the patient will have remarkable recovery, with almost no pain.

4. Though not advisable, most patients would be able to stand and do basic movement on the day of surgery.

5. Begin walking with the support of parallel bars and continue using cane/walker/crutches for the first few days to avoid overload on the knees.

6. With proper support, walking is possible in 3 to 5 days. Continue using a cane for the next few weeks to strengthen the knee.

7. Schedule a postoperative visit in the 4th to 6th week after surgery.

8. Draw up an exercise routine with your physiotherapist.

9. Ice pack can be applied to control swelling.

10. Driving should be possible, once you are off pain medications, as these can make you drowsy.

11. Blood clot in the surgical site causing a bruise will disappear in a couple of weeks.

12. Knee replacement is almost magical as in the long run (10 years postoperatively), there is a good 98% chances of success.

Having said this, it is important to remember each person responds differently to the procedure and therefore treatment/rehabilitation is completely personalized.

Are you aware of a disease called osteoarthritis that is more likely to develop in case you are aging? Osteoarthritis is a disease, which affects the joints of your body. It occurs when the cartilages that protect and cushion your bones break down, causing swelling and pain, and may make you immobile. The chances of developing osteoarthritis increase with age as your cartilages start breaking down. Women who are beyond menopause are at a higher risk of getting this disease as they do not produce estrogen, which is essential for bone growth. There are several precautions you should follow for the prevention of osteoarthritis, especially if you are aged. They are as follows:

1. Manage your occupational risks
   • Certain jobs involve repetitive motions, which cause stress on your joints.
   • If your job or occupation involves a lot of lifting, twisting, kneeling, and walking, you should consult a doctor.
2. Exercise
   • It is important for you to undertake exercises of low impact, which is very crucial for improving joint health, even if you are aging.
   • You should choose activities that involve strength training along with stretching and aerobic exercise.
   • Regular exercise helps in the slowing down or prevention of osteoarthritis. It helps you in maintaining healthy joints, reducing fatigue and pain, increasing your bone and muscle strength, and relieves stiffness.
3. Maintaining a healthy body weight
   • Excess weight is a primary risk factor for osteoarthritis, especially if you are aged. It causes extra stress on your joints that boosts the deterioration of your joint cartilage.
   • If you are obese and overweight, your chances of developing osteoarthritis are more. Hence, you should lose extra weight for improving the symptoms.
4. Rest
   • Although exercise is important for keeping your joints and muscles healthy, you should avoid overdoing them.
   • Have a balanced lifestyle, and when your joints become achy or swollen, give them a break.
   • Abstain from using your swollen joint for at least 12 to 24 hours after experiencing them. Letting your injured joint rest helps in reducing your risk of osteoarthritis.
   • Fatigue increases pain in osteoarthritis patients, and hence you must sleep properly.
5. Control your blood sugar
   • Diabetes is considered to be an important risk factor for osteoarthritis in aged individuals.
   • High glucose levels may boost the formation of molecules that make your cartilage stiff.
   • Diabetes also triggers inflammation, and promotes cartilage loss.
   • It is important for you to keep your diabetes and blood sugar levels under control for preventing osteoarthritis.

In spite of no specific cure for osteoarthritis, there are several ways of preventing and managing its symptoms. It is very important for you to maintain a healthy lifestyle and a balanced diet, and also to try and keep away from becoming obese. If you wish to discuss about any specific problem, you can consult an Orthopedist.

All of us have either suffered from back pain or neck pain at some point in time or may know someone in our family who had. The good news is that most of these spinal pains usually get better within a few days or weeks. What's more, simple self-help strategies such as these can be surprisingly effective at preventing pain and preventing it from returning:

Do's

1. Get more exercise for your back and stomach. If your back is hurting, you may think the best way to get relief is to limit exercise and to rest. A day or two of rest may help, but more than that may not help the pain. Experts now know that regular physical activity can help ease inflammation and muscle tension.

2. Daily brisk walk for about 1 hour. Try to cover 4-6 km in 1 hour.

3. Pay attention to your posture. The best chair for preventing back pain is one with a full back straight support. A chair with full arm support and a head support is preferable. Keep your knees a bit higher than your hips while seated. Prop your feet on a stool if you need to. If you must stand for a prolonged period, keep your head up and your stomach pulled in. If possible, rest one foot on a stool -- and switch feet every five to 15 minutes. Make sure your desktop is at eye level and keyboard is easily accessible.

4. Regular intake of calcium and vitamin D

Don'ts

5. Watch your weight. Extra pounds, especially on your belly, can make back pain worse by shifting your center of gravity and putting a strain on your lower back. Staying within 10 pounds of your ideal weight may help control back pain.

6. If you smoke, stop. Smoking restricts the flow of nutrient-containing blood to spinal discs, so smokers are especially vulnerable to back pain and neck pain.

7. Be careful how you lift. Do not lift away from your body. Don't bend over from the waist to lift heavy objects. Bend your knees and squat, pulling in your stomach muscles and holding the object close to your body as you stand up. Don't twist your body while lifting. If you can, push rather than pull heavy objects. Pushing is easier on the back.

8. Do not sit continuously for long hours, take a break every hour.

9. Do not carry your laptop on one shoulder, use a roll on a bag or a double shoulder bag.