BMT

What is wound healing?
Wound healing is a process in which the body repairs itself after an injury by the complex mechanism by replacing destroyed tissues. It includes three types of intentions, and they are as follows:

1. Healing by primary intention
It includes healing in which restoration of continuity occurs by fibrous adhesion. Formation of granulation tissue does not take place and results in a thin scar.

2. Healing by secondary intention
In this type, healing takes place by adhesion of granulating surfaces. It occurs when the edges of the wound are far apart, and cannot be brought together.

3. Healing by tertiary intention
It is a combination of primary and secondary intention healing. In this type, the gradual filling of a wound cavity occurs by granulations, and by cicatrix formation. In this process various growth factors are involved, such as epidermal growth factor, vasculo-endothelial growth factor, platelet-derived growth factor.

How wound healing occurs?
Wound healing is divided into following phases:

1. Establishment of rapid homeostasis: In this phase, the actual bleeding stops. It is accomplished by vasoconstriction, in which blood vessels contract to stop bleeding.
2. Stage of inflammation: During this phase neutrophils (white blood cells) proliferates at the site of a wound to destroy bacteria, and to remove debris. The neutrophils are at highest count between 24, and 48 hours after an injury, and get reduced after 3 days. After that specialized cells called macrophage arrives to continue the process. These cells secrete growth factors and proteins that facilitate tissue repair. This phase lasts for 4 to 6 days and shows symptoms of edema, redness, heat, and pain.
3. Proliferation and migration of the cells: During the process of inflammation, the body releases cell which causes migration, and proliferation. In this phase, epithelial cells proliferate to overlap the wound, and this phase can last from 4 days to 24 days.
4. Formation of blood vessel: It is also known as angiogenesis. In this process body’s cells begin to replace the veins, and arteries which are damaged. In this process, the body either creates new vessels or adds onto the existing vessels. Along with this collagen deposition, granulation formation also occurs.
5. Stage of reepithelialization: Once the blood vessels are formed, the damage tissues also start regrowing.
6. Stage of synthesis: It is the last step, or it can occur simultaneously with above stages. In this process, blood clots are formed, which helps in prevention of further bleeding.

What are the complications of wound healing?
Most common complications are as follows:

1. Deficient scar formation
2. Excessive scar formation, such as a hypertrophic scar, keloids, etc.
3. Deficient contraction of wound or excessive contraction
4. Infection

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.