Dr. C Vijaya laxmi Clinic

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 3 months to recover completely from a knee replacement surgery.

Life is constant game of changes and people who can adapt to it and move on generally tend to find their pockets of happiness. From bad finances to lack of love to a near ones loss, each of us constantly face struggles that can leave us drained and depressed. People often work on these external factors to find their happiness. Those who suffer from depression as an illness though find it taking over multiple spheres of their lives disabling them from doing routine tasks with ease. Depression, like other diseases, can also have a biological origin. 

Several theories concerning the biologically based cause of depression have been suggested over the years. Simply put, chemical imbalance in the brain can be a trigger to depression. As the 'command center' of our body, the brain uses a number of chemicals as messengers to communicate with other parts of itself and with the nervous system. These chemical messengers, called neurotransmitters are released and received by the brain's nerve cells called neurons. Neurons are constantly communicating with each other by way of exchanging neurotransmitters. This communication system is essential to all of the brain's functions.

Among the biological causes of depression, the most prominent and widely researched is the monoamine hypothesis. The three main monomine triggers of imbalances that trigger depression are neurotransmitters called serotonin, norepinephrine and dopamine. Serotonin regulates functions like sleep, aggression, eating, sexual behavior, and mood. Similarly, the catecholamine hypothesis suggests that a deficiency of the neurotransmitter norepinephrine (also known as noradrenaline) in certain areas of the brain was responsible for creating depressed mood. Norepinephrine helps our bodies to recognize and respond to stressful situations. 

Dopamine plays in important role in helping each of us seek out our 'high' or 'pleasure' from rewards. Low dopamine levels may in part explain why depressed people don't derive the same sense of pleasure out of activities or people that they did before becoming depressed.

Another leading cause of clinical depression is focused on the endocrine system. The endocrine system is responsible for making hormones and releasing them into the blood to regulate processes like reaction to stress and sexual development. Hormonal irregularities may lead to depressive symptoms like loss of appetite and sleep. It is further observed that those who have particular endocrine disorders sometimes develop depression, and some individuals who are depressed develop endocrine problems despite having healthy glands. 

In a research done among depressed individuals, over half had a hormone called cortisol in excess in their body and abnormal times of secretion. 

Depression can have many triggers and origins and it is important to see the right doctor who can treat the cause, triggers and symptoms in addition to the disease. Depression has a genetic predisposition. Also, the faulty thought pattern alters the physiology by upsetting the hormonal balance. Psychological professional help should be a priority in depression and its role should not be under emphasized.

Knee pain or injuries are very common and have numerous causes. Knee pain can emerge from delicate tissue wounds like ligament sprains and muscle strains. Bone conditions like knee joint pain, Osgood Schlatters, and biomechanical dysfunction can also cause knee pain. Treatment can include basic knee mobilization techniques, taping, massages or knee strengthening exercises completely through a careful recovery method after knee replacement or reconstruction.

Physiotherapy can help you overcome the pain and increase your strength and flexibility. A physiotherapist can suggest you a number of treatments and also help you understand your issue and get you back to your everyday routine. Physiotherapists are said to be successful in getting rid of the source of the knee pain by diagnosing a cause. This includes tightness around the knee and treating it with stretching and exercises.

Following are some of the exercises a physiotherapist might generally recommend for knee pain:

1. Hamstring stretch: Stretching keeps you flexible and increases your scope of movement, or how far you can move your joints in different directions. It additionally helps you reduce your chances of injuries and pain. Continuously warm up with a five minute walk first. Lie down when you are prepared to stretch your hamstring. Circle a bed sheet around your right foot, use the sheet to pull the leg up and hold for twenty seconds and then lower the leg. Repeat twice and switch legs.
2. Calf stretch: Use a chair for balance. Bend your left leg. Step back with your right leg and gradually straighten it behind you. Press your left heel toward the floor. You should feel the stretch in the calf of your back leg. Hold for 20 seconds. Repeat twice and then switch legs.
3. Straight leg raise: It helps build muscle strength to give support to the weak joints. Lie on the floor. Twist your left knee, foot on the floor. Keep the right leg straight, toes pointed up. Tighten your thigh muscles and raise your right leg.
4. Quad set: With these, you don't raise your leg. Just tighten the thigh muscles, also called the quadriceps, of one leg at once. Begin by lying on the floor. Keep both legs on the ground, loose. Flex and hold the left leg tense for five seconds and then relax. Do three sets of ten repetitions. Switch legs after every set.
5. Cushion squeeze: This move strengthens your legs from the inside so that they can support the knees. Lie on your back, both knees facing inwards. Place a cushion or a pillow between the knees. Press your knees together, squishing the cushion between them. Hold for five seconds and then relax. Do three sets of ten repetitions. Switch legs after every set.
6. Heel raise: Stand tall and hold the back of a seat for support. Lift your heels off the ground and rise on the toes of both feet. Hold for three seconds. Gradually lower both heels to the ground. Do three sets of ten repetitions.