Knee joint replacement is the most successful procedure in Modern Orthopaedics. Knee replacement is done to remove pain and restore motion o the joint There are about 70,000 knee replacements being done in India annually. And the number is only going up every year.

There is a lot of information about knee replacement on the internet, Television and print media, social network, awareness programmes conducted by the hospitals and product marketing by the manufacturers.

In spite of all the facts there are a lot of doubts, fears and misconceptions in the minds of people across all sections of the society. Irrespective of their caste, religion, education, geographical location people ask some very basic questions.

1.What is arthritis? Does everybody get arthritis?

Age related degeneration of the knee joint causing pain, swelling, discomfort and limitation of movements is Osteoarthiritis. In the knee joint, there is a layer of smooth cartilage on the lower end of the femur (thighbone), the upper end of the tibia (shinbone) and the undersurface of the kneecap (patella). This cartilage serves as a cushion and allows for smooth motion of the knee. Arthritis is a wearing away of this smooth cartilage. Eventually it wears down to bone. Rubbing of bone against bone causes pain, swelling and stiffness.

Pain and Early morning stiffness involving small joints of the hand in younger people is rheumatoid arthiritis. Everybody beyond the age of 50 years gets osteoarthritis. The intensity and severity of pain depends on factors like heredity, line of work, weight of the person, previous injuries and co morbid conditions.

2. How do I know if I have arthritis?

The symptoms of OA usually begin after age 50 and can vary considerably from one person to another. Pain — The main symptom of OA is joint pain that is worse with activity and is relieved by rest. In severe cases, the pain may also occur at rest or at night. The pain usually occurs near the affected joint.

Joints affected by OA may be tender to the touch. The level of pain is typically constant over time. Any sudden increases in the level of pain may indicate recent injury

Stiffness — Morning stiffness is a common symptom of osteoarthritis. This stiffness usually resolves within 30 minutes of rising, but it may recur throughout the day during periods of inactivity.

Swelling (effusion) — Osteoarthritis may cause a type of joint swelling called an effusion, which results from the accumulation of excess fluid in the joint.

Crackling or grating sensation (crepitus) — Movement of a joint affected by osteoarthritis may cause a crackling or grating sensation called crepitus. This sensation likely occurs because of roughening of the normally smooth surfaces inside the joint.

Bony outgrowths (osteophytes) — Osteoarthritis often causes outgrowths of bone called osteophytes or bone spurs. These bony protuberances can be felt under the skin near joints and typically enlarge over time.

Symptoms in specific joints — Osteoarthritis does not affect all joints equally. The condition most commonly affects the fingers, knees, hips, and spine; it rarely affects the elbow, wrist, and ankle.

3. How do you confirm oateoarthritis?

• Age greater than 50 years

• Morning stiffness lasting less than 30 minutes

• Crackling or grating sensation (crepitus)

• Bony tenderness of the knee

• Bony enlargement of the knee

• No detectable warmth of the joint to the touch

• Deformity of the joints like bow legs or knock knees

Standing X-ray s of both knee joints in anteroposterior and lateral views will confirm the diagnosis

4. What is Osteoporosis? How is it different from osteoarthritis?

Lack of calcium and vitamin D3 in the bones causing weakening of the bones leading to easy fractures is osteoporosis. Degeneration in between the bones due to loss of cartilage is osteoarthritis. Because both these conditions occur simultaneously more often in women over 50 years of age, they can be confused

5. Does every body with osteoarthritis need joint replacement?

The Patients are asked these questions and if the answer is yes, then joint replacement surgery is recommended

• Does your affected joint hurt one or more days per week?

• Does the pain interfere with your sleep?

• Is it painful for you when you perform everyday activities?

• Are pain medications no longer working?

• Is joint pain limiting your participation in activities you love?

6. What is joint replacement? Do you remove my old joint completely?

Actually the joint replacement is resurfacing of the of the worn out surfaces of the bones with metal and plastic parts. This should result in painless movements of the joint.

7. Can I withstand the surgery ?

Usually osteoarthritis is seen in elderly people and this surgery is specially designed for them. Most of the elderly patients have hypertension, diabetes and cardiac problems. So all patients are subjected to pre anaesthesia check up and are seen by cardiologist, physician and anaesthetist and taken up for surgery.

8. Does the patient need bed rest? When can the patient walk?

Patients are made to walk the next day and before discharge they are made to get up from bed, go to the bathroom and do their own work.

9. What are the complications?

1. Infection is one of the dreaded complications. Extensive pre op work up and stringent protocols during and after surgery prevent infection. Patients should maintain hygiene.

2. Blood clots. Blood clots can form in the calf muscles which can travel to lung and cause problems. Prevention is by blood thinner injection, stockinette and early mobilization.

10. Are there chances of failure? How do you make sure of the success?

World class infrastructure, team effort, state of art operation theatre, strict adherence to protocols, computer navigation, best post operative ICU and pain management are our strengths apart from leading surgeons are the key factors in our success story.

- Dr. SaiLaxman Anne

M.S,Ortho; Fellow in Arthroplasty Joint Replacement Surgeon Department of Orthopaedics, KIMS Hospitals

Ph : 88973 14141