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  Frequently Asked Questions
What is Arthritis?


Arthritis is a general term used to describe a condition where a joint is damaged and painful As mentioned above, arthritis is a general term. Many conditions can lead to the situation described above. The most common 2 types of arthritis are Osteoarthritis and Rheumatoid arthritis, but there are many others as well.

What is Osteoarthritis?

Osteoarthritis is the most common type of arthritis. When your doctor tells you that you have "arthritis", he or she usually means you have osteoarthritis.

Osteoarthritis is also known as "old age" arthritis or "wear and tear" arthritis. Although the following comparison is not totally accurate, osteoarthritis is similar in many ways to the wearing out of a tire on a car. Unless you never use your car, in time all tires will wear out their threads. So too, if we all lived long enough we would probably all wear out our joints in time.

What is Rheumatoid Arthritis?
Rheumatoid is a medical inflammatory disease of the lining of the joint rather than a wear and tear problem.

A typical joint in the body is made up of 2 bones that move against each other. These two bones are held together by ligaments and a sheath that surrounds the entire joint like the walls of a balloon or bag. This sheath or wall is called the capsule of the joint. The inner lining of this joint wall or capsule is called the synovium and is made of a special tissue that does many things including producing a special joint-lubricating nutrient fluid called synovial fluid.

In rheumatoid arthritis, the synovium of the joint becomes aggressive and inflamed. It enlarges and erodes (eats into) the neighboring bones, ligaments and joint cartilage coating damaging the joint's smooth surfaces. The end result is similar to osteoarthritis in that the joint surfaces are destroyed and painful, although rheumatoid arthritis starts differently and has additional problems both in the joint and elsewhere in the body.
What is Trauma Related Arthritis?
Trauma related arthritis results after an injury to the joint and is also commonly seen. It also causes pain, restriction of mobility and deformities.

Arthritis Summary

In general one can say that arthritis is the condition where the surface of the joint (cartilage) is damaged or worn out causing a bone on bone condition that is painful. Many conditions can cause this. The most common are osteoarthritis and rheumatoid arthritis, but there are many other less common ones. The end result is the same in all of them: damage to the smooth surface of the joint producing rough surfaces that are painful when walked on or rubbed against each other.

Who needs Joint Replacements?

As was discussed in the page on arthritis, there are several types of arthritis but when advanced enough they all end up in severe damage to the surface of the bones at the joint. That joint surface becomes rough and irregular. When the bones in that arthritis joint are forced to move against each other, the rubbing of the rough surfaces causes pain.

So, in late arthritis the main problem is the roughened bone surfaces at the joint. The logical solutions available would be restoring a smooth surface to the bones. Restoring a new smooth surface is what is done in joint replacement surgery.

Am I too old to undergo this surgery?

This operation is meant for patients above the age of 60, though sometimes younger patients need to undergo a joint replacement earlier.

How many days do I have to spend in the Hospital?
You will be admitted 48 hours before your scheduled surgery date and will need to stay in hospital for 7 to 8 days after date of surgery. You will be made to walk 3 to 5 days after your surgery.

Will I have a lot of pain during and after the procedure?

Generally epidural anesthesia is used whereby a catheter is inserted into you epidural space in the spine and your legs are made numb during surgery so that you feel no pain. If apprehensive, some sedation will also be given to you. Post-operatively you will be given pain relieving medicines through the same catheter for 48 hours, after which the epidural catheter will be removed and oral analgesics will be started.
Will I require blood transfusion ?
Knee replacement generally may require upto 2 units of blood which are cross matched and reserved for you during the peri-operative period.
What kind of results can one expect from a TKR?

The most significant advantage of having a knee replacement is relief of pain. That is the main reason the operation is done and it is remarkably successful in achieving that in most patients although some patients may continue to experience a low grade discomfort.

After the operation, you should be able to bend your knee from fully straight to a right angle. As a result, you should be able to walk further and climb stairs more easily. Sitting and squatting on the floor though possible should be avoided after a knee replacement. Knee deformities prior to surgery will be corrected restoring the limb lengths. And lastly Improved quality of life.

Following surgery, you will be advised to avoid some types of activity for the rest of your life, including jogging and high impact sports. The best recommended activity is level walking

With normal use and activity, every knee replacement develops some wear in its plastic cushion. It is important that you not become overweight, since excess weight increases the stresses on the knee replacement, and can cause loosening. Excessive activity or weight may accelerate this normal wear and cause the knee replacement to loosen and become painful. With appropriate activity modification, knee replacements can last for many years.

Where should I get my Knee operated ?
Joint replacements are institutional surgeries and one should avoid getting them done in small nursing homes.
These basic amenities should be available to you for a joint replacemen
An institute equipped with
A Laminar Airflow Operation Theatre equipped with surgical staff using Space Suits - filtered air is released into the operation theatre adding to the sterile environment
Fully functional Surgical Intensive Care Unit
24 hour Pathology Department
Highly trained Physician round the clock to tackle any medical emergency
Physiotherapy department
Paramedical staff trained to look after Joint Replacement Patients
How do I know if I need a knee replacement?

If you have difficulty walking or performing everyday activities, it may be time to consider knee replacement surgery. Analgesics if taken unsupervised daily can cause irreversible kidney damage.

Doctors generally try to delay total knee replacement for as long as possible in favor of less invasive treatments. However for patients with advanced joint disease, knee replacement offers the chance for relief from pain and a return to normal activities.

How common is knee replacement surgery?

Knee replacement is a routine surgery performed on over 600,000 people worldwide each year. Over 90% of people who have had Total Knee Replacement experience an improvement in knee pain and function.

When can I walk after knee replacement?

You can do so within 24 to 48 hrs after the operation. Patient generally goes home walking on day 5 of surgery, and can with the help of a walker go to toilet on their own.

How soon can I return to normal activities after surgery?

Within two weeks after surgery, most patients are able to walk with a cane. You will probably feel well enough to drive a car within six weeks after surgery.

In most cases, successful joint replacement surgery will relieve your pain and stiffness, and allow you to resume many of your normal daily activities.

I am knock-kneed/bow-legged. Can knee replacement surgery correct this?

Yes, all deformities can be corrected during knee replacement surgery.

One of the goals of total knee replacement is to restore your body's natural alignment.

The computer navigation system currently used by us gives accurate alignment within 3 degrees of normal in all 3 planes. Your deformities and limb lengths are corrected after bilateral surgery, enhancing the survival of your artificial joints lifespan.

How long do total joint replacements last?

When joint replacement procedures were first performed in the early 1970s, it was thought that the average total joint implant would last approximately 10 years. We now know that approximately 85 percent of joint implants last 20 years. Improvements in surgical technique, use of computer assisted surgery, prosthetic designs, bearing surfaces, and fixation methods should further increase the life span of these implants.

What are the recent Advances in Prosthesis availability?

We now have the RPF high flexion knee available, which can give our patients high knee flexion upto 155 degrees. The decision to use this implant is taken by the surgeon based on the extent of damage to your knee and the ligament integrity seen during Surgery.We may not be able to use it in every knee. Leave the decision to your surgeon. Oxinium and Gender specific knees are also in the market but their long term benefits are still not documented.

I have Diabetes. Can I undergo Knee Replacement?

Yes. Diabetes is not a contraindication for knee replacement. Insulin is given during the perioperative period to keep blood sugar levels in check. Good antibiotic cover is provided. We operate in operation theatres specially equipped for these kinds of major surgeries. Even the air coming into these theatres is filtered to remove bacteria and viruses. Still, 1 to 2 percent risk of infection is present even in the normal population in the best joint replacement centres in the world.

How are Indian patients different from their western counterparts?

Indian patients generally come up for surgery very late and have greater deformities of their knees. Some also have bent thigh and leg bones. Most are overweight due to years of inactivity. These patients require correction of all deformities during surgery. This is more accurately accomplished consistently by the Computer Navigation Surgery currently performed by us. This also increases the longevity of the artificial joint.

What are the precautions one must take after knee replacement surgery?
Avoiding repetitive heavy lifting.
Avoiding excessive stair climbing.
Maintaining appropriate weight.
Staying healthy and active.
Avoiding "impact loading" sports such as jogging, downhill skiing and high impact aerobics.
Consulting your surgeon before beginning any new sport or activity.
Avoiding any physical activities involving quick stop-start motion, twisting or impact stresses.
Cover yourself with antibiotics before undergoing any invasive surgical procedure in your body to prevent blood borne infection travelling to your artifical joint.
You may be able to sit on the floor and sit crosslegged with ease, but I do not advocate patients to do this on a daily basis.
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