Osteoarthritis of the knee is a very common condition that can cause swelling, knee pain and feeling of knee giving way. Whilst conservative or symptomatic treatment using analgesics (painkillers), steroid injections and physiotherapy is helpful in the initial stages, most people suffering with osteoarthritis of the knee ultimately have to go for knee replacement surgery. Symptoms include pain, locking, giving way of the knee, and stiffness. These symptoms are determined by the part of the knee that has been worn out.
Techniques for performing knee replacement surgeries have improved vastly over the last 30 years and knee replacement surgery has one of the highest success rates around the world.
In earlier times, replacement was done by forming a hinge to the knee joint, but in recent time knee replacements are done by only replacing the surface. It is done by removing the arthritic worn out knee surface and cementing it with an artificial surface and is specific to the patient’s anatomy.
Latest extended-flexion knee replacement design enables the knee to go through a wide range of motion after the rehabilitation course has been completed. Patients can mobilise safely and are discharged from hospital within a couple of days following joint replacement.
Keeping the knee mobile through exercises is important following discharge. The overall patient satisfaction score for successful joint replacement is in the region of 94%. The majority of patients are able to return to their daily activities which include walking long distances, playing golf, cycling, etc. Knee replacements are long lasting and can last for a number of years, exceeding over 15 years as per the National Joint Registry.
Either one area or multiple areas within the knee joint can be affected by osteoarthritis. Partial knee replacement can be done if only a part of the knee is affected. Due to advancement in knee replacement technology and its designs and the resultant improvement in success rate of knee replacement surgery, many patients opt to have full knee replacement. Patients are more confident of their knee following joint replacement surgery.
Dr. Rewat Laxman is renowned for his expertise in performing these types of surgeries as seen in the UK National Joint registry and is among the leading surgeons who perform joint replacements annually in the UK.
Achieving optimum result following joint resurfacing / replacement procedures is his passion and he has been on the forefront of many intensive rehabilitation programmes to achieve this. He has an excellent track record in the National Joint Registry and is of the belief that careful handling of the soft tissue and the most appropriate surgical technique can dramatically reduce the risk of infections and complications.
Success of knee replacement depends on accurate placement of the component and is of utmost importance to achieve excellent function following knee replacement surgery. Any misalignment of the replacement components can result in failure necessitating revision surgery.
Knee replacement surgery may not always be aided by computer technology. In such cases, the surgeon sizes up components and makes decisions about cuts to the bone and where to position implants using analogous measuring devices and x-ray imaging. This is done prior to the operation. The surgeon is aided by various instruments for positioning guides to remove the damaged cartilage and bone from the knee. In some cases, instruments are placed inside the femur and the tibia for guidance in aligning the implant. The two-dimensional radiographs need to be interpreted very accurately to make the bone cuts and achieve the proper alignment in a three-dimensional plane. These conventional alignment techniques have vastly improved with advances in mechanical alignment devices and even today are widely employed in knee replacement surgery operations.
Nowadays computer imaging is the preferred technique for producing accurate patient instrumentation. The technology used is Magnetic Resonance Imaging (MRI), a scan that helps obtain unique positioning parameters for the knee replacement operation.
The scan takes about twenty minutes and includes the knee, hip and ankle. The image produced by the scan is then studied in minute detail as it is going to be used during surgery for accurate alignment and positioning the implants. With computer assistance to perform knee replacement surgery, there is no need to incise the femur and tibia to insert the guides thus reducing the risk of infection to the wound. Also, lesser number of instruments are needed.
Computer assisted alignment gives a better accuracy for aligning the implants as found by a number of scientific studies. The three dimensional image created by MRI is completely specific to your anatomy and enables the surgeon to plan the surgery with more information. Computer software creates a virtual three dimensional image of your knee and alignment of the leg using the MRI images.
The MRI scan provides information about your knee joint in great detail. This enables the surgeon to plan the surgery beforehand in regards to the size of the implant, positioning and alignment that is specific to your knee. At times it can also be used to gain information about the types of devices to be used and its formation.
Knee joint replacement implants in earlier times were basic hinges and these tended to fail as rotational movement of the knee was not taken into account. Modern designs are not based on hinge movement and are formed only to replace the worn out bone surfaces of the joint rather than the complete joint.
Many companies manufacture knee replacement components. Some of them are Confor MIS, Zimmer Biomet, DePuy, Stryker, Smith & Nephew and so on. These are manufactured using different materials and designs.
Dr. Rewat Laxman’s preferred choice is the Signature Vanguard Knee System manufactured by Zimmer Biomet for his procedures, but patients may opt for time tested alignment methods which will still provide the desired outcome.
As procedures and processes have evolved, centers throughout the UK are seeing marked improvement in success rates of modern knee replacement through extensive rehabilitation programme. Optimum result is obtained by a planned approach to rehabilitation before and after the surgery.
This Involves:
- A detailed discussion before surgery with the consultant knee surgeon to better understand the process.
- Thorough verbal and written communication to make the patient aware of what is involved.
- Making sure the patient is fit to undergo surgery and knowledge of patient’s other medical condition.
- Using latest high-flexion knee implants which are time tested.
- Care by a team of professionals who carry out a number of knee replacement surgeries with optimum results.
- Ensuring optimum pain control following surgery by proper injection of spinal or local anaesthesia.
- An early post procedure rehabilitation programme in which the whole team of surgeon, nurses and physiotherapist is involved
- It is of utmost importance that the patient himself is motivated to exercise the knee joint after the surgery in order to gain optimum benefit from the procedure.
Dr. Rewat Laxman’s main aim is to achieve complete functionality following a knee replacement surgery. It is vital to complete the full rehabilitation course to obtain full functional recovery.
The whole team of professionals is involved like surgeon, physiotherapists, anaesthetist and nurses, to make the patients feel comfortable after surgery.
In many cases, the knee can be mobilised after 30 minutes following joint replacement surgery.
After about three hours, patients are encouraged to walk with the help of physiotherapists and nurses. Patients who have undergone knee replacement surgery can start mobilising while they are still in hospital and even climb stairs and are generally discharged after two to three days. In the ensuing two weeks, the focus is on gaining range of motion of the knee and bending and straightening the knee. Follow up appointment will be two weeks after the surgery.
The next step following wound healing and focusing on range of movement is to strengthen the muscles surrounding the knee by increasing the muscle tone. We will recommend a specialist physiotherapist to see you as an outpatient who will supervise your strengthening exercises and monitor your progress. In case you are already working under a physiotherapist, we will gladly work with him or her during the rehabilitation course. Full functional recovery without pain and good muscular tone will be restored following all these measures.