Advanced Treatment of Knee Replacement Surgery in India

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Advanced Treatment of Knee Replacement Surgery
in India
Overview Total knee replacement surgery (which is
typically known as total knee arthroplasty).Knee
replacement may be a surgical procedure that
decreases pain and improves the standard of life
in several patients with severe arthritis of the
knees. usually patients undergo this surgery once
non-operative treatments have did not offer
relief of arthritic symptoms. Non-operative
treatments will include activity modification,
anti-inflammatory medications, and knee joint
injections.Surgeons have performed knee
replacements for over three decades usually with
excellent results most reports have ten-year
success rates in more than 90 percent.
Total Knee Replacement Traditional total knee
replacement involves a 7-8 incision over the
knee, a hospital stay of 3-5 days, and a recovery
period (during which the patient walks with a
walker or cane) typically lasting from one to
three months. The large majority of patients
report substantial or complete relief of their
arthritic symptoms once they have recovered from
a total knee replacement.

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Symptoms Pain Pain is the most noticeable symptom
of knee arthritis. In most patients the knee pain
gradually gets worse over time but sometimes has
more sudden flares where the symptoms get
acutely severe. The pain is almost always
worsened by weight-bearing and activity. In some
patients the knee pain becomes severe enough to
limit even routine daily activities. Stiffness Mor
ning stiffness is present in certain types of
arthritis. Patients with morning stiffness of the
knee may notice some improvement in knee
flexibility over the course of the day.
Rheumatoid arthritis patients may experience more
frequent morning stiffness than patients with
osteoarthritis.
Swelling and warmth Patients with arthritis
sometimes will notice swelling and warmth of the
knee. If the swelling and warmth are excessive
and are associated with severe pain, inability to
bend the knee, and difficulty with
weight-bearing, those signs might represent an
infection. Such severe symptoms require immediate
medical attention. Joint infection of the knee is
discussed below

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Diagnosis An orthopedic surgeon will begin the
evaluation with a thorough history and physical
exam. Based on the results of these steps your
doctor may order plain X-rays. X-rays If a
patient has arthritis of the knee it will be
evident on routine X-rays of the joint. X-rays
taken with the patient standing up are more
helpful than those taken lying down. X-rays with
the patient standing allow your physician to view
the way the knee joint functions under load (i.e.
standing) which provides important treatment
clues. Also, plain X-rays will allow an
orthopedic surgeon to determine whether the
arthritis pattern would be suitable for total
knee replacement or for a different operation
such as minimally-invasive partial knee
replacement (mini knee).

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Treatment Medications It is important to
distinguish broadly between two types of
arthritis inflammatory arthritis (including
rheumatoid arthritis, lupus and others) and
non-inflammatory arthritis (such as
osteoarthritis). There is some level of
inflammation present in all types of arthritis.
Conditions that fall into the category of true
inflammatory arthritis are often very well
managed with a variety of medications and more
treatments are coming out all the time.
Individuals with rheumatoid arthritis and related
conditions need to be evaluated and followed by a
physician who specializes in those kinds of
treatments called a rheumatologist. Excellent
non-surgical treatments (including many new and
effective drugs) are available for these
patients those treatments can delay (or avoid)
the need for surgery and also help prevent the
disease from affecting other joints.

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So-called non-inflammatory conditions including
osteoarthritis (sometimes called degenerative
joint disease) also sometimes respond to oral
medications (either painkillers like Tylenol or
non-steroidal anti-inflammatory drugs like
aspirin, ibuprofen, celebrex, or vioxx) but in
many cases symptoms persist despite the use of
these medications. It is important to avoid using
narcotics (such as Tylenol 3, vicoden, percocet,
or oxycodone) to treat knee arthritis. Narcotics
have many side effects, are habit-forming, and
make it harder to achieve pain-control safely and
effectively after surgery ,should that become
necessary. Narcotics are designed for people with
short-term pain (like after a car accident or
surgery) or for people with chronic pain who are
not surgical candidates. People who feel they
need narcotics to achieve pain control should
consider seeing a joint replacement surgeon (an
orthopedic surgeon with experience in knee
replacements) to see whether surgery is a better
option.

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Surgery Possible benefits of total knee
replacement surgery Regardless of whether a
traditional total knee replacement or a
minimally-invasive partial knee replacement (mini
knee) is performed the goals and possible
benefits are the same relief of pain and
restoration of function.
The large majority (more than 90 percent) of
total knee replacement patients experience
substantial or complete relief of pain once they
have recovered from the procedure. The large
majority walk without a limp and most dont
require a cane, even if they used one before the
surgery. It is quite likely that you know someone
with a knee replacement who walks so well that
you dont know (s)he even had surgery!
Frequently the stiffness from arthritis is also
relieved by the surgery. Very often the distance
one can walk will improve as well because of
diminished pain and stiffness. The enjoyment of
reasonable recreational activities such as golf,
dancing, traveling, and swimming almost always
improves following total knee replacement.

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Surgical options If a knee surgeon and a patient
decide that non-operative treatments have failed
to provide significant or lasting relief there
are sometimes different operations to choose
from. Knee arthroscopy If X-rays dont show very
much arthritis and the surgeon suspects (or has
identified by MRI) a torn meniscus, knee
arthroscopy may be a good choice. This is a
relatively minor procedure that is usually done
as an outpatient and the recovery is fairly quick
in most patients.
However, if X-rays demonstrate a significant
amount of arthritis, knee arthroscopy may not be
a good choice. Knee arthroscopy for arthritis
fails to relieve pain in about half of the
patients who try it.

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Osteotomy For younger patients (typically under
age 40 but this age cutoff is flexible) who
desire to return to a high level of athletic
activity or physical work a procedure called
osteotomy (which means cutting the bone) might
be worth considering. This option is suitable
only if the arthritis is limited to one
compartment of the knee. Osteotomy involves
cutting and repositioning one of the bones around
the knee joint. This is done to re-orient the
loads that occur with normal walking and running
so that these loads pass through a non-arthritic
portion of the knee. Thats why it doesnt work
well if more than one compartment of the knee is
involvedin those patients there is no good
place through which the load can be redistributed.
Knee fusion Knee fusion also called arthrodesis
permanently links the femur (thigh bone) with
the tibia (shin bone) creating one long bone from
the hip to the ankle. It removes all motion from
the knee resulting in a stiff-legged gait.

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Because there are so many operations that
preserve motion this older procedure is seldom
performed as a first-line option for patients
with knee arthritis. It is sometimes used for
severe infections of the knee certain tumors and
patients who are too young for joint replacement
but are otherwise poor candidates for
osteotomy. Minimally-invasive partial knee
replacement (mini knee) Patients who are of
appropriate agecertainly older than age 40 and
older is betterand who have osteoarthritis
limited to one compartment of the knee may be
candidates for an exciting new surgical technique
minimally-invasive partial knee replacement (mini
knee). Partial knee replacements have been done
for over 20 years and the track record on the
devices used for this operation is excellent. The
new surgical approach which uses a much smaller
incision than traditional total knee replacement
significantly decreases the amount of
post-operative pain and shortens the
rehabilitation period. The decision of whether
this procedure is appropriate for a specific
patient can only be made in consultation with a
skillful orthopedic surgeon who is experienced in
all techniques of knee replacement.

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Minimally-invasive partial knee replacement (mini
knee) is not for everyone. Only certain patterns
of knee arthritis are appropriately treated with
this device through the smaller
approach. Generally speaking patients with
inflammatory arthritis (like rheumatoid arthritis
or lupus) and patients with diffuse arthritis all
throughout the knee should not receive partial
knee replacements. Patients who are considering
knee replacements should ask their surgeon
whether minimally-invasive partial knee
replacement (mini knee) is right for them.

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