An individual may be suffering from knee pain, which is caused by arthritis. There are over 100 types of arthritis. Osteoarthritis is one of the most common types of arthritis with over 15 million Indians affected by the same. It is characterized by a loss of bone quality and density leading to pain and swelling of the affected joint. Once considered a disease of the elderly, osteoarthritis has now become a widespread health concern alongside other non-communicable diseases like diabetes, hypertension etc.
Rheumatoid arthritis is another common type of arthritis. It is a long term autoimmune disease that involves inflammation of joints and surrounding tissues. It can occur at any age and has been linked to pathological infections, genetic predisposition and hormonal imbalance.
Other forms of arthritis include Ankylosing spondylitis, Gonococcal arthritis, Gout, Psoriatic arthritis, Reactive arthritis (Reiter syndrome), Scleroderma and Systemic lupus erythematosus (SLE).
Knee replacement surgery is considered an effective treatment option for arthritis. It involves replacing or resurfacing the portions of the knee which have been damaged by these conditions.
Understanding the Knee
To understand knee replacement surgeries, it helps to know a little about the knee. An individual’s knee comprises a) the bottom of the femur—which is the thigh bone and b) the top of the tibia – the shin bone.
When these bones come together, they form three distinct areas, or compartments:
- Medial compartment (inner)
- Lateral compartment (outer)
- Patello-femoral compartment (kneecap)
The bottom of the femur slides over the top of the tibia enabling the knee joint to move. The sliding is made comfortable by the cartilage lining the bottom of the femur and the top of the tibia. In patients, this cartilage is damaged by injury or worn away by arthritis, making knee joint movement stiff and painful.
Types of Knee Replacement Surgery
There are two main types of surgery, depending on the condition of the knee.
Total Knee Replacement
A total knee replacement involves replacing the a) bottom of the femur, b) back of the knee cap (patella) and c) top of the tibia with an artificial implant comprising a a) femoral head, b) tibial plate and c) patella component. The damaged bone is cut off from the femur in order to place the femoral head (as shown in the picture above). This is followed by removing a piece of bone from the top in order to screw in the tibial plate. Finally, a plate (usually made of medical grade plastic) is inserted between these two components to facilitate smooth and shock free movement. Finally, the back side of the patella or knee cap is fitted with the patellar component.
Partial Knee Replacement
A partial knee replacement is a viable option for patients in whom only one knee component is damaged. This enables the surgeon to conserve bone and may even decrease the patient’s recovery time (according to studies). The procedure involves replacing only one of the two compartments of the knee. The surgical technique and the implant required for a partial knee replacement is different from that required for a total knee replacement.
However, in some cases, the patient’s remaining compartment may also get arthritic in which case he/she may have to come back for another surgery.
Consulting Your Knee Doctor
Consulting the doctor not only boosts the patient’s confidence but also offers both the patient and the caregiver an opportunity to learn more about the treatment. It is advisable to be prepared when approaching the doctor. One should be sure to carry along a written list of medication being administered currently as well a medical record, detailing the surgeries and treatments undergone in the past, not related to the knees alone. Here are some important points that can be covered during the discussion with the surgeon:
- The patient is using the maximum daily dose of nonprescription pain or anti-inflammatory medicine and is still in pain
- The prescription pain medication is offering no relief from the pain
- The pain is affecting normal sleep
- The knee pain constant bothers the patient
- The patient is facing difficulty climbing even a few stairs