Deciding whether you should try surgery for knee pain

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Dr. A.k.venkatachalam

Posted By : Dr. A.k.venkatachalam - MS,DNB,FRCS,MCH ORTH

Posted On : Dec 29, 2007 (Views : 2917)

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One of the truly great advances in arthritis has been in Orthopaedic surgery. In the past, arthritis sufferers of the commonest osteo-arthritis were doomed to bed, or experience knee pain daily, when climbing stairs or after squatting on the floor. Now with the advent of medications, joint replacement, bony realignment operations, cartilage surgery, these previously infirm and symptomatic people, can now lead a life of comfort. The results are not exaggerated but are real. People have a wide variety of choices. However the exact procedure has to be tailored to the activity level, age, pain thresholds and pattern of involvement of the arthritis.


It is important to caution people about prolonged medication at first. Pain killers are prescribed as demanded and as a first line of treatment. Consumption of drugs on a long term can lead to adverse affects.  The recent withdrawal of a drug called Rofecoxib by MERCK in the US was forced by its possible association with hypertension and heart attacks after prolonged consumption for two years. Nutraceuticals like Glucosamine are also tried but are expensive in the long run.


Basic issues

Surgery in people with arthritis should not be viewed as a last resort, but it actually serves two purposes.


Joint replacement in a joint destroyed by arthritis serves to correct something that is drastically wrong and restore function to the joint. Senior citizens with arthritis need joint replacement. A second major purpose of surgery is to prevent further injury from happening. Middle aged people with bony deformities like bow legs, obese individuals, are bound to get arthritis and will need a major surgical intervention within the next ten years. In these set of people alternatives to joint replacement, are applicable and available locally. These alternatives are less expensive and safer to do. They have a very good success rate.


In deciding whether you need to go through an operation for a particular problem, it is important to consider the basic disease as well as the injury itself to the articular cartilage. Articular cartilage is the rubbery tissue that lines the ends of bones forming a joint. It is a precious tissue capable of only very limited regeneration after injury unlike the other tissues of the body. Loss of cartilage leads to bone grinding on bone and is pointed out on X'rays by your Orthopaedic surgeon as loss of joint space. Lying  X-rays taken commonly with patient lying on the X- ray table lie about the severity of the problem and special  x rays are needed in assessment of younger individuals with knee pain.


You should start thinking about the benefits that can accrue after undergoing successful surgery.  The best outcome is off course relief of pain. Chronic pain can lead to depression. Another major benefit is an improvement in the quality of your life. You will get a degree of freedom that allows you to do more things without help from others. In these days of medical insurance, you need to weigh the benefit against the cost. Medical insurance does not come with a label reserved for cancer, stroke, or heart attacks only. You will need to get a home support system to cope with modification of activities for the first weeks after surgery.


Selecting an Orthopaedic surgeon

This choice is very critical as research has shown that the success of a knee operation depends to a large extent on the skill with which the artificial joint has been implanted. No doubt qualifications and experience are the criteria that you should consider when choosing a surgeon. It is no longer the fact that only corporate hospitals have the best surgeons. A folly committed by many patients is fall to the prey of itinerant (touring orthopaedic surgeons either from abroad or from other parts of the city or state. The aPhorena or aforeigna craze still finds many takers. Many senior orthopaedic surgeons invite foreign faculty to operate on a number of patients chosen by them. The problem with this practice is that the foreigner is not familiar with the needs of the Indian patient. Indians look forward to regaining their ability to squat on the floor or kneel after a TKR. This is not catered for by the majority of knee implants. The visiting surgeon cuts, collects and flees. These patients are left high and dry as the collaborating local orthopaedic surgeon has no clue about the deficiencies of post operative care and physiotherapy, like range of movement, and other complications.


When you visit an orthopaedic surgeon, observe & judge how much care he takes to explain what is wrong and what can be done to help you. If you donot like the doctor, find some one else. Donot be shy of asking questions, for you are going to spend hard earned money on the operation for yourself or that of your dear one.


Choosing a hospital

This is another important part of your decision making process. For arthroscopic procedure, osteotomy and other procedures, hospitals with routine operating theaters will suffice. For total knee & other joint replacements, from a safety standpoint Laminar airflow theatres, clean surgical techniques and intra operative antibiotics, beside other precautions offer the best safeguard against post operative infection and subsequent loosening.


In summary, there are a number of surgical choices for knee pain. A total knee replacement is not the only option although it is a very satisfactory option for the elderly person. Other surgical options like osteotomy, cartilage surgery are within reach and available for the middle aged person who is not yet ready for a knee replacement. Discretion and caution have to be exercised in reducing the risk factors from surgery.


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