Knee Anatomy

Read about the Anatomical Structure of the Knee – Click here

 

Causes of knee pain

Most common disease of knee joint are

  • Osteoarthritis:  It is the most common form of arthritis. It is characterized by the wearing and eventual loss of Knee cartilage. Since Cartilage acts as a cushion between the bones of joint, Damage to the cartilage causes inflammation of joints which leads to pain and restricted range of motion of joints. Usually associated with old age (above 50 years of age)
  • Rheumatoid arthritis: It is an autoimmune disease (body’s immune system destroys its own tissue). Rheumatoid affects the joint lining tissue specifically causing pain and inflammation around the joint.
  • Post traumatic arthritis: Fracture of bone or tear of structures surrounding Knee Joint, which may later damage the cartilage resulting in pain and limited mobility of knee joint.
  • Overweight: Overweight puts tremendous stress on the knee and leads to damage of the knee joint.

Management of Knee pain

  • Exercise
  • Weight loss
  • Pain killer and anti-Inflammatory drugs
  • Injecting hyaluronic acid or corticosteroids (cortisone, dexamethasone) directly into joints
  • Physiotherapy
  • Occupational therapy (life style modification)
  • Surgical management
    • Arthroscopic lavage and debridement
    • Osteotomy around the knee
    • Cartilage repair surgery
      • Bone marrow stimulation
      • Osteochondral transplantation technique
      • Autologous chondrocytes implantation
    • Uni compartmental knee arthroscopy
      • Total Knee Replacement
  • Alternative therapy
  • Acupuncture
  • Ayurveda (anti-inflammatory herbs)
  • Homeopathy

Indications of total knee replacement

Who needs a knee Replacement surgery?

  • When all the conservative treatment fails to relieve pain, then total knee replacement is recommended.
  • In case of gross Knee deformity
  • Severe knee pain at rest
  • Swollen and stiff joints causing inability to perform daily activities

What is a knee Replacement Surgery?

During a total knee replacement doctor removes the damaged cartilage, Knee Joint & bone and replace it with an artificial joint made of metal and polymer. The surgery usually takes 2 to 3 hours and is performed under general anesthesia. The patient is shifted to Intensive care unit immediately after surgery and will be kept on observation for up to 48 hours before being shifted to the room. 4 to 8 weeks of rest is needed after the surgery and it normally takes 3 to 6 months’ time for the patient to get used to their replaced knees and start their daily activities.

How is a Total Knee Replacement Surgery Done?

Fitness of the patient to undergo the surgery is first evaluated and If the patient is not medically fit to undergo the surgery necessary medical treatment will be provided to make the patient medically fit to undergo the surgery.

Just Minutes before the surgery general anesthesia is administered to the patient by anesthetist and the patient’s vitals are monitored continuously by the anesthetist till the surgery is complete. Tissue preparations for surgery is done and an incision is made on the center of knee and the joint area is well exposed. Platella (knee cap) is turned over to access the lower end of thigh bone (femur) and upper end of shin bone(tibia).

 

Damaged cartilage surface is removed along with some underlying bone, Bones are reshaped to fit the artificial prosthesis and artificial prosthesis is attached to the bone by either cementing or press fitted to the bone (since there are different type of knee implants, the choice of knee implants are discussed before the surgery). Underlying surface of platella is cut and resurfaced and implant is attached Polyethylene spacer is attached between the metal components. It acts as a shock absorber and helps in smooth movement of prosthesis. Surgeon now place the suture and close the surgical site. Patient is now revived from General anesthesia and is shifted to Intensive care unit for observation for a period of 24 to 48 hours.

Prognosis – What you can expect after a Knee replacement surgery?

Total knee replacement done under an experienced Orthopedic surgeon has very high success rate. A Clear majority of the patients have significant Knee pain relief and will be able to do their day to day activities by themselves with more confidence in them. Patient will also be able to live a healthy life style by involving themselves in activities like walking, swimming, driving ING, low impact sports. Generally, the doctors advise the patient not to involve in high impact activities like running, jumping and high impact sports and this varies from patient to patient.

Longevity of artificial knee joint depends on general health and physical activity level of the patient. 90% artificial joints last for 10 to 20 years. 80% of knee replacement patient are doing good even after 20 years post-surgery.

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