What is joint replacement?

Joint replacement is not actually, completely replacing the joint, like changing a spare part of a stalled car . Infact, it is resurfacing of joint surface similar to changing worn-out sun mica on a wooden table. During this process we shave off or cut the damaged cartilage with special instruments in precise angle and shape to prepare a articulating surface for the prosthesis (implant ) to be fixed . This fixation can be done with or without using the bone cement ( an acrylic material which is initially in liquid and powder form , when mixed hardens to form a bone like substance).Occasionally plates and screws are also required to fix the implant. In the whole process to every attempt is made to preserve the ligaments and soft tissues in and around the joint.

When to go to the doctor?

In my practice over the years, I have observed that Indians have huge amount of tolerance and resilience and do not approach the doctor unless the pain goes beyond control. But nowadays due to early diagnosis, more awareness and better facility patients have started approaching the doctors early during the disease process.

The patient with joint problem mainly knee and hip usually has tried lots of other treatment ,say allopathic , homeopathy ,naturopathy etc. etc. all aiming at reducing the pain and increasing the functionality
In my opinion a patient should seriously start thinking about joint replacement when From patient point of view

  • Pain in the joint is hampering day to day activity
  • Requirement of painkiller has increased (long term painkiller has many side-effects)
  • Pain has started hampering daily exercise schedule in an otherwise active person
  • Restricted activity is leading to weight gain ( obesity increase load on joint indirectly increasing pain and aqvicious cycle starts).
  • If you have to think twice to go out for a family function , shopping or a recreational tour.
From my point of view
  • Daily requirement of anti-inflammatory
  • Weight gain due to inactivity
  • Increasing deformity (shortening , valgus , varus )
  • Complication secondary to arthritis ,back pain(change in alignment) ,shoulder pain(patient uses hands to get up from siting position).

What to ask the doctor?

What is the problem with my joint and what has caused it ?
yours cartilage which is a pain insensitive coating at the end of the bone and constitutes the joint is worn off due to which deeper layers of cartilage ,and the bare bones are exposed which is pain sensitive and is now causing pain . Depending on the amount of damage, further and the future course of treatment will be decided .
Normally amount of daily wear and tear of cartilage is simultaneously and immediately repaired by new cells and tissues , but as the age progress, the repair process lacks behind the damage process and thus there is progressive damage leading to pain and deformity around the joint .

Is operation the only option ?
It depends on the amount of damage and associated complication, It also depends on the daily requirement of the patient. What patient wants from himself. But at the end let the final verdict be left to the treating doctor.

What if I don’t go for it ?
It depends ,if damage is severe and progressive then ultimately it may lead to significant amount of handicap in terms of day to day activity ,our routine work ,sometimes amounting to bed-riddeness and total dependency on others.

Would any brace or oil help?
They can give you comfort similar to pain killer to some extent but how long and how effectively it will control the situation is difficult to say.

How useful is injection in the joint ?
Lot of surgeons give injections (steroids, hyper viscous material) in the joints to releive pain and limitation of movement. In my opinion, injection is a temporary symptomatic treartment to releive pain and discomfort. There is definite recurrence of symptoms after some period of time and may require repeated injections to reduce symptoms.
Most of the surgeons now a days use injection when a person is not suitable candidate for surgery like very old , moribund, weak patients ,patients who are medically unfit for surgery or a person actually wants to buy time before surgery.

What are you going to do with my knee ? Operation for joint replacement is a very specific surgery and like any other surgery should be performed with utmost care and precision. There is no margin of error .Extreme precaution is taken to prevent infection and other complications.

What happens if some foreign metal goes in the body ? would it rust or decay Metal and other material used in the surgery are inert material (does not react to body fluid ) and has been approved for usage in human body after painstaking and extensive research and trial and has been found to be very safe for the normal human being.

What if I have diabetes , or blood pressure or any other major ailment? Severe arthritis amounting to surgery happens usually to people more then 55-60 years , and by this time most of the people would have these disease in some form .But these diseases per say are not a contraindication in itself , of course it requires extensive workup before the surgery in view of patients fitness for surgery with the help of appropriate medical tests and examinations.
It also requires to manage all the correctable parameters before we go ahead for surgery like blood sugars, blood pressure , anaemia , mild infection. Only absolute contraindication is local skin or deep infection in and around the operative leg, multisystem disorder . sever infection like chest infection and urine infection.

How long will the joint last? Joint replacement is like putting a new tyre in a car so there is some amount of wear and tear involved . Most joint replacements last between 10 and 15 years, depending on many factors, how much stress is placed on the new joint, how much is the usage and the way it is used. so the wear rate is directly proportional to the usage.

What next (after 15 years )? In a normal built human being we can do joint replacement for three times depending on the bone stock and general condition of the patient.

How can I improve the time frame for revision surgery ? Keep yourself physically active (regular walks and mild exercises )
Keep weight under control
Avoid heavy physical work
Avoid undue loading stressing the joint during sports or leisure activities
For the patient beyond the age of 55-60 years chances are that your new knee or hip will last the rest of your life.

What are the preparation before surgery ?

Most of the time family members have to be charged up. After surgery patient will be able to do his daily routine by himself before discharged. Still for the initial 10-15 days some support is required. Arrange for a help at least in the morning hours. Fill up all your grocery and daily routine things . Keep no. of your contact , your surgeons support team , and near by relatives handy . You need to have commode toilet with the handle on the side to get up. Some time commode height has to be adjusted ,for which commode extenders are available with medical shops . It is difficult to use low height sofa or chair initially so arrange for a chair with good hight .same applies to the sleeping bed On an average the height of commode , or a chair or a bed should be around 18-20 inches. It will not be easy to cook all three – four meals for yourself for at least 3-4 weeks so think for an alternative source also. Keep adequate amount of cash with you .Pay all your telephone bill electricity bills and credit card bills.

What happens during the first 24 hr.

Preoperative check-up will be done
A Physician and the anaesthetist will come and see and explain you the whole process of anaesthesia
A night before surgery you are adviced to sleep peacefully it keeps BP under Control
If not able to sleep ask sister for sleeping tab
You will be kept fasting(no food ,no water) for 8 hr. before surgery
30 min before surgery you will be shifted to the OT recovery room
Whole process of surgery (from wheeling in to wheeling out ) takes around 3 hrs.
After surgery you will be kept in the ICU for the next 24 hour
During this time monitoring of BP ,BLOOD LOSS ,Blood transfusion (rarely required ),Pain management , is done
Monitor Epidural pump which is directly delivering medicine to the nerves in the spinal cord
Next morning drain Pipe from joint is removed. and gentle exercise is started by me or by physiotherapist
By evening patient is in position to WALK WITH A WALKER .

What Happens In the next two days?

Under the supervision of the physiotherapist and me you will be trained in walking with walker /stick, getting down the bed , using toilet , climbing few steps, independently going to the toilet and for minor thing like taking medicines and water During this period most of Intravenous medicines will be gradually withdrawn and oral medicines will be given Preparation for you to be independent at home is done .

What should I do after I go home post-surgery

Now that the surgery is done the ,although the outcome depends on many factors but the most important factor is YOU.
You need to be very positive about the whole affair.
Cooperate with the doctor’s home care team in terms of wound care , medicines , and exercise..
Don’t be hesitant in asking for help from some body as it is just a matter of time ..
Take medicines in time and SOS painkillers when required. you can use ICE packs for releiving the pain especially after exercise if you don’t want to take painkiller
Drink lots of water to keep yourself hydrated to avoid constipation . It also flushes lots of toxins from the body.
Exercise initially is a bit painful especially bending the knee but again it is just a matter of time .so be positive and keep doing it .Consider it a mission .
There is no limit to exercise and physiotherapy .you can do as much as you want. Walking especially is the easiest exercise and can be to any length and any number of times .
Quit smoking, alcohol and aerated cold drinks, it is a bad habit any ways, but it also retards healing process.
Avoid sleeping in the day time as much as possible .Doing lots of exercise is tiring and would allow good sleep in the night .Occasional mild tranquilizer prescribed by the doctor can be taken.
Any time getting out of the bed ,sit for 2-3 minutes .don’t suddenly get up there are chances that you me have fainting attack of vertigo .

Important facts

Artificial knee or hip joint means inside the body warrants you to be more careful in the future life as you may be more vulnerable to certain infections for the rest of your life.

Use of Broad Spectrum antibiotic is very important after any kind of :

  • Dental work, infection or even cleaning.
  • In abdominal surgical procedure
  • Generalized infection like Respiratory or Urinary infection
  • Procedure involving insertion of catheter inside the blood stream.
  • ALWAYS inform the treating doctor of your Operation