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When will you need a knee replacement surgery?

Dr Md Hasan Masud
If your knee is severely damaged by arthritis or injury, it may be hard for you to petform simple activities such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down. If medications changing your activity level and using walking supports are no longer helpful, you may want to consider total knee replacement surgery.
Now the question comes, "What exactly a total knee replacement is?" The simplest answer is that — it is a replacement of the worn and arthritic surfaces for the knee joint. A knee replacement is similar to resurfacing a road full of potholes. A total knee replacement puts an artificial surface on all parts of the joint that contact each other as the knee bends. With arthritis, the cartilage covering the ends of the bone within the knee joint is badly worn. In a knee replacement, .this damaged cartilage, along with a very small amount of bone, is removed with precise guides and instruments.The knee replacement implant, which is made of metal and plastic in a variety of sizes, is then fitted to the bone to provide an artificial surface that causes no pain. By resurfacing your knee's damaged and worn surfaces, total knee replacement surgery can relieve your pain, correct your leg deformity and help you resume your ■ ; normal activities.
Total knee replacement in some form has been practiced for over 50 years. One of the most important orthopaedic surgical advances of this century, total knee replacement was first performed in 1968.The complexities of the knee joint only began to be understood 30 years ago. Because of this, total knee replacement initially was not as successful as Sir John Charnley's artificial hip joint. However, over the last 20
years, dramatic advancements in the knowledge of knee mechanics have led to design modifications that appear to be durable. Significant advances have occurred in the type and quality of the metals, polyethylene and more recently ceramics used in the prosthesis manufacturing process, leading to improved longevity. As witji
most techniques in modern medicine, more and more patients are receiving the benefits of total knee replacement.
Conditions when we need total knee replacement Osteoarthritic destruction of the knee is the most common reason for total knee replacement. This is a disease of synovial joints, characterised by degenerative and reparative processes and is
observed in 40 percent of40-year-old patients on radiographic examination. However, only 50 percent of these patients are symptomatic. Osteoarthritis may be primary or secondary. Mechanical derangements (due to trauma to knee), pyogenic infection, ligamentous instability, fracture into a joint - are
among the common causes of die secondary type. Other causes of cartilage destruction include rheumatoid arthritis, hemophilia. seronegative arthritides, crystal deposition diseases, pigmented villonodular synovitis, idiopathic or steroid-induced avascular necrosis and rare bone dysplasia.
Recent studies into risk factors for severe osteoarthritis of the hip
and knee have1 revealed that siblings of individuals undergoing joint replacement are 3-5 times more likely to require similar surgery than age-matched controls. This means that genes contribute around 30 percent of the overall risk for severe osteoarthritis. Laboratory-based studies' have shown that chromo?
some 11 is linked to severe osteoarthritis of the hip and chromosome 2 to severe osteoarthritis of the knee. The precise genes involved are as yet unknown. ‘
Contradictions of knee replacement
Absolute contraindications to total knee replacement include knee sepsis (infection), a remote source of ongoing infection.
extensor mechanism dysfunction, severe vascular disease, recurvatum deformity secondary to muscular weakness and the presence of a well-functioning knee arthrodesis. Relative contra-indications include medical conditions that preclude safe anesthesia and the demands of surgery and rehabilitation. Other
relative contraindications include skin conditions within the field of surgery (e.g. psoria-sis), a past history of osteomyelitis around the knee, a neuropathic joint, and obesity.
Realistic expectations about knee replacement surgery
Most patients seem satisfied with their knee replacements and if pain relief is the main indicadon for surgery, this indeed should be the case. An important factor in deciding whether to have total knee replacement surgery is understanding what the procedure can and cannot do. More than 90 percent of individuals who undergo total knee replacement experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living But total knee replacement will not make you a super-athlete or allow you to do more than you could before you developed arthritis. Satisfactory knee function is usually restored following total knee replacement and the majority of patients are able to return to low-impact sporting activity. Long-term studies confirm satisfactory functional scores and show a 91-96 percent prosthesis survival rate at 14-15 years of follow-up. Cement less designs do not have the same length of follow-up, but studies at 10-12 years report a 95 fwrceqt prosthesissurvival raj«,, j