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Quality Of Life In Old Age: Conquering Knee Arthritis
Quality Of Life In Old Age: Conquering Knee Arthritis
-Dr. Hemant Wakankar MS Orth, DNB Orth, FRCS, MCh Orth, FRCS Orth Joint Replacement Surgeon
Pune,
Mh,
India
(prbd.net)
12/10/2011
Today more and more senior citizens suffering from knee arthritis are opting for total knee replacement surgery to improve the quality of their life. As the surgical techniques and technology have advanced, the results have become very predictable. Even those with many medical problems can also safely undergo surgery to improve their mobility and improve the quality of life.
Knee pain due to arthritis is a very common ailment in senior citizens in India. Almost every third person above the age of 60 in India suffers from knee pain during his or her lifetime. As the knee wear and tear increases, the soft cartilage cushion in the knee gets completely worn off and the two bones start rubbing against each other. Until a few years back, these arthritis sufferers had to simply bear the pain, reduce their mobility and virtually live on painkillers.
Today, millions of knee arthritis sufferers allow the quality of their life to deteriorate simply because they are too scared to consider knee replacement operation or simply do not know how modern surgery can transform their painful life to a painless one. Total knee replacement is now one of the most successful surgeries of all times. Over 8,00,000 knee replacement operations are done in USA every year. In India where the incidence of knee arthritis is much more than USA, only 60000 were done last year. There are several reasons for this. The basic infrastructure for joint replacement surgery needs to be of very high order to prevent dreaded complications like infection. This was not routinely available. Secondly the surgical expertise needed to give consistently good results was also lacking. However the situation has radically changed for good now. Newer developments in the techniques of anaesthesia and surgery have made surgery extremely safe and results are predictable. Moreover, all the imported prosthesis that are implanted in the knee have a long track record world over and studies suggest 95% possibility that it would last 15 years or more.
Ideal operation theatre for joint replacement surgery should have Laminar Airflow with HEPA filters to supply germ-free air to prevent any contamination of surgical site through airborne contaminant. If this is combined with space suits worn by all members of surgical team, the risk of infection is virtually eliminated. The new tools like computer guided 'Navigation', and Patient Specific Instrumentation (PSI) certainly improves the accuracy of bony cuts, achieve the restoration of mechanical axis of the leg and therefore improve the life of the implanted artificial joint. Perhaps the most important factor is the surgeon who should have adequate training for joint replacement and should be performing adequate number of joint replacement surgeries every year. All these factors combined together give the consistent outcome that one expects, that is to have a pain free, mobile and stable knee that allows unlimited walking, climbing stairs and even sitting on floor cross-legged. The knee bending achieved after surgery depends on the stiffness before surgery and on the type of the prosthetic joint used. Most reputed prosthesis can achieve more than 90 degrees of flexion, and some allow even full flexion, allowing patient to sit cross legged and squat.
Age is not an important consideration when deciding about surgery, but the overall medical fitness needs assessment. Even those with chronic medical conditions like diabetes, hypertension can safely undergo knee replacement operation. The goal is obviously to achieve painfree mobility and independent ambulation. As the saying goes: Life is movement and movement is life.
Some Case Studies:
Mrs. Hirabai Moghe was a 75 year old housewife who had been very active all her life. She suffered from knee arthritis pain for more than 15 years and her Orthopaedic surgeons advised her to undergo Total Knee Replacement for both knee joints. She was reluctant to consider any surgery, as she was worried about the recovery from surgery. The knee pain became gradually worse and her mobility deteriorated. A time came when she was unable to even stand comfortably or walk to the toilet on her own. At this stage she decided to undergo surgery.
Both her knee replacements were uneventful and she was able to start walking from 3rd day after surgery. She gradually gave up the use of a walker and walked only with a walking stick. She got back to her normal life without any pain in her knees. She lives alone on third floor and was able to climb stars as well. About a year back, she fell down in her kitchen and broke her hip. She required undergoing hip replacement as well. Today with two knee replacements and one hip replacement, she is mobile and active, managing her daily chores.
Mrs. Rajvanshi was a 80 year old lady with a long history of knee pain due to osteoarthritis. She had no medical problems of note except for her painful knees. For a few years, she carried on despite pain and was absolutely against any surgery. The knee had started bowing slowly and her mobility was going down. The level of knee pain was rising. Only when walking became a misery, she started considering surgery as an option.
She had no idea what the knee surgery would do to her. She had a few people telling her that you must be out of your mind to consider surgery at this age. She then sought an opinion of Joint Replacement Surgeon who explained to her the advantages of knee replacement surgery. She was shown videos of a few patients walking comfortably after surgery. The sight of patients walking comfortably after surgery helped her to make up her mind about surgery. She had her complete medical workup done which showed that she was in good health. She then was ready to undergo surgery.
After surgery the pain was controlled by epidural infusion that delivered local anaesthetic to the spinal cord. She was able to stand up on the third day after surgery putting full weight on both legs and could start walking from fourth day onwards. She was amazed how quickly she had started ambulating. The bend in her knee was gone and the leg was straight again.
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