Myths and Facts About Joint Replacement Surgery

A common problem faced in day-to-day life right from a young age to older age is pain. Most people have arthritis, knee pain, joint pain, or hip joint pain, out of which the most common is knee joint pain. Knee joint pain occurs very commonly right from younger individuals to older individuals. In younger individuals it is common because of sports injuries and accidents. Once people cross 25-40 years, usually it is because of arthritis.

Usually when a young patient comes in with knee pain, we take an x-ray of the knee. Most of these young patients have injuries to the ligaments and meniscal injuries in the soft tissue of the knee joints. When it comes to 35-40 year-old females, early arthritis sets in males it is usually at above 50 years.

There are different stages of arthritis – initially when a patient comes to the hospital and tells the doctor that they have knee pain, we advise that they take mild painkillers as well as knee exercises, weight reduction, diet control and doing physical workouts to reduce their weight and reduce pressure on the knee joints. But as age progresses, knee joint arthritis keeps increasing. There is no permanent cure for arthritis, the maximum we can do is manage it through medicines.

Below is an excerpt from a video interview with Dr BVRN Varma, Chief Orthopaedic surgeon and Joint Replacement surgeon at Omni Visakhapatnam, on questions related to knee surgery and joint replacement.

Q. What is joint replacement surgery?

A: The moment we say surgery, patients say, “Surgery? No sir, we don’t want surgery, we have a lot of doubts about it.” Most patients don’t know what joint replacement surgery is, so they believe the myths about joint replacement surgery. Joint replacement is replacing the bone with a piece of metal. The metal is not just a piece of iron or stainless steel, most of the time we use cobalt-chrome or titanium.

Q. I heard that knee surgery will not last longer than 10 years, is this true?

A: In the past, around 20 to 30 years ago, knee implants would last only 5-10 years. Later success rates rose to 10-15 years and now the latest techniques, technologies and new implant designs allow knee implants to last for 20-30 years.

At Omni Visakhapatnam, we have a good counselling session for each and every patient who has knee pain, who is above the age of 45 years, in stage 3 and having difficulty while walking. Basically in stage 3 we tell patients to go for surgery.

Q. Can a patient undergo surgery for both knees?

A: Yes, patients can undergo surgery for both knees at a time, depending on their age. Usually age factors, cardiac status, lung status, kidney status are all taken into consideration. If the patient is at high risk because of comorbid status like high diabetes, high hypertension, or if cardiac surgery was done, we tell the patient to do them one after the other. Usually if a surgery is done on Monday you can go back on Friday, within 5 to 6 days or 2-3 months after, so that you can reduce the amount of risk of the surgery to the patient.

Q. Can we walk immediately after surgery?

A: There are a lot of misconceptions about surgery. If a procedure is done in the morning, after 24 hours we will mobilize the patient with a stand or a walker along with our physiotherapy and consultants. Physiotherapy is started a day after the surgery and the patient can walk for 3-4 weeks after surgery with support. They can then gradually remove the support and then get back to their usual routine.

Climbing of staircases can be done after 6-8 weeks and they can go back to routine work after 2-3 months. Some patients may be able to go back after just 4 weeks. They can even start going on journeys after 3-4 months provided they have been doing physiotherapy. Routine movements of the knee joint should have been achieved after physiotherapy.

Q. Will I experience pain after knee surgery?

A: Most patients will experience knee pain after surgery. The pain is because of a problem with the bone, it is not because of the surgery. Bone pain is because of osteoporosis. There is a lot of difference between knee osteoporosis and knee osteoarthritis. Knee osteoporosis is weakening of the bone because of calcium reduction in the bone, while knee osteoarthritis is the erosion of knee cartilage in the bone.

So when we replace the knee joint we try to achieve a 90-95 percent success rate. But still a few patients may complain about pain. The pain is because of osteoporosis, so the best thing to do is to be fit, manage your diet, take proper calcium supplements, do knee exercises and go for a walk. Once you reduce your weight everything will start coming back to normal.

Q. When I wake up in the morning my knee gets stuck and I am unable to fold it and walk. After 20 minutes, the pain reduces and my knee works as normal. Can you please tell me what the problem is?

A: Depending on your age, if you’ve had an injury or because of severe arthritis or moderate arthritis, soft tissue structures will get damaged. So immediately after waking up, mobilize your knee joints for 5-10 minutes. Stand for 1-2 minutes, tighten your knees and then start walking. That might reduce your pain. Take the help of a physiotherapist to reduce your knee locking system.

Q. What is the age limit for surgery?

A: The age limit for surgery depends on the condition of the patient. Now rheumatoid arthritis and osteoarthritis are two different conditions. Rheumatoid arthritis is a genetic condition that involves entire joints, your bones, your ligaments, your neck and spine. It usually occurs in the younger age. So younger people can have knee replacement if they are suffering from rheumatoid arthritis and have difficulty in walking. But osteoarthritis usually starts after 45 years, most of the patients have severe stage 3 or stage 4 arthritis. The usual age for the latter is 45 years for Indian females and 52-55 years for Indian males.

Above the age of 70 years also, a patient can undergo surgery. But this depends on their cardiac status, their physical fitness and their pain threshold. Before having surgery, the patient needs good counselling from the consultant who will be performing the surgery.

Most people after the age of 70, when knee pain occurs because of imbalance or because of any other problems, it is better to use a stick while walking. If they are confident it is okay, if they are not confident using support, it is usually better for a patient above 70 to 75 years. There are patients who can walk at 80 years. Usually male patients are above 60 to 65 and female patients around 45-50 years.

Q. What special care should I take after surgery?

A: When they are in the hospital, patients will have lots of physical activity within the hospital. Our consultants and junior consultants will take care of that in the morning and evening. Once they go back home, it is very important that a physiotherapist is there with them for 2-3 weeks. If a physiotherapist is with them, the results of a knee replacement surgery after knee replacement will be very high – usually around 90-95 percent.

If you don’t do physiotherapy, the success rate will come down. So after surgery, some patients may require therapy for 2-3 weeks, some may require it for 3-4 weeks. It varies from individual to individual. After waking up in the morning, you should do knee exercises for 5 to 10 minutes. The physiotherapist will teach you those exercises. After getting up from the bed, stand for one minute and prepare your body, then start walking.

Q. What should I expect after surgery?

A: After surgery, some patients will have complications, with the most common one being pain. Pain usually is because of osteoporosis or because of the incision that is made in the skin. The skin may take some time to come back to normal. For osteoporosis, the patient should keep taking calcium supplements.

Some patients may experience swelling. This is natural and will take 2-4 weeks to subside. Some patients may still have swelling even after 6 weeks along with a fever. If this is the case they should come back to the consultant and get a blood test done and check for infection. For most knee replacement surgeries, infection is common in only one percent of patients.

Because of severe osteoporosis, some patients will have an implant problem because of loosening of the implant. So before the surgery, a patient should first check whether or not they can have surgery and whether the knee can be replaced. The weight of the implant has to borne by the bone so it has to be tested whether or not the bone can withstand the implant.

Q. Do patients come to you within knee issues again after getting treatment?

A: Some patients come to us saying that they have had orthopedic treatment but have no relief. They come back with the same symptoms as before. Most of the complications they have are pain, infection and implant failure. Implant failure is when the implant becomes very weak, or the patient might fall and sustain a fracture in the knee joint. So again, once the infection is gone we will do culture and blood tests. If it is a mild infection it is okay but if it is very severe, fluid should be aspirated and culture should be done to find out what kind of infection is there.

Q. What is the most severe complication of knee replacement surgery?

A: The most dreaded complication of knee replacement surgery is infection, but this rate is usually just one percent. Because if you have a proper operation, operation theater, preoperative evaluation, the chances of infection can be minimized to 100 percent.

The second complication is if the patient is really old, around 70 to 80 years, it is better to continue their support after knee replacement for at least 6 to 8 weeks until they are confident that they can walk without support. If not, if they fall down, they may sustain a fracture.

Q. I jog regularly, but sometimes I experience knee pain. Why does this happen?

A: Before jogging or walking, you should do warm up exercises to prepare the knee joints, spine and muscles to walk or jog. Most people directly go jogging or walking and come back knee or calf pain.

Q. What is the success rate of knee replacement surgery?

A: The success rate of knee replacement surgery is usually 90-95 percent. The remaining five to ten percent represents problems that the patient may have before surgery, or in some cases postoperative problems if proper precautions are not taken preoperatively. The patient may experience cardiac problems, kidney problems or infections. Nowadays a lot of implant designs are available in the market, which can be implanted into the knee joint and have a survival rate of up to 20 to 30 years. Earlier implants would last only 10 to 15 years.

Q. Are there any risks of doing partial knee replacement surgery?

A: Partial knee replacement surgery can be done with a select number of patients in stage 2 and stage 3, if the medial compartment is really damaged and if the lateral compartment is good. The problem with partial knee replacement surgery is, if it fails, total knee replacement surgery will have to be done. So in our Indian scenario, we try to avoid partial knee replacement.

Total knee replacement surgery is far better than partial knee replacement surgery. Partial knee replacement surgery cannot be done if the patient does not have good bone quality.

Q. What are the side effects of an implant?

A: It is extremely rare for a patient’s body to reject an implant. With the latest technology and metallurgy, with cobalt-chrome and titanium, we have better outputs and rejection of the implant is rare.