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Dr Dhananjay Parab
Joint Replacement Surgeon.

Definition

Osteoarthritis of Knees – what does it mean to the common man, to the patient.

Osteoarthritis of knees is the degeneration ie. Wear and tear of the cartilage (surface/lining) of the joint.
The joint breaks down slowly, progressively over a period of time leading to pain, disability and deformity.
Patient is disturbed physically, socially as well as mentally due to constant nagging discomfort in the lower limbs.

Myths and most common queries

Why do I need to Operate???
Osteoarthritis is a degenerative disease that continues to damage the joint surface and deform the shape of bones around the knees. The disease never stops. Medicines including painkillers just give symptomatic relief for a temporary duration and prolonged usage is riddled with serious side effects such as renal failure, peptic ulceration etc.

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Why Knee Replacement?
Knee replacement surgery is an orthopedic procedure used to replace the damaged parts of the knee joint with artificial parts. It may be done the traditional way, which is also called “open surgery,” or it may be done using a minimally invasive method, using computer navigation system or/and robotic arm.

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Continue with medicines as long as possible, why go for knee replacement surgery ?
People with advanced arthritis definitely need surgery and cannot be cured by medicines. Several rheumatoid patients require knee replacement at a relatively younger age. Managing a severely damaged knee may reduce the longevity (Life) of the replaced joint because of technical complications (weak muscles/local bony osteoporosis/associated spine related diseases).

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Alternative therapies such as acupressure, ozone treatment, massage beds, oils, laser therapy, magnetic therapy; braces will cure my advanced arthritis and knee pain ?
There is no scientifically proven permanent non surgical cure for advanced knee arthritis till date and these alternate therapies are not backed by established scientific data.
All these modalities may provide temporary relief in early to moderate arthritis for some duration but they are not curative.
It is just that YOU are Scared of surgery.
The fear of Postoperative complications usually prevents timely decisions to cure the disease.

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I’m too old / young for the surgery , what is the need now ?
Age is not a contradiction for surgery. If clinically fit, elderly patients regularly can get knee replacement surgery done.
We have seen patients who have undergone knee replacement even at the age of 90+ years and are enjoying life after knee replacement surgery.
We have also seen patients as young as 20/25 years of age who need joint replacement in severely damaged knees due to Rheumatoid Arthritis or Ankylosing Spondylitis (Inflammatory Arthtritis).

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Knee replacement is a very painful surgery. There is a lot of pain after the surgery.
To day, the pain management, such as in a multimodal approach, ensures that the patient does not feel any pain during surgery or in post operative period and has a smooth recovery.
We provide minimally invasive approach, lesser operating time, minimal incision, reduced bleeding, faster recovery, lesser hospital admission time, no need of long duration Physiotherapy.

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After knee replacement, My life will be restricted. No sports.
You have a high probability of getting back to activities like brisk walking or cycling in 6 to 12 weeks., however, it is better to avoid contact games.
Squatting and sitting cross legged is possible but should be kept to minimal in order to have a longer life of the implant.

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After a knee replacement, it takes months to recover.
Within the first 24-48 hours of surgery, patients become independent for toilet activities.
Weight bearing is tolerated and knee bending is permitted by this time.
At around 3 weeks patients can participate in outdoor social activities.
Ladies can enter kitchen and start making food as early as 3-4 weeks from the surgery.
Majority of patients can resume their Job by 6 weeks.

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Knee replacement can be done only “one knee at a time”
If the patient does not have significant co morbidities and is deemed fit to undergo the procedure; then both knees can be replaced in the same sitting.
In fact majority of our patients undergo both knee replacements at the same time.
With the current minimally invasive surgical technique, the operating time has reduced drastically.

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The new knee lasts for just 10-15 years
With modern day surgical precision, minimal tissue damage during surgery and advancement in biomaterials, the survivorship has increased considerably.
Today’s joint replacements last 20-25 years or longer and, for many people, will last a lifetime.

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I am obese, I cannot undergo Knee replacement surgery.”
Knee replacement can be successfully done in an obese patient as well.
Recent Literatures show comparable results when compared to average weight people, although requires more expertise and some special techniques during surgery.
Sometimes patients keep on waiting in the hope of reducing weight before the surgery is done, but you cannot reduce your weight without physical activity.
In fact, with painful arthritic joint, it is very difficult to lose weight as the patient is less mobile.
On the contrary, many of our patients actually lost weight after surgery as they were able to participate in brisk walking
and exercise program after knee replacement.
Some have even participated in marathons, mountaineering, etc.

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“I have Diabetes or Hypertension or Heart Ailment, so how can I undergo knee replacement surgery.”
Diabetic, Hypertension and Heart ailments are no longer a contradiction for surgery.
Detailed preanesthetic checkup is routine now a days for every patient undergoing replacement surgery.
Treated patients of heart disease (with stenting or bypass graft) are better candidates for surgery than untreated heart patients.
In fact one can gain better health and better control of Diabetes, Hypertension or Heart disease after knee replacement as one is able to walk without pain, and can go for long walks if required.

What is Knee Replacement ? Will you cut my whole knee?
The whole knee is never replaced. Only worn out articular surfaces of bones (usually 8-9 mm) are removed and replaced with artificial ones (implant).
So, technically it is more of a “RESURFACING” rather than a “REPLACEMENT”.

Expensive implants are always better!
Not true !!!!!!
The standard implants with a track record of more than 10 years are as costly as compared to some specific newer knees (Gold / RP Knees).
However, newer implants are being sold to patients with a promise that they are of higher quality, but there is reliable data to support that they are indeed superior when implanted in a human body.

I can always get good results getting a costly knee implanted.
Not true. Results of surgery depend on the implant as well as its technique.
Surgical technique, handling of the joint matter more than the actual implants.

In knee replacement surgery, the implant is rejected as a foreign body.
Artificial joints are made up of some special metals inserted into the body to replace the knee.
These metals are inert and do not react with the body tissues.
These joints are compatible with our body, and it can stay in the body for ever without causing any significant side effects.

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Continous physiotherapy has to be done after the surgery
Yes, but only till the recovery. Patients will be suggested with a course of physiotherapy after the surgery to recover.
Physiotherapy will help the new knee for free movement. This helps patients to walk, run, swim, sit down, etc. without pain.

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Latest Myth

Whats New?? How about Computer Navigation? Robotics? Has to be better??
Far from true. There is no Robot operating your knee. Your Orthopaedic Surgeon uses a robotic arm to take the usual bone cuts, with the help of a computer navigation system.

Most important myth!!!

I have heard that, after surgery I will be bedridden forever? There are many side effects, complications of the surgery?
Infection and loosening are the most common complications of TKR.
These complications are very, very rare and can be managed early to avoid any delay in ambulation.
We, at our institute, take utmost care about sterilization inside the operation theatre to reduce the chances of Infection to less than 1 percent.

Why TKR??

Osteoarthritis of the Knees is one of the most common degenerative disorder leading to disability
and severe deformities of the lower limbs.

Knee Replacement Surgery has provided Life changing experience over the last years.

TKR is now one of the most commonly performed surgery all over the world with improving life
expectancy and sedentary life styles.

The question you should ask yourself is, Why should I suffer pain when I can be completely pain
free, why take medicines, when a simple surgery can get rid of al my medicines.

Most importantly, Why stay dependent on others, Why restrict our activities, when a single surgery
can make you completely independent, mobile and change you entire LIFE!!!!!!!!!!!!

Dr Dhananjay Parab
Joint Replacement Surgeon

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