Expert Views
Knee Replacement
M.S. (Ortho) M.Ch (Ortho)
Nov-Dec 2010
With more andmore accessibilityto good medicalcare and everincreasingawareness about health and well being, the life expectancy is on the rise all over the world. Th is is a good signand a tribute to the dedication of ourmedical fraternity. People are now able to work actively in their sixties and seventies and many of these elderly members of society are participating in sports and leisure activities likegolf, tennis, trekking, swimming etc.
From a clinician’s point of view this
has lead to a huge and rising volume
of active and health conscious elderly
population. More and more of these
people are now visiting our OPD’s with geriatric conditions like cardiac
problems, hypertension, diabetes,
osteoarthritis etc. Out of all these,
osteoarthritis is one disease for which
there is a single step solution i.e. joint
replacement. Once done the patient is
free from all pain killers and visits to
the orthopaedic surgeon.
Knee replacement surgery has been
a taboo amongst our patient, people
are ‘scared’ when the doctor mentions
surgery. Th e reasons for the repulsion
are various : fi nancial, some bad
experience, lack of family support,
additional medical problems etc.
Let's take these one by one.
In spite of India’ sphenomenal rise as an economy many people don’t have reach to basic health care facilities so knee replacement is just like a dream. Another reason isthat our elderly are most of the times dependent on their next generation for finances leading to so many ‘ifs’ and ‘buts’ that the dream becomes impossibility.
Knee replacement is a dream for many surgeons also because every young surgeon wants to be a knee replacement surgeon. This has given some of the worst results and a bad name to the surgery.
Apart from finances these patients need some sort of physical assistance in their post operative period from the family members. In this age of nuclear families it may be difficult many a times for any of the younger members to devote that much time.
Most of these patients do have some medical ailments like cardiac, renal, respiratory insufficiency, diabetes etc. Such patients presume that such a major surgery (which is not a life saving surgery) is not worth taking the risk.
God helps those who help themselves
Many a times we meet patients
who are not doing well after knee
replacement. The reason why they
chose a particular hospital for their
surgery ; commonest answer is :’it’s
close to our house.’ This is something
that surprises us as surgeons. Knee
replacement is a once in lifetime
surgery, it should not be taken
casually.
Choose your hospital and surgeon
carefully. The centre should be fully
equipped for all sorts of emergencies,
should have good ICU and cardiac
back up as we are dealing with elderly
patients. One thing that is difficult to
judge for a patient is : efficient and
disciplined technical manpower. This
comes automatically to a place where
attention is given to every detail, it’s a
culture which has to be ingrained by
the institution in its every employee.
The surgeon should be trained for
joint replacement surgery which
means he must have worked at
some good centre at least for few
years. It’s an entirely different
discipline from general orthopaedics
which the surgeon subconsciously
imbibes during his training. The
initial training makes him aware of
‘something wrong somewhere’ but
with time he raises the bar and starts
looking for excellence. This doesn’t
happen in weeks and months.
How I help my patients
Over the years as a joint replacement
surgeon I have realized that my
forty minutes with the patient in the
operation theatre are going to decide
his/her fate for the rest of their lives.
But… more important than that is
how much time I spend with my
patient before and after the surgery.
I have seen patients getting operated
but they are still unable to walk,
reason: surgeon was too busy to do
a detailed examination, patient was
actually having a spine disorder!
Looks unbelievable… it happens when
we as surgeons stop looking beyond
knee joint.
We as a team make sure that the
patient is examined at least three
times before surgery i.e. in OPD,
after admission and on table justbefore surgery. Detailed history
is taken, every time by a different
surgeon. Once the patient consents
for surgery, the limb to be operated
is marked, which is again checked by
surgeon and confirmed by the scrub
nurse and patient in the operation
theatre.
The limb to be operated is cleaned
& painted with antiseptic solution
and wrapped in a sterile linen . It
starts 24 hrs before surgery and is
done twice a day. We have only one
chance to give the patient a painfree
and infectionfree knee and the
credit goes to my junior colleagues
and support staff for achieving the
same.
We are doing our knee replacements
by MIS technique. This means
smaller scar, minimal tissue injury,
less post operative discomfort and
early mobilisation. This translates
into benefit to the family i.e.
shorter hospital stay reduces cost
of treatment, less tissue trauma
means no blood transfusion again
reducing cost and complications .
Early mobility means easier nursing
care for the attendants and most
importantly for this age group the
overall physical and psychological
well being dramatically improves
once they become self dependent for
their daily activities.
After the surgery we as a team
of surgeons follow every little
development the patient makes. These
patients are not allowed many visitors
for first five days to avoid any cross
infection. Our persistent presence
sort of fills that void also. We try to
create the sense of belongingness with
these patients by spending time with
them and encouraging them to do
better. Even after the discharge our
team visits the patient frequently for
physiotherapy, feedback and to look
for any problem the patient or the
family is facing.
Conclusion
Knee replacement is an excellent surgery which has given a new life to so many arthritic patients all over the world. The family and the surgical team (the family at hospital) need to put in extra efforts, need to be more vigilant to give the best results to these senior members of our family because they deserve it.
Min O Max
7A/75, W.e.A, Pusa Road,
Karol Bagh, New delhi-5
Contact Us: + 91 9811129607
Visit Us: www.minomaxortho.com
