Knee Arthritis And Replacement

Knee Arthritis And Replacement

Knee replacement has a very high success rate when performed for indicated cases of arthritis. Arthritis of the knee refers to loss of cartilage i.e. the cushion in the knee, as a result of which, there is increased friction in the joint, with bone rubbing on bone in advanced stages. Pain medications, lifestyle modifications, physiotherapy and intra articular medications can be tried in early stages of the disease. These provide temporary relief. As the disease process advances, a knee replacement becomes the definitive and permanent treatment option. A knee replacement will not only alleviate the constant pain associated with arthritis, but also improve its function and activity level, allowing patients to achieve their own activity goals. With modern techniques, patients can be allowed to sit cross legged and return to sporting activities too.

When do I need a Knee Replacement?
A multitude of factors will decide if there is a need for knee replacement.
  • Pain – If the pain is severe, constant, with no or temporary relief after taking medications or if it disturbs sleep.
  • Stiffness – If there is significant restriction in movement of the knee.
  • Pain affecting activities of daily living.
  • Instability – When the knee is unstable due to a deformity and is affecting mobility.
  • End stage arthritis – As seen on X-rays.

The need for a knee replacement is decided based on a complete assessment of clinical symptoms, physical examination as well as patient needs and requirement. It is a surgery to provide pain relief and improve the overall quality of life.

What type of Replacement?
The knee is a complex joint made up of three different parts: the medial (inner) tibiofemoral joint, the lateral (outer) tibiofemoral joint and the patellofemoral joint (front part of the knee). Each part has its own function and contributes to the knee joint function.

Partial Knee Replacement
Partial knee replacement is a popular procedure when the arthritis is restricted to one compartment only. A partial knee replacement offers the benefit of retaining more of the native knee anatomy, allowing for a more natural feel, post-surgery. It is shown to give a faster and improved recovery. However, it is necessary to understand that it will give a satisfactory result only if performed when the arthritis is restricted to one area of the knee. If performed otherwise, there is likelihood of incomplete pain relief and also shown to have a higher and earlier revision rate, i.e. it needs to be re-done and converted to a total knee replacement sooner.

Total Knee Replacement
A total knee replacement is the gold standard treatment of choice for troublesome arthritis of the knee. It resurfaces the entire knee joint, i.e. the tibiofemoral joint in toto as well as the patellofemoral joint and also deals with damaged ligaments, if any. The joint is replaced with a metal component on either bone with a polyethylene liner or cushion in the middle which also functions as a shock absorber. The metal components are fixed to the bone using bone cement. Total knee replacements are expected to survive more than 20 years in most patients after surgery. Lastly, the patella or the knee cap is an important contributor to pain and it is thus important to resurface or replace it. While it may not be done routinely at all centers, we prefer to replace the patella in every patient so that no potential pain causing element is left unattended.

Why Robotic Knee Replacement?
The aim of a knee replacement is to have a correctly aligned and well balanced knee. Correct alignment refers to how straight the leg is. The knee position needs to be adjusted with regards to the hip and the ankle, which are both not visible at the time of surgery. By using robotic technology, we are able to align the knee with more accuracy and precision as compared to manual instruments. Secondly, the balance of the ligaments is very important so as to allow the patient to walk without any difficulty or instability. Robotic technology allows us to fine tune the replacement so as to achieve the appropriate balance and stability allowing for a significant better outcome after surgery. Additionally, this fine tuning can be done specifically for each patient’s requirement, individualizing the knee replacement as per the patients’ needs, anatomy and ligament balance. While these will have a greater impact on long term outcomes and survivorship, in the shorter term, robotic surgery has shown to have lesser blood loss, less pain and improved function right in the early postoperative phase.
Advantages of Robotic Knee Replacement:
  • Improved Precision
  • Improved Accuracy
  • Less Blood Loss
  • Less Pain
  • Improved Early Recovery

Doctor, I want YOU to Operate, NOT a robot :
A common misconception is that when undergoing robotic knee replacement, the surgery is performed by the robot and not the surgeon. The robot that we use is a passive robotic knee system. This means that the surgeon is in entire control of the robot, with the robot only assisting the surgeon in executing the plan and achieving the target with almost nil margin of error.