Initial treatment for osteoarthritis of the hip or knee is conservative, consisting of rest, avoidance of vigorous weight bearing activities, and the use of non-narcotic analgesic and or anti inflammatory medications. With worsening symptoms a cane or a knee brace may be helpful. For more severe symptoms, an injection of cortisone into the joint is frequently advised and can be quite helpful.

When conservative measures have been exhausted and are no longer helpful, and the arthritis has become disabling, surgery may be recommended. Arthroscopy is sometimes recommended for younger patients with arthritis of the knee, but long lasting benefit from arthroscopy alone is rarely achieved.

Many younger patients with mild or moderate arthritis of the hip or knee will benefit from a procedure known as osteotomy. This involves a complete cut in the bone adjacent to the hip or knee to correct deformity (i.e. bow leg or knock knee deformities) or to realign the extremity and shift weight bearing forces across the joint from areas of significant arthritic change to areas less involved in the arthritic process.

Older patients, or patients with severe arthritis, generally require total joint replacement. Total hip or total knee replacement surgery has become quite routine, and the results are generally very satisfying. While any surgery carries certain associated risks, 90 to 95% of patients undergoing total hip or knee replacement can expect to recover fully in 3 to 6 months following surgery, and return to normal or near normal activities with little or no pain. For someone with severe disabling pain from arthritis of the hip or knee, for whom even the simplest activities of daily life have become a painful burden, total joint replacement can be a blessing. It can give people a new lease on life, allowing them to enjoy normal activities and light recreation without having to pay dearly for it in the form of another miserable day or sleepless night with an aching, throbbing knee or hip.

In General – Knee replacement surgery involves removing the surface of the knee joint and replacing it with metal and plastic surfaces. This is most commonly performed for arthritis of the knee in which the smooth surface cartilage has worn away and bone is rubbing against bone, causing significant pain and deformity.

Knee replacement works best in patients who have severe arthritis throughout the entire knee. This is most commonly seen in older patients, but can occur in younger patients after infection, or significant injury. The procedure works best if the patient has significant pain and disability before surgery. This includes patients who are limited to less than a quarter mile of walking, have to walk with a cane or a crutch, have pain at night, and who have failed to respond to other forms of treatment, including activity modification, oral anti-inflammatory medications, and cortisone injections into the knee.

An incision is made at the front of the knee and the worn-out, deformed surfaces of the knee are removed. They are then replaced with stainless steel surfaces which are held into the bone with bone cement. Between the two metal surfaces of the shin bone and thigh bone, a teflon-like piece is placed which reduces friction and allows smooth gliding of the knee. A similar teflon-like piece is placed on the backside of the kneecap to prevent pain as the kneecap rubs over the stainless steel portions of the knee replacement. Patients are usually admitted to the hospital after surgery for pain control and physical therapy. The average length of stay is about five days.

Most patients have a moderate degree of discomfort in the knee which is effectively treated with pain medications given by the nurses in the hospital for the two days following surgery. Then the pain decreases over the next week or so, and by about two or three weeks after the surgery, patients are feeling much better. It takes about three months for the knee to recover to a point where patients are back to full activities, and up to a year for patients to feel their knee is "normal". Obviously, some patients recover faster and others slower, depending upon factors such as age, health status, and response to rehabilitation.

Most patients are on crutches for about four to six weeks after the surgery and then switched to a cane for the next month or so.

Most patients leave the hospital at about five days following surgery. Patients who live with their spouse, or a person who can assist them, usually are able to go home without much of a problem. However, patients who lived alone prior to surgery often might require a short stay in the hospital, where they receive physical therapy, instruction in how to take care of themselves at home on their own, and support from the caring staff.

The purpose of knee replacement surgery is to relieve pain, allow return to a high level of function. This means that most activities are okay following completion of healing. However, most surgeons recommend that you avoid "impact" type of activities, such as running, aerobics, cutting or pivoting sports, or other activities that place a high degree of stress on the knee. Walking and bicycling are often approved.

The answer to this question is somewhat variable depending upon the patient's age and activity level. In older (over age 60) patients, about 90 percent of implants are functioning well at 10 to 15 years following surgery. Unfortunately, in young patients, this rate drops to about 50 to 60 percent, usually because their higher level of activity causes wearing out of the prosthetic components. Thus, young patients, who have knee replacement, are often cautioned that they will most likely require at least one additional "re-replacement" during their lifetime.

The only way to know for sure is to make an appointment to see one of the physicians at Haq Orthopaedic for examination and x- rays of your knee. We will be happy to take the time to discuss your knee problem in depth with you and make a variety of treatment recommendations based upon the degree of arthritis or other problems in the knee.


For more information, please contact:
HAQ ORTHOPAEDIC HOSPITAL
18 Sanda Road, Lahore
Pakistan.
Phone:92-42-7312860 to 2
Email: info@haq-ortho.com