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Orthopaedics

ANATOMY OF THE KNEE

To understand how the knee problems occur, its important that we understand the anatomy of the knee ie how the parts work together. Lets begin with the basics of the knee anatomy.

The knee joint is formed by the conjunction of three bones, the thigh bone or the femur , the shin bone or the tibia, the knee cap or the patella.

THE meeting surfaces of these bones are capped by cartilage. This cartilage is a cushioning and lubricating system on the weight bearing area of the knee. There are two important ligaments , the ACL and the PCL which join the two bones together. Also the movement of the knee is controlled by several ligaments and muscles. The important muscles include the quadriceps muscles in the front and the hamstring muscles in the back.

Schematic movement at the knee showing flexion and extension

Schematic movement at the knee showing flexion and extension.

WHAT IS ARTHRITIS

Arthritis means destruction of the joint. What is the thing that is destroyed? It's the cartilage that caps the two meeting surfaces of the bones taking part in the joint.

There are several forms of arthritis

  • Rheumatoid arthritis- this is a multi jointarthritis. Its generally genetic and it involves many jonts big and small together and it affects the body as a whole.
  • Osteo arthritis- this is a mechanical wear of the joints much in the same way as the wheels of the car would wear out. This is something that we see most commonly in the knees. This is more common in the women and it starts by age of fifty.
  • Secondary osteo arthritis- this is a type of osteoarthritis which occurs at a younger age than expected. This is because of some incident which affects the joint like some trauma/fracture or ligament injury. It accelerates the wear of the knee.

SYMPTOMS OF OSTEO ARTHRITIS - WHEN MOVEMENT HURTS

The symptoms of osteo arthritis of the knee are five fold

  • Pain with movement and finally pain at rest also
  • Stiffnessand crepitus.
  • Swelling off and on
  • Instability- occasional sense of giving way of the knee.
  • Deformity or gradual bending of the knees- the knees do not look fully straight.

Treatment options

The treatment options includemedicines, in the early forms of the disease and supportive measures like walking stick. Exercises are recommended AT ALL STAGES of the disease.

WHO NEEDS TOTAL KNEE REPLACEMENT

  • Knee pain that limits your every day activity. You find it difficult to climb stairs, or walk out doors
  • Moderate pain persisting at rest
  • Chronic inflammation of knee persisting despite treatment
  • Bending of knees ie deformity
  • Stiffness or inability to bend or straighten your knees
  • Failure to obtain pain relief from the non steroidalanti inflammatory drugs.

WHAT IS THE AGE OF KNEE REPLACEMENT

There is no such fixed age but a person is more likely to benefit more when he or she is still active and this has to be assessed from case to case basis.

HOW LONG WILL THE IMPLANT LAST

A naviagated knee replacement is expected to last about twent to twenty five years that is a life time for most of us. The computer navigation increases the life span of the implant by means of precision.

BENEFITS OF TOTAL KNEE REPLACEMENT

  • Significant reduction in the joint pain or no joint pain
  • Increased painless mobility
  • Correction of deformity
  • Restoration of confidence

HOW LONG IS THE HOSPITAL STAY AND RECOVERY

One is expected to stay for a week in the hospital. One stands up the same day of surgery and walks with a walking aid like a walker the next day. One uses a walker for about two weeks. Climbing stairs start in a week. Sitting on a chair and commode starts in four to five days. One is discharged five days after surgery with walker. Independent walking starts by a month.

THE IMPLANTS

The various components of the implant which include the tibialfemoral and the patellar surfaces work together in congruity and in tandem to bring about painless motion with minimum friction.

Implant

REALISTIC EXPECTATIONS AFTER KNEE REPLACEMENT SURGERY

Its important to understand what the procedure can do and what it can not. Total knee replacement is expected to bring about dramatic reduction in knee pain and bring about painless mobility but it can not make you an athelete. You should not sit on ground after total knee replacement.

ROLE OF COMPUTER NAVIGATION IN KNEE REPLACEMENT

Computerized Navigation is a technology used in knee replacement which maps the patients knee and records the real time axis of movement .it precisely calculates the bone cuts and the placements and rotation of the implants. It also gives a simulation to various situations and allows the surgeon to select the best situation.

Role of Computer Navigation in Knee Replacement

It is different from the conventional knee replacement which puts the implant in a pre determined way but this navigation puts the implant as per the specific suitability of every patient.

The navigation machine ORTHOPILOT (this is the fourth generation navigation machineand is the only machine which not only shows bone cuts but also ligament balance) uses infra red diodes, computer, sophisticated software, the specific camera to record and suggest the real time patient specific information.

Proven in USA, EUROPE and ASIA PACIFIC, this navigation system introduces far more accurate implantation and precision technology. THIS DRASTICALLY IMPROVES THE RESULTS.

At the beginning of the surgery the surgeon specifically positions small infra red transmitters on the leg and the real time mapping of the knee bones and the various movement are done. This data is used by the computer to create the real anatomic picture of the knee and guides the surgeon to the utmost precise bone cuts, soft tissue balancing implant position.

MINIMALLY INVASIVE KNEE REPLACEMENT USING THE ORTHOPILOT

ORTHOPILOT also has very sophisticated soft ware for MINIMALLY INVASIVE KNEE REPLACEMENT.

This makes the surgery possible with small incision and much faster recovery.

ABOUT DR SANTOSH KUMAR

Dr. Santosh Kumar graduated and post graduated from the prestigious Jawaharlal institute of post graduate medical education and research , (JIPMER), pondicherry, the premier med school under the government of india .

He also worked in the same institute as orthopaedic surgeon under the directorate general of health services government of india.

He was the youngest surgeon in this country to have started doing independent joint replacements.

He has been trained at the MAX HOSPITAL new delhi in joint replacements, by the KLEOS FOUNDATION in phoenix, and the delta foundation of Australia.

He has been trained in Vienna, Austria in computer navigated knee replacement.