It is a rare operation that few Indians opted for at that time due to the fear of the unknown. Now, roughly 2.5 lakh Indians undergo knee replacement surgery every year.
Considering that more Indians — from 23.5 million in 1990 to 62 million now — suffer from degenerative joint disease osteoarthritis in which the protective cartilage cushioning the ends of bones wears down, the knee replacement numbers can only increase.
Total knee replacement, which entails cutting through ligament, cartilage and bones, may not be the only alternative for patients. Partial knee replacement could be good enough for many Indians.
The knee has three compartments: the medial (34%), lateral (33%), and patellofemoral (33%). Arthritis begins in the medial department, meaning 66% of the knee is normal and functional at this stage. “Nearly 50% of patients suffer from arthritis confined only to the medial compartment, meaning a full knee replacement may be unnecessary for them.” A total replacement for such patients means “unnecessarily removing the healthy 66%” and replacing it with an artificial implant.
“The results are impressive, showing a survivorship rate of 96.85% over five years after knee replacement.” The patients reported minimal pain, quicker return to daily activities, and could sit cross-legged.
Going by global estimates, roughly 70% of patients undergoing knee replacement will need the total opinion, while the remaining may only need partial replacement. “Only 12.7% of the Indian population is recommended surgical intervention for knee osteoarthritis, with well over 80% of those being total knee replacements. This shows that the number of medial uni-compartmental knee replacement is low in India.”
The doctors believe partial knee replacement is safer, and as it involves minimal cuts, recovery is faster.
There are specific criteria laid down for selection of patients for partial knee replacement. It’s recommended for patients who are younger (below 50), those with minimum damage due to disease and older patients with other comorbidities such as heart disease that makes total replacement a riskier surgery. “There is a grey zone where some patients may have extended indications and may want total knee replacement.”
The decision to do a partial knee replacement depends on the surgeon’s ability and belief. “Partial knee replacement doesn’t always lead to correct alignment of the leg in many patients as patient selection and surgeon’s training are of critical importance.”
“Most patients coming to me have extensive disease and would need total knee replacement,” who, incidentally, prefers other techniques such as high tibial osteotomy — a surgical procedure that realigns the knee joint by cutting and reshaping the tibia or the shin bone — to partial knee replacement.
“Some patients with single compartment disease would benefit from splints and braces and not need a partial replacement.”
WHY KNEE REPLACEMENT SURGERY IS DONE:
- Knee replacement surgery is performed to replace parts of injured or worn-out knee joints.
- Surgeons replace the damaged bone and cartilage with implants made of various metals (chromium, steel, titanium, steel), ceramic and polyethylene.
- They could help ease pain and aid mobility.
- It is mainly done to ease pain caused by arthritis. The patients would have had problems walking, climbing stairs.
