Total Knee Replacement, Arthroplasty - A complete Guide www.medodeal.com

What & Why Knee Replacement Surgery...

Knee replacement, or knee arthroplasty, www.medodeal.com is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability. It is most commonly performed for osteoarthritis, and also for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long-standing osteoarthritis, the surgery may be more complicated and carry higher risk. Osteoporosis does not typically cause knee pain, deformity, or inflammation and is not a reason to perform knee replacement.

 Other major causes of debilitating pain include meniscus tears, cartilage defects, and ligament tears. Debilitating pain from osteoarthritis is much more common in the elderly.

Knee replacement surgery can be performed as a partial or a total knee replacement. In general, the surgery consists of replac

ing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee.

The operation typically involves substantial postoperative pain, and includes vigorous physical rehabilitation. The recovery period may be 6 weeks or longer and may involve the use of mobility aids (e.g. walking frames, canes, crutches) to enable the patient's return to preoperative mobility

Knee Replacement Eligible for...

Knee replacement surgery is most commonly performed in people with advanced osteoarthritis and should be considered when conservative treatments have been exhausted. Total knee replacement is also an option to correct significant knee joint or bone trauma in young patients. Similarly, total knee replacement can be performed to correct mild valgus or varus deformity. Serious valgus or varus deformity should be corrected by osteotomy. Physical therapy has been shown to improve function and may delay or prevent the need for knee replacement. Pain is often noted when performing physical activities requiring a wide range of motion in the knee joint.

Risks...

Risks and complications in knee replacement are similar to those associated with all joint replacements. The most serious complication is infection of the joint, which occurs in <1% of patients. Deep vein thrombosis occurs in up to 15% of patients, and is symptomatic in 2–3%. Nerve injuries occur in 1–2% of patients. Persistent pain or stiffness occurs in 8–23% of patients. Prosthesis failure occurs in approximately 2% of patients at 5 years.

There is increased risk in complications for obese people going through total knee replacement. The morbidly obese should be advised to lose weight before surgery and, if medically eligible, would probably benefit from bariatric surgery.

Fracturing or chipping of the polyethylene platform inserted onto of the tibial component may be a concern.These fragments may become lodged in the knee and create pain or may move into other parts of the body. Recent advancements in production have greatly reduced these issues but over the lifespan of the knee replacement there is potential.

Techniques:

The surgery involves exposure of the front of the knee, with detachment of part of the quadriceps muscle (vastus medialis) from the patella. The patella is displaced to one side of the joint, allowing exposure of the distal end of the femur and the proximal end of the tibia. The ends of these bones are then accurately cut to shape using cutting guides oriented to the long axis of the bones. The cartilages and the anterior cruciate ligament are removed; the posterior cruciate ligament may also be removed but the tibial and fibular collateral ligaments are preserved. Metal components are then impacted onto the bone or fixed using polymethylmethacrylate (PMMA) cement. Alternative techniques exist that affix the implant without cement. These cement-less techniques may involve osseointegration, including porous metal prostheses.

Femoral Replacement..

A round ended implant is used for the femur, mimicking the natural shape of the joint. On the tibia the component is flat, although it sometimes has a stem which goes down inside the bone for further stability. A flattened or slightly dished high density polyethylene surface is then inserted onto the tibial component so that the weight is transferred metal to plastic not metal to metal. During the operation any deformities must be corrected, and the ligaments balanced so that the knee has a good range of movement and is stable and aligned. In some cases the articular surface of the patella is also removed and replaced by a polyethylene button cemented to the posterior surface of the patella. In other cases, the patella is replaced unaltered.

Post operative Rehabilitation...

The length of post-operative hospitalization is 5 days on average depending on the health status of the patient and the amount of support available outside the hospital setting. Protected weight bearing on crutches or a walker is required, until the quadriceps muscle has healed and recovered its strength.

Patients typically undergo several weeks of physical therapy and occupational therapy to restore motion, strength, and function. Treatment includes encouraging patients to move early after the surgery. One therapeutic method that assists in early movement are often range of motion (to the limits of the prosthesis) is recovered over the first two weeks (the earlier the better). At six weeks, patients have usually progressed to full weight bearing with a cane. Complete recovery from the operation involving return to full normal function may take three months, and some patients notice a gradual improvement lasting many months longer than that.

For knee replacement without complications, continuous passive motion (CPM) will can improve recovery. Additionally, CPM is inexpensive, convenient, and assists patients in therapeutic compliance. However, CPM should be used in conjunction with traditional physical therapy. In unusual cases where the person has problem which prevents standard mobilization treatment, then CPM may be useful.

Some physicians and patients may consider having lower limbs venous ultrasonography to screen for deep vein thrombosis after knee replacement. However, this kind of screening should only be done when indicated because to perform it routinely would be unnecessary health care.

Do's and Dont's Post Surgery...

Do

Follow your surgeon's and physical therapist's instructions carefully.

Keep up with your exercises. Be sure to follow the directions of your physical therapist.

Engage in lower-stress activities. These may include:

• Golfing

• Hiking

• Walking

• Biking

• Stationary skiing

• Swimming

• Cross country skiing

• Table tennis

• Rowing

• Tai Chi

• Bowling

• Competitive racquet sports (such as singles tennis)

• High-impact aerobics

• High-intensity jogging/running

• Mogul skiing

• Martial arts

• Rope jumping

• Rough contact sports

(Note: this is not a complete list).

Ask your physician or physical therapist before engaging in the following activities:

Take care of your lungs. The tissues of your body need plenty of oxygen to heal properly. If your lungs are not exercised properly, it can lead to poor blood oxygen levels and may even cause pneumonia.

Manage your pain as directed. Be sure to take pain medications as prescribed by your doctor. If your medication is not relieving the pain sufficiently, be sure to tell your doctor.

Control swelling to help reduce pain and improve your circulation and range of motion. Put ice cubes in a sealable plastic bag, wrap it in a towel (or you could burn your skin) and apply to your knee. You should also elevate your knee. In bed you can do this with pillows to lift your knee above the level of your heart.

Rest. It's important to get plenty of sleep to help your knee heal. If you are having problems sleeping, speak to your doctor. He or she can recommend an over-the-counter sleep aid or prescribe medication to help you.

Don't

Participate in high-impact activities or activities with a high risk of injury. These include those that can result in falling, getting tangled with opponents or fracturing the bone around the implant.

Participate in any of the following activities:

(Note: this is not a complete list)

Twist your knee. Instead, turn your entire body to avoid stress on your knee. Avoid any jarring forces on your knee.

Schedule dental work or surgical procedures on your bladder or colon without consulting your surgeon first. These can cause bacteria to enter your bloodstream and may lead to infection in your new joint. Before you have any procedures done, be sure to discuss them with your surgeon. Also, make sure every doctor you visit knows about your knee replacement surgery so they can take the appropriate precautions against infection.

Lift heavy objects. Doing so can cause damage to your new knee.

Push yourself too hard.

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Medical Tourism Booming in India - www.medodeal.com

Medical tourism or health tourism is the travel of people to another country for the purpose of obtaining medical treatment in that country. Traditionally, people would travel from less developed countries to major medical centers in highly developed countries for medical treatment that was unavailable in their own communities, The recent trend is for people to travel from developed countries to third world countries for medical treatments because of cost consideration, though the traditional pattern still continues. 

In the history, the first recorded instance of people travelling to obtain medical treatment dates back thousands of years to when Greek pilgrims traveled from all over the Mediterranean to the small territory in the Saronic Gulf called Epidauria. This territory was the sanctuary of the healing god Asklepios.

Spa towns and sanitariums may be considered an early form of medical tourism. In 18th century England, for example, patients visited spas because they were places with supposedly health-giving mineral waters, treating diseases from gout to liver disorders and bronchitis.

Process:

The typical process is as follows: the person seeking medical treatment abroad contacts a medical tourism provider. The provider usually requires the patient to provide a medical report, including the nature of ailment, local doctor’s opinion, medical history, and diagnosis, and may request additional information. Certified physicians or consultants then advise on the medical treatment. The approximate expenditure, choice of hospitals and tourist destinations, and duration of stay, etc., is discussed. After signing consent bonds and agreements, the patient is given recommendation letters for a medical visa, to be procured from the concerned embassy. The patient travels to the destination country, where the medical tourism provider assigns a case executive, who takes care of the patient's accommodation, treatment and any other form of care. Once the treatment is done, the patient can remain in the tourist destination or return home.

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In India:

Medical tourism is a growing sector in India. India’s medical tourism sector is expected to experience an annual growth rate of 30%, making it a $2 billion industry by 2015. As medical treatment costs in the developed world balloon - with the United States leading the way - more and more Westerners are finding the prospect of international travel for medical care increasingly appealing. An estimated 150,000 of these travel to India for low-priced healthcare procedures every year.

Market size of the Indian medical tourism sector is likely to more than double to Rs 10,800 crore by 2015 from Rs 4,500 crore at present, industry, chamber Assocham today said in its study.

The inflow of medical tourists in India is also likely to cross 32 lakh by 2015 from the current level of 8.5 lakh, it said.

"Top notch healthcare facilities like cardiology, joint replacement, orthopedic surgery, transplants and urology at a low price are certain key factors making India a favoured destination in terms of medical tourism," the study said.

States like Karnataka, Kerala, Tamil Nadu, Maharashtra and New Delhi are fast emerging as India's best medical centres with several hospitals and specialty clinics coming up in the cities, it said.

India is also offering other medical services like yoga, meditation and ayurveda, which is increasingly becoming popular as a non-surgical treatment for various ailments among the foreign patients. The country attracts large number of medical tourists from the Middle East, America, Europe and also from neighboring countries like Bangladesh, Pakistan and Afghanistan.

However, it said that the country is facing tough competition in the sector from nations like Australia, Belgium, Greece, Malaysia, Singapore, South Africa and Thailand that are actively promoting healthcare tourism worldwide.

"The proposal envisages setting up super-specialty hospitals in an eco-friendly atmosphere...with highly trained English-speaking healthcare professionals at affordable price," it added. Both central and state governments need to play key role in setting up these centres. 

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