Arthroplasty & Sports Injury Centre

"Hi,

I am Dr. Atul Mishra, Orthopedist. Today I will talk about total knee replacement. Moreover, the emphasis is on partial knee replacement. We all know that total knee replacement is a very gratifying procedure if done in the right patient and at the right place. This surgery is in practice for the last 30 years with a success rate as high as 97%. In this surgery, we put a surface bone above the knee. And there is high-density polyethylene in between. But it has been found that not all the patients are actually a candidate for knee replacement surgery. Particularly in the younger age group that is the age group between 45-65 years, in these patients, many times it has been found that the complete knee is not damaged. Only one compartment of the knee like middle compartment or the which is outside i.e. lateral compartment is gone.

That means the patient which has one compartment of the knee joint damaged does not have to undergo a total knee replacement. The solution for such patients is a partial knee replacement. In this, we do not change or resurface the whole knee. It is only the damaged component which is addressed to. There are some surgeries which are known as joint preserving surgeries where we change the access of the knee joint. and we do not touch the knee joint from inside. That is how we delay the surgery and this is known as joint preserving surgery. Many times, the patient does not agree to this because this has a success rate of around 70-80%. So, if patients want immediate results then the partial knee replacement is the solution. Here, we just open and we make a very small incision and we change the surface of only the compartment which is damaged. We do not touch the other compartment which is normal.

It can be done on the medial compartment, lateral compartment and in the patella femoral portion. The advantages of partial knee replacement are, it is a minimally invasive surgery, cutting of the normal bone is very less and the patient is immediately able to walk and back to the normal routine in 15-20 days. Moreover, there is no limitation of motion. The patient is able to do routine activities. Nowadays, it has also become a computer and robotic navigated. So, this surgery is being in practice for the last 30 years. And such patient who undergoes a partial knee replacement surgery can lead a good and active lifestyle for at least 10-15 years. Thereafter, if they have a problem then this can be converted into total knee replacement.

Thank You!

Hi,

I am Dr. Atul Mishra, director and head of the department orthopedics. Now we are talking about osteoarthritis of the knee. Osteoarthritis of the knee joint is the most common cause of pain in the knee, ghutne mein sujan, dard aur iss tarah ki pratikriya jo hai at the age of around 55 to 60 years hoti hai patients ko, isi ko osteoarthritis bolte hain. Osteoarthritis mein jo basic abnormality hai wo ye hai ki ghutne ke andar jo surface pe jo cartilage hai vo cartilage ke andar chote chote ghaav ban jate hai, vo ghaav andar bleed karte hai or pain karte hai jisse patient ko dikkat hoti hai chalne mein, roz marra ka apna kaam karne mein, sidhi chadne utarne mein. In fact, kuch mareez hamare paas is condition mein bhi aate hai jisme vo apne bed se uthke toilet tak bhi jane mein asamarth hote hai.

To hume ye dekhna hai ki awareness badhe, patients jo hai vo sahi samay pe doctori salah le paye or osteoarthritis se ek jo crippling vise jo stage hoti hai jisme insaan itna majboor apne aap ko feel karta hai ki vo thoda bohot bhi na chal paye vaise paristithi na aye. Kul mila ke 10 lakh se zada log hamare desh mein is bimari se peedit hai. Shuruvati lakshano ke andar ghutne mein sojan hona, jaha tahan ghutne ke aajo bajo aas pas dard hona, rozmarra ki activity jisme sidhi chadna utarna, niche baith ke prarthana karna, puja karna ye sab cheeze patient karne mein asamarth hojata hai. Ye bimari jo hai isme dard ek waxing and waning type phenomena hota hai, patient do mahine theek rehega or teesre mahine patient ko ye problem ayegi, phir wo kuch pain killers, kuch balm, iodex laga ke apna kaam chalata hai, problem kam ho jati hai lekin andar hi andar joint ka degeneration jo hai vo hota rehta hai. Ultimately the best possible way is to consult a doctor as early as possible or doctori salah ke andar kuch minimum amount of pain killers taki soojan aur dard kam ho vo shuru karna chahye aur ek X-ray jo hota hai jisme ghutne ki paristhiti pata lagti hai vo kara lena chahiye. X-ray se ye clear-cut define ho jata hai ki haddi ya haddi ke andar ka cartilage vo damage hua hai ya nahi hua hai.

Ek MRI scan usse bhi kafi kuch pata lagta hai. MRI cartigram naam ki ek nayi jaanch hai jo ki aaj kal hamare desh mein uplabdh hai, usme cartilage ka volumetric analysis bhi ho jata hai jisse ye maloom chalta hai ki kitna healthy articular cartilage ghutne ke andar bacha hai aur is tareeke se hum bimari ka prognosis jo hai woh determine kar sakte hai. Activity modification upchar ke liye bohot jaroori hai. 3 activities aisi hai jo ki hum patient ko bolte hain ki three activities like climbing of stairs woh kam se kam kare agar disease active hai to, niche ukdu baithna Indian style toilet mein woh kam se kam kare aur padmasan laga ke baithna yani ki ghutne ko 120 degree se zada mod ke rakhna ye aisi 3 cheeze hai jo aap apni activities daily activities mein thoda kam karein to ghutne ke andar articular cartilage mein pressure kam padega or pressure kam padega to uska wear and tear jo hai vo slow hojaega. Iske saath saath physiotherapy, regular exercises, cycling, swimming or walking iska ek apna mehtva aur apna role hai. Ye activities hamesha patient ko hum salah dete hai ki vo karte rahe taki disease badhe na.

Disease ka ghutne ke andar jo progression hai vo slow rahe. Pain killers kam se kam lene chahiye kyunki pain killers se kidney ke upar or pet ke andar gastritis, ye 2 cheeze aisi hai jispe iska dushprabhav jo hai pain killers se padta hai. Disease modifying agents kafi sare available hai aur kuch injections bhi available hai jo ki ghutne ke andar lagaye ja sakte hai, jo ghutne ko andar se lubricate karte hai or cartilage ki healing process jo hai use enhance karte hai. Activity modification aur injections in sab cheezo ke saath saath mein ek nayi padhti jisko sarkar se manyata abhi mili hai wo hai autologous chondrocyte transplant. Autologous chondrocyte transplant jo hai vo ek jo young patients hai hamare jinko bohot jaldi jo hai ghutne ke andar cartilage ka wear and tear ho jata hai khaskar chot lagne se, jab cartilage ke andar chot lagti hai, ghutne ke andar chot lagti hai or cartilage jo hai woh scruff off hoke, rub off hoke us ek chip ki tarah vo nikal jati hai, aisi paristhiti mein vo samay ke sath bohot hi kharab tareeke se ghutne ko kharab kar sakti hai.

Early stage ke andar khaskar young patients mein jinko chot lagne ke bad cartilage ki problem shuru ho, vaha par autologous chondrocyte transplant jaisi padhti jo hai vo bohot upyogi hai. Is padhti ke andar hum patient ke cartilage ke kuch cells jo hai vo lab mein regenerate karte hai aur fir 1.5-2 mahine me jab vo cells kafi regenerate ho jate hai lab mein, to fir ghutne ko chota sa incision laga ke, ghutne ko khol ke unko hum re-implant kar dete hain ghutne ke andar. Lekin ye padhti young patients ke andar kafi successful hai aur iske iski jabse abhi manyata jabse sarkar se mili hai to isse kafi mareez jo hai laabhanvit hue hai. Autologous chondrocyte transplant ke alava jab mareez ki condition aisi ho jati hai jiske andar vo cripple hona shuru hojata hai yani ghutne ki bimari ke sath mein pair ke andar alag alag tareeke ki deformity woh sab develop ho jaye aur pair tede ho jate hain, to aisi condition ke andar knee replacement naam ki jo padhti hai woh bohot kargar hai. Knee replacement surgery koi nayi ya koi vishesh tareeke se kari jane vali nahi hai, pichle 10 ya 12 saal mein is surgery ke andar bohot sare technical advancements hue hain.

Mai ye kehna chahunga ke actual mein knee replacement aisa surgery hai jo ki jisme hum ghutne ke andar pura ghutna nikal ke koi kambje vala jod nahi dalte. Basically ye surgery ki philosophy ye hai ki hum iske andar ghutne ke upar ke surface jo hai vo change karte hai. To sahi mayne mein isko surface replacement kaha jata hai. Ye ek model hai jiske andar ye ek artificial knee hai aur is artificial knee mein knee replacement kaise kaam karta hai ye dikhaya gaya hai. Jo upar ki haddi hai jise femur bolte hai usme ye is tareeke se cap ki tarah se ye upar ka component lag jata hai aur niche ki haddi yani tibia uske andar ye tibial tray ki form mein lag jati hai aur upar aur niche ke components ke beech mein ek ye high density polythene hota hai. To upar ka component is high density polythene pe glide karta hai is tareeke se aur yahi kritrim joint ya knee replacement ya surface replacement ya pratyaropad hai. Ab aaj kal jo technical advancements hai usme biomaterials ke upar nayi cheez samne jo ayi hai vo pichle 2-3 saal se naye biomaterials jaise ki gold knee naam se available hai.

Inn biomaterials ka jo sabse bada advantage hai vo ye hai ke inke implantation ke baad patient ko kisi bhi tarike ka koi allergic phenomena nahi hota hai kyunki usme ek alloy ka upar se coating hota hai. Dusri yeh hai ki woh zada uski surface property jo hai woh zada acchi hai, vo zada chikna hota hai to isse patient ko artificial jo hum surface lagate hai uski jo longivity hai vo mil jati hai. Normally ek knee replacement ka life jo kritrim joint hai uska life 10-15 saal hota hai lekin nayi technological advancement se, naye biomaterial se ab iski life 20-25 saal tak badh gyi hai. Dusra inke banavat mein, kafi revolutionary design mein, kafi technical advancements hue hai, pehle jo designs hote the wo kafi crude the lekin ab jo designs hai unki surface geometry ek is tareeke se hai joki ek insaan ke ghutne ko bohot closely match karti hai. Isilye ye knee implantation ke baad mein patient ko kafi kuch original joint jaisa hi feel hota hai, natural feel hota hai aur usme patient ko ek jo pehle ek abnormal sensation ati thi vo nahi ati hai.

Dusri cheez hai kyunki ye itna disabling disease hai aur pehle logon ke mann mein dar tha lekin ab patients ka acceptability is surgery ke liye bohot badh gya hai aur ye bohot hi safe operation hai aur agar ye ek ache centre par, ek experienced surgeon se aap karvayenge to patient ko hamesha laabh milega aur kisi tareeke ki pareshani nahi ayegi.

Thank you very much!