By DR. JOSE PUJALTE JR.
"I am interested in arthritis because I have it."
- Bernard Baruch (1870-1965), US Financier/Presidential Adviser
NY Post, appeared May 1, 1959
I know of several senior citizens who will start 2019 with a new knee (or knees). If you have been suffering from severe arthritic knee pain, maybe it's time to make up your mind and resolve to rid yourself of unnecessary physical suffering.
1. What is a total knee replacement?
Joint replacement is one of the most successful orthopedic operations performed worldwide. In the US (2017 figures), 1.6 million hip and knee replacements were done. 966,000 of those were knee replacements. The implants used consist of a metal block covering the end of a diseased thigh bone (femur), a plastic tray or plastic on-metal combination for the leg bone (tibia), and a plastic button for the knee cap (patella).
2. Who gets knee replacements?
The most common indication for total knee replacement is OSTEOARTHRITIS, or degenerative joint disease. The end stage of osteoarthritis is wearing out of cartilage (smooth, gliding bone ends) resulting in bone-to-bone contact in diseased joints. Osteoarthritis is common after the age of 65. It is progressive and becomes increasingly painful as the cartilage erodes. Younger people who get knee replacements have damaged their joints by trauma (accidents that destroy joint surfaces), infection, cancer or tumor, and inflammatory conditions such as rheumatoid arthritis.
3. Who may NOT get knee replacements?
Those who will be denied knee replacements are patients with recent or active knee infections. If the patient's knee is so weakened that it cannot be straightened from a bent position (no extension), the doctor will not think of replacement.
4. Why do you want to do a total knee replacement on me?
There are three reasons the doctor (an orthopedic surgeon) will recommend an artificial knee. These are: 1) to relieve pain, 2) to restore function, and 3) to achieve stability. As the arthritic knee becomes more painful, the patient will use it less. Function, therefore, is lost. As the arthritic knee continues to deform, the patient will feel that the joint is wobbly or unstable.
5. I'm too scared to get an operation. Are there alternatives to surgery?
If arthritis is seen early, before joint damage is severe, the doctor may recommend rest, the use of knee supports, the use of walking aids such as canes and walkers. He may suggest physical therapy and appropriate exercises. Occasionally, steroid injections into the knee may decrease pain and inflammation. A variety of drugs for arthritis exists. These range from painkillers aspirin and acetaminophen to NSAIDs (nonsteroidal anti-inflammatory drugs) such as diclofenac, meloxicam, piroxicam, mefenamic acid, ibuprofen. Cox-2 inhibitors such as celecoxib and etoricoxib are options too. If you are unsure of what medication to take, see your doctor. Do not self-medicate. Food supplements glucosamine sulfate and chondroitin have been shown to delay cartilage loss. The latest treatment for knee osteoarthritis is sodium hyaluronate. It is injected into the joint as a lubricant and shock absorber, thereby relieving pain.
6. If conservative measures don't work, and I still don't want a replacement, what can you offer me?
Again, depending on the stage of osteoarthritis and the age of the patient, there are other surgical procedures besides prosthetic replacement. Early arthritis may benefit from an arthroscopic washout -- fluid is essentially pumped into and out of the knee joint through tubes that are monitored by fiber optic video-camera (arthroscopy). Surgeries include synovectomy (removing bulky tissues that add to pain), osteotomy (realigning the joint) and arthrodesis (fusing the joint).
7. I want a knee replacement. How long will it last?
A well-executed total knee replacement can last up to 15 years (95% predicted survival of the implant).
8. What can go wrong?
As in all surgeries, there can be mishaps in technique and anesthesia. After the operation, there can be wound infection and worse, infection of the knee replacement. These may require prolonged antibiotics and possible removal of the implants. The textbook infection rate for total knee replacements is less than 2%. You must be informed of possible complications but in the end, knee replacement or any kind of surgery, is about trusting your doctor.
9. Is total knee replacement done in the Philippines?
Yes. The Philippine Orthopedic Association (POA) the professional organization of Filipino orthopedic surgeons has qualified fellows. A tighter guild within the POA is the Philippine Hip & Knee Society (PHKS) whose members have specialized training in joint replacement. Total knee replacement is a proven solution to end-stage arthritis.
Fact/Factoid. The patron saint of rheumatism is St. James the Greater and his feast day is July 25.
Dr. Jose Pujalte Jr.