Blog

• Dr. Arun Gupta
• Comments
• December 2, 2019

MYTHS AND FACTS ON TOTAL KNEE REPLACEMENT (TKR)

Myth #1: “I should wait as long as possible to undergo knee replacement surgery”

Fact – Incorrect! It is not necessary to wait for surgery until the pain becomes intolerable. The longer lifespan of joint replacements now enables people to consider surgery at a younger age, if needed. Osteoarthritis is a degenerative disease that continues to damage the joint surface and deform the shape of the bones around the knees. Unnecessarily delaying surgery makes the procedure technically more challenging for the surgeon, contributes to a decline in the patient’s overall health over time, and increases the likelihood of surgery-related complications.

Myth #2: “I should continue with medications as long as possible and avoid knee replacement surgery.”

Fact – Medications, including painkillers, provide only temporary symptomatic relief, and prolonged use is associated with serious side effects such as renal failure, peptic ulcers, and more. People with advanced arthritis definitely require surgery, as it cannot be cured with medicines alone. Many patients with rheumatoid arthritis require knee replacement at a relatively younger age. Delaying surgery and attempting to repair a severely damaged knee can reduce the longevity of the replaced joint due to increased technical complications. Additionally, individuals with a family history of osteoarthritis have a higher risk of developing arthritis at an earlier age.

Myth #3: Alternative therapies such as stem cells, PRP injections, acupressure, ozone treatment, massage beds, oils, laser therapy, magnetic therapy, or braces will cure my advanced arthritis and knee pain.

Fact – There is currently no scientifically proven permanent non-surgical cure for advanced knee arthritis, and these alternative therapies are not supported by established scientific evidence. These modalities may provide temporary relief in cases of early to moderate arthritis for a limited duration, but they are not curative. It has been observed that many people try these therapies due to fear of surgical uncertainty. While such treatments may delay surgery temporarily, they ultimately cannot prevent the need for it.

Myth#4. “I’m too old for surgery”

Fact – Age is not a contraindication for surgery. If a patient is clinically fit, even elderly individuals can safely undergo knee replacement surgery. We have treated patients as old as 87 years who have successfully undergone knee replacement and are now enjoying a better quality of life post-surgery.

Myth #5: “Knee replacement is a very painful surgery. There is a lot of pain in the post-operative period.”

Fact – Modern pain management techniques, including a multimodal approach, ensure that patients experience minimal to no pain during the surgery or in the post-operative period. These advancements contribute to a much smoother and more comfortable recovery process.

Myth #6: After knee replacement, I’ll have to give up some activities and sports.

Fact – You have a high probability of returning to activities like brisk walking or cycling within 6 to 12 weeks. However, it is better to avoid contact sports. Squatting and sitting cross-legged are possible but should be kept to a minimum in order to prolong the life of the implant.

Myth#7. Driving is not possible after Knee replacement.

Fact – This again is a complete myth. Driving is a lot easier after knee replacement. Most patients start driving within 6-8 weeks of surgery

Myth #8: After a knee replacement, it takes months to recover.

Fact – After 24–48 hours following surgery, patients become independent for toileting activities. Weight bearing is tolerated, and knee bending is permitted by this time. At around 3 weeks, patients can participate in outdoor social activities. Women can enter the kitchen and start preparing food as early as 4 weeks after surgery. The majority of patients can resume their job by 6 weeks.

Myth #9. Knee replacement is done “one at a time”.

Fact – If the patient does not have significant comorbidities and is deemed fit to undergo the procedure, then both knees can be replaced in the same sitting.

Myth #10. The new knee lasts for 10 years only.

Fact – With advancements in modern-day knee replacement precision and biomaterials (Oxinium/Opulent Gold), the survivorship has increased considerably. Today’s joint replacements last 20-25 years or longer, and for many people, will last a lifetime.

Myth #11. “I am obese, I cannot undergo knee replacement surgery.”

Fact – Knee replacement can be successfully done in an obese patient too. Literature shows comparable results when compared to average-weight people, although it requires more expertise and some special techniques during surgery. Sometimes patients continue to wait in the hope of reducing weight before knee replacement surgery is done. In fact, with a painful arthritic joint, it is very difficult to lose weight as the patient is less mobile. On the contrary, many of our patients actually lost weight after surgery as they were able to participate in brisk walking and an exercise program after knee replacement.

Myth #12. “I have diabetes or hypertension or a heart ailment, so I cannot undergo knee replacement surgery.”

Fact – Dr. Arun Gupta says, diabetes, hypertension, and heart ailments are no longer a bar for surgery. Detailed pre-anesthetic checkup is routine nowadays for every patient undergoing replacement surgery. To assess the cardiac function of the patient, several tests (echocardiography, dobutamine stress echocardiography, thallium stress echocardiography, etc. ) are done prior to surgery. Treated patients of heart disease (with stenting or bypass graft) are better candidates for surgery than untreated heart patients. Though these diseases do not affect the outcome of surgery, caution is required. In fact, one can gain better health and better control of diabetes, hypertension, or heart disease after knee replacement as they are able to walk without pain and can go for long walks if required.

Myth#13. Knee Replacement is just like replacement of kidney or liver. My whole knee will be removed and new knee put.

Fact – Not true at all. The whole knee is never replaced. Only worn-out articular surfaces of bones (usually 8-9 mm) are removed and replaced with an artificial implant. So, technically it is more of a “RESURFACING” or “REPAIR” rather than a “REPLACEMENT”.

Myth #14. “I can choose my implant by searching Google.”

Fact – There are various designs of implants available with good long-term results. Different surgeons are comfortable with different implant designs and instrumentation. So, it is better to choose a surgeon and leave it to him to choose an implant for you.

Myth#15. Getting the surgery done at Tier (i) city is always better!

Fact – Not really. There is no dearth of technology, expertise, and experience in Tier II cities. The local surgeon and his team will take much better care before, during, and postoperatively.

Myth#16. Knee replacement cannot be done a second time.

Fact – In an unfortunate event, Knee replacement can be done again. It is is called as a revision joint replacement surgery with good survivorship.

Myth#17. It’s a costly surgery?

Fact – From September 2017, the cost of a knee replacement implant was reduced and regulated by NPPA (National Pharmaceutical Pricing Authority). Because of this, the surgery is now quite affordable.