All About Joint Replacement: Interview with Dr. Aravindan Selvaraj

A veteran in the field of joint replacement surgery, Dr. Aravindan Selvaraj - Chief Orthopaedic Surgeon and Executive Director, Kauvery Hospital is a Dr. D.A Patel gold medal awardee for his academic excellence. Having special interest in the management of shoulder and knee problems and skilled in treating these problems by keyhole surgery, he has practiced in world renowned hospitals like Guys Hospital, St.Thomas Hospital, and Kings College Hospital, both in London and Ireland for more than a decade before returning to India. In this interview, Dr. Aravindan talks on the various facets of joint replacement.

WHEN DOES ONE NEED A JOINT REPLACEMENT SURGERY?

The main indication of joint replacement is when osteoarthritis reaches the advanced stage. Osteoarthritis is an age related wear and tear of the joints that happen after the age of 35-40. After the age of 40, stage I arthritis happens when the cartilage between the joints starts to degenerate. The initial stages can be managed by tablets, physiotherapy and regular exercises. When it reaches stage II, the joint lubrication becomes lesser over time, just like in the engine of a car. Patients can be benefited from an injection in the joint called viscous supplement. When it reaches stage III, patients have continuous pain throughout the day and their quality of life is severely impacted. In such conditions, we do a key- hole surgery and address cartilage damage.

WHAT ARE THE DIFFERENT TYPES OF JOINT REPLACEMENT SURGERIES THAT YOU PERFORM?

In India, the most common joint replacements are done for the knee joint, followed by hip and shoulder. Knee replacement largely depends on the age and degree of arthritis. When patients come in at a very early stage, only one half of the knee is affected. Actually the knee has three compartments, an inside compartment, outside compartment and knee cap compartment. When one component alone is affected, that can be replaced and is called as unicompartmental knee replacement. The other joint replacements include elbow, wrist, joint and ankle but they are very rare. It is usually following an injury or weight related. When overweight people come in for surgery, I advice them to first optimize their weight before going ahead with the replacement.

We did a surgery on a 88 year old man from Jodhpur, so age is not a barrier. The whole idea is that even if the patient is going to live only for a few years after the surgery, he should be as self-reliant and independent as possible.

WHAT ARE THE LATEST DEVELOPMENTS IN THIS FIELD?

The latest implants that are in the market today give a good bending capability in the knee and are called high flexions knee replacements. There is advancement in design by making a cut in the back of the knee. This cut helps achieve 130-145 degree flexibility. However, patients should have realistic expectations. They can't expect to be as flexible as they were in their 20s.

WHAT IS THE PROSTHESIS USED FOR OSTEOARTHRITIS?

These are artificial implants that comprise of two parts, metal and plastic. The joint space becomes narrow so we make cuts in the bone and replace it with a metal and put in a very high quality polyethene.

Most of the current replacements are expected to last a lifetime. The implants normally outlive the patient unless in rare circumstances where people start doing aggressive sports and wear out the replacements.

Both pre and post surgery physiotherapy are very important as it helps to strengthen quadriceps and takes off the load from the knee. The physiotherapy usually lasts for a month. Some patients with very positive mindsets even start walking in 14 days! They can go back to office in 3 weeks and driving within 2 months time.

CAN PATIENTS WITH OTHER BODILY AILMENTS UNDERGO JOINT REPLACEMENT SURGERIES?

People with cardiac surgery, diabetes etc. can undergo joint replacement surgeries as long as the risk factors are addressed and managed. It was not possible 15 - 20 years ago but is possible now.

IS THERE ANY RISK OF THE BODY REJECTING THE PROSTHESIS?

In the case of rejecting the prosthesis, nickel allergy is a rare case but is a documented phenomenon where in the body rejects prosthesis. There are special implants for those kinds of patients. It is not like the case of kidney transplants and joint replacement is not an immunity - related issue because it is just a metal that is replacing the damaged part of the body.

Visit our website.

Read More

What to Expect from Knee Replacement?

Knee arthroplasty or knee replacement surgery is for those whose knee joint has been badly destroyed which in turn causes chronic pain and impairment of functions. Knee arthroplasty is considered when all other treatments have produced no results. Generally patients suffering from osteoarthritis, in the age group beyond 50 years, are deemed to be prime candidates for a knee replacement surgery.

The Procedure

This is a surgical procedure where the diseased knee is either totally or partially replaced with an artificial (metal or plastic) joint. With advanced medical technology, it is now possible to perform keyhole surgeries or minimally invasive surgeries. The steps involved are:

1. Either general or spinal / epidural anesthesia is administrated to the patient.

2. While the patient is under, a 3-5 inch incision is made in the anterior / frontal part of the knee.

3. The knee part abutting the end of the femur or thigh bone is replaced with a metal component and the end abutting the top of the tibia (leg bone), is replaced with a furrowed plastic piece with a metal stem.

4. A plastic button maybe placed under the knee cap, depending on the condition of the kneecap.

5. The artificial parts or prosthesis function with the help of the surrounding muscles and ligaments.

In a knee replacement surgery, there is one other tissue called the posterior cruciate ligament that could be partially or totally replaced with a “polythene post”. The function of the posterior cruciate ligament is to support the hind leg from buckling backwards when the leg is in motion.

Benefits of Knee Arthroplasty

1. The incision made is very small in comparison to the traditional surgery.

2. There is lesser damage to the surrounding tissues, when an Orthopedic Surgeon is making the incision.

3. Instead of cutting through the tendons (traditional method), the Orthopedic Surgeon, operates between the fibers of the quadriceps muscles.

4. Healing time is quicker and extent of pain is considerably reduced.

5. Better motion due to less scar tissue formation.

Post Knee Arthroplasty

1. Hospital stay will be between 3-5 days.

2. A month or so later, the patient will observe a dramatic change in the movement of their knee joint.

3. There will be relief from the debilitating pain.

4. Post-surgery, the patient will be able to stand or move the joint. Generally, this can be done the very next day after the surgery.

5. To begin with the patient will walk with the help of parallel bars and later on with a walking devices like the walking stick, walker or crutches.

6. Six week later, the patient will be able to walk with minimum aid.

7. With the help of physiotherapy, the muscles are restored and the patient can then undertake any activity other than jumping or running.

Joint replacements initially were thought to last only 10 years but with advancing research it has been established that joint implants can last as long as 20 years, especially with advancing medical technology and avant-garde surgical techniques. 

Read More