We can’t imagine our life without movement and knee joints functionality. We might not be able to sit, squat, jump to greater heights, walk properly, or run faster. The joint where the thigh bone meets the shin bone is called a knee joint. This joint is lubricated with a layer of a gelatinous substance called meniscus. Meniscus absorbs the shock when the two bones come into contact and allow free gliding of the two bones against each other. Now, we have a condition that is commonly observed targeting the knee joint, called Rheumatoid Arthritis (RA). Rheumatoid arthritis affects 0.5-1% of the total population worldwide, with a peak prevalence between the ages of 30-50 years. It occurs more often in women compared to men. Knee Replacement Surgery is like a Time Machine for RA Patients This article is intended to discuss rheumatoid arthritis in particular, knee replacement as a treatment option for rheumatoid arthritis, and pre and post-operative care for knee replacement surgery. Learn now how knee replacement surgery can help in restoring your life back with improved knee joints functionality. It is like accessing past life with the time machine. What is Rheumatoid Arthritis? Rheumatoid arthritis is the second most significant common type of arthritis. It is an autoimmune disorder causing a symmetrical polyarthritis, and chronic inflammatory disorder, and often affects the wrists, hands, knees, ankles, and feet, but mainly attacks the joints producing an inflammatory synovitis. This arthritis damages the normal function of your joints and makes it painful to move them. It is so called autoimmune disorder because the immune system identifies the synovial membrane as a foreign body and begins attacking it. Rheumatoid Arthritis is characterised by synovitis with thickening of the synovial lining and infiltration by inflammatory cells. Rheumatoid arthritis symptoms may differ from person to person. In the early stages, people with rheumatoid arthritis may experience tenderness and pain, may experience redness or swelling in the joints in the later stages.
- Onset of pain
- Early morning stiffness for more than 30 minutes
- Swelling of small joints of the hands and feet
- The joints of the hands are the very first joints affected by rheumatoid arthritis. The joints appear swollen and red, tender when squeezed.
- Swan Neck Deformity
- Mallet finger
- Deformity of thumb
- Low-grade fever
- General weakness
- Muscle pain and pain with prolonged sitting
- Raynaud’s Phenomenon
Ongoing high levels of inflammation can also cause problems throughout the body. Here of some of the organs and body systems affected by rheumatoid arthritis:
- Heart and Peripheral vessels
Diagnosis: Rheumatoid joint pain at Knee area can be hard to analyze in the initial stages because the early signs and side effects are the same as those of numerous different diseases. During the physical test, our orthopaedician will check your knee joints for swelling, redness, and warmth, and they also check the reflexes and muscle strength. There are no specific blood tests or any diagnostic tests to confirm RA. To make an appropriate determination, the rheumatologist will ask some questions regarding family medical history, perform physical examinations, and run diagnostic tests, which include:
- Magnetic resonance imaging
- Blood count
- Serum antibodies
- C reactive protein
- Renal functions
- Liver enzymes
Knee Replacement Surgery for Rheumatoid Arthritis: We will consider knee replacement surgery when the medications and non-pharmacological treatment options fail and do not respond. The Surgery for RA may never be required, yet it is a very significant alternative for people who have permanent damage by RA that limits mobility and function. Joint replacement surgery is done to relieve pain and restore the function of the joint in people with lasting damage to the joints from RA. The main goal of the surgery is supplanting the damaged joint with metal, and that the artificial joint work as a natural joint in the damaged area. What is Knee Replacement? Knee replacement is known as knee arthroplasty or total knee replacement. It is a major surgical procedure to restore part of the knee damaged by arthritis, by using specialized instruments like metal and plastic. This surgery is done for someone who has severe arthritis or a severe knee injury. Rheumatoid arthritis, in people, causes inflammation of the synovial membrane and results in excessive synovial fluid. This causes pain and stiffness. It improves the quality of life of a patient suffering from traumatic arthritis. Arthritis due to an injury may cause damage to the cartilage of the knee. Knee replacement, in such cases, reduced stiffness and swelling, provides enough pain relief. Types of Knee Replacement: The orthopaedic surgeon will examine your knee conditions and discuss with you the type of knee surgery needed. Four main types of knee replacement surgery: Total knee replacement: This is the most widely common form of surgery used. Your orthopedist replaces the surfaces of the thigh bone and shin bone that interfaces with the knee. Partial knee replacement: if the knee affects on one side by arthritis, this surgical procedure might be a probability. It is done only when the knee ligaments are strong. Partial knee replacement can be performed through a small invasion. Kneecap replacement: This replaces just the under-surface of the kneecap, yet a few orthopaedic surgeons prompt against this method since the success rate for total knee replacement is high. Complex (or revision) knee replacement: This procedure is done only if the person has extremely serious joint inflammation or if more than one knee replacement surgery. Best Surgical Treatment for Rheumatoid Arthritis: In the beginning stages of rheumatoid joint inflammation, arthroscopic or open synovectomy can be of advantage. In the later stages, joint space gets destroyed, bony destruction may be seen, and deformity to the knee structure could have occurred. If the knee stiffness has set in, total knee replacement is the optimal and most reliable treatment option. Total Knee Replacement Surgery Total knee replacement is a medical procedure to supplant a badly damaged knee joint, because of rheumatoid arthritis, by an artificial joint made of metal or plastic or a combination of both. The surgery is done to reduce pain and improve mobility. It is done to individuals with extreme rheumatoid arthritis of the knee. Pre Operative Care:
- Preoperative appointments to be made approximately six weeks before surgery.
- Begin nutrition management.
- Begin Smoking Cessation.
- Approximately two weeks before surgery, the pre-op appointment with the surgeon to be completed.
- Antiseptic wipes to be used the night before surgery.
- Stop taking any medications for ten days before surgery such as Aspirin and aspirin-containing medications, all NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), including NSAID creams and gels.
- Pain management.
- Knee exercise.
- After your total knee replacement surgery, there is an assortment of things you have to know for your wellbeing, recuperation, and comfort. You will get instructions about the nutrition, medicine, physical and occupational therapy follow-up arrangements, and what signs and symptoms to watch out.
- Prescription of pain medications, as needed.
- For several weeks after the surgery, pain is normal and usually is treated with prescription medication.
- Taking a few weeks of rest and doing strengthening exercises, postsurgical pain usually becomes less intense.
- Until surgical area heals, keep the wound clean and dry.
- For about a month-and-a-half after total knee replacement surgery, patients should avoid soaking the surgical site.
- The surgeon should be contacted immediately if redness or swelling occurs near the surgery incision.
- A low-grade fever is typical for an initial couple of days after surgery. However, if fever persists (more than 101 degrees) and is accompanied by chills, sweating, or pain, then a specialist should be consulted.
- After the knee surgery, the patient is provided with a clear and specific program of activities and movements to do during the recovery period by a physical therapist. Day by day, movement and exercise can assist patients with regaining strength and with getting to work faster. It also prevents complications, such as blood clots.
- After knee replacement, if patients experience difficulty walking or doing the prescribed exercises, they should consult with their physical therapist.
- Patients should follow a healthy diet plan after knee replacement.
- Patients should walk with the help of a walker or crutches until they can walk unassisted. It may take six weeks before the patient feels steady on his or her feet.
Conclusion: The Knee is a pivotal joint facilitating several activities performed by the lower extremities such as sitting, running, walking, squatting, jumping, bending etc. As discussed in great detail, rheumatoid arthritis is the most common condition affecting the knee joints. Unlike any joint condition, RA also brings about swelling, pain, redness, limited range of motion to the joint. As knee joint acts as a supporting structure in connecting the thigh and shin bone and aids in the weight-bearing activity of the body, it is imperative that such condition addressed with an effective treatment. Knee replacement is that wholesome treatment option that provides effective relief from the symptoms brought about by RA. Knee replacement is a complex surgery, but technology has minimised the complexity of such surgery with the introduction of precision tools. Not to mention the pre and post-operative care which is as vital as the surgery itself. Proper care after the surgery has a direct bearing on the time to recovery and the extent of regaining lost motion and strength of the joint knee. If you wish to ask anything we might have missed out in the above article or if you wish an elaborate detailing of the above aspects, please Contact us at … and Meet Dr P Gopal Reddy today! About Gopal Reddy: Dr Gopal Reddy, a skilled and fellowship, trained hip replacement surgeon in Hyderabad possessing valuable experience and expertise in the field of orthopaedics. With the help of continuous education, he attained the best skills that are a must for an orthopaedic doctor to become the best hip replacement surgeon. He can deliver successful outcomes with zero complications. With 20 years of experience in the field of orthopaedics, Dr Gopal Reddy always strive to provide the world-class orthopaedic treatment to the patients suffering from the joint pain. He is a renowned total knee and hip joint replacement surgeon offering excellent and quality orthopaedic care for all the patients whoever approaches him. Education and Training
- M.S.(Ortho), Fellow-Joint Replacement Surgeon
- Trained from AIIMS, (New Delhi) & Australia
- Senior Consultant Orthopaedics and Joint Replacement Surgeon