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 Pains & Aches

February 2011
Lesser Pain And Quicker Recovery
The Mantra of Minimally Invasive Total Knee Replacement
Dr C Lenin
 
Arthritis of the knee joint cripples the patients with pain, stiffness and deformity. The only treatment, which can cure a patient from advanced arthritis, is total knee replacement. Here is comparing the advantages of the new technology with the old.

Total Knee Replacement (TKR) has come of age over the last four decades with techniques being fine-tuned. A TKR done well relieves the pain, corrects the deformity and restores the function,serving the patient minimum of 15 to 20 years.Though thousands of knee replacements are done every year in our country, still a lot of apprehension prevails among the patients about this procedure mainly due to the pain and prolonged recovery following a conventional knee replacement.

The Conventional Way
In the conventional way of knee replacement 20 to 25 cms of the skin is cut.More importantly, muscles in the front (extensors) which are responsible for the knee movement, are cut in the middle. The knee cap is flipped inside out and the thigh bone(femur) and leg bone(tibia) are separated from each other.It is then that the worn out surfaces are prepared and replaced with the artificial metal joints.

As we advance,the recognition of how crude we were arrives.
  • Today, we have reason to find the conventional way of knee replacement cosmetically less appealing, due to the long incision.
  • The cut muscles take a long time to recover from the surgery, particularly since they were already weak due to the arthritis.
  • Flipping the kneecap inside out stretches the muscles in front of the thigh by 40 per cent - which delays the recovery.
  • Sometimes it may take up to a whole year to completely recover,after conventional total knee replacements.
  • In addition to this, separation of bones from each other for preparation also stretches the tissues surrounding the joint. This not only delays the recovery after the surgery, it also results in more pain.
Minimally Invasive Solution
  • Keyhole surgery is cosmetically more appealing because only eight to 10 cms of skin is cut.
  • Instead of cutting the muscles, the surgery is done by pushing them to the side.
  • The kneecap is not flipped but it is only pushed to the side to expose the joint. Due to this, the muscles in front of the thigh extensors are preserved.
  • The bones are not separated from each other but they are cut in place.This minimises the stretch injury to the structures surrounding the joints.
  • Along with good pain control measures, all of this ensures that the pain after the surgery is very minimal.
  • Patients recover much faster (within a month or two) after minimally invasive total knee replacement.
  Dr. C.Lenin is Consultant Knee Replacement and Arthroscopic Surgeon at
Apollo Hospitals, Chennai.


    
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