In arthritis, the cartilage lining on the ends of the bones is thinner than normal or completely absent. The degree of cartilage damage and inflammation varies with the type and stage of arthritis. The capsule of the arthritic knee is thickened. The joint space is narrowed and irregular in outline; this can be seen in an Xray image. Bone spurs or excessive bone can also build up around the edges of the joint. The combinations of these factors make the arthritic knee stiff and limit activities due to pain or fatigue.
Diagnosis
The diagnosis of osteoarthritis is made on history, physical examination & Xrays. There is no blood test to diagnose Osteoarthritis (wear & tear arthritis).
Benefits of TKR
The decision to proceed with TKR surgery is a cooperative one between you, your surgeon, family and your local doctor.
The benefits following surgery are relief of symptoms of arthritis. These include:
- Severe pain that limits your everyday activities including walking, shopping, visiting friends, getting in and out of chair, gardening, etc.
- Pain waking you at night.
- Deformity- either bowleg or knock knees.
- Stiffness.
Prior to surgery you will usually have tried some conservative treatments such as simple analgesics, weight loss, anti-inflammatory medications, modification of your activities, canes, or physical therapy. Once these have failed it is time to consider surgery. Most patients who have TKR are between 60 to 80 years, but each patient is assessed individually and patients as young as 20 or old as 90 are occasionally operated on with good results.
Pre-Operation
TKR is a major procedure that should be undertaken under optimal conditions. This means that your general health needs to be assessed and any correctable problems dealt with prior to surgery. In most circumstances this will involve blood tests, an ECG and an echocardiogram. Ideally this should be done by your GP prior to you being referred for major surgery. This is especially important if you have a known heart condition and have not been seen by your cardiologist in the recent past. Dr Senthilvelan will organize much of the appropriate testing to be conducted prior to your consultation if not already done. This is very important to minimize surgical risk to yourself. Take note of the following:
- High Blood Pressure (Hypertension) should be controlled and stable.
- Diabetes should be controlled and stable with blood sugar levels checked regularly.
- Any cardiac symptoms (chest pains, shortness of breath, palpitations) should be investigated and treated.
- BMI should be less than 35. BMI is a measure of obesity and is calculated by dividing weight in kg by the square of height in meters. For example someone who weighs 100kg and is 1.89m tall will have a BMI 100/1.89×1.89 = 100/3.57 = 28. The normal range for a BMI is 20-25. A BMI over 35 is associated with an increased risk of serious complications and Dr McEwen will apply this as a cutoff for TKR. If your BMI is over 35 you should lose weight before seeking a TKR. This should be done with the aid of a dietitian and exercise physiologist.
- Smoking is very dangerous when combined with major surgery. Smoking must be ceased. Dr Senthilvelan will not undertake a TKR if you’re smoking.