Patient Education

Joint Replacements - When It Is Essential and When Avoidable (Dr. Sarvdeep Singh Dhatt)

Joint replacement surgery has rapidly become one of the most commonly performed surgeries in our age.Earlier, we saw many old people suffering due to painful joints and receding to a mundane lifestyle. But, now we are seeing that many of these same patients get a healthier and more active lifestyle after these surgeries. Patients with painful knees on painkillers and when their activities of daily living are effected require to see an Orthopaedic surgeon to discuss their option of surgery.

The absolute indications for surgery are:

• – Intractable pain

• – Severe Osteoarthritis

• – Limitation of motion – Inability to flex the knee more than 90 degrees

– considerably limits functional capacity to rise from a chair.

• – Life expectancy is an important consideration because of the duration of the joint implant and the risk of future loosening or implant failure.

The most important contraindications are:

• – Acute infection

• – Severe obesity

• – Poor health and high anesthetic risks.

• – Poor bone stock

• – Significant deformities

• – Severe neuropathy

• – Poor knee extensor function.

• – Significant arterial disease.

• – Genu recurvatum knee deformity

• – Presence of a good knee arthrodesis.

Many of these patients can be managed with some exercises, and lifestyle modifications. According to an article published last year in Arthritis &Rheumatism, it was found that only 44% of the knee replacement surgeries could be classified as appropriate, with 22% rated inconclusive and 34% deemed inappropriate in the USA. The importance of preoperative function as a prognostic factor has prompted clinicians to intervene earlier, rather than later, in the course of functional decline. The question to be debated is that do the benefits in terms of prevention of work loss/loss of independence outweigh the risks of requiring another surgery [revision] down the road and/or costs of providing these surgeries in younger folks with less severe knees?” Therefore, whether to have Joint replacement today or not should actually be a shared decision-making process between the surgeon and the patient, where the benefits and complications of this surgery should be discussed in detail.

Dr Sarvdeep Singh Dhatt,

Consultant  Orthopaedic PGI

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