Modern India Is bustling with activities. We dream big. We cram more in a day than we ever did. So much so that our hectic lifestyle takes a toll on our bodies. With little or no time for exercise and the right nutrition, as a result, wear and tear of joints, aka osteoarthntis, has become quite common. While some get injuries because of over activity, others succumb to lifestyle diseases.
Knee joints are most commonly affected by osteoarthrltls. Why?
Humans, unlike most animals, have evolved to carry out most of our daily activities, sports, etc.. in an erect posture. Our weight bearing knees take the tol of this eventually and start wearing out.
The knee joint can be roughly divided into three compartments: inner, outer and knee cap.
Most Indians have a slight bow in their shinbones (tibia). This causes more loading of the knee Joint on the inner compartment as compared to the outer compartment. As the knee wears out more on the Inner aspect, the bow In the legs increases, making us bowlegged. This is an advanced stage of osteoa rthritis as we often see in elderly people.
Doctors are now teaming up with engineers to find solutions for wom out knees. As a result, over the last few decades, people have recovered from extreme pain to enjoy living their lives.
At the onset of arthritis, doctors advise activity modifications and exercises. There are supplem ents to improve joint lubrication, and keyhole surgery can tidy up the joint to make it last a bit longer. However, when the joint shows advanced arthritis these modalities cease to help. That is when advanced engineering comes to our rescue. Knee replacement design and modern Knee Replacement Surgery was pioneered in England and the US. It aims at restoring the normal pain-free functioning of the knee joint by replacing the worn-out surface. All three compartments are replaced. A cap covers the lower end of the thigh bone. A base plate replaces the top of the shin bone. A knee cap undersurface Is also used. These components are fixed to the bone using an acrylic polymer which cements bone and a long-lasting bearing. This is known as a total knee replacement or TKR.
In the last fifty years, we have come to understand the anatomy and geometry of the knee much better. This has resulted In more precise anatomic designs of the prosthetic knees. Also, understanding the dynamics of knee motion and the way we walk has resulted in more natural feeling knee replacements. The materials used are also evolvi ng continuously.
In the beginning, standard stainless steel aloys were used. Then came cobalt-chrome, titanium alloys, which made the joints lighter and longer lasting. Use of ceramics has increased the longevity even further. I hope we have a knee which “never wears out” soon. The fixation of the prosthesis to the bone has become more natural as well, by using various types of coatings like tantakim trabecular metal and hydroxyapatite.
The tools to perform surgery used to be precision engineered mechanical guides. Computer navigation has pushed these lovely tools into history. Now, customized preplarined patient-specific knee replacements are making computers look primitive. The next stage will be the use of orthopedic robots.
Surgical technique and training have been changed by technology. Modem surgical handicraft has become minimally invasive. Patients experience much less pain, they walk home quicker and they return to active life much sooner.
Having given a general overview of the subject, let me share with you a unique experience I had with Mr. Taylor, a keen golfer and sportsm an, who came to me with wearing out of his knees. He wanted to walk, cyde. golf and lead an active working Ife without having pain. After examination, X-rays and scans, I found that only the inner compartment was worn out. The outer compartment, kneecap, ligaments were in a pristine condition.
Considering this, I offered him a very special solution using the best of modem technology and surgical precision. I would replace only the worn out medial compartment. This is known as “unicompartmental knee replacement’” or microplasty”. This technique involves a delicate fine tuning of the wom.out inner compartment by removing precisely just the worn area. The rest of the knee, which is nocrriel, is preserved as such. The result is like a hybrid engine that we see in high-end cars today — two different mechanisms married to each other, functioning in unison, for a better long-term future.
Mr. Taylor agreed to let me give him tailor-made” knees and because he was a man in a huny, with lots of commitments, I took another unusual decision in his case. I operated on both his knees in a single sitting. Normaly, I would do unicompartm ental arthrop lasty one knee at a time to alow a leisurely recovery time. In his case, I did bilateral single sitting unIcorn- part mental arthroplasty.
I believe this was a first in Maharashtra. Mr. Taylor was back on his feet in no time and did not need to use the golf cart anymore.
Step ahead with tailor-made knees.
Accredited to : Dr. Sachin Bhosle