Is It Safe To Delay Knee Replacement Surgery? Know How Long One Should Wait
Total knee replacement has the ability to correct not only the worn out surfaces, but also the mechanics, and hence providing a stable well aligned joint.
Knee arthritis is a progressive disorder leading to greater damage with time
- In severe knee arthritis the patient may face reduced mobility
- Most knee replacement surgeries are conducted before time
- Total Knee Replacement is done at the end stage severe Arthritis
Studies have shown that patients often wait far too long before doing a knee replacement. A study published in the Journal of Bone and Joint Surgery found that a vast majority of patients who would benefit from knee replacement, are taking too long to have surgery, to the detriment of their mobility and overall health. The study also showed that delayed knee surgery has negative effects on post-operative recovery.
Total Knee Replacement (TKR) is an operation for end stage severe Arthritis of the knees. It has the ability to correct not only the worn out surfaces, but also the mechanics, and hence providing a stable well aligned joint. In spite of advancements in the procedure, some people hold on to outdated notions of its risks and outcomes, and delay the knee replacement as long as they can which can potentially impact the post operation function. Correct timing of surgery is essential to optimize results of the operation. Some people do not access surgery due to limited facilities and less familiarity with the procedure's benefits. Question to ask here is - 'Is it safe to delay knee replacement surgery and how long should one wait before committing to it?'.
Knee Arthritis is a progressive disorder leading to greater damage with time. The surface of the joint continually keeps getting abraded and bone loss occurs from the surfaces. This results in increasing deformity. There is abnormal stress on the ligaments which will gradually stretch out and lead to instability of the joint. The deformities get progressively tighter and fixed resulting in unstable and abnormal gait patterns. Muscles and bones get weaker due to disuse. Adjacent joints like the spine, hip and ankle suffer damage due to abnormal strain.
Bone loss affects implant fixation and ligament damage can affect implant stability. Often special implants are required to address special situations. A good primary TKR with healthy bone stock, stable ligaments and satisfactory joint alignment promises long-term success. Excessive delay may compromise the procedure affecting longevity of implants. There also may be risks, however, in getting the surgery too early. It has been shown in the US that about 26% of knee surgeries performed are done prematurely as people who are 'likely inappropriate' for the procedure go through with surgery anyway. These patients run the risk of complications with less benefit than if the procedure were done late. Knee replacement is not to be seen as a magical cure to all knee problems. One of the commonest questions get asked by patients with severe Knee Arthritis is 'doctor, when is the best time to do a Total Knee Replacement?'
Ideal time for surgery will vary from person to person, but some pointers help in decision making.
1) Needs to be done when the knee problems significantly limit functions
2) Before major deformity, bone loss and muscle atrophy sets in
3) Earlier in patients with one good knee, so that it does not get affected because of the bad one
4) Value of this surgery is greater when overall mobility and strength is satisfactory. No point in waiting till one is too old to undergo the surgery
5) Do it before other age-related ailments prevent you from committing to the operation
6) Earlier surgery in patients with deformity and joint instability
7) Early if any condition predisposes to faster wear and tear of the joint
8) People with progressive medical conditions which are under control may consider surgery while the going is goo before it is too late.
(Dr Kaushal Malhan is Director-Orthopedic Surgery at Fortis Hospital, Mulund)
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