Raju has been roaming around the city holding an x-ray of his mother from one clinic to another, asking every doctor possible about the best treatment of the arthritis of the knee she has for quiet some time. Most of the orthopedic suggested total knee replacement as a cure while others opined about nonsurgical methods still holding relevant. Still not convinced, he continues to make the same mistake which everyone does. Treating the X-ray rather than the person which means focusing more on the x-ray images in decision making while subjective evaluation of the patient is ignored. With subjective evaluation I specifically mean asking the patient about the intensity of the pain they feel and the overall adversity associated with it. Many a times the X-ray images might look scary with destroyed joint but still the patient is managing his day today activities comfortably. So here the images point towards a possible surgery whereas clinically there is no such requirement.
Today most of the decision making to undergo a knee replacement is based upon nonspecific and under evaluated criteria like just the presence of knee pain, X-ray evidence of arthritis, financial viability etc. while often ignoring to enquire whether all forms of medical or non-surgical methods have exhausted or not. As an orthopedic surgeon I feel surgery should be thought of when every other conservative method like hot fomentation, Visco-supplementation, lifestyle changes and physiotherapy have failed to provide any major relief. Also, the amount of knee pain is very difficult to gauge. Your doctor might just could not evaluate the degree of discomfort you are experiencing. In this scenario certain questions when asked can help clear the air and aid in decision making to undergo the surgery or not. The next 3 questions address all the issues related to knee arthritis and these might have been overlooked by most of us.
- Is the pain tolerable? Do you need anti pain medications almost every day?
Total knee replacement is a major surgery, highly invasive in nature where bones forming the joint are cut and metal prosthesis are implanted. So, it is better to avoid in patients experiencing moderate, tolerable and occasional pain. This surgery should be reserved for patients having intolerable pain prompting the use of analgesics almost every day. Deliberate use of such drugs can lead to problems like gastritis, hypertension, and kidney failure. Patient becomes dependent on these deleterious medications which unfortunately is available in local drug store near you. Consequently, total knee replacement surgery comes as a savior by eliminating pain to a considerable degree.
- Are the Activities of Daily Living (ADL) affected? Is fetching even a glass of water painful?
ADL is an important parameter to measure the activity level of a person. The minimum thing one expects out of them is the ability to perform normal household day today activities. Be it taking bath or fetching a glass of water. When these are affected owing to constant knee pain, it’s high time for surgical intervention. Just take a note of activities you were able to do previously which now are becoming difficult. If the numbers of these restrictions are sufficient enough to nail you down to bed, knee replacement fairs out to be an attractive option to bring your life to normal.
- Does the knee pain hampering your Quality Of Life (QOL)? Have you stopped attending social events like marriage ceremonies, birthday parties etc.?
QOL means the overall happiness one perceives throughout the day. Pain in the knees can pose a serious limitation to social engagements like marriage ceremonies, birthday parties etc. there by hampering the QOL. It’s very logical to assume that a person with knee arthritis unable to socialize gradually turns home bound. Other than debilitating pain, prominent limping, increased dependence on others, use of wheel chair or other walking aid further discourages moving outdoors. Total knee replacement has the potential to rescue in these desperate situations providing pain relief and near normal walk. The patient freely socializes without depending on others or any waling aids thus improving the quality of life.
Always remember studies indicate that around 20 % of people undergoing TKR still complain of pain where no apparent cause has been established. Hence its always wise to first decide whether a particular person needs it without getting carried away by the resounding narrative of its super success. Who knows it might just be non-indicated in your case as several such examples are not uncommon.
The three questions I mentioned can clear the cloud and help in concrete decision making. The likelihood of success post TKR is more if the pain and limitation of movement is more. And these vital questions sufficiently point towards the debility due to knee arthritis in a more proactive and objective way. No doubt TKR is a highly successful surgery with a satisfaction rate of about 90% but in a properly selected individual. Wish you all a happy joint.
