Dr. (Prof.) Anil Arora MS (Ortho) DNB (Ortho) Dip SIROT (USA) FAPOA (Korea), FIGOF (Germany), FJOA (Japan) Commonwealth Fellow Joint Replacement

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1 Dr. (Prof.) Anil Arora MS (Ortho) DNB (Ortho) Dip SIROT (USA) FAPOA (Korea), FIGOF (Germany), FJOA (Japan) Commonwealth Fellow Joint Replacement (Royal National Orthopaedic Hospital, London, UK) Senior Knee and Hip Replacement Surgeon Associate Director Department of Orthopaedics and Joint Replacement Max Superspeciality Hospital, Patparganj, Delhi (India) anilarora@delhiorthojournal.com

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4 KNEE ARTHRITIS

5 What is Knee Joint

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7 Cartilage : elastic tissue to cushion Ligaments : connects bone to bone Tendons : connects muscle to bone

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9 Common Causes of Knee Pain Most Common : ARTHRITIS»OSTEOARTHRITIS»RHEUMATOID ARTHRITIS»INFECTIVE ARTHRITIS»GOUT (Uric Acid) After Fractures and Ligament Injuries

10 Many Synonyms Osteoarthritis

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13 Outer Side

14 Symptoms 1. Pain at the start of activity that gets better warms up over time 2. Progressive pain with activities 3. Loss of motion 4. Crunching sensation in the knee 5. Swelling 6. Over time deformity can occur in the knee

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28 Walk Waddle

29 OA Management Slow progression over many years - Cannot be cured Treatment directed at symptoms and slowing progress of the condition Goals: Decreasing pain Increase range of motion Increase muscle strength

30 Treatment 1. Education 2. Activity modifications such as using a cane 3. Physiotherapy 4. Drugs 5. Braces 6. Injections?????? 7. Surgery

31 Injections Arthroscopy Osteotomies

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37 What is Total Knee Replacement Replacing damaged surface of the bone is called Total knee Replacement.

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39 Is total knee replacement for you? Yes if you have Severe knee pain that limits your everyday activities. Moderate or severe knee pain while resting, either day or night. Failure to obtain pain relief from pain killers. Prolonged use of pain killers. Inability to tolerate or complications from pain medications. Failure to substantially improve with other treatments.

40 Indication of Total Knee Replacement Pain interfering with normal routine Instability If you require painkillers everyday

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42 Total Knee ReplacementSurgery

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44 Steps of Total Knee Replacement

45 Steps of Total Knee Replacement

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48 Knee Replacement

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50 Commonly asked Questions about Total Knee Replacement

51 When I will be able to walk? Next day! The patient can go to toilet independently very next day First with walker for a few days then using a walking stick.

52 Walk Next day!!!!!!

53 How much I will be able to walk? Depends on Stamina & is age related.

54 Will I be Able to climb the steps? Yes

55 Will I be able to sit cross-legged? Newer joints are available. But???????? Should we?

56 Does it take months to recover from the surgery? No. The patient then follows an intensive physiotherapy protocol and usually walks without support within 3-6 weeks.

57 Manju Tandon

58 Will I walk normal after TKR Mrs Bhatnagar walk

59 Pathway to Recovery : Physi cal Therapy The Physiotherapy Team will work with you to improve your functional abilities

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61 Will my knee become straight after operation Yes

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66 What does knee replacement offer? More than 95% of individuals who undergo total knee replacement experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living

67 Is it a rare surgery? No, it is not. Almost 3 lakh replacements are performed in the US every year. And India is catching up.

68 I have heard that Knee replacement is not successful and results are not good!!!

69 Diagnosis-Disease No other disease which may affect result Muscles and Nerves shall be OK and functional.

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71 Preop Anita Roy walk

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88 What if both knees have arthritis? Both knees can be replaced in the same sitting Else, sequential replacement can be done

89 What is the life of the joint? years is the normal expectancy. That is why it is not done in younger age group It should last the life of the patient but it can be repeated.

90 Is total knee replacement only for elderly or youngs?

91 I am a diabetic. Can my knees be replaced? Under strict blood sugar control, knee replacements can and is routinely performed on diabetics. However it requires blood glucose monitoring and control in preoperative and postoperative period.

92 I may never be able to sit cross legged after surgery! No, you can. Newer designs of implants permit higher range of motion and allow patient to sit cross legged. We don t want it!!!!!!!!!!!!!!!

93 Many varieties of implants are available. Which should be chosen? There is no documented evidence of superiority of one design over the other. So let your surgeon decide the implant

94 I took tons of Calcium. Why my knees are bad?

95 Any precautions after surgery? Regular light exercise Take special precautions to avoid falls and injuries. Notify your dentist that you had a knee replacement. See your orthopaedic surgeon periodically

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105 72 YR

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