Most people cannot  bend or fold their  knee after knee replacement surgery

 

That’s actually quite the opposite of why the surgery is needed in the first place. The surgery is done to improve a disabled joint and render it pain-free as possible while enabling more motion. This aim is attained in almost all majority of the patients .

 

Pain is increased after surgery

 

Again the goal of the surgery is rather to get away from the arthritic knee or hip pain so why would it become worse rather most patients get relived from heaps of painkillers medicines and unnecessary pain.

 

I am too old for a joint replacement surgery

 

Knee and hip joint Arthritis generally hits in old-age so joint replacement is done usually in elderly but this surgery is quite safe even at a advanced age. With the advent of smarter instruments and better anesthesia techniques it possible to rehabilitate the patient securely without any complication.

 

We have to take 1-2 month bed rest after surgery

 

Most primary knee and hip surgeries will rather put you off the bed in the 1st or 2nd day of the surgery and the hospital physiotherapist would be after you to push you for increasing your walking and exercise limits. Of course it might take a month’s time to rejoin your daily work or office but you would rarely require bed rest and you rather would be increasing your exercise limits and would be walking more than earlier.

 

I cannot enjoy activities like cycling, swimming, driving car or sitting cross legged after getting a knee or hip replacement.

 

Never say never again.  In most cases patients regain their activity level and have no problem in doing various activities mentioned above. We have regularly seen knee and hip replacement patients from rural areas even doing farm work including using a tractor and riding a motorbike. But all this again depends upon the body type of the patient and his/her preoperative activity.

 

I have been advised knee replacement surgery but I can delay surgery with help of cartilage forming/protecting tablets or supplements

 

If you are advised knee or hip replacement surgery then in most cases you might have bone on bone arthritis and in this case these medicines do not help at all and you end up getting your surgery delayed unnecessarily. But painkillers or NSAIDS drugs help in delaying surgery and improving function although a constant regular use of such drugs for a more than a few months should also be avoided.

 

Delaying knee or hip surgery as much as possible until I am ready would be best option for me

 

Not always a ideal choice of decision. If you had been advised a joint replacement surgery then delaying it makes sense only when your age is less than 50-60 or your knee is only moderately deformed and you have very minimal pain in your affected joints not needing any painkiller medicines. Beyond that delaying your surgery while tolerating pain and increasing your monthly need on pain-reliever medicines in a advancing age while your muscles and bones are getting weaker is not a sensible alternative. Moreover sometimes the deformity progress to such a extent  that  the implants may need other attachments or extensions to fix it stably over the bone this not only increases the cost of implants but also consumes more bone stock.

 

I can’t walk as fast as I can at this age so a knee replacement would help me

 

No. A knee or hip replacement surgery is not going to get you a nomination in race walking competition, it simply is needed if a orthopaedic surgeon says that your knee or hip have become severely arthritic and deformed  and in addition to this you have been taking pain reliving for your knee or hip pain for several months or years.  Yes you might walk more straighter but aiming to get a knee or hip replacement for  a faster walk than your spouse may lead you to repent your surgery. Think of it as a change only in the deformed joint not the weakened and old muscles

 

A double knee replacement in a single stage is the best and latest option 

 

Not always. Most knee replacement surgeries done in Europe are Single knee surgeries and the other knee is done in a gap of a couple of months. At present medical data shows a 14-15 % more chance of Death after surgery than a single knee replacement and the reason is simply doubling of all risk factors although single knee replacement surgery itself is extremely safe and has a exceedingly low rate of mortality. Still in other parts of world like Americas and Asia including India a bilateral or both knee replacement surgery is very popular in most centers  and done successfully. Sometimes both knee replacement in a single stage does seem better option in thinner, younger and fit patients who do not any other medical problems like Diabetes or heart disease and who are highly motivated.  It may appear that there is advantage of shorter overall hospital without any need of visiting the operation theater twice and faster return to work with a shorter rehabilitation. But apart from a rise in a overall risk, patients do have more blood loss and higher stress in recovery period and the rehabilitation is a bit more difficult in unenthusiastic  patients. The key lies on getting yourself thoroughly evaluated for being medically fit for surgery rather insisting and asking for a option of a both knee replacement from a Knee replacement surgeon not wanting to offend you and loose his precious patient!  Most patients who are obese, diabetic and have heart problems can avoid a bilateral knee replacement and rather have staged surgeries with better outcome and easier rehabilitation.

 

We have heard about a particular company implant and we rather want this joint  implant for our knee/hip replacement  surgery.

 

Trust your orthopaedic surgeon not your neighbor or heresy  I would rather say. Most international medical devices companies who make and market their joint replacement implants have constantly innovated their products to such a extend due to competition that most of them have hardly have much of difference in terms design, material and most importantly survival. Recent Medical data is also uncertain about a definite winner among the more recently introduced and highly marketed implants ,  and the  largely old but successful prevailing knee/hip replacement implants. In most recent data not all of the highly marketed newer implant materials have done better than older prevailing implant systems simply because they are more expensive or have fancy name.  Most patients also have” heard” about “high flexion knee” or more knee bending range implants which although available in market and be costlier may not be a better option for all patients because not all knees are alike and other factors like the extent of deformity and girth of leg and thigh also determine the bending range. Each patient has to be evaluated and a implant is selected to his/her problem than a particular implant selected on all patients. Also a  good knee implant from a reputed company may still do bad in a badly done surgery from a untrained surgeon. So rather choose your surgeon with a better instinct rather than your implant. Most knee implants categories have now similar pricing and surgeons don’t have much problem in adjusting your  ” implant inclinations ” but you better let the surgeon decide the implant he wants to choose because he might be better suited in performing surgery in a particular implant system since the instrumentation of each implant system differ and a surgeon may not be accustomed to a particular implant system of your choosing. Also there can be  special attention or demands in each case for example some patients may require stem extensions in their knee implants which are not present in all knee implant systems.

 

XYZ Surgeon does knee replacement surgery in less than 10-15 minutes. This is the best Surgeon for me.

 

No.  Choose a Surgeon who chooses his patients carefully for joint replacement surgery rather than someone who considers you a deformed piece of furniture ready to be factory re-fitted in the workshop with a monthly target of joint replacement surgeries in mind. When it comes to joint replacement surgery a surgeon who is more concerned on your needs and provides optimum solution according to your condition is needed than someone considering you just another “joint”.  A cleanly and thoroughly done implant surgery is more than required than a sprint towards the end of the surgery while largely missing all the goals of the surgery in the first place. It actually takes at least 6-8 minutes to harden the medical cement used to bind the implants to the bone and this is one of the several carefully done steps of the surgery. No medical literature shows any advantage of such surgical heroics.

 

It’s  always better to get a joint replacement surgery done outside my own city from a bigger city hospital

 

It might not be always better. Most knee replacement surgeries can be done by adequately trained and experienced locally available surgeons in the available clean modular operation theaters  now  present in most orthopaedic centers. Most of the surgical techniques and instruments are always similar whether a surgery is done in a  locally good centre or even done abroad.  In most high volume centers in not so near hospital centers the head surgeon cannot be part all the steps of the surgery as it is not possible in a when large number of cases are to be done in a single day,  to be present physically in most of the surgery and some steps are usually performed by a trainee surgeons or junior surgeons  while the heads surgeons hops around in different operation theaters to complete the implantation of implant and may sometimes miss the preparation of the bone before implantation and the final closure of the surgery which is as important as the initial surgical steps. Also most important aspect which I have seen in patients travelling 3-6 hours to meet their surgeons is they can’t  have regular and early follow up of their improvement  or loss of it, rather most patients then depend on the physiotherapists since its not always possible to get a follow up too early when you have spent half of your day for a 5 min precious inspection  with your surgeon. I have seen a few cases gone wrong in a adequately done joint replacement surgery done outside city because of lack of proper timely follow up.  I would encourage patients wanting joint replacement surgeries to choose a local able surgeon in a able centre who is emphatic , well known to you,  careful of your needs and most of all present locally within reach afterwards when you might need him.

 

After discharge daily physiotherapy through my therapist is almost always needed in joint replacement patients for initial few months 

 

This now is actually discouraged by most surgeons as most exercises needed should be and can be done by the patient himself.  All exercises are very uncomplicated and already taught and learnt through help of hospital physiotherapist  who has shared the plan of exercise schedule for each patient with the operating doctor.  Therapy and exercises through a physiotherapist  at home not aware about the restrictions in activity and the plan of rehabilitation according to the surgeon who did the surgery may lead to incomplete goal achievement after the surgery. But sometimes a physiotherapy help is advised afterwards in rare cases where the patients are not motivated enough and when there are certain problems which are expected  in complicated cases.