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Why does a joint become painful? What are the consequences of a painful joint ?
A joint is formed by the junction of two bones. The function of a joint is to allow movement. Tissues and muscles around the joint give support to it and help to direct its movements. A joint becomes painful when it gets diseased and degenerates. This can be caused by a number of reasons: old age, injury, infection, rheumatoid arthritis, gout and others. The most common cause is wear and tear because of old age. A diseased joint gets swollen and red. There is pain on movement and weight-bearing with stiffness of joints. There would be difficulty in carrying out day to day activities.
When is it necessary to replace a joint?
The ends of bones are covered with smooth, white, cartilage. This allows free and smooth movement of the joint. When a joint gets diseased, this smooth cartilage is lost. This leads to raw ends of the bones being rubbed against each other.
Rubbing of raw bone ends causes severe pain and restriction of movements. Initially, medicines and exercises help. But, joint damage will progress over time. Pain which occurs at night and disturbs sleep is an indication of serious joint damage which would need surgery. To date, there is no method of regeneration of cartilage. So, the cartilage is replaced with a new, smooth plastic and metal surface (joint replacement surgery).
What is the advantage of joint replacement surgery ?
"'The worn-out cartilage and frayed bone ends are replaced with a smooth metal and plastic surface. So, movements become easier. Pain on movement and weight-bearing goes away. Muscle strength improves and there is less difficulty in carrying out day to day activities. The pain of surgery decreases in two to three weeks time. Thus, surgery improves the quality of life.
What is the longevity of an artificial new joint ?
A new joint normally lasts fifteen to twenty years subject to follow up of exercise and taking care of movements as explained. Newer materials and newer joint designs promise unrestricted activity with ever increasing longevity. The latest plastic materials are expected to last 200 years of activity.
What are the risks and complications of joint replacement surgery ?
Joint replacement surgery is one the most successful surgeries in modern medical history. There are routine risks of surgery just like in any other operation such as allergy of anesthesia drugs, infection, displacement of knee cap, deep vein thrombosis etc.
What are the routine procedures done prior to surgery ?

The doctor examines the patient prior to surgery. X-rays and routine laboratory tests (blood and urine tests) are carried out. Physician examines the patient for fitness for anesthesia and surgery and does an ECG examination Occasionally, patients with other medical illnesses may need more specific tests like 2-D Echo, Pulmonary function tests and specialist (nephrologist, diabetologist, cardiologist or pulmonologist) checkups.
The patient is admitted after all the tests have been cleared on the day before the surgery. The leg is washed and cleaned using antiseptic solutions. Antibiotic Injections are given the night before the surgery. After the operation, injections are given through syringe pumps to make the patient pain free.

How is a joint replacement surgery performed?
An injection is given in the back to anesthetize the legs only. An incision is put on the front of the knee. The damaged cartilage and frayed bone ends are removed. A metal cap is put on the upper part and the lower part is resurfaced with plastic alone or plastic and metal. Tissues which were tight are released and deformities of the leg are corrected. As tissues around the leg are released, a long knee brace is applied over the dressings for two to three weeks to protect the knee in the corrected position.
How much time is taken during surgery ?
The surgery normally lasts less than one hour. The time for preparation of surgery is about one to one and half hours. The time for dressings, cleaning up and X-rays after surgery is roughly one hour. So, relatives can expect to see their loved ones back afterthree hours.
After how many days of surgery can I walk ?
Usually, the patient is^made to stand up and walk on the evening of the surgery itself, i.e., day one, with the help of a walker. Occasionally, it may take a day or two depending on patient's medical condition. Exercises are started from the first day itself under the instructions of the physiotherapist. The patients normally go home in their own cars and can climb up and down the stairs by the time of discharge which is usually after four to five days from the day of surgery.
How long do I need to continue medicines after surgery ?
The medicines are usually required for the first two to three weeks. After that, usually medicines for bone strengthening in form of calcium, proteins or vitamins may be continued.
How much time does it take for the swelling of the knee to reduce after surgery ?
It takes around two to three weeks for the major part of the swelling to go down. Some patients do feel some numbness around the knee for some time, which usually recovers by six weeks.
When are stitches removed after surgery? When I can have a bath?
Stitches are usually removed after three weeks. Patients can take a bath much earlier after using waterproof dressings from the third day of surgery.
What care should be taken after surgery?

For the initial two to three weeks, medicines should be taken as prescribed and the exercise program followed religiously. Most patients do not need a visiting physiotherapist but exercising at home must be continued. Walker should be used for the first one to two weeks followed by a stick for another one to two weeks. The patient should not sit cross legged or squat or run speedily for the first three weeks.

Until full movements are regained and unless recommended otherwise, they should use western style toilet. Aged patients do get salt depleted (hyponatremia) after surgery, so high salt intake is recommended under physician's guidance. Good diet is the key to early retu rn to good health.

Are only old age patients eligible for this surgery ?
Normally joint replacement is required for patients above the age of 60 years. But with newer joint materials and joint designs, surgeries can be safely done for younger patients who have severe pain because of extensive joint damage or deterioration.
Is Physiotherapy absolutely necessary ? Is physiotherapy painful?
Some tissues of the body need to be reminded that they are meant for movement. Some tissues can very easily remember that they are meant for movement. Swami Vivekananda was blessed with such an intellect that he could remember all the pages of a book just by turning them once. Some students need to keep on revising many times before they can remember. So, the need for keeping tuitions (physiotherapist) can vary from patient to patient. Similarly, the need for exercising can vary from patient to patient. But, in general, a physiotherapist is helpful in ensuring that exercises are done regularly by usually the eldest member of the family. These physiotherapy sessions are not very painful.
Information about post-operative exercises:

Ankle muscles : Keep leg straight and try to bend the ankle towards you and away from you as shown in the picture.
Thigh muscles : Stretch the thigh, press the back part of the knee to bed for 5 seconds.
Hips : Press the hips and raise the waist for 5 seconds These exercises should be done 2 to 5 times in an hour as per the guidance of the physiotherapist.

What are the differences in joints available ?
Among the imported joints, there are different joints available like all poly, high flexion and rotating joints. The life of all these joints is the same. All these joints allow tor sitting on tte bed. For sitting on the ground and to ease physiotherapy, high flexion or rotating joints are available. The cost benefit ratio for just the ease of physiotherapy may not be in favor of all patients and should be thought out well by all patients and their relatives.
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