Knee-d to Know Basis

All about total knee replacement therapy
Among those who’ve put Hyderabad on the map is Dr. Gurava Reddy, an orthopaedic surgeon who specialises in joint replacement. He performs around 3,000 knee and hip replacements every year, the second most by any doctor in Asia.
Dr. Reddy holds a triple FRCS from London, Edinburgh and Glasgow. An examiner for MRCS/FRCS for the Royal College of Surgeons (UK), he is also the founder and managing director of Sunshine Hospitals, a 350-bed facility. Dr. Reddy serves as chairman of the hospital’s orthopaedic and joint replacement department. With 20 consultants, it is the largest group orthopaedics practice in South India.
This week, You & I sat down with Dr. Reddy for a crash course in joint replacement. Here’s what you knee-d to know!
Which joints are most likely to require replacement?
I replace any joint in the body that moves and gets worn out. Knee arthritis is the most common in India, followed by that of the hip. As a result, knee and hip replacements outnumber all others in my practice.

Is joint replacement the answer for every patient suffering from knee pain?
No, certainly not. Arthritis of the knee is described in four stages, according to the extent of damage. Knee replacement is indicated only in the late third and fourth stages. The first two can be managed by drugs and physical therapy.
What are the main causes of arthritis in the knee?
Age is the primary cause. As you grow older, knee cartilage becomes thinner, and arthritis sets in. Weight is another major contributor, as is overloading the knee joints (squatting, climbing stairs). Sometimes, fractures extending into the joint can also lead to premature arthritis. Osteoarthritis is neither familial nor congenital.
What are the signs? Which age group is most at risk?
Signs include knee pain and stiffness (especially in the morning), struggling with pain while climbing stairs, swelling of the knees, and creaking sounds in the joints. Knee pain after the age of 40 can be considered arthritis pain unless proven otherwise. Nowadays, even younger patients, especially women, present with stage IV arthritis.
How successful is total knee replacement surgery?
Total knee replacement (TKR) is one of the most successful surgeries in the medical field, with an approximate 98% success rate with the proper setup. An artificial knee made of cobalt, chrome, and high-density polyethylene can last for an average of 15 years with new developments in bio-materials, pain control, and rehabilitation. These have opened new avenues in the field of joint replacement surgery. The day is not far when you can have a joint replaced to last a lifetime.
Dr. Gurava Reddy, an orthopaedic surgeon who specialises in joint replacement
After TKR, can the patient do everything he used to? Are there restrictions, temporary or otherwise?
Provided one  regularly exercises the quadriceps, every activity can be pursued with earnest. In the West, post-TKR patients play golf, ski and garden.
But is this therapy successful for everyone?
No, not at all! TKR is, without doubt, very rewarding. However, there are bound to be some complications. Infection is the mother of them all, but it is as rare as 1% in good hospitals.
TKR can be done in any age group. The youngest patient I’ve operated on was 20 years old, and the oldest was 95. Patients who are immunocompromised, who suffer from Parkinson’s, or who are severely osteoporotic are less-than-ideal candidates.
Overall, TKR is an excellent surgery, giving a new lease on life to millions of patients. However, as with any surgical procedure, the right place, the right surgeon, and the right patient make all the difference.    

..... as told to Anahita