HIGH FLEX KNEE PROSTHESIS ALLOWS NATURAL FUNCTION
High flex Knee replacment in India ,
A welcome boon for South Indians with Knee osteoarthritis
Osteoarthritis of knees affects predominantly the senior citizen
age group. Total knee replacement is a permanent solution to the
aged suffering to provide permanent pain relief. The elderly
become pain free and the quality of life improves. However there
has been a universal feeling amongst south Indians that the
majority of implants available in India and Chennai do not allow
more than 100 degrees of knee bending. The patients say that
they are unable to squat on the floor or climb stairs easily
with the operated leg going up first and have to drag it behind
the good one. Even computer assisted surgery cannot achieve
these unless the prosthesis is designed to provide this extra
bend. They may have difficulty in climbing stairs, using Indian
toilet and squatting on the floor. This is a great disadvantage
to majority of South Indians who prefer to squat on the floor
for prayer, social activities and meals. So, many people refrain
from undergoing the surgery and suffer in silence. Now with the
advent of a new type of prosthesis, patients in South India
undergoing a knee replacement need not be functionally impaired.
A new design of prosthesis allows knee bending up to 155
degrees. The patient has to be motivated to regain high knee
flexion and participate in early and aggressive physiotherapy.
They should not be obese and the pre operative knee bend should
be above 90 degrees. This prosthesis is implanted by special
instrumentation which is minimally invasive and does not damage
the tissues. Hence post operative pain is less and
rehabilitation is faster. This prosthesis is different to the
many claims of rotating platform prosthesis. Preoperative
considerations for a High flexion knee replacement- Not all
patients can get a high degree of flexion after a knee
replacement. To qualify for this procedure, the patients must
not be obese, have a thigh calf index of > 90 degrees and should
be motivated to participate in physiotherapy in the early days
after surgery, bearing post op pain. The wound is likely to weep
slightly more as it would be subject to stretching. Cycling is
an activity that promotes the building of hamstrings and
quadriceps.
High flexion knee prosthesis- Special knee implants are now
available which provide more flexion or bending at the knee to
suit Indian, and South Asian habits of kneeling for prayer, or
sitting cross legged on the ground for meals or social purposes.
Muslims in particular need this to offer prayers. Japanese
customs also require high knee flexion. Even westerners have
begun to appreciate the benefits of high flexion knee prosthesis
as they can pursue hobbies like gardening and are also gratified
for the ability to do recreational activities. The prosthesis
used allows high flexion from 130 degrees to 155 degrees.
Rotating platform prosthesis alone does not allow high flexion
as claimed by many centers. These centers are monopolizing a
particular brand which does not allow high flexion.
Minimally invasive technique
Traditionally knee replacements have been done through incisions
in the skin about 14- 20 cm long. Special instrumentation allows
the operation to be performed through a modified new surgical
approach without dividing the thigh muscles (Quadriceps). By
down sizing the incision to 9 cm (3 inches), the amount of
postoperative pain is less, hospital stay is shorter (5 days)
and return to function is faster. As post op pain is less the
patient will cooperate with the physiotherapist to do the
required exercises regularly.
Recent advances in knee replacement have occurred in the lat one
year driven by higher patient expectations. The introduction of
the High flex prosthesis in the market will spur many more
people who have suffered in the last decade from knee arthritis
to undergo a Total Knee replacement in Chennai.
The author is a knee surgeon in Chennai and has performed the
first High flexion knee replacement with the Nex gen prosthesis
from Zimmer.
The author is a consultant Knee surgeon in Chennai's
Venkataeswara and Kamakshi hospitals. He can be contacted on
mobile 9282165002 o r email at akvenkat@gmail.com