Tuesday, January 17, 2006

Partial Knee replacement/ reconstruction in India

Unicondylar or Partial Knee replacement in Chennai
Many middle aged men and women develop osteoarthritis of the knee. In Indians Osteoarthritis of the knee affects the inner half or medial compartment to start with. Localized attrition occurs in the beginning. Later on it gradually affects the front and inner portion of the inner half of the knee. This is obvious on standing x rays as a pit or depression.
The standard permanent surgical treatment for osteoarthritis knee has been a total knee replacement. However the ideal candidate for a TKR is a person beyond 65 years, when he can live out the life of an artificial joint which is about 15 years. Says Dr.A.K.Venkatachalam, Knee surgeon of India,
Clearly someone in their fifties is not suited for a TKR as his/her life span would exceed that of the joint and he would need a revision knee replacement later on.
Surgical alternatives include an osteotomy and a Uni condylar knee replacement. In an osteotomy, the thigh or leg bone is divided and re aligned so that the abnormal weight bearing axis is normalized. Pain relief is provided for a period of up to 10 years but is not total. It is suited for manual laborers whose work demands would wear out an artificial joint.
A unicondylar knee replacement substitutes the inner worn half of the joint with prosthesis. The bony resection is restricted to the affected half alone sparing the outer half and the patella unlike a total knee replacement. The operation can be done by a minimally invasive technique sparing the quadriceps muscle. The pre requisites are that the inner half alone must be worn as seen on x- rays and the anterior cruciate ligament should be intact. Shorter hospital stay, quicker recovery, small incisions, no blood transfusion, less pain, less cost (vs. TKR) and better function (squatting, kneeling, climbing stairs) are the much acclaimed benefits. The knee feels more natural as sensations carried by the ligaments are intact.
The Oxford unicompartmental knee is a mobile bearing uniknee. Survivorship analysis is 98% at 15 years. The wear of the mobile polyethylene insert is minimal.
In India,
The first bilateral Oxford knee replacements at Chennai's Knee replacement centre were performed recently for a British marine consultant from Sussex,
Mr.Cliff Arkley at Venkataeswara hospital, Chennai by Dr.A.K.Venkatachalam, Consultant orthopaedic surgeon. The procedure was performed through small incisions about 3 inches long( see photo)(minimally invasive surgery)(MIS). A Knee cap replacement operation in India only costs one third of that in the UK.