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High Flexion Knee Replacement Updated 1/20/2010 By Alampallam Venkatachalam Total knee replacement surgery is a permanent solution to the aged patient suffering from Osteoarthritis in India. 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 do not allow more than 100 degrees of knee bending. There is a high degree of dissatisfaction with standard knee replacements. The patients say that they are unable to squat on the floor or climb stairs easily with the operated leg. Even computer assisted surgery cannot achieve deep knee bend 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 a knee replacement 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. Please visit www.kneeindiablogspot.com for videos and photos of patients with unilateral and bilateral High flex knee replacements. Dr. A.K. Venkatachalam |
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