Knee osteoarthritis…can be changed
Paolo Hospital Phaholyothin
For how many years have we heard our mother complain about having knee pain? Though taking painkillers or applying medicine, the knee pain will return sporadically, especially while walking or sitting with the knees bent for a long time. Knee osteoarthritis is a disease that most elderly people cannot get away from. The symptoms may be serious or minor, or they may come on slowly or quickly, depending on the usage of our knee joints since youth. However, when knee osteoarthritis occurs, daily life will not be as convenient or quick moving as before.
The symptoms of knee osteoarthritis comes from the deterioration of the articular surface, which causes the joint to rub against each other while bending the knee and leads to pain and suffering. If receiving treatment early on, like using medication to nourish the articular surface, receiving artificial synovial fluid injection, or cleaning the joint for smoother surface, people of old age can prolong the useful life of the knee joint for a long time. However, if not receiving the treatment and leaving it until the knee osteoarthritis becomes severe and painful, the elderly may not want to walk because they cannot endure the pain. To completely treat severe knee osteoarthritis, total knee replacement might be needed.
Total knee replacement is a treatment for severe knee osteoarthritis by removing the deteriorated articular surface and replacing it with an artificial surface. It is an alternative surgery that provides a good result, satisfaction, and worthwhile to increase the quality of life of the patient and help patients with “knee osteoarthritis” to heal the pain. The legs will become straight. The patient will walk better, heal a bent knee, and will be able to bend the knee better. Moreover, the patient will be able to live their daily life with no limitations. Most importantly, this artificial knee joint can be used for a lifetime without the need for revision surgery.
The components of artificial joint consist of 3 main parts, which are:
• Femoral component is made from cobalt-chrome alloy, which is the most suitable metal for making the articular surface. Its properties are hard and shiny. It is does not easily rust or erode, and does not cause electric charge or carcinogens. It looks like a cap with appearance like the articular surface. When inserting, the appearance looks like the articular surface of the normal femoral.
• Tibial component is a metal key that is made from titanium alloy, which is the most suitable metal that acts as a medium in transferring the weight from the artificial joint to the bone because its hardness is similar to the human bone. It does not rust, cause electric charge or carcinogens. It is a key that is placed on the bone with a spur that looks like a foundation pile that stretches into the tibial cavity.
• Polyethylene tibial insert is an ultrahigh molecular weight polyethylene with very hard texture that is used in medicine only. It has the highest purity of the polymers. It is used as the surface of the joint, which acts as the articular surface and disc.

Properties of metal alloy
The metal alloys are of the highest purity for medical use only. It can often be an alloy of many types that depends on the purpose of use, such as artificial surface or key to support the weight. Moreover, the artificial surface withstands scratches and does not easily become deformed. Most importantly, it can safely pass through the electro-magnet x-ray machine. In Thailand, this metal alloy is popularly called the simple name of titanium, which means a lightweight metal that does not rust or cause carcinogens, and is compatible with the human body. Moreover, there are other materials, like ceramic, for those who are allergic to tantalum trabecular metal, which is used in difficult cases.

Currently, total knee replacement
uses Computer Navigator to help with the positioning of the artificial knee joint be more precise. The computer will produce 3-dimensional picture of the knee joint of the patient for the doctor to look at during the surgery. It can also provide thorough information for planning modification of knee joint surface so that the doctor can place the artificial knee joint surface on the knee joint surface of the patient in the best position. According to studies, it was found that total knee replacement by using Computer Navigator provided precise positioning of artificial joint up to 97%, and reduced the complications with smaller surgery wound. The artificial knee joint will have a longer useful life and the balance adjustment of the muscles around the knee joint during the surgery will be more precise, allowing the patient to use the artificial knee joint after the surgery as close to natural.
In order to reduce the fear of having severe pain after the surgery, leading the patient not wanting to walk or do physical therapy as instructed by the doctor, “Adductor Canal Block” will be used to suppress the nerve in the adductor to reduce the level of pain. It can suppress only the feeling of patients after having the total knee replacement. Total knee replacement is a surgery that causes pain in quite a severe level. After the surgery, many patients refuse to take a step for physical therapy. Therefore, effective pain relief will help to reduce any complications and relieve muscle pain without weakening the leg’s muscles. The patient can recover and walk using the walker faster without having to endure the pain. They can lift their knee and walk, which can reduce complications after the surgery, bedridden condition, and the recuperation period in the hospital.
Currently, there is development
in using the ultrasound machine to find the nerve position by the anesthetist before the painkiller will be given. According to research, it was found that Adduct Canal Block can reduce the dosage of painkillers and the pain level while bending the knee. The patients are able to walk more than those who did not use Adductor Canal Block. However, the use of Adductor Canal Block will depend on the suitability of each patient and be under the close supervision of the anesthetist throughout the surgery period.

For more information, please contact Orthopedic Center, Building 4, 1st Floor, Tel. 02-2717000 Ext. 40129-30