Total knee replacement (TKR) is a highly successful surgery rewarding the patient with a pain-free life and improved function when performed rationally. TKR is commonly performed for worn out joints due to arthrosis or late arthritis where the initial disease remained uncontrolled and ate away the joint. Infection is a very uncommon cause of primary damage to the knee joint, but some unfortunate patients may develop knee joint destruction due to infection.
In a marvelous achievement in providing rejuvenated life to knee of patient total knee replacement was done is a patient suffering from tuberculosis (TB) of knee joint causing complete joint destruction. This young patient had knee problem since several years for which diagnosis of anterior cruciate ligament (ACL) tear was made elsewhere and he underwent ACL reconstruction at reputed regional medical college. The patient kept developing recurrent swellings of the knee joint with increasing pain and thinning of thigh muscles. Symptomatic treatment was given to him, and ‘possible infection’ was controlled by repeated courses of long-term antibiotics. This gave him temporary relief for few months, but he went to seek relief and diagnosis at another medical college. On evaluation the patient was found to have tuberculosis of the knee joint, and he consulted various surgeons withing and outside the state for treatment. He was mostly advised medical management and expensive surgical treatment was offered by experts specialising in managing infected joint. It is to note that doing joint replacement in the presence of infection is very complicated affair needing meticulous planning and execution so guarded treatment is commonly offered. When the patient came to seek my opinion at Shri Mata Vaishno Devi Narayana Superspeciality Hospital he was virtually walking like a lame person not able to put his lower limb to floor due to extremely severe pain and deformity. The power in the limb was also less to support comfortable walk due to pain and the muscles were very weak. He was barely able to walk a few meters and rested for long time in between due to aggravated pain and weakness. He was thoroughly evaluated for feasibility of providing pain-free joint that can bear weight and patient can move about as normal as possible. Systematic planning was done, and patient was put to kill the disease process by appropriate regimen for control of tuberculosis, simultaneously the damage to knee joint was assessed. The knee was bent to 30 degrees and rotated outwards for 25 degrees with minimal further movements. These deformities in a knee joint are difficult to reconstruct given the poor status of bones that were also eaten away by the disease. Muscle weakness added to the problem of providing power to the joint if replacement would be done. So, treatment to improve bone quality was simultaneously given along with muscle building program so that recovery after surgery would be optimal and fast. The patient improved marvellously with the medications and graded physiotherapy program along with significant improvement of the bone quality over 6 weeks whence the surgery was planned.
He underwent a knee joint replacement surgery which was carefully done ensuring that the structures supporting the joint were saved during the surgery. The patient was able to walk with the help of a support the next day from the surgery.
He was able to use toilet the next day and became independent to be able to walk without support by 10th day of surgery. Now he is a happy patient walking well comfortably without need of support and muscle strength has greatly improved. This patient epitomised the saying ‘where there is will there is a way’, he persuaded his will to live a pain free functional life. On his first consultation with me when I was explaining him the limited life of knee joint and complications, he said the most important thing that – life is to be lived without limitations else it is a burden, that really encouraged me also to give him the best. His positive attitude and will embraced him with successful independent pain free life. Age is not a bar to treatment especially when it comes to live a happy pain-free life. All his treatment cost got covered under the government run scheme, thanks to the wonderful boon given to public by the largest health care scheme run by the government of India.
Dr. Manish Kumar Varshney
Senior consultant orthopaedic Trauma, Tumor, Spine and Joint Replacement surgeon.
SMVD Narayana super specialty hospital, Kakryal, Katra.
