What should decide a knee replacement when rheumatoid arthritis no longer responds to painkillers?
Dr. Mahajan is Chairman Orthopaedics, Joint Replacement & Chief Robotic Joint Replacement at Max Smart Super Speciality Hospital, Saket.
A woman in her fifties, whose work keeps her standing for long hours, had two years of knee pain when she came to Dr Ramneek Mahajan.
What had the pain taken from the patient's daily life?
The patient says her knees had hurt badly for two years when she stood, including when she got up in the morning; her work keeps her standing for long hours. A family member says they kept trying, but the pain did not ease.
Dr Mahajan says the patient could no longer go to the office, use the toilet or do the kitchen work, and painkillers had stopped working. The same family member says the patient's work needs a lot of standing and walking, that her confidence was falling, and that the family felt she needed the operation.
What did the doctor find?
Dr Mahajan says the patient has rheumatoid arthritis, a disease in which the body's own defences attack the joints, and was taking medicines for it. But over four or five years the damage grew until it reached grade 4, the last stage on the scale doctors use, when the smooth surface of the joint has worn through.
Why this operation?
Dr Mahajan says the aim was for the patient to keep living her daily life, and that a woman having surgery at fifty needs what will carry her through the rest of her life.
The patient says that from her X-rays he told her a knee replacement was necessary and, because of her age, suggested the robotic operation, in which the surgeon uses a robotic arm to guide the cuts.
How did the recovery go?
Dr Mahajan describes the patient's recovery at two points:
Within 15 days she was walking, up and down, without a stick or support.
Within a month she was going to the office and working again.
What should a patient with rheumatoid arthritis in the knees ask?
This is one woman's story, not a promise: what an operation can do for you depends on your own case.
Ask what grade your arthritis has reached, and whether medicines or painkillers can still help.
Ask what the first two weeks and the first month after a replacement will look like for someone who stands at work.
What this case teaches
Rheumatoid arthritis is an autoimmune disease: the immune system attacks the lining of the joints by mistake, the NHS explains.
Long-term medicines can relieve the symptoms of rheumatoid arthritis and slow its progress, the NHS says.
Most knee replacements are for osteoarthritis; other types of arthritis are treated with one less often, the NHS says.
