Is it risky to get a knee replacement in the midst of Covid-19?

Chronic pain in multiple joints reportedly affects 1 in 4 adults over the age of 18 and by the time we get to age 65, about 2 in 5 adults are affected. Chronic aches, swelling and pinching or sharp shooting pain in the knee or hip are some of the issues when you face joint problems which is affected mostly due to some sports injury, accident or just degenerative osteoarthritis.

These symptoms not only give you sleepless nights but also restrict your ability to do things you would normally do but many patients in need of joint replacement surgery are postponing their procedures because of pandemic-related concerns. In an interview with HT Lifestyle, Dr Shubhang Aggarwal, Orthopaedic and Robotic Joint Replacement Surgeon and Director at NHS Hospital in Jalandhar, shared, “It’s a common health condition in middle to old aged people but these days younger adults are also affected by joint problems and it’s mostly due to some sports injury, accident or just degenerative osteoarthritis. Experts suggest that in order to tackle such joint pains a person should take adequate rest with anti-inflammatory medications.”

He added, “If the condition still persists then one should consult a doctor and explore the possibilities of cartilage preservation surgery otherwise they will have to go for joint replacement surgery.” Dr Biren Nadkarni, Senior Consultant Orthopedic and Joint Replacement Surgeon at Sitaram Bhartia Institute and Holy Family Hospital in New Delhi, highlighted, “Covid-19 pandemic has changed everyone’s mindset around. There is no doubt that fear of such a dreaded infection has scared everyone to think with a sense of security to come out openly and of course they think 10 times to undergo any planned surgical procedure like knee or hip replacement.”

Though many patients who suffer from chronic debilitating hip and knee pain have been very confused and stressed about proceeding with surgery, not knowing if they can, and not knowing what their options are, the reality is that, even without the stress of a pandemic, people often wait far too long to consider a more permanent solution to their severe or persistent joint pain — joint replacement.

Dr Biren Nadkarni said, “By the time people get to a conversation about joint replacement, they have pain on a daily basis and it’s occupying a disproportionate part of their lives. It’s the kind of pain that leads them to become less active, whether athletically or socially and many people get to the point where the pain becomes such a big part of their lives they become unhappy. While many people would rate their joint pain as difficult and debilitating, they often view surgery as a last-resort treatment. Do not let fears of joint surgery or coronavirus keep you from doing something about your joint pain.”

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Spilling the beans on important things to know if you experience chronic joint pain, Dr Shubhang Aggarwal and Dr Biren Nadkarni answered some common questions:

When to consider surgery?

When you work, sleep, walk or even sit for a longer period of time and your hip or knee pain continues to affect you, and you feel that you are getting dependent on other people to carry out your activity of daily living, or if you feel that you are trying to change your lifestyle to become less active in order to avoid pain, then you should opt for a surgical procedure such as total joint replacement. Surgical procedure is suggested only when non-surgical treatments including medications and physiotherapy do not provide any relief from your pain and improve the quality of life. Knee and hip replacement surgery is now a technically demanding, precise but extremely successful surgery and it has become a very common scenario to have a knee replacement surgery.

Through total joint replacement surgery, surface of an arthritic or damaged joint are removed and resurfaced or replaced with a metal, plastic, or ceramic device called a prosthesis. These prostheses are designed in such a way to replicate the movement of a healthy joint. This procedure is mostly used to replace hip and knee but now it can be performed on other joints including wrist, ankle, elbow and shoulder.

Since the advent of robotics, and availability of excellent quality long-lasting implants, trying to placement surgery is no longer an age-related surgical procedure, anybody can opt for it to improve the quality of life. This procedure is a must for those who have bone-on-bone osteoarthritis of the hip or knee. In any good centre across the world, the two main complications of joint replacement surgery or deep vein thrombosis and infection. The rate of infection is usually less than 0.5% and with better infrastructure and operation theatres using laminar airflow is to filter and provide bacteria free air in the operation theatre, the rate has been maintained low. To prevent deep vein thrombosis, early mobilisation and use of blood thinners post operatively have gone a long way to protect patient from these.

Consequences of delaying Joint Replacement Surgery:

Patients are suffering, not only in their mobility and comfort but in their general health too. The vast majority of the time, these patients will rehab and return to their pre-decline baseline. Patients who are putting the surgery off due to the fear of coronavirus will get to the point where their rehab becomes difficult or impossible to do. If you get debilitated to the point that you can’t do that rehab, then the recovery is going to be tough.

Joint pain due to underlying degenerative or inflammatory arthritis is usually managed non-operatively initially. A stage comes when these modalities don’t work any longer and patients tend to become bedridden and analgesic dependent. Uncontrolled pain, which is the most important reason for undergoing joint replacement surgery, can cause sleep disturbance, depression, state of hopelessness. These patients opt for joint replacement surgery so that they can get their “life back” and be “independently mobile”.

Recovery:

Surgical technique and technology improvements have reduced recovery time, making joint replacement surgery more efficient, predictable and less painful. This means people not only regain function more rapidly after surgery, but data also shows that patients usually return to their jobs within six weeks.

Doctors now, are better at controlling patient’s pain before, during and after surgery with new medications and using older medications a bit differently, depending on the patient’s needs. With robotic surgery and aggressive rehabilitation protocols being followed in certain centres of the country, you will be made to stand up and walk three hours after your surgery. The more you exercise the better you will feel.

Exercise as suggested by the doctor and guided through a physiotherapist, if done properly becomes the most integral part of the recovery process. Your physiotherapist will guide you with specific exercises that will help in restoring movement and strengthening of the joint. Sometimes, there is a temporary pain in the replaced joint because of the surrounding muscles and tissues. This generally gets over in a week or so.

Is it safe to get the joint replacement surgery at this time?

The answer is, yes. We know that any patient who needs joint replacement has psychological pressure of being exposed to Covid19. Hospitals have gone to great lengths to make elective surgeries very safe in the inpatient setting. Hospitals are completely following CDC guidelines and keeping surgical patients on separate floors from Covid patients because there is very strict smart protocol in hospitals for safety measures with current norms and there is complete segregation of non-Covid and Covid patients, wards and operation theatres.

We take all necessary precautions to take care of patients and all healthcare workers in the hospital. We assure all our patients along with their family members that till today in this pandemic we have operated on many patients with all safety measures and none of them became positive for Covid.

If you’re considering a joint replacement, know that hospitals and clinics are safe and taking extra precautions like eequiring all patients, visitors and employees to wear masks, screening patients and employees upon arrival, isolating Covid-19 patients from other patients, allowing us to treat everyone safely, practicing social distancing in our waiting rooms, utilizing video visits to reduce patient traffic, increasing housekeeping and vigilance in our disinfection protocols and testing every patient for Covid-19 prior to surgery.

The new coronavirus is going to be with us for some time and your doctor can help you understand if a joint replacement is right for you, as well as discuss any fears or concerns you may have about the procedure or timing. Knee and Hip Replacement surgeries are being performed with at most care and safety to all concerns.