A 60-year-old woman, Rajesh Devi, who came in crawling has gone out walking, after a complex knee replacement at Paras Hospitals, Gurgaon. A deformity-correcting Knee Replacement procedure has given her a new lease of life. The woman, with severe neglected osteoarthritis and osteoporosis, and permanently deformed knees, had been bed-ridden for the past one and a half years. The procedure marks a major success, as cases of flexion deformity of more than 100-110 degrees achieving a successful outcome have been rarely reported. After having been refused surgical intervention by a few hospitals, she finally reached the Joint Replacement Centre at Paras Hospitals, Gurgaon. A detailed examination revealed that the wheel chair bound lady from the village of Kheri Hosdarpur, Jhajjar (Haryana) had a severe case of advanced osteoarthritis and severe osteoporosis. The procedure performed on Ms Devi is high risk on many counts. However, relying on their own experience of handling severe deformities, Dr Vivek Logani, Chief of Joint Replacement Surgery at Paras Hospitals, Gurgaon, and Dr Deepak Thakur, Consultant, Joint Replacement decided to take up her case. “It was not a simple case of arthritic or injured knees needing joint replacement. The case was much more complex and challenging, as the flexion deformity was over 100 degrees - meaning that the patient’s knee was bent at an angle more than 100 degrees (considering straight knee to be zero degree). The woman’s bones had become very weak, since they had not been subjected to weight-bearing loads for a long time. The knees required extensive soft tissue releases at the back, and also meticulous balancing of the ligaments, to correct the deformity,” said Dr Logani. The surgery was undertaken using the latest computer navigation system, to ensure accurate alignment of the artificial implants and balancing of the knee-joints. Special knee implants with stems were used, to get a better hold of the soft bones. In a procedure that lasted five hours, the surgeons worked meticulously to perform soft tissue releases and ligament balancing, to accomplish one of the most complex Knee Replacement procedure - on both the knees. The procedure turned out to be encouragingly successful, with 80-90% of the deformity having been corrected during the operation; further correction is planned during the post-operative rehabilitation. “Such cases need meticulous surgical technique and planning. The patient started doing exercises the day after the surgery and started walking on the second day. Her muscle strengthening is progressing, and on the fifth post-operative day she was walking comfortably. Both her knees were straight, free of pain and deformity, and were bearing the full weight of her body,” said Dr Logani. Unfortunately, in India, a large section of the population fails to receive treatment for arthritic disability and ends up remaining unattended - owing either to its ignorance or a fear of being operated on. “Osteoarthritis may be age-related but it is not untreatable. A gross lack of awareness and poor accessibility, particularly in rural areas, are the factors responsible for a large number of people failing to receive any treatment and ending up disabled for life,” added Dr Logani. For Rajesh Devi, who had all but given up hope of walking again, it was like being born again. Being able to stand on her feet and walking after one and a half years of debilitating disability was nothing less than a miracle for her. “After spending months bound to a bed, I had almost given up hope of recovery - more so when several hospitals refused to take up my case, considering it virtually untreatable. I am extremely grateful to the doctors of Paras Hospitals for enabling me to regain not just my mobility but also my independence and dignity,” said Rajesh Devi.
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