Avoid/Delay Knee Replacement


Proximal Fibular Osteotomy(PFO) – New Treatment Technique for Osteoarthritis(OA) Knee.

PFO is a new procedure to deal knee pain bypassing the knee replacement and delays osteoarthric changes of knee due to aging so delays the knee replacement. This technique is popularized by Dr. L. Prakash of Chennai.

  • Technique details: Human leg has two long bones i.e. Tibia (main bone) and Fibula. Tibia is the main load bearing bone and fibula has very little role in functioning of leg. In routine orthopedic surgeons take some portion of fibula and use it for bone grafting. This removal does not make any difference to leg functioning. So in this procedure surgeon removes 1-2 cm of fibula.
  • Indications:

Knee pain.

Single compartment disease.

Age more than 45 yrs.

  • Complication:

No major complication. No blood loss.

In some cases temporary foot weakness for few days.

  • Special features:

Simple daycare, Can walk on same day.

No prolonged bed rest.

No need of walking aid.

Fit for medically unfit patients.

Low cost.

Natural knee preserved, No implant.

No chance of complication like infection of knee, implant reaction, loosening of implant etc.

  • Prognosis:

Literature says it can give relief upto 10 yrs.

  • Message:

It is a very safe, low cost, effective procedure to get rid off knee pain. There is nothing to loose, patient will get total to some relief, if it does not work there is a choice of TKR in the last which a massive surgery with major complications. We suggest you to consider this procedure before indulgding in TKR.


Why to sacrifice knee for knee pain? When alternative treatments are available.

Knee joint is a weight bearing joint so degenerative changes starts early usually after the age of 40 yrs. Degenerative changes(Osteoarthritis) goes on increasing fast or slow with age depending on the factors like genetics, hereditary, previous injury, obeseness etc. and these changes leads to knee pain, deformity of knee etc. as OA changes grow knee pain also grows and person feels handicapped. This knee pain is the main indication for total or partial knee replacement surgery. But now a days medical research is focused on to stop/delay progression of pathology which leads to stop the sacrifice of natural knee by massive total or partial knee replacement. There are treatment modalities i.e. nonoperative or minor/less traumatic surgical procedures those are helpful to give relief from knee pain. These are:

1.Life style:

Do knee exercises, cycling.

Maintain body weight.

Avoid squatting.

Avoid jumping movements.

Good heathy diet.

2.Medication and suppliments:

Knee protective(chondroprotective drugs) like Glucosamine, Dycerin etc

Platelet rich plasma (PRP) injections:

PRP injections are derived from a sample of the patient’s own blood.PRP injections attempt to take advantage of the blood’s natural healing properties to repair damaged cartilage, tendons, ligaments, muscles, or even bone.


Hyaluronic acid supplements:

Hyaluronic acid injection is used to treat knee pain by increasing joint fluid. Hyaluronic acid is similar to a substance that occurs naturally in the joints.

3.High Tibial Osteotomy.

Surgical procedure to correct the alignment the knee but requires long bed rest for three months.

4.Daycare surgical procedure for Osteoarthritis Knee – Most recently used technique



"The Silent Thief" Osteoporosis.

Osteoporosis is a common metabolic bone disorder characterized by the progressive loss of bone mass density. It predominantly affects the thoracic and thoracolumbar regions of the spine and is a serious contributing factor to hip and wrist fractures that occur from falling. Osteoporosis causes bones to become weak, fragile and susceptible to fracture. This can cause loss of height, stooped posture, humpback (kyphosis), and severe pain that can be debilitating. Although osteoporosis is more common in women, men are at risk too. The National Osteoporosis Foundation recently reported that osteoporosis is responsible for approximately 700,000 vertebral fractures each year!

Common Risk Factors:

Knowing the risk factors can help you prevent or control osteoporosis.

Factors You Cannot Control

Risk Factors You Can Control


-Low calcium diet

-Asian background

-High caffeine use

-Fair complexion with blue eyes


-Thin petite body build

-Excessive alcohol consumption

-Family history of osteoporosis

-Chronic Dieting

-Early menopause

-Estrogen deficiency

-Lactose intolerance

-Sedentary lifestyle

FAQ about Total Knee Replacement.

What is TKR?
It is the replacement of normal knee joint by artificial joint made up of stainless steel alloy called cobalt chrome alloy and plastic called ultra high molecular weight high density polyethylene. Steel part covers the bone ends of joint and polyethylene insert remains in between the two steel ends.

When it is necessary?
Most common indication of TKR is pain which is not relieved with non operative methods like medicine, intra- articular injections, braces, physiotherapy etc

At what age can joint replacement be done? Can it be done for children?
Joint replacement is commonly done for patients above the age of 60 years. It may be done between ages of 40 and 60. It is occasionally done between ages of 20 and 40. It is never done in children.

What is that condition which leads to TKR?
Most common is age related degeneration of knee joint i.e. osteoarthritis, rheumatoid arthritis, tumor related joint disease etc

How these diseases affect the joint?
Every disease has its own way to destroy the joint by destroying the cartilage i.e. tissue layer which smoothens the bone ends to make joint frictionless , decreasing the joint lubrication by decreasing the synovial fluid, decrease in joint space, inflammation & swelling, extra bone formation, muscle weakness, decrease in range of motion, deformity of knee, and leading to painful gait, limp, life confined to bed.

How one can avoid destruction of joint?
Age related degeneration comes with growing age as other diseases like cataract, graying of hair, tooth decaying etc. but one can keep the joint healthy by doing regular exercises for knee, avoiding squatting and overweight.
Other conditions with specific pathology should be treated accordingly by doctors.

Is there any alternative to TKR?
Yes, before going for the TKR one can try medicines like analgesics to decrease pain, chondroprotective drugs for regeneration of cartilage which is the important tissue of joint, steroid intra- articular injections to reduce inflammation, injections to increase lubrication of joint, braces etc. All these measures can delay the TKR, but ultimately TKR is the choice.

Is there any operation which can replace the TKR?
No, there is no alternative operation to TKR till date but there is a variant of this known as unicondylar knee replacement i.e. half knee replacement, is being done in some selected conditions.
One procedure is there known as high tibial osteotomy, which is advised in early stages of osteoarthritis to correct the alignment of knee. With this operation knee load distribution becomes equal and leads to pain free knee movement. This is recommended in selected cases, but ultimately lands with TKR.

What is the average time taken for joint replacement surgery?
The average time taken for joint replacement surgery is 1-1.1/2 hrs.

How much is the hospital stay after TKR?
It varies with the condition of the patient, normally it is 7-14 days.

What is the role of physiotherapy and exercises after joint replacement?
Physiotherapy exercises called CPM - Continuous Passive Motion machine start within 1-2 days after joint replacement, while walking is started 2-3 days after joint replacement with full weight bearing, as tolerated.

How many days patient takes to get out of bed and walk?
Usually after 3 days patient starts walking with walker but it depends on the condition of patient./

For how many years it works?
About 20 years is the life of TKR.

Can a person with diabetes, high blood pressure, or heart trouble undergo joint replacement?
Even a person with diabetes, high blood pressure, cardiac disorders can undergo joint replacement surgery under medical supervision. The diabetes or BP must be under control.

Is there any risk to life during this operation?
TKR is like other operation so no added risk is involved in this operation. But generally this is done in elderly age group those are having other diseases like diabetes, heart disease, hypertension, asthma etc. so one should be confident that his hospital is fully equipped to tackle these added risks.

After the knee replacement will the patient be able to squat?
It is difficulty to do the traditional squatting. However, one can sit cross legged for a special occasions and can also sit in the sideways sitting position of the ground avoiding full bending at knee using support below knee.

What are the precautions to be used after joint replacement?
It is advisable to use a bedside commode for 3 to 4 weeks and a English toilet after that, Avoid sitting on floor, jogging, running and fast sports after joint replacement surgery. Moderate speed walking, climbing stairs and swimming are permitted

Does one need plaster of Paris cast after surgery?
No, your knee is free, a brace is used for few days for comfort and support and, usually hinged knee cap is used for walking for a few weeks

How far can one walk after a Joint Replacement?
One can walk as many kilometers as general health will allow. Some patients can walk even 8 K.M at one stretch. But generally one can walk for 2-5 K.M without any problem
So go for new treatment modalities and live with pain free knee.
For further queries contact ORTHOMAX, bone & joint center.