Results of unicondylar knee arthroplasty in Indian rural population. Should UKA be the first choice in surgical treatment for osteoarthritis in India?
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 17, Issue 2
Abstract
Background: The Rural population makes 90 percent of India. Previously their access to modern methods of surgical treatment was limited. Now with wider skill set and training in rural surgeons, total knee arthroplasty has become a regular feature of treatment in rural population, although patterns of osteoarthritis in India mainly involve the medial compartment. It is pertinent to note that total knee arthroplasty has longer rehabilitation, morbidity, and costs.This may make it unaffordable to most Indians from rural population. Total knee arthroplasty of course remains the only choice in severe & tricompartmental arthritis. We decided to investigate the possibility of using Unicondylar knee replacement for treatment of medial compartmental osteoarthritis in a tertiary care rural medical setup in western Maharashtra. Methods: 41 patients were evaluated by our protocol at a mean of 11.5 month (1-2 year) following Unicondylar Knee Arthroplasty for medial joint OA. The mean age was 62.53(Range 55 to 69 year). All of these 41 patients with 61 operated knees were available for analysis using Oxford knee score questionnaire, VAS Score & a specific questionnaire for post operative compliance with rural lifestyle with questions not included in Oxford score. Results: Postoperatively, we found functional outcome after UKA was extremely satisfactory for all patients in our study group measured with Oxford score and VAS score. There is improvement in from mean of 16.92 to 43.17 in Oxford score and for VAS score there is reduction from mean of 8.52 to 1.56. In addition, in our questionnaire we noted the ability to perform specific rural oriented tasks i.e. squatting, praying in cross-legged position, doing agricultural work, animal tending tasks which is not measured by standard western scoring systems. Patients reported high satisfaction levels in ability to perform above a high flexion activities. About 82 percent resumed complete prior routine & work schedule including sitting cross legged & animal & farm tending. Conclusion: Patients satisfaction following UKA for pain relief, early return of physical activity, able to sit cross leg and squat is excellent.The routine practice of recommending total knee arthroplasty should be questioned in light of better comfort, earlier & more complete return to pre morbid activity & more compliant recovery with Indian rural lifestyle. Level of evidence: 3
Authors and Affiliations
Pavankumar kohli, Pawan Rajurkar2, Ankush Nawale3, Murlidhar Warunjikar, Sunil Nadkarni5
Keywords
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