Patient Background

A 64-year-old retired school teacher came to Vyom Ortho Care Clinic in Akshayanagar, Bangalore, on a wheelchair, unable to walk and experiencing severe pain in her right knee. She had a history of recurrent patellar dislocation since childhood, for which she had been operated on for patellar instability in her younger years. Despite the surgery, she continued to experience dislocations and significant discomfort. Additionally, she had an ankle deformity resulting from an ankle fracture 10 years ago.

Over the years, her condition had worsened, leading to a complete inability to walk without assistance.

Symptoms

• Severe pain in the right knee, which was persistent and worsened over time.
• Inability to walk or perform daily activities without assistance.
• Recurrent patellar dislocations despite previous surgery.
• Instability in the knee and difficulty maintaining proper joint function.

Diagnostic Method

An X-ray of the right knee revealed the following:

• Severe osteoarthritis with significant joint degeneration.
• Valgus deformity of the knee, indicating the knee joint was severely misaligned.
• The X-ray also confirmed patellar instability and complications from the previous surgery

These findings aligned with the patient’s history of recurrent patellar dislocations and contributed to the ongoing knee dysfunction.

Disease Diagnosed

• Severe osteoarthritis with valgus deformity, leading to the complete wear-and-tear of the knee joint.
• Patellar instability resulting in frequent dislocations, contributing to chronic knee pain and immobility.
• Secondary ankle deformity, which had compounded the patient’s mobility issues.

Treatment Plan

Challenges:

• Short stature (140 cm): Conventional knee jigs were too large for the patient’s anatomical structure.
• Previous surgical scar from prior knee surgeries, which made accessing the knee joint more complicated.
• Patellar instability: The challenge of maintaining proper patellar tracking during the procedure
• Severe valgus deformity: The knee joint was severely misaligned, leading to ligament laxity and instability.
• Secondary ankle deformity: This complication further affected the patient’s ability to walk and affected knee mechanics.

Plan:

Dr. Veeresh Patage, a renowned orthopedic surgeon in Akshayanagar, Bangalore, designed a comprehensive approach for the surgery:

• Lateral parapatellar approach to access the knee, improving patellar tracking and managing the valgus deformity.
• Semi-constrained knee replacement with the option of a constrained (hinge) knee as a backup to accommodate the severe joint instability and deformity.

This treatment plan was tailored to the patient’s unique anatomy and previous surgical history to ensure the best possible outcome.

Surgery

As planned, the patient underwent Total knee replacement surgery with a semiconstrained knee implant and a lateral Parapatellar approach. Patella tracked well after surgery. The knee was stable throughout the range of motion. Patient tolerated the surgery well.

Post-Surgery Guidelines

• The patient was mobilized the next day using a walker to begin the rehabilitation process immediately
• She was discharged on the 3rd day post-surgery, as she showed steady recovery and comfort.
• She actively participated in a comprehensive rehabilitation program, focusing on restoring strength, flexibility, and function.

Outcome

• By 6 weeks post-surgery, the patient was able to walk comfortably without support, marking a remarkable recovery given her complex case.
• The patient regained significant improvement in knee function, allowing her to resume daily activities with minimal discomfort

Long-Term Care

The long-term expectation for this patient is that she will continue to experience improved mobility and reduced pain. With ongoing physiotherapy and proper care, the total knee replacement will help maintain knee function for years, improving her quality of life.

Dr. Veeresh Patage emphasized that while the surgery offers long-lasting relief, regular follow-ups and physiotherapy are crucial to ensuring long-term success and preventing future complications.

Patient Feedback

“I’m incredibly grateful to Dr. Patage and his team for their exceptional care. I never thought I’d be able to walk again without pain. The surgery was life-changing, and the rehabilitation program helped me regain mobility quickly. I’m now looking forward to enjoying my life without the constant knee pain,” shared the patient during a follow-up visit.