All about chronic low back pain
Written By :
Dr. Ankur Saurav
Sr.Orthopedic Surgeon
Fellowship in Joint Replacement (Germany), Fellowship in Sports Medicine (ISAKOS)
This is a very frequent query from my patients in my OPD. Sometimes the answer is straight forward but very oftenly it requires a thoughtful analysis involving multiple intricacies.
Lets do some logical deductions:
Point 1: Your quality of life is severly affected by your knee arthritis and you have tried all conservative methods for sufficient time(pain killers, injection, physiotherapy, braces) to get relief but all went in vain.
Point 2: After evaluation of your xrays and other clinical test by your Knee surgeon you had been diagnosed to have advance knee Arthritis.
So That’s it! If you fulfill both point 1 and point 2 then its time to go for Knee Replacement. Right?
Yes for many patients these are the two ruling factors. However for many it is much more complex and requires brain storming analysis.
So know you known that 1+2 is not equal to Knee Replacement in every patient.
Lets take a tour of decision making from a Surgeon perspective:
- Do as surgeon I am more inclined to operate? The answer is “NO”. So what is our primary concerns?
- We want your knee Replacement to be very successful in improving your quality of life and significant reduction in pain. This outcome gives us huge satisfaction and pride in our work.
- We want your recovery to be uneventful and smooth. This doesn’t mean that we don’t manage complicated patient but it is always better to avoid complications in the first place.
Thus many patients coming to me is not an ideal patient because of multiple different problems like diabetes, stroke, chronic kidney disease, chronic liver disease, heart attack, morbid obesity other joints damaged, chronic low back pain etc etc…
- As your Knee specialist, I need to decide:
- That do we want to take that risk with you.
- Also are you as a patient willing to try to mitigate this risk factors?
- Even if you tried could you be successful?
The answer to these questions is somtime very complex to find but if our approach is methodical and scientific it is not impossible to reach a conclusion
I explain you with example:
1.Suppose a patient with advance Knee Arthritis leading to severe compromise in day to day activities, is having obesity(BMI >30) and uncontrolled diabetes with stenting done for heart problem, age something between 60 years to 70 years can we do knee Replacement in this patient?
- The first thing which I assess is your willingness to get rid of your knee pain and your will power towards it, next deduction is based on scientific literature that because of immobility your blood sugar is very tough to be controlled and your obesity will keep on increasing as you are not moving much and thus these two factors can make you seriously ill in future if left unaddressed. So in these patients we must try to operate as this will not only relive the knee pain but also increase his longevity and thanks to morden advances in medical services that we can carefully take this risk. But again their is a caveat many a times you will not choose to operate if medical problems are to alarming and life threatening.
2.One more example: A patient with advanced knee Arthritis with chronic low back pain(due to sever secondary degenerative lumbar spine) and multiple joint pain age 55 years to 70 years, should we operate?
- Now here I ask my patient “if I fix your knee right know and it felt great, would this significantly improve your life quality? Would you be able to get out of your house and do the activities you are missing presently. Sometimes the answer is “YES” but sometimes they feel that they may not be able to perform well even if knee is corrected(So no knee surgery should be offered in this case straight away).
Thus as a patient you must consider the following:
- Are you mentally ready to go for major surgery(A patient with great motivation and will power to perform after knee replacement is found to do excellent even after lots of comorbidities)?
- Do you have a realistic expectation?
- Do you fully understand the timeline of recovery?and it is wise to do net practice(knowing risks and benefits) before going for a tournament.
Feel free to write to me as I know their are many more you want to know.