Knee Replacement

Knee replacement surgery can help relieve pain and restore function in severely diseased knee joints.

WHAT EXACTLY IS KNEE JOINT REPLACEMENT?

The procedure involves cutting away damaged bone and cartilage from your thighbone, shinbone and kneecap and replacing it with an artificial joint (prosthesis) made of metal alloys, high-grade plastics and polymers. In determining whether a knee replacement is right for you, an orthopedic surgeon assesses your knee's range of motion, stability and strength. X-rays help determine the extent of damage. Your doctor can choose from a variety of knee replacement prostheses and surgical techniques, considering your age, weight, activity level, knee size and shape, and overall health.


When a knee replacement is needed
  • Knee replacement is usually necessary when the knee joint is worn or damaged so that the mobility is reduced and patient is in pain while doing his/her ADL (Activities of Daily Life).
  • The most common reason for knee replacement surgery is Osteoarthritis (degenerative arthritis).
  • Other health conditions that can lead to Knee Replacement include:
  • – Rheumatoid arthritis
    – Knee Trauma – Distal femur & Proximal Tibia Fractures
    – Haemophilia - Gout
    – Avascular Necrosis of femoral condyles - Knee deformity
    – Neuropathic joint - Sequelae of septic arthritis

    Who is offered knee replacement surgery
  • Knee Replacement is a major surgery, so is normally only recommended if other treatments, such as medications, lifestyle modifications, physiotherapy or intra-articular injections, have not reduced pain or improved mobility.
  • I offer knee replacement surgery if:
  • – Pt. has severe pain, swelling and stiffness in his/her knee joint and his/her mobility is reduced
    – Pt. knee pain is so severe that it interferes with his/her quality of life and sleep
    – Everyday tasks, such as going out or getting out of the bed, are difficult
    – Pt. is feeling depressed because of the pain and lack of mobility
    – Pt. also need to be well enough to cope with both a major operation and the rehabilitation afterwards.


    Types of knee replacement surgery


    Figure 1

    Total knee replacement (TKR) – both compartment of the knee joint are replaced

    Figure 2

    Partial knee replacement (UKR) – only 1 compartment of the knee joint is replaced


    Technique:

    • Pre op counseling
    • Spinal anesthesia
    • Pre operative starting of analgesia / I.V antibiotic
    • No tourniquet
    • Smaller incision in both skin & soft tissue
    • Minimum soft tissue handling
    • Mechanical Axis Alignment / Soft tissue Ligament Balancing
    • No drain
    • Minimum post operative analgesics
    • Early Discharge ( 3rd POD- U/L ) ( 5TH POD- B/L )
    • Immediate post operative mobilization:
    – Walking within 3-4 hour
    – Staircase climbing next day

    TECHNIQUE (Standardization + High volume )

    • It helps reducing surgical time drastically
    - Implant Trial 15-20 minutes
    - Implanting 10 minutes
    - Wound Closure 15-20 minutes
    • Helps me to make decision faster, hence less complications.
    • It reduces chances of infection markedly : < 1 %.
    • It reduces confusion on OT table.


    Recovering from knee replacement surgery

    • Usual hospital stay is for 3 to 5 days, but recovery times can vary.
    • Pt. needs to use a frame or crutches at first and a physiotherapist will teach them exercises to help strengthen the knee.
    • Most people can stop using walking aids around 4 weeks after surgery, and start driving after 6 to 8 weeks.
    • Full recovery can take up to 2-3 months as scar tissue heals and the muscles are restored by exercise. A very small amount of people may continue to have some pain after 6 months.


    Risks of knee replacement surgery

    Complications are rare but can include:

    • Superficial and/or Deep infection
    • Ligament, vascular or nerve damage in the area around the knee joint
    • Deep vein thrombosis (DVT)
    • Aseptic / Septic loosening
    • Persistent pain in the knee
    • Fractures in and around Knee during or after the operation
    • Instability
    • Stiffness of the knee