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Medical Specialties |
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Total Knee Replacement India
What are various causes for knee pain?
There are many different causes of knee pain which may include injury, infection or arthritis.
What is the cure?
There can be various methods to treat the knee pain. Mild knee pain can be treated through conservative treatment like rehabilitation, while the severe cases may require surgery.
Why is total knee replacement surgery performed?
Knee replacement surgery is performed to treat advanced arthritis. If the medical management for the knee pain is not effective, or deformity has become severe and debilitating, knee replacement surgery is advised.
What is knee arthritis?
Arthritis can be defined as inflammation or deterioration of the joints. In the knee joint, it is because of the damage to the gliding surface of the knee called articular Cartilage. Routine activities such as walking, climbing become difficult which vary according to the amount of damage. It may also result in the deformity.
Do I need a Total Knee Replacement Surgery?
If you have knee deformities or severe X-ray changes, or advanced symptoms of arthritis, you require a total knee replacement surgery.
Symptoms of advanced knee arthritis are pain, crepitus, stiffness, limping, muscle weakness, limitation of motion, and swelling
Total Knee replacement surgery is generally delayed by the doctors in favor of less invasive procedures. But, if you have difficulty walking or performing everyday activities such as getting dressed, you do require knee replacement surgery.
Total knee replacement surgery offers relief from pain and to restore normal activities in life.
How common is total knee replacement surgery?
Knee replacement is a routine surgery performed on over 600,000 people worldwide each year. Over 90% of people who have had Total Knee Replacement experience an improvement in knee pain and function.
How old is the average patient?
The average knee joint replacement patient is around 65-70 years old; however patients of all ages have received knee implants.
What is a total knee replacement?
The total knee replacement surgery involves resurfacing the parts of the bones of the knee that rub together with metal and plastic implants. Using special, precision instruments, the surgeon will remove the damaged surfaces of all three bones. The replacement surfaces will then be fixed into place.
The surface of the femur is replaced with a rounded metal component that comes very close to matching the curve of the natural bone. The surface of the tibia is replaced with a smooth plastic component. This flat metal component holds a smooth plastic piece made of ultra-high-molecular-weight polyethylene plastic that serves as the cartilage. The undersurface of the kneecap may also be replaced with an implant made of the same polyethylene plastic.
Are all knee joint replacements the same?
No, there are six different types of knee replacements:
- Uni-compartmental
- Posterior cruciate ligament (PCL) retaining
- Posterior cruciate ligament (PCL) substituting
- Rotating platform
- Stabilized
- Hinge
These different prostheses can be made of cobalt chrome, titanium, and polyethylene (plastic), and can be fixed to the bone with acrylic cement or can be press-fit, which allows bone to grow into the implant. Use of a particular implant design, material, and fixation method depends on many factors related to each individual patient.
How is the knee replacement surgery done?
The knee replacement surgery starts with an incision over the knee that exposes the joint. The special precision guides and instruments are used to remove the damaged surfaces and shape the ends of the bones to accept the implants.
The implants are then secured to the bones. When the surgeon is satisfied with the fit and function of the implants, the incision is closed. The surgery takes two to tree hours to complete, which varies from patient to patient.
A bandage is applied and a special drain is usually inserted into the wound to drain the fluid that naturally develops at the surgical site. You would then be taken to the recovery room, where you would be closely monitored.
When you regain consciousness, you would be taken to the hospital room, where a nurse would be with you. You would also be given pain killers and the knee might remain swollen for a few days.
How is the knee rehabilitation done?
A total knee replacement rehabilitation program is begun after the surgery.
To help regain strength, balance and range of movement in your knee, a specifically designed rehabilitation programme is started when you are back in the hospital room. The physical therapist will help you perform appropriate exercises. About 24 hours after surgery, you will probably be asked to stand.
Within the next 24 hours, you will probably begin to walk a few steps with the help of a walker. You can expect to stay in the hospital for about five to six days after your surgery. You may or may not be transferred to a rehabilitation facility for a few more days, as determined by your surgeon. Your bandages and sutures will usually be removed before you leave the hospital. At home, you will need to continue your exercises.
When can I return to normal activities after surgery?
Most patients start walking with the cane within six weeks of the surgery. Few patients also start driving within seven to eight weeks after surgery.
But, there are some precautions to be taken even after you have fully recovered. One should not put excessive strain on the knee like jogging, skiing, high impact aerobics and other sports which put strain on the knee joint.
What precautions do I need to take after the surgery?
Though this is not an exhaustive list of the precautions, these are the general guidelines to be followed after the surgery. The surgeon and the physical therapist will guide you in details about the do's and don'ts after the surgery
- Avoid heavy lifting and excessive stair climbing
- Maintain appropriate weight
- Avoid "impact loading" sports such as jogging, downhill skiing and high impact aerobics, twisting or impact stresses.
- Consult your surgeon before beginning any new sport or activity
- Avoid excessive bending when weight bearing, like climbing steep stairs
- Do not lift or push heavy objects
- Do not kneel
- Avoid low seating surfaces and chairs.
What is the life of a replaced knee?
The longevity of the prosthetic varies with every patient depending upon physical condition, activity level, weight as well as the accuracy of implant placement during surgery.
Though total knee replacement has become a common and predictable surgery, with very high success rates, it should be kept in mind that there is no guarantee that a prosthetic joint will last the rest of patient's life.
As with any mechanical joint, the knee components move against each other. Natural fluid in the joint space, called synovial fluid, helps to lubricate the implants just as it lubricates the bones and cartilage in a natural joint. Still, the prosthetic components do wear as they roll and slide against each other during movement. As with car tires or brake pads, the rate of wear depends partly on how the knee joint is used. Activities that place a lot of stress on the joint implants, as may be the case with heavier and more active patients, may reduce the service life of the prosthesis. Implant loosening and wear on the plastic portions of the implant can lead to the necessity for revision surgery to replace the worn components, or all of the components.
What is Partial Knee Replacement, and how is it different from Total Knee Replacement?
The total knee replacement surgery involves resurfacing of all the three bones with metal and plastic implants. The surface of upper bone is replaced with a rounded metal component close to the natural curve of the bone. Similarly, the surface of lower bone and the undersurface of knee cap are also replaced with a flat metal component or with a slab of ultra-high-molecular weight polyethylene plastic
In patients, who have some of the joint surfaces still healthy, partial knee replacement is done. Here, only the diseased portion of the knee is resurfaced, before placing the implant, leaving the healthy portion untouched. This means that the surfaces are replaced on only one side of the joint, that is, only one of the rounded projections is replaced beneath it.
What is MIS and how is it different from the standard procedure?
MIS stands for Minimal Invasive Surgery.
During MIS only a small incision, which is one- third to one- fourth the size of traditional incision is made and only the diseased portion of the knee is removed through it unlike total knee replacement surgery, where all the three bones are resurfaced and replaced.
The rehabilitation time also varies. Whereas the rehabilitation time for MIS is around 5 weeks, for TKR it is approximately 10-12 weeks.
What are the benefits of the MIS procedure compared to traditional knee replacement surgery?
Shorter hospital stay
Faster Rehabilitation
Smaller incision scar
Patients may also experience an increased range of motion after recovery.
How do I decide whether I MIS and Uni Knee replacement or TKR is for me?
You need to consult the surgeon and discuss in details the pros and cons of both. A number of factors determine whether you are qualified to go for MIS or TKR and how successful would they be.
An ideal candidate for Uni knee replacement is someone who has osteoarthritis of the knee that is isolated to only one condyle (or compartment) of the knee. Candidates also may include people who are not responding to other forms of treatment such as medication, arthroscopy or cartilage transfers. The Uni Knee replacement is not performed on individuals with rheumatoid arthritis.
Do I need to take antibiotics after dental and other procedures after the joint replacement?
Your total joint replacement is an immuno compromised area in your body. Your immune system and white blood cells have a difficult time clearing bacteria from joint replacements. Therefore, it is best to avoid and reduce the risk of any possible infection. To do this, it is commonly recommended that for dental procedures, particularly those involving a dental abscess, and for other procedures that are at risk for putting bacteria into the blood stream, that a patient be given antibiotics around the time of these procedures. The greatest risk for infection to occur after these procedures is within the first two years. After that time, there is a risk of infection with these procedures but it is significantly reduced.
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