Total Knee Replacement Surgery
How do I know 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 great relief from pain
and it restores normal activities in life.
How common is total knee replacement surgery?
Knee replacement is a routine surgery performed on over 650,000
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 for knee joint replacement
surgery?
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 surgery?
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 knee joint replacement
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 knee replacement
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 Joint 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.
What is the average cost of knee replacement in India?
The cost of knee replacement in India is fractional to what
you would have to shell out for same services in USA/ UK. The
price varies with the city and the facility you choose to stay.
Please contact us to know options
best suited for you.
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