Total Knee Replacement

Who need a Knee Replacement?

If your answer is yes to most or all the questions, you probably are a candidate for knee replacement surgery.

  • Does severe knee pain limit your activities? (walking, climbing stairs, getting in and out of chair)
  • Is your knee often swollen, not responding to medications or rest?
  • Are your knees deformed?
  • Are your knees stiff, which makes it difficult to bend or straighten?
  • You don’t get satisfactory relief from pain killers and other conservative methods?

Procedure

Knee joint is exposed using a midline incision on the front of knee. Joint is exposed after separating the muscle and cutting through the capsule. The worn and damaged surface of bone and cartilage from lower end of femur (thigh bone) and upper end of tibia (shin bone) are removed and shaped to accept the prosthetic implants. These surfaces are replaced with metal and plastic implants which closely mimic natural knee motion and function. The soft tissues around the knee are carefully balanced to correct the alignment of the joint and optimize the function of knee.

Realistic expectations

  • Ultimate goal of knee replacement surgery is pain relief and improved knee function.
  • Knee replacement surgery will not treat pain arising from other joints or back.
  • Discomfort and swelling may take some months to disappear.
  • Restrictions like avoiding running, high impact aerobics and sports like tennis are to be practiced for rest of life.
  • Extreme knee bending, squatting and sitting cross-leg although achievable in few, should be avoided to prevent wear or early loosening of implants.
  • Knee replacements last many years, but may need revision surgery when they wear out or loosen.

Points to remember after total knee surgery

After knee replacement, certain important aspects of your recovery need to be kept in mind:

  • Walking and limited post-op exercises are important and should be performed as instructed by your physiotherapist. These have to be continued lifelong.
  • Balance rest and activity, especially early in your recovery.
  • Follow instructions to prevent clots.
  • Know the signs of infection.
  • Be careful and avoid falls.
  • Carefully adhere to restrictions.

Getting ready for the surgery

  • List all the medications you are currently taking. You may be advised to stop certain medicines like clopidogrel and ecosprin a week before surgery. Talk to anesthetist regarding this issue at the time of your pre anesthesia checkup.
  • List any allergies or adverse reactions to drugs or anesthesia in past.
  • Bring your recent x-rays at the time of hospital admission.

Frequently Asked Questions

Q. When I shall be able to walk?

A. You will be made to walk on second day after operation; physiotherapist will be there to assist you. At the time of discharge you will be able to walk to toilet or bathroom on your own with the help of walker or cane.

Q. What is the material used for replacement?

A. The implant is a special highly polished alloy (Cobalt-Chrome) femoral component articulating with high quality polyethylene.

Q. How long I have to stay in the hospital after surgery?

A. In case you are getting one knee operated you will stay in the hospital for six days after surgery. In case, both the knees are operated together, duration of stay is for nine days after surgery.

Q. I am staying alone, how long I will need someone for help at home after discharge from hospital?

A. As discussed above, you will be able to walk to toilet or bathroom on your own at the time of discharge, but, if you are staying alone, you should have someone around for a month after surgery to assist you in daily activities.

Q. When can I start driving?

A. You can start driving after two months of surgery depending on the quadriceps strength and comfort.

Q. When can I climb stairs?

A. You can climb to first floor in one go approximately 3 – 4 weeks after surgery.

Q. When can I travel abroad?

A. Traveling in the city for short duration may be started after 2 – 3 weeks. Going out of city may be done approximately after a month. Overseas travel should be undertaken not before 3 months after surgery.

Q. What are the lifelong precautions after surgery?

A. 1. Not to sit cross legged, squat or use an Indian toilet.
2. Avoid impact sports like jogging, jumping, badminton etc
3. Antibiotic prophylaxis before any dental, gynaecological or urinary procedure.

Q. How long I will need to do physiotherapy?

A. You will be guided in your exercises by our team of physiotherapist during your stay in the hospital. After discharge you will need to continue with some easy exercises that you can do on your own. This may be required for a period of 6 – 8 weeks or till the time you are comfortable with your walking. Physiotherapist assistance after discharge may be required for 2 weeks (for single knee) to 4 weeks (for both knees).

Q. I am over weight, should I lose weight first and then undergo surgery?

A. Thin patients are easy for us to operate and postoperative recovery is also good. But, losing weight and maintaining weight loss can be difficult in patients with osteoarthritis of the knee, since their symptoms often limit the amount and type of exercise in which they can participate.

Q. How long are these joints going to last?

A. Life of the artificial joint depends on number of variables, including the type of activities you are engaged, quality of bone, whether you are overweight etc. Normally these joints have a finite lifespan of 15 – 20 years.