What is a total knee replacement ?
A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with an artificial joint. During a total knee replacement, the end of the femur (thigh bone) is removed and replaced with a metal shell. The end of the shin bone (tibia) is also removed and replaced with a metal plate and stem. A polyethylene spacer is placed between both these metal surfaces. Depending on the condition of the knee cap portion of the knee joint, a plastic "button" may also be added under the kneecap surface.
What patients should consider a total knee replacement?
Total knee replacement surgery is considered for patients whose knee joints have been damaged by either progressive degenerative arthritis , trauma, or other rare destructive diseases of the joint. The most common reason for knee replacement in India is severe osteoarthritis followed closely by Rheumatoid arthritis of the knees. Regardless of the cause of the damage to the joint, the resulting progressive pain and stiffness, and decreasing daily function often leads the patient to consider total knee replacement.
A Knee Replacement Expert takes 1 to 1 ½ hours. It is usually performed under an epidural anaesthetic, which means that you will be awake throughout the procedure and will feel no pain. Once the anaesthetic has taken effect, an incision will be made down the front of your knee. The worn or damaged surfaces will be removed from both the end of your thighbone and the top of your shin bone. The surfaces will then be shaped to fit the knee replacement.
The replacement parts will be fitted over both bones. Sometimes the part of your kneecap that is in contact with the new knee joint is replaced with a plastic prosthesis. This is called patellar resurfacing. After the new parts are fitted and tested to make sure they move smoothly, your surgeon will close the wound with stitches or clips and cover it with a dressing.
Step 1: Knee Incision
To begin the surgery, knee replacement surgeon will make an incision on the front of your knee, cutting through the tissue surrounding the muscles and bone. The kneecap, or patella, is rotated to the outside of the knee, to help your doctor see the area where the implant will be placed.
Step 2: Prepare the Femur
The surgeon will use special cutting instruments to measure and make precise cuts of the bone. The end of the femur (thigh bone) is cut into a shape that matches the corresponding surface of the metal femoral component.
Step 3: Prepare the Tibia
The tibia (shin bone) is prepared with a flat cut on the top. The exposed end of the bone is sized to fit the metal and plastic tibial components.
Step 4: Implant the Femoral Component
The femoral component is then placed on the end of the femur.
Step 5: Implant the Tibial Component
The metal tibial component is inserted into the bone. Then a plastic insert is snapped into the tibial component. The femoral component will slide on this plastic as you bend your knee.
Step 6: Implant Patella
If needed, the patella (kneecap) is also cut flat, and fitted with a plastic patellar component. Knee replacement surgeon may choose to use cement to help fix the implants onto your bone.
After the operation
You will be given painkillers to help relieve any discomfort as the anaesthetic wears off. If you had an epidural anaesthetic, you may not be able to feel or move your legs for several hours after your operation. You won't have any pain in your legs. Starting from the day after your operation, a physiotherapist usually visits you every day to help you do exercises designed to help your recovery. Before discharge, your nurse will give you advice about caring for your stitches, hygiene and bathing.
Recovering from a knee replacement
Once home, you should take painkillers if you need to, as advised by your surgeon or nurse. The exercises recommended by your physiotherapist are a crucial part of your recovery, so it's essential that you continue to do them. You must follow your knee replacement surgeon's advice about walking, climbing stairs and driving. Your knee will continue to improve over a period of at least six months.
FAQs About Knee Replacement
Normal knee joint anatomy:
The knee joint is the largest joint in the human body that is formed between the thigh bone (femur), the leg bone (tibia) and the knee cap (patella).
What is arthritis?
Arthritis is a condition caused by breakdown of cartilage. Cartilage is a protein substance that normally serves as a cushion between bones of a joint.
What causes arthritis?
Primary osteoarthritis is related to ageing. With ageing, the water content of the cartilage changes and protein makeup degenerates, gradually leading to a loss of cartilage cushion between joint bones. This causes friction between bones, leading to pain and limitation of joint mobility. Arthritis can also be caused by trauma, rheumatoid arthritis, gout and various other causes.
Why get your knees replaced?
The simplest answer to this would be WHY SUFFER PAIN? Knee replacement is a highly successful procedure with excellent results giving the patient a pain-free improved quality of life.It is recommended that you should get treated from the best Knee Replacement Surgeon in Delhi.
Signs You Need a Knee Replacement
You have knee pain that keeps you awake, or awakens you, at night.
You have knee pain which limits activities necessary to go about your daily routine (such as getting up from a chair or climbing stairs).
You have tried other conservative treatments for a reasonable period of time, and you still have persistent knee pain.
You and your doctor must consider many other factors prior to surgery, including age, overall health, and bone density.
What exactly does knee replacement mean? What will be replaced in my knee?
It is just the surface 9 mm of femur and surface 8 mm of tibia that is replaced
Steps of a Knee Replacement Surgery
In a knee replacement, bone and cartilage on the end of the thigh bone (femur) and top of the shin bone (tibia) are removed. This is performed using precise instruments to create surfaces that accommodate the implant perfectly. A titanium knee replacement implant is then placed in to function as a new knee joint. Depending on the condition of the cartilage of the kneecap, the kneecap surface may also be replaced.
What is the ideal age for knee replacement?
Most patients are elderly, above 60 years of age, but since the main indication for surgery is PAIN, younger patients may also need replacement. Age, both young and very old, is never a contraindication for surgery.
How long does the patient have to stay in hospital?
1-2 days before surgery to 5-7 days after surgery. This is to provide pain relief, anticoagulant prophylaxis and patient ambulation.
When and how can you walk after surgery?
The patient is made to walk 24-48 hours after surgery. Crutches or walker are used to aid ambulation for 3-4 weeks, then a stick for another 3-4 weeks. So, you can walk without any support after 1 ½ to 2 months.
Can one climb stairs after surgery?
Stair climbing is allowed 10-12 days after surgery.
Can both knees be replaced simultaneously?
Yes. If you are medically and anaesthetically fit without any major cardiac, pulmonary, vascular or other medical disorder, both knees can be replaced in a single sitting. The advantages of this are single surgical event, single anaesthesia, shorter overall hospital stay compared to 2 admissions for 2 procedures, and symmetrical post operative rehabilitation for both knees.
What implants are used?
We use only standard prostheses made in USA. These are imported to India by the same companies that operate worldwide- Zimmer, Depuy (Johnson & Johnson), Biomet.
Is knee replacement painful?
Post operative pain is controlled to tolerable levels by excellent multi-modal anaesthesia, epidural block and patient controlled analgesia. Initial injectable painkillers are replaced by oral tablets within 2-3 days.
How long does the surgery take?
Anaesthesia induction time is 20 to 30 minutes. A primary replacement takes 1 to 1 ½ hours. A difficult, badly deformed knee or a revision surgery may take 2 to 2 ½ hours.
For how many years is my replacement expected to last?
A well done TKR lasts 20-25 years, after which it may need revision, which itself is a successful procedure.
What kind of physical activity can you do after surgery?
You can walk as much as you want. You can climb stairs, drive a car, and even gradually go back to non-contact sports like golf.
When can the patient go back to work?
This depends on the job. A sedentary or desk job person can return to work in about a month. If the work involves a lot of walking or standing, then about 2 months.
Can you travel overseas after the operation?
For overseas patients, it can be done 3-4 weeks after surgery. Any patient can safely go abroad 2 months after surgery.
What precautions should you take after a TKR?
Avoid squatting, sitting cross legged, using a low chair or an Indian toilet to increase the longevity of the implant. Do not ignore any infection (dental, skin or otherwise)- consult a doctor in case of any infection.
Photo & Video Gallery
Model of Total Knee
Model of Total Knee
X-ray Of Normal (Left) and Abnormal (Right) knee
Grossly Deformed Knees
Post op X-Ray (Front View)
Post op X-Ray (Side View)
Unicondylar Knee Replacement
Unicondylar Knee Replacement
Bad deformed knee pre op walk
Range of Movements 2 weeks after surgery
Walking 6 weeks after surgery
Steroid Injections Leading to Fractures?,
A retrospective study from Henry Ford Hospital in Michiga