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Knee Replacement

Knee Replacement

“THE FIRST STEP TO RESTORING THE JOY OF MOTION”

Learning about your condition is the most important step to resuming many of your favorite activities. Please take the time to read this brochure, so you can have an informed discussion with your doctor about the treatment that is right for you.

Joint Disease Can Gradually Reduce Your Independence

Normal Knee Joint

When it is healthy, the knee is a remarkable mechanism. In a healthy knee, a layer of cartilage covers the surface of the joint allowing smooth motion.

Diseased Knee Joint

When arthritis intrudes; however, the protective layer of cartilage in the knee gradually wears away, becoming frayed and rough, making it painful to move the joint. The knee then becomes unable to effectively cushion the body from impact and stress. The result is a painful joint that can gradually hamper your quality of life, reduce your independence, and make it hard – or impossible – to do the things you want to do.

Cause

The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

  • Osteoarthritis
  • Rheumatoid arthritis
  • Post-traumatic arthritis

When Surgery Is Recommended

There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from total knee replacement often have:

  • Severe knee pain or stiffness that limits your everyday activities, including walking, climbing stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker
  • Moderate or severe knee pain while resting, either day or night
  • Chronic knee inflammation and swelling that does not improve with rest or medications
  • Knee deformity — a bowing in or out of your knee
  • Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries

Candidates for Surgery

There are no absolute age or weight restrictions for total knee replacement surgery.

Recommendations for surgery are based on a patient’s pain and disability, not age. Total knee replacements have been performed successfully at all ages, from a young teenager with juvenile arthritis to an elderly patient with degenerative arthritis.

Orthopedic Evaluation

An evaluation with an orthopedic surgeon consists of several components:

  • A medical history about your general health and about the extent of your knee pain and your ability to function
  • A physical examination. This will assess knee motion, stability, strength, and overall leg alignment
  • X-rays. These images help to determine the extent of damage and deformity in your knee
  • Other tests. Occasionally blood tests, or advanced imaging such as a magnetic resonance imaging (MRI) scan, may be needed to determine the condition of the bone and soft tissues of your knee

The Operation

Total Knee Replacement is the surgical removal of the diseased joint and replacing it with an artificial joint that is attached to the thighbone (femur) and the shinbone (tibia). This is known as a prosthesis. In most cases, bone cement is used to fix the artificial joint to the thigh and shinbone. Your surgeon will discuss with you the most suitable type of prosthesis for your condition and health. The operation takes about 2 – 4 hours to complete. At the time of surgery and for a short period after your surgery, you will be given antibiotics and a form of therapy ie injections or tablets, to thin your blood. Please tell your doctor at least one week before your surgery in case you are taking Aspirin, anti-inflammatory drugs, or blood-thinning agents, e. g Warfarin.

Realistic Expectations

An important factor in deciding whether to have a total knee replacement surgery is, understanding what the procedure can and cannot do.

More than 90% of people who have total knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement will not allow you to do more than you could before you developed arthritis.

With normal use and activity, every knee replacement implant begins to wear in its plastic spacer. Excessive activity or weight may speed up this normal wear and may cause the knee replacement to loosen and become painful. Therefore, most surgeons advise not to indulge in high-impact activities such as running, jogging, jumping, or other high-impact sports for the rest of your life after surgery.

Realistic activities following total knee replacement include unlimited walking, swimming, golf, driving, light hiking, biking, ballroom dancing, and other low-impact sports.

With appropriate activity modification, knee replacements can last for many years.

Outcomes

How Your New Knee Is Different

Improvement of knee motion is a goal of total knee replacement, but the restoration of full motion is uncommon. The motion of your knee replacement after surgery can be predicted by the range of motion you have in your knee before surgery. Most patients can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently to climb stairs and get in and out of a car. Kneeling is sometimes uncomfortable, but it is not harmful.

Most people feel some amount of numbness around the incision. You also may feel some stiffness, particularly with excessive bending activities.

Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated.

Protecting Your Knee Replacement

After surgery, make sure you also do the following:

  • Participate in regular light exercise programs to maintain proper strength and mobility of your new knee
  • Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery
  • Make sure your dentist knows that you have a knee replacement. You should be given antibiotics before every dental surgery for the rest of your life
  • See your orthopaedic surgeon periodically for a routine follow-up examination and x-rays, usually once a year

Extending the Life of Your Knee Implant

Currently, more than 90% of modern total knee replacements are still functioning well 15 years after the surgery. Following your orthopaedic surgeon’s instructions after surgery and taking care to protect your knee replacement and your general health are important ways you can contribute to the final success of your surgery.

Are all knee replacements the same?

Knee replacements are not the same. There are different types of knee replacements such as:

  • Uni-compartmental
  • Posterior cruciate ligament (PCL) retaining
  • Posterior cruciate ligament (PCL) substituting
  • Rotating platform
  • Stabilized
  • Hinge

Recent advances:

Gender-specific High-Flex Knee Implants compensate for the most important differences between women’s and men’s knees.

The Patient-Specific Instruments Planner is the next generation in surgical planning. The surgeon can preoperatively view the patient’s anatomy in its purest geometrical form to develop a customized surgical plan for each patient.

Computer-assisted surgery lead to increased accuracy for implant alignment, better knee function, increased quality of life, and decreased blood loss.

Tell your doctor if you have

  • Redness, swelling or warmth around the cut
  • Leakage from the cut
  • Fever and chills
  • Severe knee pain that is not relieved by prescribed painkillers
  • Sudden sharp pain and clicking or popping sound in the knee joint
  • Loss of control over leg movement
  • Loss of leg movement
  • Further surgery planned for the future i.e. dental work, bladder catheterisation, examinations of the bowel, bladder, rectum or stomach

What is unique in our advanced knee replacement

We correct every kind of knee deformity, from mild to extremely severe, using the most advanced prostheses in the world.

Minimally-invasive total knee replacement, where the procedure is performed through an incision that is just 8 – 10 centimeters wide

  • Early recovery and less pain due to multimodal pain management protocol consisting of nerve block, injection into the knee, and cryotherapy. With this protocol, the patients have pain free recovery and early ambulation
  • Fewer chances of infection as patients are discharged faster than conventional knee replacement patients so the risk of hospital-acquired infection is minimized
  • Physiotherapy is initiated on the day of surgery itself and patients are made to stand or walk on the day of surgery itself
  • On the first postoperative day, knee bending exercises and exercises to strengthen thigh muscles are started and the patient is encouraged to walk with the help of a walker frame support. Thus early ambulation and early rehabilitation helps reduce the chances of postoperative complications like deep vein thrombosis, pulmonary thromboembolism, urinary tract infections, chest infections, pressure sores etc.,
  • Average stay in hospital is about four days including the day of surgery

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Navigation surgeries in knee replacements

Navigation surgeries in total knee arthroplasty has revolutionized surgical outcome in patients with severe and complex deformities.

Navigation and GPS (guided personalized surgery) basically involves the use of sensors (either ultrasonic or infra red) which is used to map the patient’s limb and detects his/her deformities. This information is captured by the computer which displays the information and helps the surgeon make accurate bone cuts (within 1mm and 1 degree accuracy).

The surgery requires specialized and expensive equipment and expertise for all patients; however, it is most beneficial for patients with severe multi planar deformities and extra articular deformities (deformities arising from beyond the joint).

The basic steps in surgery, the post operative rehabilitation and recovery are all comparable to conventional knee replacement surgeries. Computer aided surgeries however require on an average, a slightly larger incision than normal surgeries.

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