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Knee Replacement Surgery in India

Total Knee ReplacementKnee joint made of three bones - femur, tibia and patella - when severely diseased from osteoarthritis, rheumatoid arthritis, traumatic arthritis and other problems can result in severe pain, joint deformity and motility problems. Total Knee Arthroplasty, another name for total Knee replacement, an effective method to alleviate chronic knee pain from such problems, is a surgical procedure aimed to cure painful knees by restoring the joint functionality in severely diseased knees. After removing the damaged surfaces of all the three bones of the diseased joint; damaged knee is replaced with an artificial joint (prosthesis) by precisely reshaping and recapping with metal surfaces and plastic liners promoting a low friction gliding within the implant.

Unicompartmental Arthroplasty (UKA) also called partial knee replacement is a viable option for some patients when only one side of the knee has been damaged. While UKA involves smaller incisions, less bleeding, quicker recovery, and less bone loss than a total knee replacement, most patients with chronic knee pain, have significant wear in two or more regions (lateral, medial and patellofemoral) that necessitate total knee replacement in them.

Components and types of the implant

Type of the implant can be selected based on type of the implant and components used in making them. You can discuss with your doctor before you decide on a specific implant that suits you better. Different companies manufacture different knee replacement implants that fit into two basic types - cemented knee replacement implants that are fixed into the bone immediately and press-fit knee replacements where the surrounding bone grows into the rough surface on the implant, holding the implant in position. The newer type of implants like rotating knee replacements designed to closely replicate normal knee motion are not famous for their longevity. Research studies are yet to prove if they are better than the standard knee replacements.

Components of knee replacement implant are made of metal (femoral and tibial components) and plastic (patellar component). While the standard implant has Cobalt-Chrome and polyethylene, new metals are constantly tested to improve the results, some surgeons use ‘all-poly’ tibial insert.

Decide if you need the surgery. Are you an ideal candidate for knee replacement surgery?

It is important to understand the drawbacks of the surgery and be prepared to take the risks, rather continue with the symptoms affecting the quality of life. Anyone with severe knee pain and a compromised lifestyle need to understand the risks versus benefits of having a knee replacement surgery and get motivated to consult an orthopedic surgeon with their medical records, MRI and X-rays.

Inability to perform simple day to day activities like walking, taking stairs, sitting and getting up the couch (sofa), requiring support while walking, feeling pain at rest and significant stiffness without any significant relief from pain killers, severe deformity in the knee (lock-knee, bow legs) would call for surgery in an ideal patient. An ideal patient for total knee replacement should have severe knee joint problem, have a diagnosed

Osteoarthritis with a stable or only slightly unstable knee joint, strong surrounding knee musculature, be greater than 60 y/o with less than 100kg weight and without any serious co-morbid diseases. Post-surgery, the difference can be felt immediately with increased mobility and less pain in the joint. With mild exercise, strength is regained in the joint and will be able to perform daily activities.

What you can expect from before, during and after the surgery?

You can have your regular meal on the day before the surgery. However, the night before surgery, you will not be given anything to eat or drink after midnight but a five minute scrub shower is performed on the surgical area preparing you for the surgery.

Even though the time in operating room is longer, the actual surgery itself takes about 1.5 hrs. Once completed, you will be closely monitored in the recovery room for 1-3 hours where your vitals (blood pressure, pulse, respiratory rate and temperature) will be checked frequently while paying close attention to the circulation in your legs and feet ruling out any sensations of tingling or pain and numbness. Once stabilized and awake, you will be shifted to your room.

Post-surgery, you will be left with an eight inch incision closed with staples in front of the knee that will normally remain in the skin for about two weeks and then removed as outpatient follow-up visit in the office. However, with major surgeries like knee replacement, you should remember that no procedure is risk free and prepare yourself to face any.

What are the risks and complications of Knee Replacement Surgery and how will they be addressed?

Performed over many years, knee replacement surgery is one of the most successful surgeries with high success rate and less complications that are minor, temporary and generally treated easily.

Numbness around incision area, infection, minor bleeding/bruising, allergic reactions to tape/dressing/latex, abnormal/painful scar formation and urinary tract infection are the most common minor complications.

Complications such as infection, stiffness and loosened prosthesis will require further repair. Artificial knees when infected need to be removed leaving a stiff leg that is shorter than the normal leg by 1-3 inches. Though this leg is reasonably comfortable, such situations might require support from crutches or shoe lift until surgery is repeated after a course of antibiotics.

Though uncommon, many major complications can develop based on your overall health. Knee replacement surgery patients with heart, lung or kidney problems, diabetes etc. are more likely to develop complications when compared to healthy patients that underwent surgery.Once replaced, the implants remain functional and in service for 12 to 15 years after which they can they can be replaced as needed with anticipated good functional results.