Total Knee Replacement

Anatomy (Knee Structure): The knee joint of the human body is made up of several parts; leg bones Femur & Tibia, muscles, ligaments and tendons. The muscles are of two types- quadriceps that are located on the front side and hamstring which are on the back side. The knee Joint is also a ball & socket joint and is the largest joint in the body. These are the main parts of Knee Joint–
  • Femur: It is the upper leg bone also referred to as thigh bone.
  • Tibia: It is the lower leg bone also called shin bone.
  • Patella: It is a plate that covers the knee, provides strength and stability to the joint.
  • Cartilage: The entire surface of the bones at the knee joint is covered with connective tissue called Cartilage. It connects one bone to anotherIt reduces friction and helps in flexibility.
  • Synovial Membrane:It is the tissue that covers the complete knee joint forming a capsule around it. This membrane secretes a fluid that provides lubrication to the knee joint.
  • Ligaments:These are a type of connective tissue that are tough & elastic and surround the knee bone and decide the range of motion of the knee joint.
  • Tendon:Just like the ligaments, the tendons are strong connective tissue that connect the bones to muscles and control the movement of the knee.
  • Meniscus: These are part of the cartilage that work as shock absorber, expanding the surface area of Joint .
Non- Operative Solution: When a patient approaches a doctor with pain or disability of a knee, the doctor closely examines the condition of the knee and the range of movement of the knee joint. He might ask the patient to get an X-Ray done to understand the severity of injury. He then recommends a combination of these solutions–
  • Pain-killer, Analgesics to manage the pain due to injury.
  • Anti-inflammatory medication to reduce swelling in the injured area.
  • Support during walking like Cane or walker.
  • Limitation of activities that cause pain.
  • Physiotherapy under a trained Specialist.
  • Viscosupplementation to provide lubrication in the joint, hence reducing the pain during various activities.
  • Steroid Injection in case the non-steroidal medications don’t work and there is no effective management of pain.

When none of the combinations of the above solution work, your doctor might suggest going for Total Knee Replacement. This procedure is also referred to as Arthroplasty. In this process the prosthetic parts, made of metal and plastic are used to create new surfaces of the bone ends; where they form the knee joint. Arthroplasty was performed for the first time in 1968. Since then the techniques, procedure and prosthetic parts being used have been improving and the surgery has become more effective as a solution.

Causes of Surgery: There are a few common reasons for knee damage that can result in Surgery. Here are different types of Arthritis that can lead to severe damage in the knee joint–
  1. Osteoarthritis: It is common in people above 50 years of age and is therefore the inevitable cause of knee damage in the majority of the population. In this case the cartilage surrounding the bone surface at the joint wears off. As a result, the bones rub against each other causing pain and swelling.
  2. Post -Traumatic arthritis: it occurs as a result of fracture in the bones of knee joint or tearing of knee ligaments.This further causes damage of articular cartilage leading to knee pain, stiffness and limitations during movements.
  3. Rheumatoid Arthritis: This is different from the first two cases. In rheumatoid arthritis, the synovial membrane located around the knee joint to form a capsule becomes swollen and thick . This in turn damages the cartilage and results in knee pain and stiffness. This form of Arthritis is also referred as “inflammatory arthritis”
Surgery as “Solution”– When the pain, stiffness and swelling cannot be controlled by medication and physiotherapy, or there is a knee deformity, the doctor suggests Arthroplasty. The patient then goes to the Orthopaedic Surgeon. Both the patient and the Surgeon together decide if surgery is the most suitable option or not after the sur geluationon does the medical evaluation
  1. Medical history: The surgeon will try to collect as much information as possible about general health, knee injury-how & when it took place, chronic ailment if any, any long term medication going on, previous surgery etc
  2. Physical Examination:The surgeon will carefully examine the knee joint, swelling and by movement of knee understand the intensity of pain and injury. He will check the range of movement being performed by the patient.
  3. X-Ray: The surgeon often asks the patient to get various x-rays done to understand the severity and damage inside the knee.
  4. Advanced Tests:Sometimes the surgeon also asks the patient to get Magnetic resonance imaging (MRI) of the knee done to get bigger picture of the bones in the joint and the surrounding tissues.
  5. Urinary Evaluations: Various urinary tests are done to make sure if the patient is prone to some type of infection. In case he is prone to such an infection or is currently under some treatment , it should be completed before surgery.
  6. Dental Check-Up: Dental tests are also important before considering surgery.If the patient is undergoing any implant or tooth extraction or RCT treatment, it should be completed before surgery to avoid any complication later.

After considering so many factors the decision is made to take surgery as the solution. The patient is then prepared for the surgery. Since he won’t be able to do his routine activities for a while, he will need someone at home to help him with his daily chores. Also he needs to prepare his house like safety bars in shower, handrail in staircase, preferably shifting ent everything to ground floor.Make all things available at home and within reach.

Surgery: The patient is admitted to the hospital on the day of surgery. After the surgery, the patient can go home the same day. We, at The Cruciates have tied with multispeciality well-equipped hospitals where we perform the surgery and discharge the patient on the same day. This saves time and money for the patient as well as the doctor. In case there is any requirement , the doctors keep the patient for a day or two under observation.

After the patient is admitted, the anaesthesia specialist, the surgeon and the patient decide the most suitable anaesthesia for surgery. It might be a general anaesthesia (puts the patient to sleep), regional nerve block anaesthesia or a spinal epidural(the body is numb below the waist).The patient is then given the anaesthesia.

The orthopaedic surgeon makes the incision remove the damaged surfaces. He then places the new metal and plastic implants. The prosthesis used these days is a cemented prosthesis. It is attached to the bone with surgical cement. The prosthesis is usually made of three parts
  • The tibial component to form the tibial surface
  • The femoral part to make the surface of thigh bone
  • The patellar part to make the bottom of kneecap

The incision is then closed using stitches or surgical staples . After that dressing is done. The procedure takes around 2 hours. The patient is then shifted to the recovery room and kept under observation for a few hours. Later on he is moved to the hospital room before being discharged.

Post -Operative Care: Medications including opioids, steroids, non-steroids, anti-inflammatory drugs are given to manage the pain of surgery. Blood clot is also an important concern.The orthopaedic surgeon takes precaution, like use of special support hose inflatable leg coverings and blood thinners.

Soon after the surgery a physiotherapist meets the patient to decide upon an exercise plan. Sometimes a passive motion machine is used to move the new knee joint. After that the physiotherapist gives the patient a detailed plan of exercise to be followed at home.

Recovery at home: Deciding on the condition of the patient, he is discharged in 2-3 days. The recovery as well as success of this surgery largely depends on how closely the patient follows the instruction given by his surgeon. The following are the major points that need to be taken care of–
  1. Wound Care: This is the first and foremost thing to be strictly maintained. The stitches will be removed after a few weeks. The wound should be kept dry all the time. The bandage should be regularly changed to keep it clean and avoid irritation.
  2. Diet: A well balanced diet preferably rich in iron is suggested to support recovery. The patient may experience loss in appetite but he should continue to eat good food to get well soon.
  3. Physical Activity: It is a crucial step especially during the first few weeks after surgery. If the instructions are carefully followed,the patient is able to perform daily activities within 3-6 weeks. The patient can perform tasks like sitting, standing, climbing stairs without any help and pain. But he might experience pain during the night. All this needs to be done under strict observation of a trained physiotherapist. The patient can start driving in around 4 weeks.
The prosthetic knee cannot completely restore full motion but they are still able to perform wide range of motion and activities without any support and pain.
We at The Cruciates have a team of experts who can perform the surgery, give post -operative and help in recovery. You can get in touch with us by clicking on the link below–…..Even if you are looking for a second opinion or an Anaesthetic or Orthopaedic expert you can connect with us 24×7 at the no—. We are happy to help and guide you in every stage.

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