Knee Replacement Surgery: A Quick Overview

Knee replacement, also called “knee arthroplasty” or “total knee replacement”, is a surgical procedure in which the natural cartilage and bone of the knee are replaced with prosthesis (artificial/man-made components), recreating the weight-bearing surface of the joint. Usually recommended to individuals with severe arthritis or a significant knee injury, the procedure involves the use of metal and/or plastic components to replace or cover the damaged components of the knee joint.

Types of Knee Replacement

There are several types of knee replacement surgery that help alleviate discomfort and improve mobility; each meant to address specific conditions and levels of joint damage. Let’s look at some of the commonly prescribed surgeries:

Total Knee Arthroplasty

Total knee replacement (TKR) is the most common type of knee replacement surgery. During this surgical procedure, the entire knee joint is replaced with a prosthetic joint, consisting of metallic components for the femur (thigh bone) and tibia (shin bone), separated by a plastic spacer. TKR surgery is primarily used to treat advanced osteoarthritis, rheumatoid arthritis, or severe knee trauma.

Unicompartmental/Partial Knee Replacement

Unicompartmental/partial knee replacement, also called PKR, is a surgical procedure where only the damaged or affected portion of the knee joint is replaced with a prosthesis. This approach is particularly effective when only one compartment of the knee, such as the medial (inside), lateral (outside), or patellofemoral (front) area, is affected. PKR is often recommended to patients with localised arthritis or specific knee joint issues.

Kneecap Replacement (Patellofemoral Arthroplasty)

When arthritis affects the knee joint, it can be a source of persistent pain and reduced mobility. One surgical option for addressing this issue is kneecap replacement, formally called “patellofemoral arthroplasty”. This procedure focuses on replacing the undersurface of the kneecap and its groove (the trochlea) when they are the primary areas affected by arthritis.

Complex/Revision Knee Replacement

Complex or revision knee replacement is a surgical procedure performed when a prior knee replacement fails, or complications arise. It involves correcting issues like implant loosening, infection, or severe bone loss. Skilled orthopaedic surgeons use advanced techniques and specialised implants to restore function and alleviate pain in these challenging cases.

Why is Knee Replacement Required?

Knee replacement becomes necessary when the knee joint experiences severe damage or disease, resulting in chronic pain, limited mobility, and a decreased quality of life. Common reasons for knee joint replacement include advanced osteoarthritis, rheumatoid arthritis, traumatic injuries, or other conditions that cause persistent pain and hinder normal knee function.

How Common is Knee Replacement Surgery?

Knee replacement surgery has become increasingly common in India, driven by factors such as an ageing population, growing awareness of joint health, and advancements in healthcare infrastructure. While exact statistics may vary, India has witnessed a substantial surge in the annual number of knee replacement procedures. As a result, the country is now recognised as a leading destination for orthopaedic surgeries, including knee replacements.

What Are the Tests Recommended Before a Knee Replacement?

Before undergoing knee replacement surgery, a series of essential tests and evaluations is imperative. These evaluations are pivotal in assessing the patient's overall health, identifying any underlying medical conditions, and establishing their eligibility for the procedure. To ensure the highest quality of care, it is strongly advised to choose the best knee replacement hospital in India for these assessments.

• Physical Examination: The orthopaedic surgeon conducts a thorough physical examination of the knee joint, assessing range of motion, stability, and deformities.
• Medical History: A comprehensive medical history is taken to identify pre-existing health conditions, allergies, medications, and any previous surgeries.
• X-rays: X-rays of the knee joint are performed to assess the extent of joint damage, alignment issues, and the overall condition of the knee.
• Blood Tests: Blood tests may be done to assess general health and to check for conditions such as anaemia, infection, or clotting disorders.
• MRI (Magnetic Resonance Imaging): In some cases, an MRI may be ordered to provide a more detailed image of the knee joint, especially to assess soft tissue structures like ligaments and tendons.
• Bone Density Scan (DEXA Scan): This test may be recommended to assess bone density, especially in older patients, to evaluate the risk of osteoporosis.
• Assessment of Mobility and Functional Status: The surgeon assesses the patient's mobility, functional limitations, and ability to perform daily activities to determine the potential benefits of surgery.

Knee Replacement Recovery Time

The recovery period following knee replacement surgery is a journey that varies from person to person and is influenced by several factors, such as overall health, surgical approach, and post-operative rehabilitation adherence.

• Hospital Stay: Most patients generally spend a few days in the hospital immediately following knee replacement surgery. During this period, they receive initial post-operative care, closely monitored recovery, and guidance for rehabilitation.
• Immediate Postoperative Period (Days 1-7): During the hospital stay, patients work with physical therapists to initiate knee mobility exercises and practice walking with assistance, often utilising a walker or crutches. Effective pain management is paramount during this phase, with medications provided as needed.
• First Few Weeks (Weeks 1-6): Patients continue their rehabilitation journey at home or in an outpatient facility after being discharged. Here, they gradually increase weight-bearing and mobility as swelling and bruising begin to subside. As mobility improves, some may transition to assistive devices like canes.
• Six Weeks to Three Months (Weeks 6-12): Continued improvement in mobility and strength is the focus during this phase. Most patients receive clearance to resume driving after consulting with their surgeon. Physical therapy remains essential, concentrating on enhancing range of motion and strengthening the knee and surrounding muscles.
• Three to Six Months (Months 3-6): Patients typically experience a significant reduction in knee pain and substantial improvements in knee function. Depending on their surgeon's recommendations, some individuals may reintroduce low-impact activities such as swimming and cycling. However, the return to activities like golf or light jogging varies among individuals.
• Six Months and Beyond (Months 6+): At this stage, most patients have fully recovered and are ready to resume their regular activities, including sports and recreational pursuits. Nevertheless, it remains crucial to consult with the best knee replacement doctors in Delhi or anywhere else, before engaging in high-impact activities. Additionally, your healthcare provider may suggest ongoing maintenance exercises and regular check-ups to ensure knee replacement's long-term success and durability.

Exercises after Knee Replacement Surgery

After knee replacement surgery, following a structured exercise program to aid your recovery is essential. These exercises will help improve the strength, flexibility, and mobility of your new knee joint. Here's a description of the recommended exercises:

• Ankle Pumps: This exercise stretches and strengthens the calf and ankle muscles and helps reduce post-surgical swelling, enhance circulation, and lower the risk of blood clots.
• Heel Slides: By engaging your quadriceps and gluteal muscles, heel slides contribute to expanding the range of motion in your knee, thus improving overall flexibility and mobility.
• Knee Extensions: Knee extension exercises primarily target your quadriceps, promoting improved knee flexibility and mobility.
• Leg Raises: This exercise targets the gluteal muscles in the hip and the quad muscles above your knee. Strengthening these muscles is essential for better knee support while walking.
• Quad Squeezes: Your quadriceps play a pivotal role in supporting and controlling knee joint mobility. Quad squeezes are a low-impact way to strengthen these muscles without straining your knee.

Questions to Ask Your Knee Surgeon

• What are the knee replacement benefits?
• What difficulties does a person living with a knee replacement need to face?
• What are the knee replacement complications?
• What are the knee replacement side effects?

Minimally Invasive Knee Replacement

The team at Max Super Speciality Hospitals, Shalimar Bagh, employs innovative techniques for minimally invasive surgery (MIS). At Max Super Speciality Hospital, Shalimar Bagh, minimally invasive surgery is performed by a team of well-trained, highly experienced orthopaedic surgeons. Our orthopaedic surgeons understand the problem and the possible risks and leverage their experience in knee replacement surgery to create personalised treatment plans.

The Benefits of Minimally Invasive Knee Replacement

Minimally invasive surgery allows surgeons to insert the same time-tested knee replacement implants through a smaller incision using a surgical approach that avoids trauma to the quadriceps muscle, which is the most important muscle group around the knee. MIS requires an incision of about 5”, whereas traditional knee replacement requires an incision of about 10”. With the use of small incisions, customised instruments and innovative imaging techniques, the surgeries entail less pain, minimal scarring, and faster recovery.

Who is an Ideal Candidate for Minimally Invasive Knee Replacement?

Candidates for minimally incision procedures are thinner, younger, healthier and more motivated to participate in the rehabilitation process compared to patients who undergo the traditional surgery. Overweight, obese or very muscular patients, those who have undergone other knee surgeries earlier or patients who suffer significant deformity or instability of knee are less suitable for MIS of the knee.

If you’d like to learn more about knee replacement or minimally invasive knee replacement surgery, please consult a knee replacement specialist at Max Hospitals.