Knee Replacement Surgery

• Total Knee Replacement
  
  Total Knee Replacement or 'Arthroplasty' is relining of the joint (bone end surfaces) with artificial parts called prostheses. There are three components used in the artificial knee.
  
  1. The femoral (thigh) component is made of metal and covers the end of the thigh bone.
  2. The Tibial (shin bone) component, made of metal and UHMWPE (medical-grade plastic), covers the top end of the Tibia.
  3. The third component, the patella or kneecap, is made up of polythene. The surgeon decides at the time of operation if it should be replaced in a particular situation or not.
  
  Patients with severe arthritis of both knees can be offered replacements of both knees together after a thorough medical evaluation. Joint replacement using computer assistance is also performed which improves implant alignment and surgical precision. Before a total knee replacement surgery is performed, Orthopaedics evaluate the medical history, conduct a physical examination, X-rays, and other tests like MRI and blood tests. The doctor then reviews the results and discusses with the patient if total knee replacement surgery is the best option in their case to improve function and relieve pain.
  
  
  
• Unicondylar Knee Replacement
  
  In some patients, only one-half of the knee joint is worn out. In these situations, only one side of the knee is replaced. This is termed as Unicondylar Knee Replacement. It can be done in specific conditions, which only the surgeon can judge and advice. This surgery is comparatively economical, and since the operation is less extensive, the post-operative recovery is faster.

If a patient’s knee is sternly damaged by arthritis or because of any injury, it may be difficult for them to perform everyday activities, such as climbing stairs or walking. After a period, they may even begin to feel pain while sitting or lying down. When non-surgical treatments like the use of walking supports and medications prove no longer to be helpful, the doctor may advise the patient to undergo a total knee replacement surgery. It is a safe procedure that helps in pain relief, corrects leg deformity, and allows the patient to resume normal activities.

Knee replacement surgery treatment is performed when a patient experiences the following:

• Osteoarthritis
• Pain in and around the joint
• Stiffness
• Difficulty in squatting and sitting crossed leg
• Difficulty in negotiating stairs
• Deformities of the joint
• Inability to walk for long distances
• Joint swelling
• Decreased movement of the joint
• Rheumatoid arthritis
• Infective arthritis
• Traumatic Arthritis
• Gouty arthritis
• Pain in deformed knee

The surgical treatment becomes an option in severe cases and the medical treatment fails.

Medical treatment includes

• Activity modification.
• Anti-inflammatory medications
• Joint injections

• When the medical treatment fails to relieve the pain
• There is severe deformity of the joint so much so that it affects the daily activities of the patient
• There is instability of the knee joint
• There is decreased range of motion of the joint

Osteoarthritis most commonly referred to as the wear and tear of the joint usually affects the elderly and middle age to elderly people. In osteoarthritis the cartilage between the joint breaks down.

• Older age
• Obesity
• Previous traumatic joint injury/overuse of joints
• Joint deformity

• Pain in and around the joint
• Stiffness
• Difficulty in squatting and sitting crossed leg
• Difficulty in negotiating stairs
• Deformities of the joint
• Inability to walk for long distances
• Joint swelling
• Decreased movement of the joint

• History and clinical examination
• Standing X rays of the knee joint
• Some patients may knee CT Scan/ MRI

Activities to be Avoided After Knee Surgery:

• Squatting
• Sitting crossed leg
• Using Indian commode
• Avoid high level impact activities like sports and heavy physical work

The Post-Operative Physical Therapy

After the knee replacement surgery, the patient is shifted to the post-operative observation room (HDU). A bandage is tied over the knee with a drain tube coming out of the bandage. This removes any blood collected in the knee and minimizes the chances of infection.

An intravenous line is used for transfusing blood or fluids into the patient's arm. This is later used to administer antibiotics over the next few days and transfuse blood. In some instances, a urinary catheter may be used to help elderly patients or those who have urinary difficulty. Some leads are attached to the body to continuously monitor the ECG, blood pressure, pulse rate, breathing rate, etc. The patients remain in the observation room for a night. Once the anaesthetists are satisfied, patients are shifted to their respective rooms, the next day.

The surgeon will supervise the knee rehabilitation programme, which usually begins 24-hours after the surgery.

• Isometric quadriceps exercises are started 24 hours after the surgery
• The patient is allowed bed side sitting 24 hours after the surgery
• The patient is made to stand on the next day of surgery
• The patient is made to walk with the help of walker 48 hours after the surgery.
• Knee bending exercises are started 48 hours after the surgery
• Patient walk with the aid of walker up to 6 weeks
• After 6 weeks walker is replaced with stick for next 6 weeks
• Patient walks unaided after 3 months

The physiotherapy is continued for 6 months after the surgery.

• Myths and Facts on Total Knee Replacement (tkr)
• Knee Replacement is not the only Surgical Option for Patients with Knee Arthritis!
• A Walk Through Knee Replacement!
• 5 Common Reasons Behind Knee Pain