Total Knee Replacement

What is Total Knee Replacement ?

Total Knee Replacement (TKR) Surgery is one of the most commonly performed

Surgical treatments around the World with excellent outcomes if performed by a

skilled and experienced orthopaedic surgeon.

The purpose of the surgical procedure is to achieve pain-free movement again,

with full functionality of the joint, correct deformity and to recreate a stable joint

with a full range of motion.

Total Knee replacement is most commonly done:

• In case of advanced Osteoarthritis where the bone is damaged, and cartilage is worn off, and due to no cartilage, there is friction between the thigh bone (Femur) and shin bone(Tibia) the patient is having severe pain and stiffness and his activities get hampered.

• In the case of Rheumatoid Arthritis in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”

• Post-traumatic arthritis can follow a severe knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

Some of the symptoms of arthritis

• Severe pain and stiffness make it hard for you to walk, climb stairs, or get out of a chair

• Continuous knee pain bothers you while resting, possibly keeping you from sleeping well.

• You often have a swollen knee.

• There are a Crepitus and tenderness on examination and patient complains of crackling sound on bending or flexing the knee.

• Waddling is present while walking

• Your knee is bowed or has other defects.

• Physical therapy and medication haven’t helped.

• Walking is becoming difficult without support

When the patient has severe complaints and functional limitations in the knee, the surgeon suggests total knee arthroplasty. The surgery takes some 40-60 minutes and involves the placement of the three-part prosthesis.

The three-part prosthesis:

● A part for the femur,

● A part for the tibia,

● A polyethene shock-absorbing disc as a substitute of Meniscus and

● Sometimes a replacement patella.

● A high comfort insert design is chosen to achieve this

There are three basic steps to a knee replacement procedure

• Prepare the bone: The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone to remove the diseased part and create a room for implant/ prosthesis, but the implant thickness is always minimal and replicates the natural bone structure and shape

• Position the metal implants : The surgeon replaces the removed cartilage and bone with metal components that recreate the surface of the joint. They then cement these parts into the bone as per the specifications

• Insert a spacer : A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

• Resurface the patella : The surgeon resurfaces and replaces the undersurface of the patella (kneecap) with a plastic button if required depending upon the case.

Once the experts complete the procedure, they will monitor your progress and

administer post-surgery care. With advanced medical techniques today, recovery

is quicker by minimizing the hospital stay.

Before And After Surgery

Scanogram before and after surgery

What is the hospital procedure if I plan to undergo Total knee replacement ?

For a Total knee replacement, admission in the hospital is usually one day before the day of surgery. After completing the admission procedure, the hospital authorities will shift you to

your allotted room. You will be explained and requested to sign a consent for the Surgery.

An anesthesiologist will examine before the Surgery. The surgeon usually performs the Total

knee replacement procedure under spinal or epidural anaesthesia, but sometimes general

anaesthesia is also used. The doctor will explain these options to you and an informed

consent obtained for the same. Whatever be the anaesthesia choice, be rest assured that

your operating room experience will be a tranquil one. Once the operation theatre is ready,

they will shift you there. The surgical time for a Unilateral Total knee replacement is about

45 minutes, but the total duration in the operation theatre, from anaesthesia to recovery is

about 2 hours.

Is this Surgery a painful undertaking?

Some pain after any surgery is inevitable. However, with the current tools at our disposal, to

manage post-operative pain, this is minimal and not bothersome. You will be discharged on

some pain medications and with DVT Prophylaxis to enable you to perform activities of daily

living and physiotherapy without much discomfort.

What happens during Total knee replacement surgery?

The surgeon usually performs the procedure under spinal anaesthesia. Sometimes an

epidural block or a femoral nerve block is also used. If this is the case, you will notice

numbness and tingling in your legs when you wake up, which will gradually wear off over 8

hours or so. After leaving the recovery area, the doctors will put you on tables to achieve

pain control. They prescribe anti-inflammatory medication to help with pain control, so you

must tell your anaesthetist if you have ever had a history of stomach ulcers or bleeding, as

this medication may not be appropriate in that situation.

You will be shifted to the ward/room within 45 minutes of the operation and should be able

to eat and drink after approximately 3 to 4 hours. On return to the ward after the

procedure, the orthopaedic surgeon places an inflatable cuff (Cryo-Cuff) around the knee,

which is filled with iced water to help control swelling. Patients find this very comfortable.

Depending on your surgeon’s preference, you may have one drain placed in the knee joint

so that unwanted blood does not accumulate and inhibit recovery. The surgeons remove

these drain tubes the day after Surgery while they perform the post-operative dressing.

What about recovery after surgery? Will Physiotherapy be needed?

Physiotherapy is begun on the day of surgery to rehabilitate your knee. The operated knee is

kept in an extended knee brace, for full-time wear for about three weeks. Your knee will be

placed in Continuous Passive Machine (CPM) by the physiotherapist to move the knee,

which helps reduce the swelling. Weight-bearing, as tolerated, is usually allowed from the

next day. No walking aids are necessary, but one may use an elbow crutch for comfort for a

few days. Icing the knee using a cryocuff, reduce pain and swelling. Discharge from the

hospital is usually after two days.

Long Knee Brace (Usually worn for first 3-4 weeks)

The therapy aims to achieve knee motion, muscle strength and reduce swelling. Adherence

to the physiotherapy protocol helps in faster recovery and reduces complications.

Bathing After Knee Surgery

The surgical incision following your surgery will be typically be closed using absorbable.

stitches. This does not require subsequent removal. Sometimes, skin staples or stitches may

be used which need removal later. In all cases, however, an absorbent water repellent

dressing is applied. You may take a bath at home after discharge, but the dressing must not

be made wet. It would help if you took a bath on a high plastic chair or stool preferably

under the shower. It would help if you took care to prevent a slip and fall in the bathroom.

Here are some ways in which you can protect the dressing from getting wet. Commercially available plastic covers are ideal for occluding the dressing. These are easy to remove with minimum assistance and can be used multiple times.

FAQ - Total knee replacement

What is a total knee replacement?

A knee replacement is a surgical procedure to resurface a knee damaged by arthritis. The

surgeon uses metal and plastic parts to cap the ends of the bones that form the knee joint

along with the kneecap.

When is a total knee replacement needed?

The surgeon may recommend a total knee replacement surgery for patients with severe

arthritis or a severe knee injury who have chronic, constant pain, difficulty walking or

climbing stairs and pain while resting.

What are the benefits of total knee replacement?

Total knee replacement can increase mobility and decrease pain in people who have an

arthritic knee joint.

What happens during surgery for a total knee replacement?

A knee replacement usually takes 1 to 2 hours. The doctor will make an incision on the top

of your knee and remove the damaged cartilage and bone. The doctor will then attach the

metal implants to the ends of the thigh and calf bones. A plastic spacer goes between the

metal pieces and helps the new joint move smoothly.

What happens after surgery?

Rehabilitation begins almost immediately after your wake up from surgery. Within the first

24 hours, you will start to stand and walk using an assistive device (walker or crutches) with

the help of a physical therapist (PT). They will show you how to get in and out of your bed

and how to move around using either a walker or crutches.

A nurse will help you with tasks such as changing the bandage, dressing, bathing and using

the toilet.

When do patients start rehabilitation?

You will begin rehabilitation one day after surgery and will continue after leaving the hospital for the next several months.

When do patients start rehabilitation?

You will begin rehabilitation one day after surgery and will continue after leaving the hospital for the next several months.

How long does it take to recover from a total knee replacement?

Most patients can care for themselves and resume normal daily activities six weeks after surgery. Driving is possible between three and six weeks if you can bend your knee far

enough to sit in a car, have enough muscle control to operate the brakes and accelerator

and are no longer taking narcotic pain medications. It may take between six months and a year to make a full recovery.

When do patients start rehabilitation?

You will begin rehabilitation one day after surgery and will continue after leaving the hospital for the next several months.

Bilateral (Double) Knee Replacement

A bilateral knee replacement is when both knees are replaced with artificial joints either on

the same day or staged so one knee is done first and the other is replaced several days,

weeks or months later. People with severe arthritis in both knees are often good candidates

for this as it will allow the gait to be restored evenly.