Q.How knee replacement is
done?
A. Total knee replacement is
a procedure utilized to resurface an arthritic
knee joint. Unlike total hip replacement, where
a large segment of bone is removed, in total knee
replacement it is simply the arthritic surfaces
of the bone that are trimmed and then resurfaced
with metal (femoral side) and plastic(tibial side)
Implants. In that regard, this is very similar
to Hip Resurfacing. The ligaments that join between
the femur and the tibia on the outer portions
are maintained.
Q.I am bow-legged. Can knee replacement
surgery correct this?
A. Yes. Total knee replacement
is very effective at straightening a deformed
knee joint and restoring good functional ambulation.
Q. How long does
the operation take?
A. A primary total knee replacement
takes between about an hour to 90 minutes. Anesthetic
induction time is about 30 minutes. Extubation
and shifting takes another 15 minutes. A difficult
knee may take about two hours.
Q. What anesthesia
will I receive?
A. You can have the operation
done under general anesthesia (fully unconscious)
or a regional anesthesia( spinal or epidural)
in which you will be sedated but not knocked out.
Regional anesthesia is a safe mode for diabetics
and elderly people.
Q. How the postoperative
pain is controlled?
A. Post operative pain is controlled
by blocking the nerves which carry the pain sensation
This is achieved by injecting medication into
the epidural space after putting a catheter around
the spinal cord. This is called epidural analgesia.
Q. When can I walk after knee replacement?
A. You can do so within 24 –
48 hrs after the operation.
Q. How long should
a patient remain in hospital after a knee replacement?
A. After a total knee replacement,
one week’s hospitalization is required.
This is to ensure that the patient is pain free
and is confident to stand up and walk. After a
bilateral total knee replacement the patient will
remain for a week after the second operation,
so that makes two weeks of admission in hospital.
Q. For how long
will I have to use a walker?
A. You may need a walker for
about 15 days and a cane or crutches for another
fortnight. Then you can walk without any aids.
Q. What prosthesis
do you use?
A. I use only standard prosthesis
made in the US. These are all imported to India
by the same companies that operate the world over
These are
a) PFC from Depuy( Johnson & Johnson)
b) NexGen prosthesis from Zimmer
c) Genesis from Smith and Nephew
Q. I am diabetic. Can I have the operation?
A. Many of my patients are diabetic.
I endeavor with the help of a good diabetologist
to bring your sugar levels to within normal levels.
My anesthetist is very competent at epidural anesthesia
and hence the operation is pretty safe. Wound
healing is good in well controlled diabetes. If
not, control is achieved and then I operate.
Q. When can the
patient go back to work?
A. This depends on the nature
of the job. A sedentary or desk top person will
find it possible after a month. If the job involves
a lot of time on the legs or walking, then it
takes about two months.
Q. Can I travel
overseas after the operation?
A. In the case of overseas patients,
you can do so after 2 weeks. You need to spend
only a week in the hospital for your recovery
and the balance can be spent in a resort nearby.
This is to ensure that you have recovered fully
well after the operation and are fit to travel.
An x ray is taken in the post op period and again
after a month.
Q. When Can I drive
a car after surgery?
A. As you may require using an
aid for about a month to six weeks, it is inadvisable
to drive a car for six weeks. Then it is safe
to do so.
Q.How long will knee replacement surgery
last?
A.Knee replacement surgery has
been documented to last beyond 15 years in more
than 90% of the patients.
What are the complications
of knee replacement?
Infection of the replaced joint, and Deep vein
thrombosis (blood clot in the calf muscle) pulmonary
embolism(blood clot travel to the lungs) can occur
in less than 1% of the cases.
BILATERAL KNEE REPLACEMENT
Q. Can both knees
be operated simultaneously?
A. If you are healthy and can
stand up to anesthesia, then I can do both knees
in one sitting( Bilateral TKR). Other wise I operate
on the second knee after 5 days after the first
knee and you have had time to recuperate. Many
elderly patients’s health condition allows
a sequential( after 5 days) knee replacement.
Will an implant
set off a metal detector?
Since knee implants are made of metal,
there’s a chance they could set off metal
detectors. You will be provided with a certificate
to keep in your wallet explaining that you have
a knee implant.
