Faq's For Knee Replacement Surgery
Q. How do I know I need a Total Knee Joint Replacement Surgery?
A. If you have knee deformities or severe X-ray changes, or advanced symptoms of arthritis, you require a total knee replacement surgery.
Symptoms of advanced knee arthritis are pain, crepitus, stiffness, limping, muscle weakness, limitation of motion, and swelling. Total Knee replacement surgery is generally delayed by the doctors in favor of less invasive procedures. But, if you have difficulty walking or performing everyday activities such as getting dressed, you do require knee replacement surgery.
Total knee replacement surgery offers great relief from pain and it restores normal activities in life.
Q. How common is total knee replacement surgery?
A. Knee replacement is a routine surgery performed on over 650,000 people worldwide each year. Over 90% of people who have had Total Knee Replacement experience an improvement in knee pain and function.
Q. How old is the average patient for knee joint replacement surgery?
A. The average knee joint replacement patient is around 65-70 years old; however patients of all ages have received knee implants.
Q. What is a total knee replacement surgery?
A. The total knee replacement surgery involves resurfacing the parts of the bones of the knee that rub together with metal and plastic implants. Using special, precision instruments, the surgeon will remove the damaged surfaces of all three bones. The replacement surfaces will then be fixed into place.
The surface of the femur is replaced with a rounded metal component that comes very close to matching the curve of the natural bone. The surface of the tibia is replaced with a smooth plastic component. This flat metal component holds a smooth plastic piece made of ultra-high-molecular-weight polyethylene plastic that serves as the cartilage. The undersurface of the kneecap may also be replaced with an implant made of the same polyethylene plastic.
Q. Are all knee joint replacements the same?
A. No, there are six different types of knee replacements:
- Posterior cruciate ligament (PCL) retaining
- Posterior cruciate ligament (PCL) substituting
- Rotating platform
These different prostheses can be made of cobalt chrome, titanium, and polyethylene (plastic), and can be fixed to the bone with acrylic cement or can be press-fit, which allows bone to grow into the implant. Use of a particular implant design, material, and fixation method depends on many factors related to each individual patient.
Q. Which knee replacement is ideal for me?
A. The type of knee replacement and implant best suited for depends on your age, the degree of involvement of each of the three compartments of your knee, choice of your orthopedic surgeon and your level of activity. This would be discussed with you and analyzed by your surgeon before you choose to come here for the surgery.
Usually, total knee replacements are ideal for severe osteoarthritis affecting all the three compartments of your knee and rheumatoid arthritis.
For unicompartmental knee arthritis affecting the medial or inner half alone there are two options available. One is a hemiarthroplasty with a metal( Unispacer) or a UNIcondylar knee replacement in sedentary ladies. Patello femoral replacements are now back for those cases of severe patello femoral arthritis which have failed to respond to tibial tubercle surgery and lateral release. It is possible to combine a unispacer knee with a patello femoral replacement for the common combination of inner sided wear and knee cap wear. Mobile bearings are available. These reduce the amount of wear and increase the longevity of the prosthesis. The contact surface area is increased in such prosthesis.
Q. How is the knee replacement surgery done?
A. The knee replacement surgery starts with an incision over the knee that exposes the joint. The special precision guides and instruments are used to remove the damaged surfaces and shape the ends of the bones to accept the implants.
The implants are then secured to the bones. When the surgeon is satisfied with the fit and function of the implants, the incision is closed. The surgery takes two to tree hours to complete, which varies from patient to patient.
A bandage is applied and a special drain is usually inserted into the wound to drain the fluid that naturally develops at the surgical site. You would then be taken to the recovery room, where you would be closely monitored.
When you regain consciousness, you would be taken to the hospital room, where a nurse would be with you. You would also be given pain killers and the knee might remain swollen for a few days.
Q. How is the knee rehabilitation done?
A. A total knee replacement rehabilitation program is begun after the surgery.
To help regain strength, balance and range of movement in your knee, a specifically designed rehabilitation programme is started when you are back in the hospital room. The physical therapist will help you perform appropriate exercises. About 24 hours after surgery, you will probably be asked to stand.
Within the next 24 hours, you will probably begin to walk a few steps with the help of a walker. You can expect to stay in the hospital for about five to six days after your surgery. You may or may not be transferred to a rehabilitation facility for a few more days, as determined by your surgeon. Your bandages and sutures will usually be removed before you leave the hospital. At home, you will need to continue your exercises.
Q. When can I return to normal activities after knee joint replacement surgery?
A. Most patients start walking with the cane within six weeks of the surgery. Few patients also start driving within seven to eight weeks after surgery.
But, there are some precautions to be taken even after you have fully recovered. One should not put excessive strain on the knee like jogging, skiing, high impact aerobics and other sports which put strain on the knee joint.
Q. What precautions do I need to take after knee replacement surgery?
A. Though this is not an exhaustive list of the precautions, these are the general guidelines to be followed after the surgery. The surgeon and the physical therapist will guide you in details about the do's and don'ts after the surgery
- Avoid heavy lifting and excessive stair climbing
- Maintain appropriate weight
- Avoid "impact loading" sports such as jogging, downhill skiing and high impact aerobics, twisting or impact stresses.
- Consult your surgeon before beginning any new sport or activity
- excessive bending when weight bearing, like climbing steep stairs
- not lift or push heavy objects
- Do not kneel
- Avoid low seating surfaces and chairs.
Q. What is the life of a replaced knee?
A. The longevity of the prosthetic varies with every patient depending upon physical condition, activity level, weight as well as the accuracy of implant placement during surgery.
Though total knee replacement has become a common and predictable surgery, with very high success rates, it should be kept in mind that there is no guarantee that a prosthetic joint will last the rest of patient's life.
As with any mechanical joint, the knee components move against each other. Natural fluid in the joint space, called synovial fluid, helps to lubricate the implants just as it lubricates the bones and cartilage in a natural joint. Still, the prosthetic components do wear as they roll and slide against each other during movement. As with car tires or brake pads, the rate of wear depends partly on how the knee joint is used. Activities that place a lot of stress on the joint implants, as may be the case with heavier and more active patients, may reduce the service life of the prosthesis. Implant loosening and wear on the plastic portions of the implant can lead to the necessity for revision surgery to replace the worn components, or all of the components.
Q. Do I need to take antibiotics after dental and other procedures after the joint replacement?
A. Your total joint replacement is an immuno compromised area in your body. Your immune system and white blood cells have a difficult time clearing bacteria from joint replacements. Therefore, it is best to avoid and reduce the risk of any possible infection. To do this, it is commonly recommended that for dental procedures, particularly those involving a dental abscess, and for other procedures that are at risk for putting bacteria into the blood stream, that a patient be given antibiotics around the time of these procedures. The greatest risk for infection to occur after these procedures is within the first two years.
Q. What is the average cost of knee replacement in India?
A. The cost of knee replacement in India is around $ 6500 which is a fractional of what you would have to shell out for same services in USA/ UK. The price varies with the city and the facility you choose to stay. Please contact us to know options best suited for you.
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