Knee Replacement Surgery

Dr Ameet Pispati

Dr Ameet Pispati

Orthopedic Surgeon, Jaslok Hospital, 25 years experience

September 12, 2017 Bone Health 10260 Views

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What is Knee Replacement Surgery?

Knee replacement is also known as Total Knee Replacement (TKR) or a Knee Arthroplasty is a surgical procedure where the surgeon replaces the damaged surfaces of the bones forming the knee joint, with artificial material or an implant.

Total Knee Replacement is a misnomer considering that the parts of the bone forming the joint are not actually removed and replaced but instead just the damaged part is sliced off and artificial components or implants are added to cap the ends of the bones. So a better term to use is ‘knee resurfacing operation’. 

This procedure is performed to relieve joint pain and disability in patients with osteoarthritis. It can also improve knee function in cases of rheumatoid arthritis, trauma, or injury. 

Another variation of knee replacement surgery is partial knee replacement. Partial knee replacement surgery is strictly done in a partially damaged knee. It is less invasive yet as good as total knee replacement surgery. Here the knee is opened and a prosthesis (artificial part) is attached on top of the damaged part. Partial knee replacement surgery is preferred in younger patients. 

Let us tell you in detail about knee replacement surgery in this article.

  • What is the purpose of Knee Replacement Surgery?
  • Who should avoid Knee Replacement Surgery?
  • What are the steps of preparation before Knee Replacement Surgery?
  • What is the procedure of Knee Replacement Surgery?
  • What are the types of Implants used in Knee Replacement Surgery?
  • What is the care taken after Knee Replacement Surgery?
  • What changes can one do at home to prepare for recovery after Knee Replacement Surgery?
  • What are the risks of Knee Replacement Surgery?
  • What is the cost of Knee Replacement Surgery in India?
  • FAQs about Knee Replacement Surgery

What is the purpose of Knee Replacement Surgery?

Arthritis which causes pain and disability is the most common reason for total knee replacement. Apart from this, the following may also indicate the need for total knee replacement surgery.

  • Osteoarthritis (a condition causing painful inflammation in the joints)
  • Other conditions, such as rheumatoid arthritis
  • Knee injury giving rise to arthritis
  • Fractures, ligament tears, tears in the cartilage resulting in severe damage to the knee
  • Severe and intermittent knee pain 
  • Swelling in the knees cannot be reduced by medication
  • Joint stiffness
  • Reduced range of motion
  • Limping
  • Joint deformity
  • Tenderness in the joint

( Know more about- Home remedies for Arthritis )

Who should avoid Knee Replacement?

Your doctor will decide if you are fit for the surgery or not after a proper examination

Patients who are NOT suggested to get a knee replacement surgery are:

  • Patients having a difficulty in extending their knee (extending the knee refers to the action of straightening the knee. e.g. Knee extension occurs when we stand up from a sitting position)
  • Patients having sepsis (infection)
  • Patient less than 50 years of age (although such patients can still undergo knee replacement if they are in severe pain and all other treatment options have been tried and exhausted)
  • Very obese people
  • Patients with a physically demanding profession involving daily high impact activity,  where the results of the surgery might not be long lasting

( Know more about- Elbow pain: causes, symptoms, and treatment )

What are the steps of preparation before Knee Replacement Surgery?

Before the knee replacement, your orthopedist will perform some tests to diagnose problems with your joints such as:

  • Physical Examination – The patient is examined in the lying-down position. This is followed by the doctor looking for signs of joint swelling, any joint deformity, and muscle wasting. The doctor then feels the joint to check for the presence of warmth, swelling, fluid, and tenderness of the joint. Further, the doctor examines the range of motion of the joint by moving the knee back and forth to check for any stiffness of the joint. 
  • Blood Tests – Specific blood tests can be done to check for the level of inflammation or the presence of antibodies. For example, the presence of rheumatoid factors (RF) in the blood can indicate the presence of autoimmune disease, especially rheumatoid arthritis. General blood tests like CBC, blood glucose, Kidney Function Tests, Liver Function Tests are done preoperatively.
  • Joint Aspiration – A small sample of fluid is collected from the knee joint using a needle and sent for further testing. This is done in select patients, only when needed.
  • Imaging Tests – The most commonly used imaging tests are X-rays as they help look for structural changes, signs of joint erosion, loss of cartilage or tissue tear, swelling, the amount of fluid present, etc. Sometimes, MRI or CT scans are obtained to provide further information to plan the surgery.

What is the procedure of Knee Replacement Surgery?

  • Knee replacement is done under spinal or general anesthesia.
  • During knee replacement, an incision (cut) is made on the skin at the front of the knee to reach the kneecap (patella). The patella is then rotated outwards to get a better view of the area that needs to be repaired.
  • The lower end of the femur (thigh bone) is then measured and resurfaced. The damaged part of the bone and cartilage are sliced from the lower end of the femur by using special instruments and then the metal femoral component of the prosthetic (artificial) knee is fit in.
  • Subsequently, the tibia (shin bone) is resurfaced by removing the damaged bone and cartilage from the upper end of the tibia and then reshaped to fit the plastic or metal tibial component.
  • The patella is then readjusted. The damaged portion of the patella is resurfaced and fitted with a patellar button, or the patella is reshaped. The surgeon adds a plastic spacer between the femoral and tibial components to avoid friction between the prosthesis.
  • The prosthesis is most commonly attached to the bone by surgical cement and is known as cemented prosthesis.
  • The functioning of the implant is checked by bending the knee and the incision is closed with sutures or surgical staples.
  • A properly executed knee replacement surgery gives approximately 10-15 years of excellent functioning of the knee.

What are the types of Implants used in Knee Replacement?

There are various types of knee implants available, but the standard way of performing the surgery is to fix the parts with bone cement.

The parts themselves are made of cobalt-chromium alloy or titanium. Oxinium or Gold knee replacement is used in select patients.

What is the care taken after Knee Replacement Surgery?

  • After the knee replacement, the patient is shifted to the recovery room, where his vitals are monitored under the doctor’s care. In addition, physical therapy can be started on the same day. The patient may have to stay in the hospital for approximately 3-5 days. After a few days, the patient is allowed to go home. 
  • The patient initially will require a walker or crutches or a stick. 
  • The patient must continue exercises/physical therapy once he gets home.
  • There may be some difficulty in getting up or sitting but the patient is advised to keep moving his/her knees.
  • The patient must follow the instructions given by the surgeon and contact his surgeon in case of any complications.
  • A physiotherapist will be assigned to the patient who will guide the rehabilitation and help in gaining complete functioning of the knee.

 (Know more about –What is Physiotherapy? )

What changes can one do at home to prepare for recovery after Knee Replacement Surgery?

  1. Make space at home for ease of movement. 
  2. Install a handrail in the bathroom and next to the toilet.
  3. Have a non-slip bath mat ready.
  4. Wear non-skid socks.
  5. Install night lights.
  6. Ask for help. If close friends and family cannot provide help, hire a nurse or home help to help at least for the first few weeks.

What are the risks of Knee Replacement Surgery?

The patient might experience the following risks and complications after knee replacement:

  • Infection at the incision site
  • Deep vein thrombosis wherein blood clot gets formed in the deep veins of the leg 
  • Pulmonary embolism (Blockage of the arteries in the lungs because of a blood clot)
  • Allergic reaction to metal components in implants
  • Bleeding from the wound
  • Damage to major nerves (the common peroneal nerve that controls the movement and sensation over the lower leg, foot, and toes is most commonly injured) and arteries in the leg
  • Problems with placement or malfunction of the implant
  • Fractures during the surgery
  • Loosening of implants
  • Ligaments getting stretched during the postoperative years
  • Unusual bleeding into the knee joint

What is the cost of Knee Replacement Surgery in India?

The total cost of knee replacement surgery in India can range from around INR 2,00,000 to  INR 3,00,000.

If you are coming from abroad, in addition to the cost of knee replacement, there will be an additional cost of accommodation and food, the cost of local travel, etc. After the surgery, the patient has to stay in the hospital for a few days and in the hotel for around 10 days, after getting discharged from the hospital, for complete recovery. This might add to additional charges. So, the total cost of knee replacement surgery is around INR 4,00,000.

FAQs about Knee Replacement Surgery

Q1. Can I avoid Knee Replacement Surgery?

Ans. Your doctor will usually advise you to try different methods to relieve your symptoms before recommending surgery. Some of these non-surgical methods may include: 

  • Physiotherapy
  • Weight loss (if applicable)
  • Medications to reduce joint inflammation
  • Cartilage repair supplements
  • Acupressure

However, if these non-surgical techniques do not reduce your joint pain and interfere with your day-to-day activities, hampering your quality of life, then surgery might be the best option for you.

Q2. How long does the surgery last?

Ans. Most Knee Replacement operations take 1 to 1.5 hrs to complete.

Q3. For how long will it pain after Knee Replacement Surgery?

Ans.

  • General pain may persist for several weeks post-surgery.
  • Swelling may persist from 2-3 weeks up to as long as 3 to 6 months
  • Bruising may persist for a couple of weeks following surgery.

Q4. Will I need any walking support after the surgery?

Ans. Most people need the help of crutches or a walker or a stick during the first few months after the surgery. A physiotherapist will teach you how to walk using your new knee and give you exercises to improve the mobility of your joint. Sometimes your Orthopedic surgeon might suggest you use a CPM machine (Continuous passive motion). A CPM machine helps you maximize your range of motion and to reduce scar formation. However, once a full recovery is achieved, you do not need to use any support for doing your day-to-day activities.

Q5. How long will it take for complete recovery?

Ans. Typically, a patient can be discharged from the hospital within 1-5 days and they can resume their day-to-day activities within 6 weeks after surgery. However, it takes 3 to 6 months after surgery for a complete recovery.

Q6. How long does an artificial knee last?

Ans. A knee replacement gives approximately 10-15 years of excellent functioning of the knee after which the prosthesis might require a change if it gets loose.

We hope that we could answer your questions regarding Knee Replacement Surgery through this article.

If you have any further queries regarding Knee Replacement Surgery, contact an Orthopedic surgeon. 

We only aim to provide you with information through this article. We do not recommend any medicine or treatment to anyone. Only a qualified doctor can give you good advice and the correct treatment plan.

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