Total Knee Replacement

A total knee replacement is a surgical procedure wherein the damaged knee is replaced with an artificial material or implant. It is also known as knee arthroplasty. This procedure is performed to relieve joint pain and disability most commonly for patients with osteoarthritis, and for damage from other conditions such as rheumatoid arthritis and trauma or injury.

Know More About Surgery

A knee replacement surgery may be considered for those patients who knee joints have been severely damaged. This can either be due to conditions like arthritis, sever injury or trauma, or any other disease that may cause damage to the knee joint. The most common cause for the need for knee replacement remains arthritis, which can present with the following symptoms:-

  • Sharp and intermittent pain
  • Swelling in the knees
  • Fatigue
  • Stiffness in the joints
  • Reduced range of motion
  • Limping
  • Joint deformity
  • Joint redness
  • Tenderness in the joint

The following tests and diagnostic methods are used in order to diagnose problems with the joints:

  • Physical exam- the doctor would conduct a physical exam to check for signs of joint swelling, stiffness or redness. The doctor would also feel the joint for presence of swelling, warmth and fluid. Range of motion is also be checked by moving the joint back and forth.
  • Blood tests- blood tests may also be performed to check for the level of inflammation or the presence of antibodies. For example, the presence of rheumatoid factors (RF) in the blood indicates the presence of rheumatoid arthritis.
  • Joint aspiration- a small sample of fluid is drawn out of the joint for testing using a needle.
  • Imaging tests- the most frequently used tests for this purpose are X-rays which help in looking for structural changes, signs of joint erosion, cartilage loss or tissue tear, inflammation, amount of fluid present etc. 

An incision is made at the front of the knee in order to access the kneecap (patella). The patella is then rotated outside the knee area in order to get a better view of the area that needs to be repaired and operated on. The femur (thigh bone) is then measured and resurfaced and the damaged bone and cartilage from the end of the femur is cut away using special instruments to fit the metal femoral component of the artificial knee is at the end of the femur. Next, the tibia (shinbone) is resurfaced by removing the damaged bone and cartilage and then reshaped in order to fit the plastic and metal tibial components. The patella is then readjusted. The surgeon might flatten the patella and attach an additional plastic component in order to fit with the rest of the implant. The functioning of the implant is checked by bending and flexing the knee and the incision is closed with stitches or staples. 

Total knee replacement is a major operation and there are certain risks associated with the same.

  • Infection at the site of incision
  • Deep vein thrombosis or pulmonary embolisms
  • Allergy to the metal components in the implant
  • Bleeding from the wound
  • Damage to major arteries in the leg
  • Problem with placement or malfunction of the implant

The procedure is usually one and a half to three hours long. The patient’s vitals are monitored in a recovery room and physical therapy can begin after 48 hours. The patient may have to stay in the hospital for a minimum of 5 days. A device called continuous passive motion (CPM) may be used to speed recovery. Walkers or crutches will be required initially and the patient will have to perform certain home exercises prescribed by the doctor.

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Total Knee Replacement

A total knee replacement is a surgical procedure wherein the damaged knee is replaced with an artificial material or implant. It is also known as knee arthroplasty. This procedure is performed to relieve joint pain and disability most commonly for patients with osteoarthritis, and for damage from other conditions such as rheumatoid arthritis and trauma or injury.

Symptoms

A knee replacement surgery may be considered for those patients who knee joints have been severely damaged. This can either be due to conditions like arthritis, sever injury or trauma, or any other disease that may cause damage to the knee joint. The most common cause for the need for knee replacement remains arthritis, which can present with the following symptoms:-

  • Sharp and intermittent pain
  • Swelling in the knees
  • Fatigue
  • Stiffness in the joints
  • Reduced range of motion
  • Limping
  • Joint deformity
  • Joint redness
  • Tenderness in the joint

Diagnosis

The following tests and diagnostic methods are used in order to diagnose problems with the joints:

  • Physical exam- the doctor would conduct a physical exam to check for signs of joint swelling, stiffness or redness. The doctor would also feel the joint for presence of swelling, warmth and fluid. Range of motion is also be checked by moving the joint back and forth.
  • Blood tests- blood tests may also be performed to check for the level of inflammation or the presence of antibodies. For example, the presence of rheumatoid factors (RF) in the blood indicates the presence of rheumatoid arthritis.
  • Joint aspiration- a small sample of fluid is drawn out of the joint for testing using a needle.
  • Imaging tests- the most frequently used tests for this purpose are X-rays which help in looking for structural changes, signs of joint erosion, cartilage loss or tissue tear, inflammation, amount of fluid present etc. 

Treatment

An incision is made at the front of the knee in order to access the kneecap (patella). The patella is then rotated outside the knee area in order to get a better view of the area that needs to be repaired and operated on. The femur (thigh bone) is then measured and resurfaced and the damaged bone and cartilage from the end of the femur is cut away using special instruments to fit the metal femoral component of the artificial knee is at the end of the femur. Next, the tibia (shinbone) is resurfaced by removing the damaged bone and cartilage and then reshaped in order to fit the plastic and metal tibial components. The patella is then readjusted. The surgeon might flatten the patella and attach an additional plastic component in order to fit with the rest of the implant. The functioning of the implant is checked by bending and flexing the knee and the incision is closed with stitches or staples. 

Risks

Total knee replacement is a major operation and there are certain risks associated with the same.

  • Infection at the site of incision
  • Deep vein thrombosis or pulmonary embolisms
  • Allergy to the metal components in the implant
  • Bleeding from the wound
  • Damage to major arteries in the leg
  • Problem with placement or malfunction of the implant

After Procedure

The procedure is usually one and a half to three hours long. The patient’s vitals are monitored in a recovery room and physical therapy can begin after 48 hours. The patient may have to stay in the hospital for a minimum of 5 days. A device called continuous passive motion (CPM) may be used to speed recovery. Walkers or crutches will be required initially and the patient will have to perform certain home exercises prescribed by the doctor.

FAQ Section

1) What is Total Knee Replacement (TKR)?

Total Knee Replacement Surgery abbreviated as TKR is also known as Knee Arthroplasty, is a surgical procedure that helps in relieving knee pain and restore normal functioning of the knee joint.
It typically involves replacing the damaged bones and cartilage with an artificial joint or prosthetic made of metals or high-grade plastics. There are several types of knee replacement surgery like total knee replacement, uni compartmental (partial) knee replacement, complex or revision knee replacement. Your doctor and the orthopedic surgeon should help you to choose the best option for you.

2) Why does one need to undergo Total Knee Replacement(TKR) Surgery?

The most common reason for knee pain is an injury to the knee or osteoarthritis. Due to damage and deterioration of the cartilage cushioning the knee joint, the range of motion is restricted which causes pain during normal activity like walking, climbing, sitting and standing for a longer duration.
Knee replacement surgery is one of the most common surgeries performed to relieve such knee pain. 90-95 per cent of patients achieve excellent results with pain relief and significantly increased mobility and activity.

3) What are the risk factors of a Total Knee Replacement (TKR)?

Common risk factors in Knee Replacement procedure include infections, blood clotting, complications arising due to anesthesia or transfusion, allergy to metal components etc. On a national average, fewer than two per cent of patients experience knee joint infection or other major difficulties.
Blood clotting in leg veins is one of the most common complications but it can be effectively prevented with medications and low impact exercises. Always consult your orthopedic surgeon about the same.

4) How effective is Total Knee Replacement Surgery?

Total knee replacement is one of the most successful of all surgeries with mostly positive outcomes. The chances of prosthetic lasting for a decade are very high, according to a recent study. The recovery time is also less and TKR provides 80 to 90 per cent reduction in pain making it one of the most sought out procedure in India and abroad.

5) When is the right time to undergo Total Knee Replacement?

Usually, Total Knee Replacement is seen in patients aged 50 to 80 years but age is not the only parameter in determining the need of TKR. Only an orthopedic surgeon can very well determine when you need replacement depending upon the underlying damage.

6) Can I avoid TKR surgery?

If deterioration is less, lifestyles modifications like an increase in consumption of less inflammatory foods, exercise and physical therapy are beneficial in prolonging the surgery.

7) What are pre-diagnostic measures in TKR ?

Your orthopedic doctor will determine whether you are a suitable candidate for surgery depending upon PAT analysis which may include.
• Physical Examination
• Lab Tests
• Total Erythrocyte Count, to rule Anemia and Hypoxia
• Urinalysis testing
• Coagulation testing, to determine whether any clotting factor is absent or not.
• Metabolic analysis of your organs
• Electrolyte status
• ECG/EKG to check the status of your heart
• Complete x-ray of your knee.

8) How is Total Knee Replacement performed?

TKR is a simple yet complex procedure. Your orthopedic surgeon will make an incision of about 4 to10 inches depending upon underlying condition. The damaged bones and cartilages will be removed and replaced by metal and plastic components which are also known as implants.These components will mimic the natural joints and function as an artificial knee thereby helping in movements and reduce the knee pain.

9) How long will Total Knee Replacement operation take?

Usually, the Total Knee Replacement surgery lasts for about 1 to 2 hours. Most of this time is taken by the operating staff to prepare you for surgery.

10) What components are used in Total Knee Replacement?

Implants are used to replace the damaged parts of the knee. There are different types of knee implants available and you orthopedic surgeon will select them based on the deterioration of your knee and other factors like age, level of activity and overall health conditions. Implants comprise of metals and medical grade plastics which are biologically compatible.
Further, for combining prosthetics, the bone cements are used.

11) Will I experience pain?

You may experience pain for 4 to 5 days maximum. In some patients, pain may last for a year. Physical therapy and lifestyle modifications and alternative therapies like acupuncture are also very effective in pain relief after the Total or Partial Knee Replacement surgeries.

12) What is the duration of recovery?

With the help of a walker, most candidates can walk on the day of surgery itself or next. However, the physical therapist has to make sure you are able to flex and extend properly after surgery.
Physical therapy can continue regularly for weeks and gradually your orthopaedic surgeon will stop your pain medications.
Some of the patients will be allotted hospital stay for three to four days after their surgery. If you need more time for recovery after TKR, your doctor or orthopedic will prescribe the same.

13) What activities can be performed after Total Knee Replacement surgery?

You will be able to resume normal daily activities like walking, bathing etc in a few days. Low impact exercises can also be resumed with time. You may need assistance for a few days after surgery.

14) What is the cost of Knee Replacement surgery in India?

The cost of Total Knee Replacement surgery in India may vary between INR 2-3 lakhs in some of the best hospitals in India. The type of the implants can make a difference in the overall cost. The cost for a partial knee replacement surgery is usually 10-15% less than that of a TKR.

15) Do people come from abroad for knee replacement surgery in India?

Yes, many people come to India for joint replacements due to attractive packages by medical tourism companies, state of art infrastructure of hospitals, patient-centric approach and availability of experienced doctors in India.
Most of the international patients who came to India for specific surgical procedures experienced that staff in India was very much approachable and friendly.

16) How do I choose the best doctor and hospital for a Total Knee Replacement Surgery?

This is a very tough and important decision for any family to make. Orthopedic surgeons who have performed these procedures before are to be preferred more. The hospitals with good rehab centres and therapists are always a good choice for joint replacement surgeries.