Total Knee Replacement

Total knee replacement is a surgical procedure in which the diseased knee joint is replaced with an artificial prosthesis.

The knee joint is a type of hinge joint formed at the junction of the femur (thigh bone) and tibia (large bone of the lower leg).
Total knee replacement involves the replacement of all the three components of the knee joint, that is, the medial or inside portion of the knee, the lateral or outside portion of the knee, and the patellofemoral part or the part underneath the kneecap.
The prosthesis used to replace the knee joint parts is usually made up of metal or plastic.

Know More About Surgery

The following symptoms could indicate the requirement for a total knee replacement surgery:

  • Severe pain in the knee joint
  • Severe stiffness in the knee joint 
  • Knee pain not relieved on sleeping or resting
  • Knee joint inflammation
  • Knee joint swelling 
  • Deformity in the knee joint, such as bowing in or out of the knee
  • Other treatment options fail to treat knee pain and stiffness 

The following diagnostic tests may be done before a total knee replacement surgery:

  1. Physical examination: The doctor checks the knee strength, stability, motion, and leg alignment. The symptoms of the patient are noted.
  2. X-rays of the knee joint: This test helps the doctor check the image of the knee joint and see if any deformity or damage is present.
  3. CT scans and MRI scans: Imaging tests such as MRI scans and CT scans help in obtaining clear images of the knee joint and checking the condition of the bone and soft tissues present in the knee joint.
  4. Blood tests: Certain underlying medical conditions can be diagnosed with the help of these tests.
  5. Urine tests: Underlying urinary infections can be checked using these tests.
  6. Electrocardiogram (ECG): The electrical activity of the heart can be recorded by an ECG. 

 

Total knee replacement surgery is generally performed under general anesthesia (the patient is put to sleep during the procedure).
The procedure may be performed in the following different ways:

1. Open surgery:

  • An incision or cut is made by the surgeon at the knee region.
  • The damaged cartilage surfaces present at the end of the femur and tibia are removed along with a small part of the underlying bone.
  • The removed cartilage and bone are now replaced using metal components that recreate the joint surface.
  • These metal parts can either be cemented or press-fitted into the bone.
  • The undersurface of the patella (kneecap) is now cut and resurfaced with a plastic button. However, in some cases, the doctor may not resurface the patella.
  • A plastic spacer is inserted between the metal components. This creates a smooth gliding surface.
  • The incision is closed using sutures or stitches.

2. Laparoscopic surgery:

  • The surgeon makes several small keyhole incisions at the surgical site.
  • A tube with a camera on one end, known as a laparoscope, and other small surgical instruments are inserted through these tiny incisions to carry out the procedure of total knee replacement.
  • The procedure is less painful, has quicker healing, and has fewer complications than open surgery.

3. Robot-assisted surgery:

  • The procedure is performed using a laparoscopic approach.
  • The procedure is performed by robotic arms that are controlled by the surgeon who views the inside of the surgical site through a video monitor.
  • The procedure is more precise than an open or laparoscopic technique.

 

Total knee replacement surgery may have the following complications:

  • Infection
  • Bleeding
  • Scar tissue formation inside the knee
  • Blood clot formation
  • Blood vessel damage around the knee
  • Nerve damage
  • Allergic reaction to the anesthesia 
  • Wearing down of the implant 
  • Loosening of the implant 
  • Persistent pain in the knee joint
  • Need for another surgery 

 

  1. The patient is usually discharged from the hospital one to three days after the surgery.
  2. The patient’s physiotherapy sessions are started within 24 hours of the surgery.
  3. Physiotherapy sessions need to continue for a few weeks after the surgery. They help in improving the patient's range of motion, muscle strengthening, and prevention of circulation problems.
  4. The patient can start walking using a walker or crutches about two to three days after the surgery.
  5. The patient will notice a significant improvement in mobility approximately one month after the surgery.
  6. The patient can resume his/her daily activities three to six weeks after the surgery.
  7. The patient should avoid heavy lifting and other strenuous activities for a couple of weeks after the surgery.
  8. The patient should avoid any injury or fall during the recovery period.
  9. Complete recovery after the surgery may take up to four months or more. 
  10. The scar tissue may take as long as two years to heal completely.

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Total Knee Replacement

Total knee replacement is a surgical procedure in which the diseased knee joint is replaced with an artificial prosthesis.

The knee joint is a type of hinge joint formed at the junction of the femur (thigh bone) and tibia (large bone of the lower leg).
Total knee replacement involves the replacement of all the three components of the knee joint, that is, the medial or inside portion of the knee, the lateral or outside portion of the knee, and the patellofemoral part or the part underneath the kneecap.
The prosthesis used to replace the knee joint parts is usually made up of metal or plastic.

Purpose:
Total knee replacement surgery is generally done in the following cases:

  1. Osteoarthritis: It is an age-related, wear and tear type of joint inflammation in which the cartilage that cushions the knee bones wears away.
  2. Rheumatoid arthritis: It involves the inflammation and thickening of the synovial membrane (the membrane surrounding the knee joint) causing cartilage damage and cartilage loss.
  3. Post-traumatic arthritis: Knee ligament tears or fractures of the bone surrounding the knee due to an injury may lead to articular cartilage damage and knee pain.

Symptoms

The following symptoms could indicate the requirement for a total knee replacement surgery:

  • Severe pain in the knee joint
  • Severe stiffness in the knee joint 
  • Knee pain not relieved on sleeping or resting
  • Knee joint inflammation
  • Knee joint swelling 
  • Deformity in the knee joint, such as bowing in or out of the knee
  • Other treatment options fail to treat knee pain and stiffness 

Diagnosis

The following diagnostic tests may be done before a total knee replacement surgery:

  1. Physical examination: The doctor checks the knee strength, stability, motion, and leg alignment. The symptoms of the patient are noted.
  2. X-rays of the knee joint: This test helps the doctor check the image of the knee joint and see if any deformity or damage is present.
  3. CT scans and MRI scans: Imaging tests such as MRI scans and CT scans help in obtaining clear images of the knee joint and checking the condition of the bone and soft tissues present in the knee joint.
  4. Blood tests: Certain underlying medical conditions can be diagnosed with the help of these tests.
  5. Urine tests: Underlying urinary infections can be checked using these tests.
  6. Electrocardiogram (ECG): The electrical activity of the heart can be recorded by an ECG. 

 

Treatment

Total knee replacement surgery is generally performed under general anesthesia (the patient is put to sleep during the procedure).
The procedure may be performed in the following different ways:

1. Open surgery:

  • An incision or cut is made by the surgeon at the knee region.
  • The damaged cartilage surfaces present at the end of the femur and tibia are removed along with a small part of the underlying bone.
  • The removed cartilage and bone are now replaced using metal components that recreate the joint surface.
  • These metal parts can either be cemented or press-fitted into the bone.
  • The undersurface of the patella (kneecap) is now cut and resurfaced with a plastic button. However, in some cases, the doctor may not resurface the patella.
  • A plastic spacer is inserted between the metal components. This creates a smooth gliding surface.
  • The incision is closed using sutures or stitches.

2. Laparoscopic surgery:

  • The surgeon makes several small keyhole incisions at the surgical site.
  • A tube with a camera on one end, known as a laparoscope, and other small surgical instruments are inserted through these tiny incisions to carry out the procedure of total knee replacement.
  • The procedure is less painful, has quicker healing, and has fewer complications than open surgery.

3. Robot-assisted surgery:

  • The procedure is performed using a laparoscopic approach.
  • The procedure is performed by robotic arms that are controlled by the surgeon who views the inside of the surgical site through a video monitor.
  • The procedure is more precise than an open or laparoscopic technique.

 

Risks

Total knee replacement surgery may have the following complications:

  • Infection
  • Bleeding
  • Scar tissue formation inside the knee
  • Blood clot formation
  • Blood vessel damage around the knee
  • Nerve damage
  • Allergic reaction to the anesthesia 
  • Wearing down of the implant 
  • Loosening of the implant 
  • Persistent pain in the knee joint
  • Need for another surgery 

 

After Procedure

  1. The patient is usually discharged from the hospital one to three days after the surgery.
  2. The patient’s physiotherapy sessions are started within 24 hours of the surgery.
  3. Physiotherapy sessions need to continue for a few weeks after the surgery. They help in improving the patient's range of motion, muscle strengthening, and prevention of circulation problems.
  4. The patient can start walking using a walker or crutches about two to three days after the surgery.
  5. The patient will notice a significant improvement in mobility approximately one month after the surgery.
  6. The patient can resume his/her daily activities three to six weeks after the surgery.
  7. The patient should avoid heavy lifting and other strenuous activities for a couple of weeks after the surgery.
  8. The patient should avoid any injury or fall during the recovery period.
  9. Complete recovery after the surgery may take up to four months or more. 
  10. The scar tissue may take as long as two years to heal completely.

FAQ Section

1. What is Total Knee Replacement?

A. A surgical procedure involving the replacement of a diseased or damaged knee joint with an artificial prosthesis is known as total knee replacement.

 

2. What is the difference between total knee replacement and partial knee replacement?

A. Total knee replacement involves the replacement of all three components of the knee joint, which are:

  • Medial (inner) portion of the knee
  • Lateral (outside) portion of the knee
  • Patellofemoral portion (the part underneath the kneecap)
  • Partial knee replacement involves the replacement of only one compartment of the damaged or diseased knee joint.

3. What is a knee joint?

A. The knee joint is a kind of hinge joint. It is formed at the junction of the femur (thigh bone) and tibia (shin bone).

 

4. When is a Total Knee Replacement Surgery performed?

A. A total knee replacement surgery may be recommended in the following cases:

  1. Osteoarthritis: A wear and tear type of joint inflammation that occurs due to an increase in age, in which the cartilage that cushions the knee bones wears away is known as osteoarthritis.
  2. Rheumatoid arthritis: The inflammation and thickening of the synovial membrane (a membrane that surrounds the knee joint) leading to cartilage damage and cartilage loss is known as rheumatoid arthritis.
  3. Post-traumatic arthritis: An injury may lead to the tear of the knee ligaments or bone fractures causing cartilage damage and knee pain.

5. What are the symptoms that indicate the need for a Total Knee Replacement Surgery?

A. A patient having the following symptoms may need a total knee replacement surgery:

  • Severe knee pain
  • Severe knee stiffness 
  • Knee pain that cannot be relieved on sleeping or resting
  • Knee joint swelling 
  • Knee joint inflammation
  • Knee joint deformity
  • Failure of other treatment options in treating knee pain and stiffness 

 

6. Who performs a Total Knee Replacement Surgery?

A. An Orthopedic Surgeon usually performs a total knee replacement surgery.

 

7. What is the diagnostic procedure before a Total Knee Replacement Surgery?

A. The doctor may recommend the following diagnostic tests before a total knee replacement surgery:

  1. Physical examination: The knee strength, motion, stability, and leg alignment are assessed by the doctor. The patient is asked about his/her symptoms.
  2. X-rays of the knee joint: The image of the knee joint obtained on an x-ray can help the doctor see if any deformity or damage is present.
  3. CT scans and MRI scans: Imaging tests like MRI scans and CT scans help to obtain clear images of the knee joint. The bone and soft tissue condition present in the knee joint can also be checked.
  4. Blood tests: Certain underlying medical disorders can be detected using blood tests.
  5. Urine tests: Certain infections can be detected with the help of urine tests.
  6. Electrocardiogram (ECG): The electrical activity of the heart is measured using an ECG.

8. How to prepare for a Total Knee Replacement Surgery?

A. The following preparation is required before a total knee replacement surgery:

  • Inform the doctor if you are taking any medications or supplements currently.
  • The doctor should be told about any medical illnesses that you may have.
  • If you are allergic to any medicines, latex, iodine, tape, or anesthetic agents, inform the doctor about the same.
  • You are advised to quit smoking as soon as you can.
  • If you are overweight, lose any excess weight that you may have before the surgery by eating a healthy diet and regular exercising.
  • The doctor may tell you to stop blood-thinning medications like aspirin and warfarin a few days before the procedure.
  • You cannot eat or drink anything after midnight, the day before the procedure.

 

9. How is a Total Knee Replacement Surgery performed?

A. Total knee replacement surgery is generally performed under general anesthesia (the patient is put to sleep during the procedure).
The procedure may be performed in the following different ways:

1. Open surgery:
An incision or cut is made by the surgeon at the knee region.
The damaged cartilage surfaces present at the end of the femur and tibia are removed along with a small part of the underlying bone.
The removed cartilage and bone are now replaced using metal components that recreate the joint surface.
These metal parts can either be cemented or press-fitted into the bone.
The undersurface of the patella (kneecap) is now cut and resurfaced with a plastic button. However, in some cases, the doctor may not resurface the patella.
A plastic spacer is inserted between the metal components. This creates a smooth gliding surface.
The incision is closed using sutures or stitches.

2. Laparoscopic surgery:
The surgeon makes several small keyhole incisions at the surgical site.
A tube with a camera on one end, known as a laparoscope, and other small surgical instruments are inserted through these tiny incisions to carry out the procedure of total knee replacement.
The procedure is less painful, has quicker healing, and has fewer complications than open surgery.

3. Robot-assisted surgery:
The procedure is performed using a laparoscopic approach.
The procedure is performed by robotic arms that are controlled by the surgeon who views the inside of the surgical site through a video monitor.
The procedure is more precise than an open or laparoscopic technique.

 

10. How to care after Total Knee Replacement Surgery?

A. The following are the post-procedure steps after total knee replacement surgery:

  • The patient usually goes home from the hospital one to three days after the surgery.
  • Physiotherapy sessions begin within 24 hours of the surgery.
  • These physiotherapy sessions usually continue for a couple of weeks after the surgery. They help in improving the range of motion of the patient, strengthening the patient’s muscles, and preventing circulation problems.
  • The patient can use a walker or crutches to start walking approximately two to three days after the surgery.
  • Mobility of the patient shows a significant improvement one month after the surgery.
  • The patient is usually able to resume his/her daily activities three to six weeks after the procedure.
  • Heavy lifting and other strenuous activities should be avoided for a few weeks after the surgery.
  • It is important to be careful to prevent any injury or fall during the period of recovery.
  • Complete recovery following a knee replacement surgery may take up to four months or more. 
  • Complete scar tissue healing may take up to two years.

11. What are the risks of a Total Knee Replacement Surgery?

A. The following complications may be seen after a total knee replacement surgery:

  • Bleeding
  • Scar tissue formation 
  • Infection 
  • Allergic reaction to the anesthesia used 
  • Blood clot formation
  • Nerve damage 
  • Blood vessel damage 
  • Knee pain even after surgery 
  • Wearing down of the prosthesis 
  • Loosening of the implant prosthesis 
  • Requirement for another surgery 

 

12. What is the cost of Total Knee Replacement Surgery in India?


A. The cost of total knee replacement surgery varies depending on the type of procedure performed and the overall health condition of the patient.
The cost of total knee replacement surgery is different among different doctors in different hospitals. Usually, the cost of total knee replacement surgery in India is between INR 1,50,000 to INR 5,00,000.