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

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).

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.

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 

A. An Orthopedic Surgeon usually performs 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.

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.

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.

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.

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 

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.