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What is Knee Replacement Surgery?

Knee replacement is surgery for people with severe knee damage. Knee replacement can relieve pain and allow you to be more active.
Knee replacement surgery- also known as knee arthroplasty- can help relieve pain and restore function in severely diseased knee joints. During knee replacement, a surgeon cuts away damaged bone and cartilage from your thighbone, shinbone and kneecap and replaces it with an artificial joint made of metal alloys, high grade plastics and polymers.

If you suspect a fracture, however, seek immediate care from your doctor or emergency department. Home care, which you can do until medical care arrives, includes the following:
  • Rest: Stay off the injured knee so you do not injure it further. Certain damage could require you to have a knee joint replacement.
  • Elevate: Keep the injured knee elevated to decrease swelling and knee pain.
  • Ice compresses: Apply ice packs for 15-20 minutes at a time, 4 times a day, to keep swelling and pain down. Do not put ice directly on your skin. Wrap the ice pack in a towel.
  • Pain relief o Ibuprofen (Motrin, Advil) or naproxen (Aleve, Naprosyn) is ideal for knee injuries because they reduce both pain and inflammation. Follow the directions on the label or your doctor's instructions.You also can use acetaminophen (Tylenol) if you cannot tolerate the others.

Knee replacement, or knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for knee diseases such as rheumatoid arthritis and psoriatic arthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long standing osteoarthritis, the surgery may be more complicated and carry higher risk. Other major causes of debilitating pain include meniscus tears, cartilage defects, and ligament tears. Debilitating pain from osteoarthritis is much more common in the elderly.

Knee replacement surgery can be performed as a partial or a total knee replacement. In general, the surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee. The operation involves substantial postoperative pain, and includes vigorous physical rehabilitation. The recovery period may be 6 weeks or longer and may involve the use of mobility aids (e.g. walking frames, canes, crutches) to enable the patient's return to preoperative mobility.


Know Your Knee Joint


know all about your knee joints
The healthy knee joint is a hinge joint formed by the top of the shin bone called the tibia and the bottom of the thigh bone, or femur. Your kneecap is called the patella. Cartilage provides padding between the bones and helps assure an effortless, smooth gliding movement of the joint. A special membrane called the synovial membrane produces a lubricant that contributes to the smooth movement of the knee. When it is healthy, the knee is a remarkable mechanism. For a knee to function normally, the quality of smoothness where each bone moves upon the other becomes important in the function of the knee joint. Since it is the most used joint in the body, it is not surprising that as we grow old, the joint lining (articular cartilage) wears away and people find it painful to move – Osteoarthritis of old age.When arthritis intrudes, however, the knee is unable to effectively cushion the body from impact and stress.

The result is erosion of the joint and pain that can gradually hamper your quality of life, reduce your independence and makes it hard -- or impossible -- to do the things you want to do!!! If you have Osteoarthritis (OA), the pain in your knee is being caused by cartilage wearing out. While you can treat the symptoms of knee OA (such as pain, stiffness, and difficulty moving) in a variety of ways from weight loss to medications to injection therapy, there is no cure for the condition and your pain and debilitation is likely to get worse over time.

Early diagnosis of knee OA with proper treatment is important for the future of your long-term mobility. If your doctor has recommended that you undergo a total knee replacement, don't delay your surgery. Delaying surgery can lower your quality of life even more than OA does on its own, both before and for up to two years after surgery! Remember, there is no cure for OA and it is degenerative, which means that your pain and limited mobility can get worse over time.

+ Common Causes For Knee Pain

common causes of knee pain
The most common cause of chronic knee pain and disability is Arthritis; of which Osteoarthritis, rheumatoid arthritis, and arthritis following injuries are the most common forms. Osteoarthritis usually occurs after the age of 50 and often in an individual with a family history of arthritis. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another causing knee pain and stiffness. Rheumatoid Arthritis is a disease in which the synovial membrane becomes thickened and inflamed, producing too much synovial fluid, which over-fills the joint space. This chronic inflammation damages the cartilage and eventually causes cartilage loss, pain and stiffness. Post Traumatic Arthritis can follow a serious knee injury. A knee fracture or severe tears of the knee's ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

+  Is total knee replacement for For You?

  • Severe knee pain that limit's your everyday activities, including walking, going up and down stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker.
  • Moderate or severe knee pain while resting, during the day or night.
  • Failure to obtain pain relief from drugs. Their effectiveness in controlling knee pain varies greatly from person to person. These drugs may become less effective for patients with severe arthritis and may also have serious side effects with prolonged use.
In summary, in the early stages when the arthritis is mild to moderate, pain is relieved by conservative means like physiotherapy, medications or injection etc. In the advanced stage however when the pain is severe and medication etc. don't relieve the pain anymore and your daily activities become very restricted, you need the operation of total knee replacement.

+  Orthopedic Evaluation

The Orthopedic evaluation consists of several components

  • A medical history, in which your Orthopedic surgeon gathers information about your general health and asks you about the extent of your knee pain and your ability to function.
  • A physical examination to assess your knee motion, stability, and strength and overall leg ligament.
  • X-rays to determine the extent of damage and deformity in your knee.
  • Your orthopedic surgeon will review the results of your evaluation with you and discuss whether total knee replacement would be the best method to relieve your pain and improve your function.
  • Your Orthopedic surgeon is the right person to decide for the surgery.

+ Pre operative instructions for knee replacement surgery

  • Full body checkup- Blood investigation
  • Cardiac clearance
  • Oral cavity check up/ dental clearance
  • R/O urine or any other form of infection
Takes 3-5 days for these tests

+ One knee or two?

About 20% of knee replacements are for both knees. Of these "bilateral" replacements about half are undertaken at the same time,that is, both knees are operated on under the same anesthetic event. Otherwise one knee is replaced and then the other in a second procedure. Since the aggravation of the knee replacement is roughly the same for having one or two knees done, why doesn't everyone have them both done at the same time?

The reasons given for not replacing both knees at the same time are:

  • Older, weaker patients may not tolerate the twice-as-Iong operation safely enough. The recovery process requires somewhat more athletic patient when he does not have one "good" leg to help the other. Some Older patients are very feeble. But plenty of determined people do both, so it's not just athleticism that Counts.
  • The lesson: Plan for physical therapy does not even mention how to do various exercises if both legs are incapacitated; giving examples of how to walk by saying "Start with the good leg..." However, with any degree of athletic ability, working two bum knees rather than one is not a big deal. One manages, and is soon over the hump. (But if you are weak, it would matter.)

+  What are benefits of knee replacement surgery?

Benefit of Knee Replacement Surgery

  • Relief from joint pain.
  • Increased mobility.
  • Correction of deformity (straight legs).
  • Increased leg strength (if you exercise).
  • Improved quality of life and ability to return to normal activities.
  • Most likely jumping or other high–impact activities will be discouraged.
  • Swimming, playing golf etc. are usually done comfortably.

+  What to Expect

You will most likely be admitted to the hospital a day before your surgery. After admission, a nurse takes your vital sings. You will be evaluated by a member of the anesthesia team. The most common types of anesthesia are:

General Anesthesia, in which you are asleep throughtout the procedure.

Spinal or epidural anesthesia, in which you are awake but your legs are anesthetized.

The epidural anesthesia is better for knee replacement because it provides pain relief for two three days after operation. The procedure ifself takes about 90 minutes for a single knee.

+  The three-hour operation(Both Knees)

Step 1
An incision is made on the Knee with a surgical knife to open up the knee. Blood vessels are doubly checked to ensure there is no blood flow. Layers of fat and the surrounding soft tissue are pushed aside so that the bones- tibia and femur-within are revealed.

Step 2

knee replacement surgery step 1
knee replacement surgery step 2
knee replacement surgery step 3

Cuts are made into the femur bone to allow the artificial knee frame to fit. A hole is drilled into the tibia so that the plate can be fixed to it. Another hole is made in the femur to reduce bone pressure. The idea is to minimize eventual strain on the artificial knee. Using sharp instruments, the debris of the cartilage is removed.

Step 3
knee replacement surgery step 4
knee replacement surgery step 5

The roughened portions from the tibia and the femur are nibbled off. A thin section of the tibia bone surface is sliced off to accurately level the surface so that the artificial plate can easily sit on it.

Step 4
Bone cement-polymethymethyacrylate-is mixed into a thick liquid consistency. This is filled into the drilled holes and behind the two frames that make up the knee joint. The plate is finally placed on the tibia and femoral implant is fitted in the femur.

Step 5
knee replacement surgery step 6
The implants are firmly pressed and hammered into position. The plastic plate which pushes the joint is attached over the tibia plate. A plastic implant is also fixed to the knee cap. Any remaining gaps are plugged with the cement which hardens in about 10 minutes.

Step 6
Once the artificial knee parts are in place, a little tube is inserted to suck away any blood for the next two days to prevent infection. The main incision is then closed carefully using vicryl-a suturing material which dissolves after 90 days.

+  How Your New Knee Is Different


knee and joint replacement surgery
Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated.
You may feel some numbness in the skin around your incision.

You also may feel some stiffness, particularly with excessive bending activities. Improvement of knee motion is a goal of total knee replacement. The motion of your knee replacement after surgery is predicted by the motion of your knee prior to surgery.

Most patients can expect to nearly fully straighten the replaced knee and to bend the knee sufficiently to go up and down the stairs and get in and out of a car. Occasionally, you may feel some soft clicking of the metal and plastic with knee bending or walking. These differences often diminish with time and most patients find these are minor compared to the pain and limited functions of knee joint, they experienced prior to surgery.

preparing for knee replacement surgery

+ Preparing for admission to the hospital

preparing for knee replacement surgery

First and foremost, check with your insurance company to make sure which benefits you have. Find out specifically how long they will allow you to stay in the hospital.

It is very important to know how the insurance company will deal with you before, during and after the knee surgery. Call the number on the back of your insurance card or ask your insurance agent the following questions: (Find out with whom you are speaking and their position as need to speak to them on a few occasions)

  • I want to know what benefits I have for a total Knee Replacement. Find out details for the category of room and which hospital.
  • If there a co-pay?
  • Do I have home therapy benefits after the knee replacement? If yes, What are they?

+  How long will be the stay at hospital?

  • Single stage- Both knees- Conditions- 5-7 days
  • Staged both knees- Both knee surgery 3-4 days apart
For patients suffering from cardiac problems uncontrollable diabetes or any other co morbid conditions – 7-10 days

+  How to make knee replacement last a lifetime?

Recovery at Home
You will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed two weeks after surgery. A suture beneath your skin will not require removal.

+ Surgery Recovery Time

You will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed two weeks after surgery. A suture beneath your skin will not require removal.
3 Weeks to 6 weeks

+ Post operative instructions for knee replacement surgery

  • To avoid sitting on floor/squatting/use of Indian toilets
  • Routine activities like walking/ staircase climbing permitted
  • Light sporting activities like swimming/ golf/ driving permitted after 6 weeks to 3 months

Wound Care

Avoid soaking the wound in water until the wound has been thoroughly sealed and dried. A bandage may be placed over the wound to prevent irritation from clothing or support stockings. A balanced diet is important to promote proper tissue healing and restore muscle strength.

Home Planning

Some modifications at your home are suggested, to make your recovery easier post surgery.
  • A stable chair for your early recovery with a firm seat cushion (height of 18-20 inches), a firm back, two arms, and a footstool for intermittent leg elevation.
  • You will need Grab Bars put into your shower/tub (don't use your towel bars). Put them in before you have the surgery, installation is not that difficult and you will be grateful for the assistance over the next couple of months. This is a major safety issue. Balance will be tough after your Knee Replacement Surgery especially the first couple of weeks.
  • You should buy a shower stool/bench so you can sit while bathing.
  • Removing all loose carpets and cords.
  • Secure handrails along your stairways.
  • A toilet seat riser with arms, if you have a low toilet
  • A temporary living space on the same floor, because walking up or down stairs will be more difficult during your early recovery.
  • After surgery you will be requested to use only western style toilet to avoid sitting on the floor or squatting.

+  Total Knee Replacement at A Glance

  • Not Life But Quality of Life..!!
  • Patients with severe destruction of the knee joint associated with progressive pain and impaired function may be candidates for total knee replacement.
  • Risks of total knee replacement surgery have been identified.
  • Physical therapy is an essential part of rehabilitation before and after total knee replacement.
  • Patients with artificial joints are recommended to take antibiotics before, during, and after any elective invasive procedures (including dental work).

+  Why choose Dr. Sachdev?


To provide successful results by use of
  • Latest techniques
  • Minimal invasive procedures
  • Computer navigation
  • Pain management techniques to make the entire procedure as comfortable as possible
  • Reasonable cost at best hospitals

Contact us

  • Dr.Anshu Sachdev
  • The Orthopedic Speciality Clinic :
  • Amber Park,Jogger's Park Lane,
    viman Nagar, Pune-411013

  • Helpline: +91 99234 06258
  • Telephone: +91 020 6500 0249

  • Email: thekneeklinik@gmail.com

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