Knee Replacement Surgery

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WHAT IS KNEE REPLACEMENT SURGERY?

Knee replacement is treatment 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.

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

A person who has injured or damaged his joint may experience extremely severe pain at the site of the joint.
In certain instances when

  • The pain is extremely severe, one may “avoid using the joint, weakening the muscles around the joint and making it even more difficult to move the joint”.
  • If you are joints are hurting you so much that it is difficult to climb up the stairs or even walk.
  • Your other treatments and medication and injections do not give you rid of pain.
  • Swelling in your knee is unbearable

The advantages of hip or knee replacement surgery are to get rid of damaged part of the joint which are replaced by metal or plastic IMPLANTS.

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.

  • 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.

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.
  • Full body checkup- Blood investigation
  • Cardiac clearance
  • Oral cavity check up/ dental clearance
  • R/O urine or any other form of infection
  • 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.)

  • 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.
  • 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.
  • 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.

  • 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

  • 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.

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

  • 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
  • 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).
  • Latest techniques
  • Minimal invasive procedures
  • Computer navigation
  • Pain management techniques to make the entire procedure as comfortable as possible
  • Reasonable cost at best hospitals

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