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Total Knee Replacement


If your knee is damaged by an injury or osteoarthritis, it may be difficult for you to perform basic activities like walking and moving upstairs even you may feel tremendous pain while sitting or getting up from lying position. If the usual nonsurgical treatments, such as medications and other walking supports are no longer helpful, total knee replacement surgery is said to be the safest and effective surgical procedure particularly to those whose knees have been damaged by osteoarthritis.

total knee replacement

Cartilage:

This is a thin, white covering on the bone ends which keeps them bones and provides a smooth, slippery surface for painless, free movement of your knee.

cartilage

3 compartments of the Knee

Three compartments of the knee are:

  1. Medial Tibiofemora compartmentl
  2. Lateral Tibiofemoral compartment
  3. Patellofemoral compartment

compartments

What is osteoarthritis (commonly called Arthritis) of knee?

The end of your thigh bone (femur) can be compared to a rocking chair. It has two distinct surfaces called condyles, which rest on the shin bone (tibia), forming two ‘compartments’, the inner (or medial) and the outer (or lateral compartment). A third compartment is in the front of the knee behind the knee cap (patello-femoral compartment).

total knee replacement

In knees with osteoarthritis, the cartilage protecting the ends of the bones gradually deteriorates, joint fluid loses its shock-absorbing qualities and bones may begin to rub against each other — all of which may cause the knee pain you're feeling. It is the most common cause of knee pain above 50 years of age. More common in women than men. Wear and Tear of the cartilage is constant process and body tries to repair it to very limited extend (as there is no blood supply to cartilage), however as age advances the natural repair activity is not able to maintain the cartilage and hence cartilage is lost.

total knee replacement

If your knee is damaged by an injury or osteoarthritis, it may be difficult for you to perform basic activities like walking and moving upstairs even you may feel tremendous pain while sitting or getting up from lying position. If the usual nonsurgical treatments, such as medications and other walking supports are no longer helpful, total knee replacement surgery is said to be the safest and effective surgical procedure particularly to those whose knees have been damaged by osteoarthritis.

What is a total knee replacement?

'Knee Replacement' is actually misleading as your whole knee is not replaced! It only involves resurfacing the entire cartilage on the 3 bones where they move against each other. The new surfaces are made of metal and polyethylene and are fixed to your bones with special bone cement. The implants we use are imported, have been well tested, and have been used successfully for many years.

The surgeon removes a part of damaged bones from the lower end of the thighbone (femur) and replaces with a metal shell. Similarly damaged part of the bone from the upper end of the shinbone (tibia) is removed and replaced by channeled plastic piece with a metal base. Assessing the condition of the kneecap part of the knee joint, a plastic body may be added under the kneecap surface.

total knee replacement

Model Showing Osteoarthritis on left side and Knee replacement on right side.

When is total knee replacement recommended?

The reasons for recommendation of total knee replacement are:

  • Severe knee pain including stiffness in the knee that limits everyday activities like walking, sitting in and out of chairs and climbing stairs
  • Chronic knee inflammation and swelling which does not improve while resting
  • Knee deformity like a bow in (Varus) or out (valgus)
  • No substantial improvement found even after medication, lubricating or cortisone injection or physical therapy

Who is a candidate for total knee replacement?

Total knee replacement surgery recommendation depends on patient’s pain and degree of disability and not on age. Generally, total knee replacement surgery is done to the patients between the age group of 50 and 80 irrespective. However, in case of juvenile degenerative arthritis, the surgery also happens earlier.

What is orthopaedic evaluation is necessary for total knee replacement?

Following evaluation method is performed by the orthopaedic surgeon:

  • A medical history is gathered for your general health and the extent of knee pain and problem
  • Physical examinations of your knee movement, strength, stability and alignment of the leg are checked and recorded
  • X-ray images are taken to assess the extent of damage and deformity of your knee
  • Occasionally blood tests or MRI scan may be necessary to evaluate the bone condition of the knee and soft tissues associated with it

What is the surgical procedure?

Anesthetist will evaluate and apply general anesthesia that suits you the best. The surgical procedure generally takes 1 to 2 hours. The surgeon will remove the damaged bone and cartilage and place the prosthetic implant to restore the knee alignment and function.

How is the postoperative recovery?

You will stay in the hospital for 3 to 5 days for different supportive treatments for anti-pain, anti-inflammatory, prevention of blood clots and other physical therapy for smooth knee movement and finally you will be released to go home with proper medication and diet chart with physical therapy schedule.

Can both my knee replacements be done at the same time?

Yes, if your tests done beforehand are normal and both your knees are affected, knee replacement can be safely done in both knees at the same sitting. Your hospital stay (2-3 days) and pain will be the same as when knee replacement is done only for one side. The advantages are that both legs will be of the same length, your knees will recover together, you will walk correctly from the first day, and you will not need to return to hospital for the second knee.

How successful is knee replacement?

Success depends on the surgeon and his team's experience, skills and technique in performing it, and the implant design. We are internationally trained in is this operation and have excellent results.

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DR SHAILESH KESHAV MISHRA

Consultant Orthopedic, Joint Replacement and Arthroscopy Surgeon

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