Total Knee Replacement

What is Total Knee Replacement?

Total Knee Replacement, also known as Total Knee Arthroplasty, is one of the most successful and cost effective interventions in modern medicine. Total Knee Replacement is commonly performed in the elderly population to relieve severe pain. The primary reason for 90% of total knee replacement surgeries is Osteoarthritis, followed by Rheumatoid Arthritis.

All forms of arthritis and other joint disease can lead to severe damage to the joints; cartilage is severely damaged, resulting in severe damage to the joints leading to unbearable pain. This is called end-stage joint disease.

Why Total Knee Replacement Surgery?

Total Knee Replacement is only advised when one is suffering from one or more conditions mentioned below:

  1. Aged above 60 years.
  2. Unbearable Knee pain.
  3. Impaired daily activities.
  4. Experiencing severe pain in the night.
  5. Failure of other joint treatments.

Based on the severity of the condition diagnosed, a treatment is advised.

Although surgery is not always needed, the majority of the knee ailments can be managed without surgery through physiotherapy and anti-inflammatory prescribed medicines. For someone younger than 60 years, but severely affected by knee pain, may also be considered for surgery.

In rheumatoid arthritis, patients usually suffer from the involvement of multiple joints at a younger age. Due to the crippling nature of this disease, surgery is performed. The doctor will rule out other sources of leg pain, such as pain radiating from spine or hip. Other factors like body weight and medical fitness to surgery are also important. Generally, patients who are obese have less favourable long-term results.

The conditions when you can't have Knee Replacement?

In case of medical contradictions, it is not advisable for a patient to undergo surgery.

  • In case, if you are suffering from an infection.
  • In case, if you are suffering from an infection anywhere else in the body.
  • If the muscles of that particular joint are weak due to Poliomyelitis or other paralytic conditions.
  • If you are suffering from decreased blood supply to the affected joint or may be suffering from a severe illness, healing of the surgical wound may be impaired.

 

The goal is to make you perform day to day activities without experiencing any pain.

What happens pre and during the surgery?

Pre-surgery procedure

  • Usually, the patient is admitted a day or a week before(based on a specially designed preoperative assessment clinic) the surgery for general evaluation.
  • Then based on the assessment, the patient can get admitted on the same day of the surgery, if found fit.
  • Before surgery, a general physician, an anaesthetist and a cardiologist might assess the patient.
  • Few reports like a batch of blood tests, an ECG, an Echocardiogram, and a chest X-ray is also required.
During the Total Knee Replacement surgery procedure
  • After the general assessment, an anaesthesia is given, depending on your general health, it might be general or spinal.
  • A femoral block, or adductor block or an epidural anaesthesia is induced to control pain for the following two days after surgery.
  • After the desired preparations, surgery is performed with a midline longitudinal cut of about 8 cm to 10 cm on your knee. The thigh bone called ‘femur’, leg bone called ‘tibia’, and the kneecap called ‘patella’ are visualised.
  • The size of the bones are measured. The affected area is then removed using surgical instruments.
  • Bones are cut in a way that components are correctly fixed using the replacements used at the time of the surgery.
    Leg is aligned, and ligaments on both the sides of the knee are balanced.
  • A trial prosthesis is tested and if everything goes well, then the final components are fixed on your bone using bone cement.
  • Once the cement hardens, the wound is stitched layer by layer.
  • Once the whole procedure is performed, you are shifted to the recovery ward based on the after care treatment. Post surgery care is advised like diet and simple bedside exercises, that are to be performed once they can sit up.
  • Recovery from the surgery usually depends from patient to patient. For instance, while some patients may be able to walk on the same day of the surgery whereas some might start walking only from the next day post surgery.

 Fig: An incision made on the knee.

 Fig: Placement of components during surgery.

 Fig: Closing the wounds.

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