Orthopaedic doctor |Joint Pain Specialist in Delhi -Dr Dhananjay Gupta

Knee Replacement Surgery

Knee replacement refers to a surgical procedure that reduces pain and improves the quality of life in various patients suffering from severely diseased knee joints. Usually, the patients undergo this surgery after various non-operative remedies like activity adjustment, anti-inflammatory medications, physiotherapy, or knee joint injections. However, all these methods have failed to give the long-term relief of arthritic symptoms.

Surgeons have performed knee replacements for over three decades usually with excellent results. The procedure involves cutting away damaged bone and cartilage from the thighbone, shinbone and kneecap and replacing it with an artificial joint (prosthesis) made of metal alloys, high-grade plastics and polymers.

For determining whether a knee replacement is appropriate for you or not, an orthopaedic surgeon evaluates your knee’s range of motion, strength and stability. X-rays are particularly useful in ascertaining the extent of the damage. A doctor can pick a variety of knee replacement prostheses and surgical techniques, keeping in mind your age, knee size and shape, weight, activity level, and overall health.

Traditional total knee replacement (TKR)

Total knee replacement involves about an 8” incision over the knee. It also requires around 3-5 days of hospital stay and sometimes an extra stay may be needed for inpatient rehabilitation before they can go home. The recovery period of a traditional knee replacement lasts from one to three months. Various patients report visible or complete relief of their arthritic symptoms after recovering from a total knee replacement.

Minimally invasive surgery

A minimally invasive surgery (MIS) technique can greatly reduce trauma to tissue, decreases blood loss and lessens the pain — this ultimately results in the speedy recovery of the patients. It minimises the incision up to 3 to 4 inches. The kneecap in this surgical procedure is pushed to the side rather than being turned over.

  • Smaller incisions are done on the quadriceps tendon,causing, lesser trauma to the quadriceps muscle.

  • Healing is quicker, and patients can feel the better range of motion after recovery.

  • The procedure alters the techniques used in traditional surgery while making use of implants from traditional surgery. Manufacturers give specialized instruments that help in placing the implant perfectly but smaller incisions can also be made as small as possible. Since the only change between MIS and traditional surgery is in the surgical process, though the long-term clinical outcomes are comparable.

    Computer-assisted surgery (CAS)

    Increasingly, surgeons are trying computer-assisted methods for both performing traditional and minimally invasive procedures. A surgeon records the patient’s anatomical data into the computer and creates a 3-D model of the knee.

  • It allows a more accurate computer-assisted image of the knee. The image helps the surgeon in aligning the knee components more accurately in the bone and improves the odds that the device will operate effectively.

  • It gives the chances of a smaller incision and helps the patient by reducing recovery time.

  • Minimally invasive knee replacement is an evolving area and more research is required on the long-term function and endurance of the implants. The advantages of minimally invasive knee replacements are:

  • Limited damage to soft tissues

  • less painful and quicker recovery

  • Quick return to normal activities.

  • Like all surgery, minimally invasive surgery has a risk of complications. These complications include nerve and artery injuries, wound healing problems, infection, and errors in positioning the prosthetic knee implants.

    Just similar to all other surgeries, minimally invasive surgery possess a risk of complications. These complications include wound healing problems, infection, nerve and artery injuries, and inaccuracies in positioning the prosthetic knee implants.

    Comparable to traditional knee replacement surgery, minimally invasive surgery needs to be performed by a well-trained, experienced orthopaedic surgeon. Your orthopaedic surgeon can help you with your condition with all their experience with minimally invasive knee replacement surgery, and the potential risks and benefits of the techniques for your individual treatment.

    The Orthopaedic procedures that are carried out today are increasingly sophisticated and safe. They are making way for millions of people for enjoying and living a healthy and active life.Talk out with your surgeon for determining what procedure is best for your particular needs.

    Knee replacement, also known as arthroplasty is a common surgical procedure for resurfacing a knee damaged by arthritis. Different types of arthritis may affect the knee joint. Osteoarthritis is caused by the collapse and eventual loss of cartilage of one or more joints. It mainly afflicts middle-aged and older adults. Rheumatoid arthritis, an autoimmune disorder leads to the inflammation of the synovial membrane and leads to an excessive synovial fluid, causing pain and stiffness. Traumatic arthritis occurring because of an injury may lead to the damage to the cartilage of the knee.

  • Plastic and metal parts are extensively used to cap the ends of the bones shaping the knee joint, along with the kneecap.

  • This surgery is appropriate for patients who have severe arthritis or a severe knee injury.

  • These surgeries are remedial in nature hence gives maximum recovery range.

  • Knee replacements can be conducted in two ways, which depends upon the magnitude of the damage:

    Total knee replacement

    In the surface of the damaged bones are removed and reconstructed with an artificial implant which fits the shape of the knee. Overall, the operation is a four-step method.

  • The first step requires the preparation of the bone by eliminating damaged cartilage surfaces at the ends of the thigh bone (femur) and shin bone (tibia), aside from the tiny portion of the underlying bone.

  • In the next step tibial and femoral made of metal up is implanted and either connected to the bone or press-fit there. “Press-fitting” supports the implants made from the rough surfaces to support the bone in your knee to grow into them, thus securing the implants essentially.

  • A medical grade plastic spacer is put between the tibial and femoral metal components for forming a gliding smooth surface that mimics the motion of the natural knee.

  • Inserting the plastic button beneath the kneecap (patella). This requires resurfacing the undersurface of the kneecap for connecting it to the button.

  • Success Rate:

    Various patients undergo a dramatic reduction in knee pain and are able to resume daily activities. Moderate use of your artificial knee would improve that your implant will last for several years. About 85-90% of these implants work quite well even after 15 to 20 years after the operation.

    Risk factors:

    Although it is a safe procedure, however still there are certain risks associated if it is not done by an experienced surgeon like:

  • Blood clots resulting in stroke or death

  • extended knee instability and pain.

  • Partial knee replacement (PKR)

  • Infection that could result in additional surgery
  • Partial knee replacement (PKR)

    Partial knee replacement (PKR) also known as unicompartmental knee replacement, is an alternative only for a small percentage of people. Here, only a portion of the knee is replaced in order to maintain the original healthy bone and soft tissue as likely. Candidates suitable for this type of surgery normally suffer from osteoarthritis in just one compartment of their knee. In this surgery, a surgeon separates the arthritic portion of the knee — that includes bone and cartilage — and replaces that compartment consisting of metal and plastic components.

    Partial knee replacement has few benefits over Total knee replacement such as;

  • Lesser stay at the hospital

  • Less trauma and blood loss

  • Better range of mobility

  • Faster recovery and restoration period

  • Lesser pain after the surgery

  • Though, there are fewer chances that a PKR will eliminate or treat the underlying pain completely. As the sealed bone is still responsive to arthritis, there is also a higher chance that follow-up TKR surgery may be needed somewhere in the future.

    Surgeons normally carry out PKRs on patients who are below the age of 65, living an active life and who have sufficient of healthy bone remaining. The procedure is done on one of the three knee compartments. If more than two or two knee compartments are damaged, it’s apparently not the best option.

    Post-surgery requirements:

  • An extensive rehabilitation program and homestay while recovering.

  • Supported movement with the help of a walker, crutches, or a cane directly after the surgery.

  • Loosening of the implant or its failure can occur — particularly if misalignment occurred between the implant and the bone while performing the surgery or afterwards. Proper follow-up needs to be done in case of any discomfort.

    Knee Replacement Surgery Recovery

    Patients are suggested to involve themselves in some of the other forms of exercises after undergoing surgery using a walker or other orthopaedic device. A patient needs to stay in the hospital for 1 to 2 days, and longer if is required. Some patients can go home on the same day of the surgery if your doctors approve it. However, in some cases, a patient who does not have any family support needs to be transferred to a rehabilitation centre.

    Physical Therapy After Knee Replacement Surgery

    Physiotherapy is generally prescribed by the consulting surgeon or an expert therapist. It is suggested to start within a week of surgery. A physical therapist will teach the patient following things:

  • How to use assistive walking devices, such as a walker and cane

  • Knee strengthening exercises

  • Knee exercises to encourage range of motion and reduce scar tissue

  • The improvement also depends on how the patient recovers after a knee replacement surgery. Most patients can take care of themselves and adopt their normal activities within 6 weeks. It may take 4 to 6 months or a year to fully recover and to achieve benefits of knee replacement surgery.

    How long does a Knee Replacement Last?

    In 90% of the cases the knee replacements last for 15 years and can extend up to at least 20 years. This is because the patients comply with their physical therapy routines and avoid doing high – impact activities like jumping or jogging.