Knee Replacement: Procedure, Recovery, Cost, Risk & Complication

Knee replacement surgery — also known as knee arthroplasty (ARTH-row-plas-tee) — 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.

Why is it done?

The most common reason for knee replacement surgery is to relieve severe pain caused by osteoarthritis. People who need knee replacement surgery usually have problems walking, climbing stairs, and getting in and out of chairs. Some also have moderate or severe knee pain at rest.

The Procedure

The procedure begins with you being administered general anesthesia, after which, an incision of 9-12 inches is made on the knee. The part of the joint that has been damaged is gotten rid of, following which the surfaces of the bone are redesigned to hold an artificial joint. Cement is used to attach the artificial joint to the shin, knee cap and the thigh bone. Once the fitting is complete, the artificial joint is supported by the surrounding muscles.

Results

For most people, knee replacement provides pain relief, improved mobility and a better quality of life. Consult a doctor about what you can expect from knee replacement surgery.

Three to six weeks after surgery, you generally can resume most daily activities, such as shopping and light housekeeping. Driving is also possible at around three weeks if you can bend your knee far enough to sit in a car and if you have enough muscle control to operate the brakes and accelerator.

After you've recovered, you can enjoy a variety of low-impact activities, such as walking, swimming, golfing or biking. But you should avoid higher impact activities — such as jogging, skiing, tennis and sports that involve contact or jumping. Talk to your doctor about your limitations.

Aftercare

The duration of the hospital stay is around 2-3 days. The effects of the surgery start becoming noticeable within a month of the surgery being carried out. Initially, you may require walking aids. It takes about 5-6 weeks to regain your ability to walk without any external or physical support.

You will have to undergo physical therapy after the surgery to improve your muscle strength. The physiotherapist may prescribe various exercises to strengthen the muscles around the knees. You need to follow certain precautions after the surgery; squatting and kneeling become certain activities which you should avoid. Avoid activities that places undue stress on the knees.

Knee osteoarthritis is a common condition affecting the knee joints. This condition results from age related degeneration of joint cartilage and synovial fluid. This results in excessive stiffness, swelling, pain and decreased mobility due to loss of lubricant functions of joint cartilage.

Treatment for Knee Osteoarthritis:

Treatment for knee osteoarthritis consists of anti inflammatory drugs, lifestyle modifications and knee exercises. In advanced stages where pain is severe or conservative therapy fails, replacement of knee joint is required. In many cases, knee replacement is not feasible or desired due to various reasons. For such cases, other treatment option is available in form of Platelet rich Plasma (PRP) injection in knee joint.

How is PRP therapy done?

The procedure involves drawing a sample of blood from the patient and then placing it in a Centrifuge machine which extracts the Platelet rich plasma (PRP) constituent from blood.The sample constitutes of platelets (blood cells) which consist of numerous healing and inflammatory chemicals. This PRP sample is injected in the knee joint under sterile precautions. This decreases inflammation, and promotes healing.

Benefits of PRP therapy:

1. The body’s first response to soft tissue injury is to deliver platelets. Platelets carry cells, proteins, and other growth / healing factors that initiate repair and recruit stem cells. PRP therapy’s natural healing process intensifies the body’s efforts by delivering a higher concentration of platelets within the damaged joint. Research has shown PRP therapy to be very effective at relieving pain and returning patients to their normal activities. Both Ultrasound and MRI images have shown definitive tissue repair after PRP therapy, confirming the healing process.

2. The need for knee replacement can also be greatly reduced by promoting repair of cartilage before joint damage becomes extensive. In fact PRP therapy works best when done in early stages of Knee Osteoarthritis.

3. Relieves pain without the risks of surgery or general anesthesia.

4. No hospital stay is required. The procedure is performed safely and takes approximately two hour including preparation and recovery time. In fact, most people return to their jobs or usual activities right after the procedure.

5. Most patients require 2 to 3 sessions of knee PRP therapy.

Side effects of PRP Therapy:

The procedure is free of side effects when done by experienced pain specialists. Since the therapy involves injecting patient's own blood derivative, it is a safe procedure. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

My mother aged 65 years has severe arthritis of both knees, should she get both knees replaced in one sitting?

You should do both knees in one sitting if the severity is same in both the knees and the patient is unable to differentiate the painful knee. In case the patient says one knee is more painful than address one knee at a lime. Your own knee is always the best till it lasts.

What are the advantages of doing both the knees in one sitting?

• Exposure to the risk of anaesthesia reduced to only once
• Aids simultaneous rehabilitation especially in severely deformed knees
• Bilateralprocedure reduces cost
• Earlier return to baseline function and convenience for the patient and relatives
• Shorter cumulative hospital stays

What are the risks associated with bilateral Total Knee Replacement (TKR) and are there any studies to support the same?

The risks of cardiac and infection related complications for bilateral TKR are lower than the combined risk of two unilateral TKRs. A population-based comparison of the incidence of adverse outcomes after simultaneous-bilateral and staged-Bilateral Total Knee Arthroplasty published in The Journal of Bone And Joint Surgery.

Result: Records were available for 11.445 simultaneous-bilateral arthroplasty Procedures and 23.715 staged-bilateral procedures.

Conclusions: Simultaneous-bilateral total knee arthroplasty was associated with clinically important reduction in the incidence of infection and malfunction within one year after arthroplasty.

What is the latest Technology available which could help improve surgical outcomes?

Custom Fit Knee Resurfacing: A knee with your name on it i.e. customized specifically based on your dimensions.

Understanding Custom Fit Knee Resurfacing: You are unique and so is your individual anatomy and thus lack of accuracy leads to discomfort and even further corrective surgeries That is why Custom Fit Knee replacement surgery, which utilizes MRI (Magnetic Resonance Imaging) technology to create personalized positioning guides for total Knee replacement is recommended.

Practical Benefits Of Custom Fit Knee Replacement

• MRI of the affected knee is done based on which we can make a customized jig for better fitting of the implant for the patients
• No intra medullary instruments so minimal chances of fat embolism
• Minimally Invasive (just a 4-5 inch incision)
• Improves the speed of the operation theater time (40% reduced surgical time)
• Increases implant inventory efficiency (know sizing)
• Faster recovery of the patient
• Perfect patient alignment thus better mobilization

What is the role of body exhaust 'space' suits in Bilateral TKR?

• 'Space' suits maintain a more sterile environment and offer more mobility to the surgeons.
• Space suits are used to help reduce contamination from the operating teams from entering the wounds.
• The impure air exhaled by the operating team is pushed down by the rotating fan in the helmet of space suits and absorbed by the laminar air flow in the 0.T.

Knee replacement is a procedure where the weight-carrying surfaces of knee joint are replaced surgically to ease the pain or any disability. People suffering from osteoarthritis, rheumatoid arthritis or psoriatic arthritis undergo knee replacement. All these conditions revolve around stiffness and painful knee. This surgery is usually performed on people aged over 50.

Surgery Types: 
Knee replacement is mainly of two main types:

1. Total knee replacement where both the sides of knee joints are replaced
2. Partial knee replacement where only single side of the joint is replaced

Procedure: In case of partial knee replacement with minimal invasion, a smaller incision, which is 3 to 5 inches, is required. This leads to minimal tissue damage and the surgeon can work between the fibres of the quadriceps muscles. Here, an incision through the tendon is not required. This may result in less pain, recovery time is reduced, and motion is better as scar tissue formation is less.

In total knee replacement, four steps are performed:

1. Removal of damaged cartilage surfaces, which is at the ends of the femur and tibia, with a small quantity of underlying bone.
2. Replacement with metal components, which help as a recreated surface of the joint
3. Incision of knee cap with a resurface made of a plastic button, which is optional based on the case
4. Insertion of a medical grade plastic spacer amid the metal components. This creates an effortless gliding surface.

After general or spinal anaesthesia, an incision of 8-12 inches is made in the front part of the knee. Joint part which is damaged is removed from the surface of the bones. The surfaces are then formed in a way to hold a metal or plastic artificial joint. The thigh bone shin as well as knee cap is attached to the artificial joint with either cement or a special material.

After Effects of the Procedure: After the surgery, patients may stay in a hospital for three to five days. Post surgery, notable improvement can be seen after a month or later. The patient is gradually relieved from pain with the construction of new gliding surface during surgery.

There will be slow progress in the movement. In the beginning, one may walk with a support of parallel bars and then with the help of crutches, walker, or cane. After full recovery in about six weeks, people can enjoy normal activities except running or jumping.

Presently, over 90% of total knee replacements function well even after 15 years of surgery. Hence, knee problem is no problem at all!

Knee is a hinge joint where the lower leg bone tibia meets the thigh bone femur. During osteoarthritis, cartilage or ligament defects and degenerative arthritis, knee replacement surgery is recommended world-wide to get relief from extreme pain. Knee replacement surgery, also known as knee arthroscopy, is a surgical procedure, in which the affected knee joint is replaced with synthetic material. The most likely candidates for total knee replacement are the patients with severe destruction of the knee joint coupled with progressive pain and impaired function.

Modern technological advances have made computer assisted knee replacement surgery extremely popular around the globe. In this surgery, the surgeon is assisted by a computer to remove the optimum amount and angle of the bone, which otherwise is done by inspecting manually. This is an excellent example of surgery through small incision and it eliminates the chances of human error. A perfect alignment and balance is achieved and hence longevity is also increased to 20 - 30 years. Knee replacement surgery is also specific to gender as the anatomy of male and female patients is different.

There are many types of knee replacements, most common being the total knee replacement or Total Knee Arthroplasty. In addition, there is partial knee replacement, bilateral knee replacement, revision knee replacement and knee arthroscopy.

In knee replacement surgery, the worn out surfaces of joints of knee are replaced with artificial implant of plastic and metal. The lower end of the femur bone is removed and replaced with a metal shell. The upper end of the lower leg bone (tibia) is also removed and replaced with a channelled plastic implant with a metal stem. A plastic ball is also added under the kneecap depending on its condition. These artificial components are commonly referred as prosthesis. The design of these highly flexible implants replicate knee, with the rotating knee replacement implants assist in backward and forward swing of the legs.

Patients whose knee joints have been damaged by either trauma or progressive arthritis should consider total knee replacement surgery. Post-surgical hospital stay after knee joint replacement is usually three to five days. The surgery has a very high success rate and shows dramatic improvement after a month. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is reduced significantly when the new gliding surface is constructed during surgery. Initially, patient will walk with the help of a walking aid until the knee is able to support full body weight. After six weeks, patient can walk comfortably with minimal assistance. Patients with artificial joints are prescribed to take antibiotics during the course of any elective invasive procedures including dental work. Physiotherapy is an essential part of rehabilitation and it will increase the muscle strength and patient can enjoy most activities, except running and jumping.