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

What is Knee Replacement?

Knee replacement, which is also known as arthroplasty is a type of surgical procedure done to resurface the knee as a result of damage due to the onset of arthritis. The surgery is generally recommended for a patient who is suffering from a serious case of arthritis or an individual who have experienced a bad knee injury. The surgery, resurfaces the damaged part of the knee so as to reduce acute knee discomfort. This type of surgery is known to effectively reduce knee pain for almost 90% of the patients who opt for it.

Knee replacement surgery is classified into 2 basic types-

  • Total knee replacement surgery- Through this procedure the knee joint is repaired with a metal covering that is placed on the thigh bone.
  • Partial knee replacement surgery- Through this procedure only the part of the knee that is damaged is repaired.


Knee replacement surgery is generally recommended to patients who have a severe case of osteoarthritis. It generally occurs with old age and the knee cartilage tends to break down because of the constant wear and tear. The onset of this condition hinders with knee movement and can cause acute pain. The condition may be treated through other methods like prescription of painkillers, physiotherapy and anti-inflammatory medication. But if such treatment is ineffective doctors generally recommend knew replacement procedure.

A knee replacement may also be advised in case of a severe injury to the joint due to an accident.


Pre Procedure

Before one undergoes the procedure, the doctor explains the proceedings in detail and you will have to sign a consent form. A detailed medical history is taken again and relevant tests are done. Make sure to inform your doctor about any allergies you have or medication that you are taking.

In order to prepare the patient for the operation, water and food is stopped some 8 hours prior the procedure. A sedative is given just before the procedure to help the patient relax. Patients are also asked to arrange for someone to help them with recovery for a couple of weeks post the procedure.

During Procedure

Knee replacement surgery is performed under the influence of anaesthesia. The procedure is as follows-

  • The patient is prepped for the surgery and brought into the operation theatre
  • The skin at the site of the incision is cleaned with an antiseptic, and a cut is made.
  • The damaged part of the knee is removed and resurfaced with prosthesis, which may be metal or plastic. The prosthesis used may be either cemented or un-cemented, or even a combination of both, depending on the patients requirement.
  • The incision is then closed and stitched up or stapled. A drain is generally placed at the site of the incision to facilitate easy removal of fluid. The surgical wound is dressed.

Post Procedure

Once the surgery is done the patient is shifted from the operation theatre to the recovery room, where he is monitored constantly. You may have to stay at the hospital for a few days after the surgery. During this period you will start physical therapy to help you gain back knee movement. During this period pain killers are also prescribed to bring down the pain and help with exercise.

Once you are discharged and go home, ensure that you take care of the surgical wound. It should be kept clean and dry. Specific instructions will be given about how you can bathe and clean up. The dressing is generally removed at the next check-up. In case you develop a fever, or experience acute pain and swelling inform your doctor immediately. You can go back to your normal routine as soon as your doctor says it is okay to do so.

Risk & Complication

All surgical procedures involve certain complications, and so does knee replacement. A patient should be aware of the various risks of the surgery before undergoing it. A knee replacement procedure involves complications like-

  • bleeding or onset of infection
  • formation of blood clots at the site of surgery or in the lungs
  • fracture or the prosthesis may become loose
  • acute pain and stiffness of the knee
  • Injury to nerve cells or blood vessels at the site of the surgery
  • There may be some other risks involved depending on the patient’s health and medical condition, which should be discussed with the doctor before the procedure.

More Info

Knee replacement procedure was first done during the 1970s. During that period doctors were of the opinion that a knee implant would last for 10 years. Today, knee implants have a life of about 20 years. In fact it has been predicted that by the year 2030 about 450,000 knee replacement procedures will be done each year.

After the surgery the pain is reduced to a great extent and disappears in most cases. One can gradually go back to their normal daily activities and can even indulge in sports like golf, tennis, running and swimming without any problems. Quality of life is greatly improved.

Popular Health Tips

Know Everything About Knee Replacement

DNB (Orthopedics), Diploma in Orthopaedics, MBBS
Orthopedist, Mumbai
Know Everything About Knee Replacement

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.


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.


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.

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Knee Osteoarthritis and PRP therapy

MBBS, MD - Anaesthesiology, FIPM, Fellowship in palliative medicine, certificate in interventional pain management, Multidisciplinary pain management course
Pain Management Specialist, Pune
Knee Osteoarthritis and PRP therapy

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.

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Bilateral One Staged Total Knee Resurfacing Surgery - Is a Boon or Bane?

DNB (Orthopedics), Diploma in Orthopaedics, MBBS
Orthopedist, Mumbai
Bilateral One Staged Total Knee Resurfacing Surgery - Is a Boon or Bane?

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.
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Steps Involved in Knee Replacement Procedure

M.CH. (Ortho), MS - Orthopaedics, MBBS
Orthopedist, Delhi
Steps Involved in Knee Replacement Procedure

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!

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Knee Replacement

Fellowship in Knee Replacement, D.N.B. (Orthopaedics) , MBBS
Orthopedist, Mumbai
Knee Replacement

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.

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Popular Questions & Answers

My mother has undergone 7 previous surgeries. She is highly diabetic. Presently she is suffering severe pain in left knee. Xray report suggestions are to go for knee replacement. Being v obese and with past surgical records knee replacement is risky situation. Any other option available.

Physiotherapist, Noida
Chiropractic adjustment will help. Quadriceps exercise Hams Stretching- lie straight, take the leg up, pull the feet towards yourself, with a elastic tube ornormal belt. repeat 10 times, twice a day.

I am 60+ years old & suffering from arthritis for the past 10 years. Both knees are affected. I consulted a doctor and he has suggested knee replacement in both knee. Is knee replacement necessary? What are the advantages of knee replacement? Will I be able to walk properly after the operation?

MBBS, Craniosacral Balancing, Quantum Touch, Visceral manipulation
Pain Management Specialist, Panchkula
Knee replacement is a good alternative these days. Don't worry follow proper precautions as advised to you after operation (physiotherapy etc.) You will enjoy your life. For any type of stress in any field of life mind management is available for which you can contact us on Lybrate. More details about the treatment on our profile/personal statement column.
3 people found this helpful

I am 65 years old ,suffering from arthritis for the past 10 years Is knee replacement is necessary. What is the advantages of knee replacement?

PG Diploma in Health Promotion, Bachelor of Physiotherapy, certificate in Yoga Therapy & Ayurveda
Physiotherapist, Delhi
It depends upon the condition of your joints. however, many at times Total knee replacement is not even recommended, still patients get their knee changed. Surgery should be the last option. I suggest you to go for conservative treatment before going for surgery option. Give your kness a chance to survive by its own. I treated many patients with knee problems. They lost all hope and were going for surgery. But exercise and modalities helped them. & their knee got saved from surgery. Before you go for surgery I suggest you to go for Physiotherapy sessions. regards
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Table of Content

What is Knee Replacement?

Knee replacement surgery is classified into 2 basic types-



Risk & Complication

More Info

Play video
Knee Replacement
Benefits of Knee Replacement

Hello, friends, I am Dr. Gaurav Khera I am a consultant orthopedic surgeon joint replacements and spine. Today I will be talking to you about total knee replacement. Knee replacement is the most common surgery which is being done these days it is also a surgery which has got a lot of bad name to it because of a few complications that are associated a few myths which are associated. I'd like to clear all those out today.

Before I start talking about knee replacements I would like to tell you something about the anatomy of the knee joint. (Displaying knee model) now this is the knee joint knee joint is a type of a hinge joint, a modified hinge joint, it has three compartments, it has the middle or the inner compartment the lateral or the outer compartment and the patella femoral compartment. now what basically happens in osteoarthritis that is the reason why we do a total knee replacement is that the joint it starts to age or it starts to degenerate, and as the joint degenerates this blue coloured cartilage cover it starts to go away, as the cartilage cover goes the joint tries to recover from this degeneration process and in doing so in the repetitive process these osteophytes which are like bony specules they are formed, now these bony spicules as they are getting formed they start pinching into the surrounding tissues, surrounding tissue means the ligaments, basically 4 ligaments are in the joint 2 of which are inside and 2 of which are outside. the outside ones are the lateral and the middle collateral ligament and the inner other anterior and posterior cruciate ligament now the first ligament to get involved is the medial collateral ligament which is on the inner aspect of the knee joint and there is tightening of this ligament which takes place as the recommend gets tightened this middle compartment it starts to tighten up and there is further rubbing of these bones as these bones are out this blue cartilage it goes away and the bone gets exposed and the raw bone Easter surfaces they rub against each other causing severe excruciating pain.

The patients come to us then they complain of pain when they are going up and down stairs they complain of funny sounds which are coming, they complain of difficulty and squatting difficulty in cross leg sitting. so this is the reason why you get all these pains. now Osteoarthritis is not the only reason why were doing knee replacements. knee replacements are also being done father causes like hemophilia, septic arthritis, septic arthritis means infections. a few other causes like imposed tuberculosis, again its an infection. now there are two types of knee replacement surgeries which are being don,e one is the unicondyler knee replacement and one is the total knee replacement, a unicondyler knee replacement what we do is we change only the middle aspect of the joint or the inner aspect of the joint and in total knee replacement we change the entire joint. now changing of the joint does not mean that we remove the bone from the top and bottom and we just put in a new knee, basically were just changing the damage surface so this is the model of a knee replacement surgery.

Basically there seven cuts which is involved in a total knee replacement the main cut being the table cut and the other cuts are the femoral cuts now the femoral cuts are again you know the distal anterior posterior the chamfer the box so once these cuts are done this is how the femur of the knee joint looks like of the implant. this is then fitted onto these cuts with the help of a bone cement and on the tibia we put a tibial plate which is again fixed with a cement and then we put a insert. the size of the cuts and the amount of bone which is being cut is generally decided inter operatively. the types of implants which are being used are different, the types of implants vary we have patient-specific implantations we have computerized implantations you know in which we can do computerised cuts during the surgery and we have high flex knees we have normal needs so huge variety of things which are coming. now coming to rehabilitation process after the surgery the rehabilitation process for you as a patient is the most important, see normally the patient requires two to three months to recover after the knee replacement.

We make the patient walk after 24 to 48 hours .now the reason why we are making you walk so early is so that we can get your knee to start moving we can prevent complications like DVT and we can start your physiotherapy for muscle strengthening as soon as possible. your physiotherapy will continue for at least two months after the surgery and you will be able to lead a completely normal life that is hardly any activity which is going to be restricted after your surgery, you can go for your cycling you can go for your mountaineering you can go for your running you can go for your walks, we will only advise you not to be squatting and not to be cross leg sitting other than these you will be allowed to do all other activities. the complication rates of the surgery has come down tremendously. about 10 years back the complication rates were much higher now the complication rates have really come down that is because the most common complication is infection. now infection the methods which we are using in this surgery they are better antiseptic methods that we are using, there are better barriers which are there in the hospital, better antibiotics so infection rates have come down. the other thing is the failure of the implants there is a much better understanding of how the knees functioning, there is a much better understanding of what the soft tissue balancing is required. so all these complications have really come down so I would advise you that

If you are really suffering from a lot of knee problem if you re having to take a lot of painkillers if youre not being able to do your daily activity then you should get in touch with us and you start thinking of a knee replacement surgery. you can contact me and come and meet me at my clinic at dr Kheras wellness clinic, I am here everyday in the evening from 6 to 9. I am also available at Apollo spectra hospital, you can call text or video chat with me through Lybrate. Thank you.
Play video
Total Knee Replacement
Benefits of Total Knee Replacement

hello, I am Dr. Hardik Ghundiyal practicing in Bombay since last six years. I am mainly into total knee replacements. I have been doing a minimally invasive total knee replacement since last six years. In this replacements, I usually do not cut open the muscles.

The advantages of this procedure are that it is a minimal invasive. The small incision and the recovery of the patient are very fast. Well in my process the patient can stand on the same day of the surgery and walk on the other second day itself. The third day usually all my patients get discharged from the hospital and the amount of movement of the knee the amount of motion of the knee is usually same as pre-operation or maybe 10 to 20 21 degrees more than what the preoperatively it was.

Depending also on the medical condition and obesity of the patient. Age is not the criteria for the total knee replacement as per everyone s belief. It can be done at the old age also. The whole criteria being the pain and the disability of the patient. If it is a 90 year old patient but is walking everywhere, confined to bed only because of the knee pain of course he is a patient for the total knee replacement and we will would like to go ahead and give the best results for him, the same if the 60 years old guys who is confined to the bed and is not able to walk there is no point of doing total knee replacement for such kind of patients as he is never going to walk in his life.

So against all the beliefs age is never the criteria for total knee replacements. For more information you can contact me on
Play video
Total Knee Replacement
In total knee replacement, we replace the rollout cartilage with body friendly implant and bone and muscle remain as same. The total knee replacement is a simple procedure in which the patient remains admitted for 7 days in hospital. First day be thoroughly investigate the patient surgical fitness second day with generally operate the patient it usually takes 2 hours for both knees and next day of the surgery or third day we start physiotherapy. 4th and 5th day we make the patient walk sit and go for washroom and 7th day the patient goes home.

The patient leads a normal life in 3 to 4 days. It's about 96% successful rate in literature. Nowadays, it's about 99% success rate of the surgery. If you are suffering from osteoarthritis of knee joint, then you can contact me on and come at my clinic at SK orthopedic centre, Krishna Nagar. Thank you very much.

Play video
Knee Replacement
Benefits of Bilateral Total Knee Replacement

I am Dr. Rakesh Nair. I am an exclusive knee replacement surgeon practicing at Zen Hospital in Chembur. I am also attached to the Fortis Group of Hospitals at Vashi and Mahim and Holy Family Hospital at Bandra. Today, I am going to talk about Bilateral One Stage Total Knee Replacement. To understand the basic term which I have used here when I say Bilateral One Staged, I say both knees and one sitting. They are done together once the patient is wheeled in. They are not done in a gap of a few days. That s what I mean by both knees and one sitting.

In the surgery, all we remove is hardly 7-8 mm of bone from the thigh bone and around 7-8 mm from the shin bone, that is the lower part and all we do is just change the cap. It s like changing the cap of a tooth, so your bone and your muscle are your own. We are not chopping off the whole knee and replacing it. So, that is the reason why I am using the terminology Knee Resurfacing, we are changing only the cap.
Once the cap is changed, we are able to mobilize the patient, the same evening if required. And, with the advanced anesthesia techniques that we have, I am able to make the patient walk the same evening. So, there are some videos here also which would tell you the same where the patient has been operated in the morning by around 12 o clock once he or she is wheeled out the operation theatre. In another four hours by 4 o clock evening, the patient is walking with full weight on the leg without much pain because of the pain techniques that we in terms of the pain management.

Now, why would I say that we should be doing both knees in one sitting? So, what are the advantages of doing both knees in one sitting? If you see the further videos which I would also show you, most of the patients who come to me have severe deformities. They, like, have severe bow legs, legs which are severely bent, either towards the inside or either towards the outside. So, doing one knee and then doing another knee is not going to help at all because the patient is not going to be able to walk. So, when I do both knees in one sitting it restricts the surgical procedure so it is like saying I do everything under one anesthesia. The patient gets short of medication. The medicines also which go into the body is once you are wheeled into the operation theatre. The most important part is that the patient can be mobilized very easily because immediately both the legs are straight and the patient can walk with full weight bearing on both the legs. So, I can make the patient walk in the evening or the next day depending on how strong the bones and the muscles are. Another thing is, it reduces the hospitalization also, plus the hospital cost also goes down because we don t double use the medication nor the stay is doubled. The stay is same; it varies between 3-7 days depending on how strong the patient's knees are before surgery. So, I would definitely advocate doing both knees in one sitting.

What are the main advantages and what would you say in terms of why wouldn t we do a knee after a week or 10 days? There are studies which say that it is not the number of joints, so the number of knees you do in which causes the problem or the commonest cause which is an infection. The problem arises if you keep on wheeling the patient into the operation theatre. So, if somebody says that we do a knee today and then we do a knee after 4 or 5 days then cases of infection will increase because the patient is being wheeled into the operation theatre on two separate occasions. So, it is not that I have not done both the knees in one sitting, which is a better option because the chances of infection are less than doing one knee now and then doing the other knee after 4-5 days, where the patient gets the same medicines repeatedly plus he is bought into the operation theatre again and his stay also increases in the hospital.

We would be showing you some videos where the patient, how the patient is walking before surgery. If you see most of these patients, the legs are severely deformed. So, all of them I have been able to do a One Staged Bilateral Knee Resurfacing where I have done both the knees in one sitting. You see them how they are walking before surgery, you see them how are they are walking after surgery. And, if you compare the function, they are really able to walk very comfortably.

My patients even sit cross-legged after surgery but that is not. I will show you one of these videos which are showing the patient sit cross-legged after surgery. But that is not something which we promote. It is just to show that they get very good function and they would definitely be able to sit cross-legged but that is not something we tell the patient to do because that compromises on the life of the knee. So, there are a lot of records and results which say that, whether we do a Bilateral One Staged Knee Replacement or whether we a One Staged Knee Replacement, the complications in terms of infection, an embolism is always similar. In fact, it is much more in a unilateral knee than in a bilateral knee.

We use body exhaust play suits, again, during surgery. I will show you this video which is showing you the body exhaust play suits where we are working in a very sterile environment. We would not want to give any infection even from the OT personnel to the patient. So, these are body exhaust playsuits which prevent the impure air breath out of the operating team, it is not allowing it to go to the patient. In fact, it is sucked up by a rotating fan which is there on top of the body exhaust playsuits and the whole impure air is taken out from the patient s atmosphere. Even our conventional methods of mixing cement have been changed and we are using basically vacuum mixing for cement so there again is no impurities in the bowl in which we are mixing the bone cement to fix the implants to the bone.

We have all the options in terms of the knee replacement where we even have computer assisted Total Knee Replacement. We have Unilateral Knee Replacement where basically the unilateral knee replacement is used for younger patients who have deformities or pain in the insides of the knee where only a part of the knee has been damaged, the rest of the bone is all right, that s where we use the Unilateral Knee Replacement. The latest what we have is the Customized Jigs in Total Knee Replacement where we get the MRI done of the affected knee. On the basis of the MRI, ceramic Jigs are made and on the basis of the ceramic Jigs, the positioning of the implant can be as perfect as required. Obesity has always been, the patient has always come up to me saying, Doc, I am little on the heavier side, I am so heavy, is it a contraindication to my surgery? So, obesity as such is not a contraindication to surgery. Definitely chances of wound healing are a problem but, instead of a week to ten days, it will take another week to ten days for healing. Otherwise, it is not a contraindication to the surgery.

Now, a very important question which comes from the patient is, Doctor, how long will these knees last? So, I give a very simple answer to that is that, the more you take care of it, the longer it will last. So, the longevity of the knee all depends on how strong your muscles are before surgery, how strong your bones are after surgery or before surgery and depending on that we normally get a bone density done for the patient and we treat the patient either on a yearly injection for osteoporosis or daily injection which are meant to fill up the bone and that decides on how well the implant is going to hold on and how long the life of the knee is going to last.

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