Total Knee Replacement Surgery

Total Knee Replacement is one of the most common surgical Procedures performed in all of medicines. Total Knee replacement removes and replaces the damaged knee surface with an implant. A total knee implant is made up three parts: metal femoral component (thighbone), metal tibial component (shinbone) and a plastic spacer that is placed in between. A forth component made of plastic is sometimes used to cover the back of the patella (knee cap).

In this care you are out of bed and walking on the second day after surgery performed, also climbing stairs 5 days after surgery, it takes approximately 3 months to fully recover from this surgery. You have complete freedom from knee pain.

What Is Knee Replacement Surgery Procedure..?

Knee replacement Surgery should be considered when all conservative measures fail to provide relief. Surgery may be performed for the following reasons: Relive pain, improve joint stability, Improve alignment and correct bone deformity, Maximize quality of life, Optimize activities of daily living. If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.

Knee Joint

The knee is the joint where the bones of the lower and upper legs meet. The knee moves like a hinge, allowing you to sit, squat, walk or jump. The knee consists of three bones:

Femur – Thigh bone.
Tibia – Shin bone.
Patella –Knee cap.

The ends of the bones are covered with a layer of articular cartilage, a slick, elastic material that absorbs shock and allows the bones to glide easily against one another as they move.

Between the tibia and femur bone there are two crescent-shaped pads [cushion] of connective tissue that reduce friction and disperse the weight of the body across the joint. They are:

The lateral meniscus.
The medial meniscus.

The bones are held together by a joint capsule and an inner membrane, called the synovium, which secretes a fluid to lubricate the joint.

Two groups of muscles support the knee. They are:

Hamstrings muscles on the back of the thigh.
Quadriceps four muscles on the front of the thigh.

Knee Joint Pain Osteoarthritis

The Knee and Osteoarthritis

The Knee is a hinge – like joint made up of the Femur (thighbone), tibia (shinbone), and Patella (Kneecap) held together by muscles, ligaments, and other important soft tissue. In between the knee is a natural cushioning called meniscus that is made up of cartilage. This material provides shock absorption during weigh bearing activities such as walking or climbing stairs. Through wear and tear, the cartilage in your knee can break down causing a disease known as osteoarthritis. Age, obesity, heredity gender and other factors can lead to the progression of osteoarthritis. Common symptoms include pain, swelling and stiffness.

Common causes of knee Arthritis:

Osteoarthritis
Rheumatoid arthritis
Arthritis following injuries

Osteoarthritis usually occurs after the age of 50-55. The cartilage becomes soft and undergo wear and tear. The bones then rub against one another causing knee pain and stiffness.

Rheumatoid Arthritis is a disease in which the synovial membrane becomes thickened and inflamed which damages the cartilage and eventually causes cartilage loss, pain, and stiffness. Post Traumatic Arthritis can follow a serious knee injury like a fracture or severe tears of the knee’s ligaments.

Single or Both Knee Total Knee Replacement

Simultaneous Bilateral Total Knee Replacement – Replace both knees on the same day, under one anesthesia. It includes undergoing anesthesia only once, fewer days in the hospital, and only one rehabilitation that lets you resume normal activities sooner than two separate ones. Simultaneous knee replacement surgery is also a good option if the condition of your both knee joints is so poor that replacing only one joint would still leave you unable to function during physical therapy, thereby slowing your recovery.

Staged Bilateral Total Knee Replacement

At a time only one knee is replaced and after some days other knee get replaced. Surgeries are performed several months apart from one from the other, requiring two hospital stays, two anesthesias and two rehabilitation periods. People with age over 70 years and those with cardiovascular or lung disease are usually offered staged procedures. If you have any significant medical risks, you are probably better of having two separate operations.

Pre-operative [Before Surgery] Preparation:

Medical Evaluation
Physical examination with an orthopedic surgeon and physician several weeks before the Single or both knee Total Knee Replacement.
Investigations: X-Ray, Blood investigations, ECG, 2D ECHO, Urine tests
Dental Check-up.
Cardiology check-up.
Additional medical conditions assessment.
Arrangement for blood transfusion.
Medication modification: Medicines like blood thinners should be adjusted or stopped as per physician advice.

Total Knee Replacement Surgery:

Admission to Hospital: One day before surgery.
Anesthesia
General Anesthesia
Spinal (epidural) Anesthesia – It anesthetizes your body from the waist down. In Epidural anesthesia thin plastic tube is inserted in the lower back, through which calculated dose of medication is injected during surgery, making only the legs numb below the waist. It is safe for the elderly, those who have high blood pressure or heart trouble & during surgery it helps reduce bleeding. After the surgery, it can be continued as epidural analgesia, eliminating the need for sedatives and allow early exercises.

Antibiotics

Intravenous antibiotics are started just before surgery and continued for 1day after surgery.

Surgery

Surgical time is about 90 to 110 minutes. Along with surgical time, pre-operative preparation, anesthesia and recovery stay will keep patient in an operation room for 3 to 4 hour. In this surgery, the damaged cartilage and bone surface will be removed saw, then position a new metal and plastic joint surfaces to restore the alignment and function of your knee.

Components of the Artificial Joint:

Femoral component – Made of a highly polished strong metal.
Tibial component – Made of durable plastic held in a metal tray.
Patellar component – Plastic.

Bone cement:

Used to fix these components to bone.

After surgery:

The patient will have a dressing on the knee to protect your wound. Your wound dressing will be changed regularly until it’s healed over. If required blood transfusion will be done as per hemoglobin levels.

Our physiotherapist will help you to get up and walk about as quickly as possible. Generally, you’ll be helped to stand within 12-24 hours after your operation. Walking with a frame or crutches is encouraged. Most people are able to walk independently with sticks after about a 1 to 2 weeks but this can vary depending on the individual.

Generally, one knee Total Knee Replacement patients are discharged after 1 day of surgery and in case of both knee Total Knee Replacement patients are discharged after 2 days. Discharge to home is generally assessed by a recovery of the patient.

During your stay in the hospital, a physiotherapist will teach you exercises to help strengthen your knee. You can usually begin these the day after your operation. It’s normal to experience initial discomfort while walking and exercising, and your legs and feet may be swollen.

Wound Care – The stitches or staples will be removed about two weeks after surgery.

Possible Complications of Surgery:

Because of modern medicine, the complication rate of Total Knee Replacement surgery is less. Some of them are:

Infection: Can be avoided with modern well-equipped operation room complex, antibiotics, etc.
Wound healing problem
A blood clot in leg vein: Prevented by exercises, blood thinning medication, anti DVT stockings

Your Recovery At Home

Total Knee Replacement is major operation and muscles and tissues surrounding your new knee will take time to heal. You feel tired at first.

The exercises your physiotherapist gives you are an important part of your recovery. It’s essential to continue with them once you’re at home.

Your rehabilitation will be monitored by a physiotherapist. You should be able to stop using your crutches or walking frame and resume normal leisure activities six weeks after surgery. However, it may take up to three months for pain and swelling to settle down. You should be able to resume most normal light activities of daily living within three to six weeks following surgery. Some discomfort with activity, and at night, is common for several weeks.

Diet:

Some loss of appetite is common for a few days after surgery. A balanced diet, often rich with an iron, calcium, vitamin and protein supplement, is important to promote proper tissue healing and restore muscle strength. Be sure to drink plenty of fluids.

Care After Total Knee Replacement:

Continue to take prescribed painkillers or anti-inflammatories to help manage pain and swelling for the initial days
Use your walking aids but aim to gradually decrease the amount you rely on them as your leg feels stronger.
keep up your exercises to help prevent stiffness and do not force your knee
Raise your leg when lying in bed and use ice packs to help with swelling.
Resume sitting, standing, walking up and down stairs.
Light sporting activities like swimming/ golf/ driving permitted after 3 months.