Knee Procedures / Total Knee Replacement

The knee is a hinge type of joint. A total knee replacement (TKR) is a surgery that replaces a diseased knee joint with an artificial metal or plastic replacement parts called the ‘prostheses'.

Normal Knee   Arthritic Knee
The typical knee replacement, replaces the ends of the femur (thigh bone) and tibia (shin bone) with man-made metal prostheses and plastic inserted between them, and, usually the patella (knee cap) is replaced with plastic.
Patella
The procedure is commonly recommended for patients who suffer from pain and loss of function mainly due to arthritis, although there may be several other causes.

What to expect as a patient of TKR

You are examined by me and, if suitable, a decision to proceed with TKR surgery is made. This is a co-operative decision between you, me, your family and your local doctor. The whys and wherefores of this surgery are discussed in detail with you. Main benefits to be expected of this surgery are

Reduced Knee pain
Enables you to sleep without pain.
Improved quality of life, ability to return to normal activities.
Return to sports such as tennis, golf, bowls, cycling, gentle snow skiing and walking. It is not advisable to be running following a total hip replacement.
Pre-operation

Heart test called Dobutamine Stress Echocardiography (DSE) on outpatient basis few days before the scheduled date. This test can be arranged locally or by calling 25763595 at Hiranandani Hospital. Report to be informed to me only if the test is positive. The date of surgery can be fixed by emailing to vijaydshetty@gmail.com.

Upon arrival in the hospital for admission, the front office may ask for some deposit. You may deposit 50% of the estimate at the time of admission.

Admission is one day prior to the scheduled date of operation around 11am at the front office.
If you are on blood thinner tablets, stop those tablets two days before surgery.

Once you are in the ward, you will be given hospital clothes to change into. You will undergo some blood tests and x-rays. Junior doctors, nurses, anaesthetists and physician may visit you. The anaesthetist will discuss with you the type of anaesthetic. You will be asked to stop eating or drinking after midnight that day.

Day of Surgery

Surgery is usually done in the morning at 8.30 am. Approximately 45 minutes prior to surgery, you will be transferred to the operating theatre. A urinary catheter will be inserted in the recovery room. The operation takes about 60-90 (surgical time) minutes for each knee.

However, total theatre time (i.e. time away from the room) would be roughly five hours for both knees.

Surgery

The surgery involves correction of the deformity, removal or excision of diseased joint surfaces and replacing them with man-made artificial joints called prostheses. Many arthritic knees are bowed or knock-kneed. A total knee replacement will correct this deformity. Once the two metal components are fixed to the bone, a plastic insert is placed on the tibial surface. This plastic acts as the shock absorber. The plastic allows the low friction movement to occur. The plastic may either be fixed or mobile depending on the type of prosthesis.

Replacement of the kneecap is controversial. I am aware of the debate but I normally do not replace the kneecap. Following insertion of the components the wound is closed usually with absorbable sutures inside and a drain is inserted. Skin usually gets removable sutures. The operation takes about 60-90 minutes

Post Operation

Day of Surgery

You will wake up in the recovery room with a number of monitors and tubes to record your vital signs such as blood pressure, pulse, oxygen saturation and temperature. You will have a bulky dressing on your knee/s.

Post-operative x-rays will be performed later in the day. Once you are awake and alert, you will be shifted back to the ward or ICU as per the decision of the anaesthetist. You will have one or two drip lines in your arm for injections.

On the same day, or a day following surgery, you will be allowed to sit or walk under the supervision of a physiotherapist. You may experience some pain and discomfort. However adequate pain relief can be achieved with epidural injections and medications.

You will be discharged approximately 5 days after surgery depending on your mobility. You will need to visit the hospital OPD three weeks after the operation for stitch removal. You will require walker assistance for about three to four weeks. Please note there will be swelling in both feet for few months after the operation.

COST: The standard operation costs roughly 5.5 lacs in economy room, 6 lacs in twin sharing room and 7 lacs in private room for both knees. Single knee costs roughly 60% of this estimate. There is NO hidden extra. Please note, newer implants may cost more.

Finally, for any further assistance, please call +919833228602 or visit www.hipandkneesurgeonmumbai.com

Risks and Compliactions of Knee Replacement Surgery

Surgery is not a pleasant prospect for anyone, but for people with arthritis, it could mean a major difference between leading a normal life and compromising with the quality of life, putting up with a debilitating condition.

Total knee replacement is one of the most successful procedures in orthopaedic surgery, and, evidence shows that the benefits of total knee replacement surgery far outweigh the potential disadvantages. However, as with any major surgery, there are potential risks involved. It is important that you are informed of these risks before the surgery takes place.

Anaesthetic complications. As anybody undergoes general or regional anaesthesia, there are risks associated with it although, with technology as it is today, the chances of having a major anaesthetic complication are rare. The risks, of course, are magnified if you have abnormal general medical conditions of your vital organs such as heart, lungs and kidneys. Therefore a complete evaluation of those systems has to be performed before you are taken to the operating theatre.

Blood clots (Deep Vein Thrombosis). These can form in the calf muscles and can travel to the lung (pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your doctor. Being fully aware of the debate, I take full precautions and I use aspirin 75 mg daily for four weeks, after surgery, as a prophylactic dose.

Infection. Superficial wound infections may occur early on and deeper infections can occur at a later stage. The incidence of infection is less than 1%. Infections are usually treatable with antibiotic treatment. You are given antibiotics before the operation and for the first two days to prevent infections from happening. Very rarely, if a joint has a deep infection that cannot be controlled with antibiotic therapy, the joint requires removal and a second joint re-implanted at a later stage.

Leg length discrepancy. It is not unusual for there to be up to 1cm leg length discrepancy following a total knee replacement. This is quite easily tolerated.

Fractures. Very rare at the time of surgery and this is usually treated immediately. It is not uncommon to fracture around the replacement in elderly patients at a later stage.

Loosening of the prostheses. Over a period of time the prostheses may loosen if the bone does not grow into it sufficiently or if the bearing surface wears out to produce areas around the prostheses, leading to loosening. Should a prosthesis loosen, then it can be revised. If only the bearing surface wears out, then usually only the bearing surface requires revision which is a much smaller operation.

Damage to nerves and vessels. It is unusual to damage any major nerves or blood vessels following a knee replacement. However nerve palsy can develop if the nerve is stretched during surgery, especially if surgery involves correction of severe deformities.

Haematoma. Occasionally a bleed may occur around the knee joint following the operation that may require drainage. Spontaneous recurrent bleeding episodes after total knee replacements have been reported in the literature.

Scarring. Some patients tend to scar more than others and it may be that the scar that you have will be quite thickened (keloid).

Long-term bruising and swelling. Occasionally the operated leg may remain bruised and swollen for a number of months and the knee may appear bigger than the un-operated knee for a long time, but in general this tends to resolve.

Numbness around the wound. It is quite possible to get numbness around the wound. It may be temporary or permanent but, this should not affect the function of your knee in any way.

Stiffness in the knee . Ideally your knee should bend beyond 100 degrees but on occasion the knee may not bend as well as expected. Sometimes manipulations  are required, this means, going to theatre and under anaesthetic the knee is bent to achieve more flexion.

General advice after knee replacement surgery

You should have a regular check every year with an x-ray.

If you have had any major bowel, bladder or dental surgery, antibiotic cover should be given prior to the surgery.

Metal prostheses can activate security alarms at the airports.

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