Total Knee Replacement (Arthroplasty)
|Knee Replacement Osteoarthritis
The Knee Joint
The Knee Joint is formed, where the thigh bone (femur) and the shin bone (Tibia) meet. The joint surfaces are covered with smooth and shiny cartilage, which facilates the bony ends to glide smoothly over each other. There are also structures like the menisci (shock absorbers) and ligaments, which aid support and stability to the knee joint.
Reasons for Total Knee Replacement Surgery (Indications)
A patient suffering from Pain, loss of motion, deformity or instability, may benefit from a Total Knee Replacement. The above symptoms may be due to underlying conditions like Osteoarthritis, Rheumatiod Arthritis, Previous injury and various other conditions. Surgery is indicated, if the above symptoms continue to affect your lifestyle, inspite of adequate non-operative treatment.
Consultation before Knee Replacement Surgery (Pre-OP)
It is important to discuss with your surgeon, your diagnosis, other options of treatment, the procedure, the post-operative course and possible complications. Please take your medicines with you and you may be advised to stop some of them, before surgery.
You may also be required to see other specialists like the Anaesthetist ( The doctor, who may put you to sleep or otherwise), Other medical specialists like the Cardiologist, if required, the Physiotherapist and the Occupational therapists.
Total Knee Replacement X-Ray
Total Knee Replacement X-Ray
Total Knee Replacement Implant
Anaesthesia for Knee Replacement
The Anaesthetist, in consultation with you, usually decides on the type of Anaesthesia. The options are usually General Anaesthesia, Spinal Anaesthesia, Epidural Anaesthesia and Nerve blocks. Sometimes, a combination may also be employed to provide adequate Anaesthesia during the procedure and adequate analgesia (pain relief) after the procedure.
The Operative Procedure for Total Knee Replacement
It involves a skin incision (surgical cut) on the midline of the knee. By careful dissection, the joint is approached and inspected. The worn out cartilage and bone surfaces are shaved off. The bone ends are prepared meticulously and systematically to accept the selected prosthesis (artificial knee implant). These are usually fixed with a special cement (poly-methyl-methacrylate), but may not be in some implants (uncemented). Apart from the long bone ends (femur and Tibia), the patella may also be re-surfaced, in some instances.
The tissues are carefully repaired back with sutures and clips. Dressings are applied around the knee, at the end of the procedure. Antibiotics are usually administered at the start of the procedure, to minimize the risk of infection. The precautions taken include, maintaining a sterile field, using antibiotic loaded cement and performing the procedure in laminar flow Theatres.
After the procedure, the patient is usually moved to the recovery room for a few hours and subsequently back to the ward.
Post-operative Care after Knee Replacement Surgery
Pain relief after the procedure is adequately provided by various options like epidurals, patient controlled anaesthesia, Nerve blocks, Injections, patches, tablets etc. The Anaesthetist, who may be a part of the pain team, will be responsible for this.
Whilst in the ward, you may be provided with stockings, fitted with compressive stockings and may be given injections or tablets, to minimize the risk of developing clots in the body.
You may have to visit the Radiology department, to get some X-rays of your operated knee, showing the implants. You may a couple of dressing changes, while you are in the hospital.
Post-operative rehabilitation after Total Knee Replacement
The physiotherapist will visit you in the ward and encourage you to start getting up and walking. The sooner a patient is able to do this the earlier the progress in rehabilitation and the earlier the discharge. Initially you may be provided with a walker or a frame and subsequently progressed to crutches or sticks. If you have steps to negotiate at home, they will help you with them, before discharge.
After Discharge from Knee Replacement Surgery
You will be advised to wear your anti-embolic stocking for atleast 6 weeks. You will be advised on the physiotherapy and appropriate exercises. It is important to diligently perform these to get good extension and flexion in the joint.
You will be advised to see the doctor in 2 weeks time, when the clips or sutures on the skin may be removed. Here you will be advised on the progress of your physiotherapy and subsequent review.
Total Knee Replacement is an extremely successful operation through out the whole world. It is very good for relieving pain in the appropriately indicated patients. The success rate is reported at 95%.
TOTAL JOINT (KNEE) REPLACEMENT
If your symptoms continue to be bad and you have had no relief from the above mentioned options, your doctor may offer you a Total Knee Replacement. This is a surgical procedure, where the joint surfaces that are worn out are replaced with metal implants and an intervening polyethylene insert. You would need a General or a Regional Anaesthesia for this procedure.
In the appropriately selected patient, Total Knee Replacement, offers excellent pain relief and great improvement in their quality of life. It is one of the most successful of operations, performed through out the world. Most people are extremely happy with the outcome.
But as this is a surgical procedure, you have to familiarize yourself with the Pros and Cons, as well as the Dos and Doníts, before embarking on one.