Many types of designs and materials are currently available. The knee joint is divided into three compartments for the purpose of description the medial [inner), the lateral [outer) and the kneecap compartments. Arthritis can affect one or more compartments of the knee joint. When two or all three compartments are damaged by arthritis, your surgeons will usually recommend a Total Knee Replacement.

There are two categories of Total Knee Replacement (TKR)

Fixed Bearing - the plastic cushion in this form of knee replacement is fixed to the metal tray on the tibial side of the knee joint.

Mobile Bearing - the plastic cushion is not firmly attached but is allowed to rotate on the tibial tray. This is a newer type of design. The wear rate of the plastic component is probably lower compared with fixed bearing design. However not all patients are suitable for a mobile bearing TKR.

Unicompartment - If only one compartment is affected by arthritis, your surgeon may recommend a Partial Knee replacement (Unicompartment knee Replacement). In this form of knee replacement, smaller components for the femur and tibia are used and the operation can be performed through a much smaller incision (Minimal Invasive Technique). Because of the less invasive nature of the operation, the recovery period after the surgery is much shorter and blood loss is significantly lower compared with a total knee replacement operation. Most patients are able to return home one or two days after the surgery.

Another advantage of unicompartment knee replacement is that the range of the motion tends to be better than that after a total knee replacement. Unicompartment knee replacements are however less durable than total knee replacements.

Good quality x-rays in different positions are invaluable in arriving at correct diagnosis and for further management. Therefore, it is advisable to take x-rays under supervision of our staff for standardization.

While you are waiting for the result of your X-ray, you may wish to view the computer program / video film pertaining to knee replacement surgery or you may go through this booklet.

Treatment for knee disorders is advised taking into consideration your age, medical history, the intensity of pain, findings of clinical examination and x-rays.

You are asked to provide your surgeon with information regarding:

If you have any infections, your surgery may need to be postponed.

Medications:

You should cease taking any anti-inflammatory (arthritis) medicine, three weeks before coming to hospital.

You may need pain killer to help with pain relief during this time.

Diet:

Diet is especially important in times of stress such as Surgery. Be sure to include as many iron rich foods in your diet as possible, example: red meats, liver, beans, nuts and dried fruits.

If you are overweight, reducing weight will generally help your exercise program, make you feel better and reduce extra stress on your knee. Avoid crash dieting however as this is not healthy prior to surgery.

Blood transfusion:

Total joint replacement is major surgery, so you may require blood transfusion. Up to three units of blood may be needed.

Patients wishing to pre-donate autologous blood, should discuss this with their surgeon, and then arrange an appointment with Fortis Blood Bank.

If you are advised knee replacement surgery you may require to undergo:

Investigations as follows:

Your Hospital Stay :

For a knee replacement procedure, it is of essence that you get admitted at a well-facilitated hospital, at least a couple of days before the operation. This will give you ample time to get used to the surroundings over there. All the necessary pre-operative medical tests can also be conducted with ease. We would here take a look at what would be your daily schedule on the day of the surgery, and the days preceding and succeeding it:

Day Before The Surgery:

Night Before The Surgery/Day Of Surgery:

The knee replacement surgery can be scheduled either during the morning, or during the afternoon. Depending on that, pre-operative food and drinks are recommended:

N.B. à If you have to fast, you will find all details regarding the time of fasting from the Bookings Office of the hospital.

In addition, the following would be done on the night before/morning of the knee replacement surgery:

N.B: A standard knee replacement surgery requires one to two hours of time.

Post-operative care:

For a knee replacement surgery, you need to stay at the hospital for 4-7 days. Once the post-operative treatment is complete, you will be able to resume your regular activities, as was your routine earlier.

The physiotherapist at the Education Class, to enable you to commence the exercise before your surgery, will demonstrate a home exercise program. This will help strengthen the muscles and keep joints mobile, reduce the risk of blood clots, prevent chest infection and subsequently assist to speed your recovery.

Breathing exercises

Regular deep breathing and coughing practiced in the seated position will help keep your lungs clear and free from congestion and reduce the risk of infection. Take ten deep breaths, holding each breath for 3 seconds, followed by a strong cough each hour. Smokers should stop smoking two weeks prior to their surgery, so the lungs will be cleared of phlegm, as to reduce the risk of chest complications following surgery.

Activity program after surgery

Exercise is a critical component of your recovery, particularly during the first few weeks after surgery. You should be able to resume most normal light activities of daily living within three to six weeks after surgery. Some discomfort with activity, and at night, is common for several weeks.

Your activity program, which begins during your hospital stay, should include:

Stairs

When walking up the stairs, you always put your non-operated leg up first, then followed by your operated leg and walking aid together.

When walking down the stairs, you need to put the operated leg and walking aid down first, and then followed by your non-operated leg.

How is your new knee different

You may feel numbness in the skin around the incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time and most patients find these are minor compared to the pain and limited function they experienced before surgery.

Your new knees may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated. You may also ask your orthopedic surgeon for a card confirming that you have an artificial knee.

After surgery, make sure you also do the following:

Before leaving the hospital:

Your doctor will discharge you from hospital depending on your condition and mobility.

We will be giving you:

Total knee surgery is safe and effective. The vast majority of patients who undergo total knee replacement surgery do not experience complications. Your orthopaedic surgeon and the hospital staff will do their best to minimize the risk of these complications from occurring. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can or limit your full recovery.

The following write-up describes some of the complications associated with total knee replacement surgery. This list is not exhaustive and your surgeon and his clinical assistants would discuss with you other possible complications. Please ask your surgeon if you have any questions about this or other aspects of the surgery.

Anesthetic complications

Replacement surgery in India your anesthetist is the best person to discuss this with you prior to your surgery. If you have any questions regarding the type of anesthesia you are going to receive, or if you have had previous problems with anesthesia, please do not forget to let your anesthetist know. Some medications interact with anesthetic agents, so it is necessary to inform your anesthetist of any medication you are taking.

Infection

The risk of infection after total knee replacement is between 1-2%. Infection is more common amongst patients who have a condition affecting their immune system. Infections may be superficial or deep. Deep infections are more serious and further surgical treatment and prolonged hospitalization may be required for uncontrolled infections. This is fortunately very rare. Treatment of infection might mean multiple trips to operating theater for drainage and cleaning of wound. If the infection is deep, your surgeon might elect to remove all the metal and plastic parts, together with all non-visible tissues. Depending on the type and severity of infection, antibiotics may be administered through the veins for a period of two to six weeks. When the infection is controlled, a new prosthesis can then be implanted.

Deep venous thrombosis and pulmonary embolism

Knee replacement in India, clotting of the blood in the veins of the legs is a recognized complication and perhaps the most common complication of total knee replacement surgery. These clots, unfortunately, sometimes get detached and travel in the blood stream to reach the lungs. This is known as a pulmonary embolism. This is a serious condition and life is sometimes at risk. Every effort is made to try to minimize the occurrence of these complications. These measures include daily or twice daily injections of a substance into the abdominal wall that thins the blood and reduces the risk of clotting. Your medical condition and other considerations will influence the use and dosage of this substance (prophylactic anti - coagulants). You will be provided with white compressive leg stockings to wear. Usually these stockings are worn for a total period of six weeks.

Clots in the lungs cause shortness of breath and chest pain. Inform the nursing staff, if you experience such symptoms. Treatment is by oxygenation and administration of blood thinners

Instability/ Dislocation of the kneecap

Hip replacement surgery in India, dislocation of the kneecap, or more rarely dislocation of the plastic cushion (in a mobile bearing knee replacement), can happen after total knee replacement. In case the kneecap does shift to the outer portion of the knee, severe pains might ensue. Realignment of the kneecap generally requires a further surgical procedure. At times dislocation results from erroneous positioning of the components and a revision operation may be necessary. However, with rapid advancements in the techniques for knee replacements, such dislocation risks have reduced considerably.

Fat embolis

Fat from the bone marrow can reach circulation and could travel to the lungs. This condition is quite similar to the previous complication of pulmonary embolism. That is why it is called a fat embolism. The symptoms are quite similar to those of pulmonary embolism.

Mobility Loss

Post-operative stiffness can lead to a certain degree of mobility loss for the patients. Instead of the general knee joint mobility of 0-135 degrees, a person who has undergone surgery can achieve mobility only up to 110 degrees. However, with the increasing popularity of medically approved ‘high-flex' knees and the implants they contain, such mobility losses can be reduced to a minimum. The amount of mobility loss also depends on how flexible the knee joint of a patient was, before the operation.

Wound complications

Wound necrosis (which means that the wound edges turn black) and wound breakdown (which means that the surgical wound opens up) are two complications that sometimes occur. When these complications occur, a further operation to repair the wound may be necessary.

General medical problems

General medical complications can sometimes occur after any major surgery. These complications includes heart attack, strokes, lung collapse, pneumonia, various heart problems, kidney dysfunction and bed sores.

Pressure sores

Pressure sores, especially of the heel area, can develop within 24 hours of lying in the bed. They can be prevented by avoiding inactivity in bed. It is necessary that you relieve pressure from the heel and buttocks (sacral area) regularly. If you notice sensations of burning or pain in pressure areas, you should inform your doctor or the nursing staff.

Vessel and nerve injury

A number of large blood vessels and the main nerves that supply the lower limb surround the knee. These structures are always at risk from stretching or direct injury. Every precaution is taken to minimize the risk of these structures. The lateral popliteal nerve is at particular risk of injury in total knee replacement surgery. Other nerves and vessels can be compromised during surgery. Nerve and vessel injuries can result in long-term disability.

It is very common for some superficial sensory nerves to be divided during surgical exposure of the knee. This can result in altered or reduced sensation over the front of the knee. Occasionally a swelling of the nerves develops. This uncommon complication may cause hypersensitivity of the skin or wound.

Fractures

Fractures of the shaft of the femur and the tibial bone occur sometimes, especially when the bones are soft and weak. The complication is more common during revision knee surgery. Fractures also occur if you sustain a heavy fall following surgery.

Loosening and wear

Your new knee replacement is not expected to last forever. More than 95% of knee replacements are expected to be functioning well after fifteen years from implantation. You can help to prolong the life expectancy of your knee by looking after it. This means that you should remain active but not over active. Squatting, heavy impact sports and activities, and running should be avoided. Should the prosthesis loosen or wear excessively, a revision operation may be needed to treat the problem.

Knee alignment

In performing a total knee replacement, your surgeon aims to align the knee to take into account the weight - bearing axis of the leg. A difference in alignment of the knees is common after surgery particularly if only one knee is replaced.

Limp

Most patients have a mild limp after surgery and for about six months. The limp usually disappears or at least subsides significantly after six months.

Stiffness

Your knee is expected to move from being fully straight to at least ninety degrees of bending. There is an element of unpredictability about the range of motion after total knee replacement surgery. Some knees are stiffer than others are. If your surgeon is not happy with the amount of bending you are getting, he may decide to perform a manipulation of the knee under anesthetic and try to improve the range of motion in your knee. This is usually done between four and eight weeks after the operation.