Total Knee replacement Surgery

There are several ways to treat the pain caused by arthritis. After all the conservative methods fails to overcome the problem total knee replacement surgery is only way to treat the pain. The decision to have total knee replacement surgery should be made after consulting your doctor.
In total knee replacement surgery, the bone surfaces and cartilage that have been damaged by arthritis are removed and replaced with artificial surfaces made of metal and a plastic material. We call these artificial surfaces “implants,” or “prostheses.”

In total knee replacement or TKR a small amounts of the bone surface are removed from the front, end, and back of the femur (thigh bone). This shapes the bone so the implants will fit properly.The amount of bone that is removed depends on the amount of bone that has been damaged by the arthritis.

 

A small portion of the top surface of the tibia(leg bone) is also removed, making the end of the bone flat.
The back surface of the patella (kneecap) is also removed.

Attaching the Implants:

An implant is attached to each of the three bones. These implants are designed in such a way that the knee joint will move in same fashion as that theoriginal knee joint moved when it was healthy. The implants are attached using a special kind of cement for bones.
The implant that fits over the end of the femur is made of metal. Its surface is rounded and very smooth, covering the front and back of the bone as well as the end.

 

                             Final picture after replacement

                                     Rehabilitation

After TKR generally patient is made to stand the next day of the surgery,with support(walker & long knee braces). Also knee bending is initiated with the help of CPM(continuous passive movement)
Patient walk a few steps next day or day 2 of the surgery.
By and large between 5-7days patient is allowed to walk in the corridor by himself/herself & discharged home .

Stitches are removed on 12th day of the surgery and adequate rehab is started
Rehabilitation is a most important tool to get good functioning of knee after TKR. Knee bending is progressively measured and patient is asked to walk with stick at 6 weeks.
Complete independent ambulation (walking ) is advised by 3 months by which time all pain swelling, and discomfort settle down. Generally by this time one is ready to drive by himself/herself

Frequently Asked Questions

What causes knee pain?
There are many different causes of knee pain, including injury, trauma, arthritis and infection.
What is a knee replacement?
In total knee replacement surgery, the parts of the bones that rub together are replaced with metal and plastic implants. Using special, precision instruments, your surgeon will typically remove the damaged surfaces of all three bones. The replacement surfaces will then be fixed into place.
The surface of the femur is replaced with a rounded metal component that comes very close to matching the curve of your natural bone. The surface of the tibia is replaced with a smooth plastic component. This flat metal component holds a smooth plastic piece made of ultra-high-molecular-weight polyethylene plastic that serves as the cartilage. The undersurface of the kneecap may also be replaced with an implant made of the same polyethylene plastic.

How do I know if I need a knee replacement?
If you have difficulty in walking or performing day to day activities such as getting dressed, climbing stairs, walking long distance it may be time to consider knee replacement surgery.

Doctors generally try to delay total knee replacement for as long as possible in favor of less invasive treatments. However for patients with advanced joint disease, knee replacement offers the chance for relief from pain and a return to normal activities.

What can I expect after knee replacement surgery?
When you are back in your hospital room after your surgery, you will begin a rehabilitation program that will help you regain strength, balance, and range of movement in your knee It may include a machine, called a continuous passive motion machine that automatically moves your leg to help reduce stiffness.
Your physical therapist will help you perform appropriate exercises. About 24 hours after surgery, you will probably be asked to stand. Within the next 24 hours, you will probably begin to walk a few steps with the help of a walker. You will be discharged as soon as your surgeon determined that you have recovered sufficiently. You can expect to stay in the hospital for about 5-7 days after your surgery.Your bandages and sutures will usually be removed on 12 day of the surgery. At home, you will need to continue your exercises. Your physical therapist will instruct you about proper home care, and may continue to work with you after surgery.

How soon can I return to normal activities?
Within six weeks after surgery, most patients are able to walk with a cane. You will probably feel well enough to drive a car within eight to ten weeks after surgery.
In most cases, successful joint replacement surgery will relieve your pain and stiffness, and allow you to resume many of your normal daily activities. But even after you have fully recovered from your surgery, you will still have some restrictions. Normal daily activities do not include contact sports or activities that put excessive strain on your joints. Although your artificial joint can be replaced, a second implant is seldom as effective as the first.
How common is knee replacement surgery?
Knee replacement is a routine surgery performed on over 600,000 people worldwide each year. Over 90% of people who have had Total Knee Replacement experience an improvement in knee pain and function.

How old is the average patient?
The average joint replacement patient is around 65-70 years old, however patients of all ages have received knee implants.

I am knock-kneed/bow-legged. Can knee replacement surgery correct this?
Many people are born with a natural tendency toward knock knees or bowleggedness. However, severe arthritis can lead to an uncomfortable degree of misalignment.One of the goals of total knee replacement is to restore your body’s natural alignment. Total knee replacement set has special instrumentation to help surgeons replicate natural, optimum alignment.

How long will a joint replacement last?
Longevity of the prosthetic knee varies from patient to patient. It depends on many factors, such as a patient's physical condition, activity level, and weight, as well as the accuracy of implant placement during surgery. It is useful to keep in mind that prosthetic joints are not as strong or durable as a natural, healthy joint, and there is no guarantee that a prosthetic joint will last the rest of a patient's life.
Today, total knee replacement has become a common and predictable procedure. Many patients enjoy relief from pain and improved function, compared to their status before surgery. As a result, some patients may have unrealistic expectations about what the prosthetic knee can do and how much activity it can withstand. As with any mechanical joint, the knee components move against each other. Natural fluid in the joint space, called synovial fluid, helps to lubricate the implants just as it lubricates the bones and cartilage in a natural joint. Still, the prosthetic components do wear as they roll and slide against each other during movement. As with car tires or brake pads, the rate of wear depends partly on how the knee joint is used. Activities that place a lot of stress on the joint implants, as may be the case with heavier and more active patients, may reduce the service life of the prosthesis. Implant loosening and wear on the plastic portions of the implant can lead to the necessity for revision surgery to replace the worn components, or all of the component.
For longevity and success of your replaced knee replacement:

 Avoiding excessive bending when weight bearing, like climbing steep stairs
 Not lifting or pushing heavy objects
 Avoiding repetitive heavy lifting
 Avoiding excessive stair climbing
 Maintaining appropriate weight
 Staying healthy and active
 Avoiding "impact loading" sports such as jogging, and high impact aerobics
 Consulting your surgeon before beginning any new sport or activity
 Avoiding any physical activities involving quick stop-start motion, twisting or impact stresses