Dr. Mohit Arora
Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Total knee replacement is one of the most successful procedures in whole of the medicine. According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States.
Total knee replacement is gaining popularity among Indian population in past 2 decades. But still it is one of the procedures that patients dread and is full of myths and fear.. Minds of patients are full of queries. Here are answers to some ofthe frequently asked questions by the patients and their relatives.
Who needs a Total Knee Replacement (TKR)?
Osteoarthritis ( wearing out of joint) can progress to such a stage when the pain becomes too much to bear and the patient may have difficulty walking or performing everyday activities such as climbing up a flight of stairs. On x-ray examination, the knee joint on x-ray shows sufficient damage to the cartilage lining, it may be time to consider knee replacement surgery. Doctors generally try to delay total knee replacement for as long as possible in favour of less invasive methods of treatment. However for patients with advanced joint disease, the procedure offers the best chance of relief from pain and a return to normal activity. The only indication of TKR is PAIN in the knee joint.
How is the knee ‘replaced’?
Before reading about the procedure, one needs to understand the structure of the knee joint. The knee joint is one of the largest and most complex joints of the body. It joins the thigh bone to the shin bone, and is a hinge joint. The three bones forming the knee joint are all covered with cartilage. When this cartilage is worn away, it results in arthritis.
The word ‘knee replacement’ is actually a misnomer. The knee is not ‘replaced’ as such. Only the surface of the bones that rub together is changed. with metal implants and a plastic insert is placed in between. This is usually done by a surgeon using precision instruments. First, the surgeon removes the damaged and degenerated surfaces, the cartilage lining of the thigh and shin bones (called the Femur and the Tibia respectively), and if required, also of the knee cap (the Patella). The new, metallic surfaces will then be fixed into place with cement. This creates a new, smooth cushion and a functioning joint that does not pain .
How successful is the Total knee replacement surgery?
Over 95% of people who have had Total Knee Replacement experience an improvement in knee pain and function. The satisfaction level of the patient after surgery is 95 % in terms of pain relief. The success rate depends on multiple factors1. the competence of the surgeon . 2. the quality of other facilities (hospital facilities,) 3. Proper alignment of implant. 4. Patient factors like weight and bone density , co-morbid conditions etc.. Knee replacements are being performed through smaller incisions today, with high performance instruments through the Minimally Invasive Approach, less soft tissue cutting and this newer approach has drastically reduced the recovery time , increased the longevity of joint and decreased the failure rate.
How painful is the procedure?
Tka is a painful surgery. But with the multimodal analgesia, its all gain and less pain. Pre operative painkiller administration decreases the post operative pain as well. At the time of anesthesia ,regional anesthesia (spinal)is preferred and a epidural catheter is put. Through the catheter pain killer drug is administered by a pain control system which decreases the pain in postoperative period. It stays for 48 hrs of surgery. Oral and i/v pain killers are given for first week. After which the doses are decreased as per the demands of the patient.
How long does the patient need to stay in the hospital?
pre-operative tests are carried out. He/she is asked to consult an anaesthetist, a physician and by a cardiologist (if required) and their clearances are obtained before the patient is operated upon. The patient is typically admitted to hospital a day before the operation. Post-surgery, the patient is discharged in about five days. There are several goals that the patient must achieve while in hospital before they can be discharged.
How long patient has to stay bed ridden?
Usually, the patient has to stay in bed on the day of the operation. 1st postoperative day patient isallowed to sit and side turning started. 2nd post operative day patient can be out of bed and walking is started with the help of a walker . 4th day use of high commode is allowed..
Everyone heals from total knee replacement surgery at a different pace. In most cases, however, the patient is likely to use a walker for three to four weeks after the operation. They will then advance to walking with a cane and gradually progress to walking with no support.by 6weeks. In general, most patients are close to full recovery after eight weeks.
When can I return to work after total knee replacement surgery?
When you can return to work after total knee replacement surgery depends on your profession. If your work is sedentary, you may return to work as early four weeks after the operation. If your work is more rigorous, you may require more time, sometimes up to ten to twelve weeks before you can return to full duty.
What are the major risks involved with the surgery?
Most surgeries go well without any complications. However, there is a small risk of infection(0.5-1%) and blood clots being formed. These can be prevented by preparing the operation theatres and post operative intensive care units (ICU) better and by administering antibiotics and blood thinners to the patients.
What activities are permitted following total knee replacement surgery?
On recovery, one may return to most activities, including walking, climbing of stairs, gardening, and driving. Some of the best activities to help with motion and strengthening are swimming and an exer-cycle.
What activities should I avoid after total knee replacement surgery?
One should avoid impact activities, such as running and jogging, and vigorous racquet sports like football, squash or tennis.
Will an implant set off a metal detector say, at an airport?
Since knee implants are made of metal, there’s a chance they could set off metal detectors; whether it actually does so depends, of course, on the type of implant that has been put in and the sensitivity of the security checkpoint equipment. It is customary to provide the patient who has undergone a TKR with a special card or certificate to keep with oneself, explaining that they have a knee implant.
When can I start driving after total knee replacement surgery?
Driving is not recommended for at least eight weeks after the operation, especially if one is on a course of strong painkillers which cause sedation.
How long will my new knee last and can a second replacement be done?
A joint implant’s longevity will vary from patient to patient. All implants have a limited life expectancy, and how long they last would depend on an individual’s age, weight, activity level and medical condition. By and large, over 90% of knee replacements will be functioning well even 10 to 15 years after the operation. With continued improvements in knee replacement technology, a new knee may soon last approximately 20 years.
What can I do to increase the life of my replaced joint?
Weight reduction, regular walk and exercise, healthy diet rich in calcium and due precautions like not sitting on ground increases the life of the joint.
What are the benefits of a custom-fit surgery?
No two persons have same joint size. Hence this is a made to order joint. Because the process is personalized and creates a more optimal fit between the artificial joint and each individual’s unique anatomy, it helps to create more accuracy in the operating room. As a result, patients may experience several benefits, including:
* Less time in surgery
* Faster recovery
* Greater range of motion
* A longer-lasting implant
( The author is consultant, joint replacement and Orthopedics Department, Fortis escorts hospital, Amritsar).
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