A knee replacement surgery is a surgical procedure that involves the replacement of the weight-bearing surfaces of the knee. This is done to relieve pain and treat the disability. The surgery is also known as knee arthroscopy. The knee replacement surgery is of 2 types – total knee replacement and partial knee replacement. The total knee replacement involves the substitution of the entire knee joint with an artificial one and the partial knee replacement consists of replacement of only the damaged part of the joint, in which the surgeon removes a part of bone and cartilage from the area of the damaged knee. The thigh bone is replaced with a metal implant while the shinbone is replaced by a plastic insertion.
The surgery can be recommended in any type of cases, where there are pain and dysfunction involved with the knees. However, most of the time the patients having osteoarthritis, rheumatoid arthritis, psoriasis arthritis, any case of trauma or injury are advised to have their knees replaced. Some of the other main causes involve meniscus tearing, the cartilage defects, and a ligament tear.
Before the procedure
During the pre-operative appointment, the surgeon takes a complete medical history and conducts the required physical examinations and other routine investigations needed to be done before the surgery. This also includes the x-ray of the knees. Other than this, the patient is asked if he takes any blood thinner such as aspirin and similar medications. His entire history of infection or bleeding disorder is also taken.
If the patient is taking any blood thinners, he is advised to stop taking them 24 hours before the surgery. The patient is also advised not to eat anything for 8 hours before the surgery. During the preparation of the surgery, the patient is administered anesthesia, which may be general or spinal anesthesia. General anesthesia will make the patient entirely unconscious, whereas the spinal anesthesia has its effect only on the lower body.
Sometimes the patient is also given antibiotics intravenously before the procedure to prevent any post-surgical infection. Some surgeons also prefer the give a local nerve block around the knee area to further facilitate the surgery.
During the procedure
The knee replacement surgery in India continues for at least 1 to 2 hours. One way of doing the surgery is making a cut in front of the knee, which is around 8-10 inch in length. The damaged part is removed of the joint and also the bones surrounding the joint. This is followed by the replacement of the artificial joint by the damaged bone.
Another way is the minimally invasive technique in which a shorter incision is made which is of 4-6 inches, creating lesser damage to the muscles involved. Moreover, there is faster recovery after the surgery.
After the surgery
Most of the knee replacement surgeries are a part of day-care procedures. After the surgery, the patient is taken to the ward for 1-2 hours for the recovery. In some cases, the patient may also be admitted to the hospital for a couple of days.
The surgery is followed by the prescription of some pain-relieving medications by the doctor. These medications are given for any pain that occurs due to the inflammation that happens after the surgery. The patient is also encouraged to do physical therapy with the help of a trainer. This helps is the faster recovery of the knee. Sometimes the patient is advised to wear the compression boots to avoid swelling and clotting of the wound.
Just after the patient is discharged from the hospital, he/she is advised to start walking with the help of crutches or canes if needed and eventually without any aid. It is a must to exercise for at least 2 months after the surgery under a trained physiotherapy. The patient is also supposed to take all the medications prescribed to him. It is possible to have mild to moderate swelling around the knee, which may go on for 3-6 weeks. The patients are advised to use the ice pack for compression and elevate the legs while lying down.
There are several factors that affect the recovery time of the patient. These include:
Obesity – Sometimes, if obese people do not exercise or involve themselves in physical activity, they tend to have reduced chances of recovery. Other than that, the success rate is almost the same for everyone.
Age – In elderly people, the body is unable to adapt with changes happened within. It gets difficult for the body to accept any external substance without any immune reaction. This hampers the recovery of the knee replacement surgery.
Delay in the surgery – The recovery period of the surgery keeps increasing with the amount of time taken to decide for the surgery. This is because more damage has happened to the joint before the surgery is planned.
For most of the patients, there is a huge relief and improvement in knee mobility. As per the top 10 orthopedic surgeons in India, most of the surgeries tend to last for around 15-20 years if taken proper care of.
The operation typically involves substantial postoperative pain, and includes vigorous physical rehabilitation. The recovery period may be 6 weeks or longer and may involve the use of mobility aids (e.g. walking frames, canes, crutches) to enable the patient’s return to preoperative mobility.
Guideline on Total Knee Replacement Surgery
How successful are total knee replacements?
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