Joint Replacement & Orthopedic Consultancy

[Kunjan]

A total knee replacement is a surgical procedure whereby the diseased
knee joint is replaced with artificial material. The knee is a hinge
joint which provides motion at the point where the thigh meets the
lower leg. The thigh bone (or femur) abuts the large bone of the lower
leg (tibia) at the knee joint. During a total knee replacement, the
end of the femur bone is removed and replaced with a metal shell. The
end of the lower leg bone (tibia) is also removed and replaced with a
channeled plastic piece with a metal stem. Depending on the condition
of the kneecap portion of the knee joint, a plastic "button" may also
be added under the kneecap surface.

The posterior cruciate ligament is a tissue that normally stabilizes
each side of the knee joint so that the lower leg cannot slide
backward in relation to the thigh bone. In total knee replacement
surgery, this ligament is either retained, sacrificed, or substituted
by a polyethylene post. Each of these various designs of total knee
replacement has its benefits and risks.

What patients should consider a total knee replacement?

Total knee replacement surgery is considered for patients whose knee
joints have been damaged by either progressive arthritis, trauma, or
other rare destructive diseases of the joint. The most common reason
for knee replacement in India is severe osteoarthritis followed
closely by Rheumatoid arthritis of the knees.

Regardless of the cause of the damage to the joint, the resulting
progressive pain and stiffness, and decreasing daily function often
leads the patient to consider total knee replacement. Decisions
regarding whether to undergo knee replacement surgery are not easy.
Patients should understand the risks as well as the benefits before
making these decisions. A detailed discussion with your surgeon will
help arrive at a decision especially when there are so many implant
choices now available!

Knee replacement

This fact-sheet is for people who are considering having a knee
replacement operation.


A knee replacement replaces damaged or worn parts of the knee joint
with a prosthesis made up of metal and plastic parts.

Depending on the condition of your knee, a "total" or a "half" knee
replacement may be done. In a half knee operation, only the inner or
outer half of your knee is replaced.1 A total knee replacement is more
commonly done.

Why have a knee replacement?

Your knee joint is made up of the ends of the thigh bone (femur) and
shin bone (tibia), which normally glide over each other smoothly
because they are covered by smooth particular cartilage. The joint is
held in place by ligaments and covered at the front by the patella
(kneecap).

If the cartilage is damaged by injury or worn away by arthritis for
example, the ends of the bones can rub together, causing pain and
restricting movement. If this happens, your knee joint can be replaced
with a prosthetic one.

Types of knee replacement

There are several different types of knee replacement.

Some need special bone cement to keep them in place. Other types of
artificial knee parts are coated with a chemical which encourages bone
to grow into it to hold the components in place.

Your surgeon will discuss the various options with you.

What are the alternatives?

Surgery is usually recommended only if non-surgical treatments such as
taking medicines to reduce pain and inflammation or using physical
aids such as a walking stick do not help to reduce pain or improve
mobility.

Other surgical options

There are alternative operations depending on how badly your knee is
damaged - such as an osteotomy, which may help if only one side of
your knee joint has worn down. Alternatively, you may have keyhole
surgery called arthroscopy.

Your surgeon will explain your options.

What happens before a full knee replacement?

Your surgeon will discuss how to prepare for your operation.
For example, you may be asked to give up smoking as it increases the
risk of you getting a chest infection and slow the healing of your
wounds.

What should I expect in hospital?

Before surgery you will talk to your surgeon about the operation and
you will be asked to sign a consent form. This confirms that you
understand the risks, benefits and possible alternatives to the
procedure and have given your permission for it to go ahead.

If you are having a general anesthetic, you will be asked to follow
fasting instructions. Typically, you must not eat or drink for about
six hours before a general anesthetic. However, some anesthetists
allow occasional sips of water until two hours beforehand.

The operation

A knee replacement takes one to two hours.

It is usually performed under an epidural anesthetic, which means that
you will be awake throughout the procedure and will feel no pain.

Once the anesthetic has taken effect, an incision, usually around
10-30cm (5-12 inches) long will be made down the front of your knee.
The length of the incision may be shorter depending on the technique
your surgeon is using.

Your kneecap will be moved to one side so the joint can be reached.

The worn or damaged surfaces will be removed from both the end of your
thighbone and the top of your shin bone. The surfaces will then be
shaped to fit the knee replacement.

The replacement parts will be fitted over both bones.

Sometimes the part of your kneecap that is in contact with the new
knee joint is replaced with a plastic prosthesis. This is called
patellar resurfacing.

After the new parts are fitted and tested to make sure they move
smoothly, your surgeon will close the wound with stitches or clips and
cover it with a dressing.

After the operation

You will be given painkillers to help relieve any discomfort as the
anesthetic wears off. If you had an epidural anesthetic, you may not
be able to feel or move your legs for several hours after your
operation. You won't have any pain in your legs.

Starting from the day after your operation, a physiotherapist usually
visits you every day to help you do exercises designed to help your
recovery.

People generally stay in hospital for 5-10 days. After this time, you
will be able to walk with sticks or crutches.

Before discharge, your nurse will give you advice about caring for
your stitches, hygiene and bathing.

Recovering from a knee replacement

Once home, you should take painkillers if you need to, as advised by
your surgeon or nurse.

The exercises recommended by your physiotherapist are a crucial part
of your recovery, so it's essential that you continue to do them.

Most people find that they are able to move around their home and
manage stairs, but some routine daily activities will be difficult for
a few weeks.

You must follow your surgeon's advice about driving. You shouldn't
drive until you are confident that you could perform an emergency stop
without discomfort.

You can go back to work after about six weeks if you have an office
job. However, if your work involves a lot of standing or lifting, you
should stay off for longer (usually about three months).

Your knee will continue to improve over a period of at least six
months.

Deciding on treatment

A knee replacement is a commonly performed and generally safe surgical
procedure. For most people, the benefits are far greater than the
disadvantages. However, in order to make a well-informed decision and
give your consent, you need to be aware of the possible side-effects
and the risk of complications.

Side-effects are the unwanted but mostly temporary effects of a
successful procedure, for example, feeling sick as a result of the
general anaesthetic. Anyone having a knee replacement can also expect
the side-effects listed below.
v Your knee may be sore when you move it and swollen for up to
three months.

v There will be a scar (8-12 inches long) over the front of the
knee. The scar and the outer side of the knee may be numb, which can
sometimes be permanent

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