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Knee Replacement – Procedure Risks and Treatment

Knee Replacement Surgery

Knee replacement surgery (also called knee arthroplasty) is a surgical procedure to restore a damaged knee joint. In this surgery, the damaged bone and cartilage present in the knee joint is replaced with an artificial joint. Knee replacement helps an individual in restoring function by relieving the pain that could not be ceased by medication or other treatments. 

The Procedure involves cutting away the damaged cartilage and bones from thighbone, shinbone and kneecap and using metal and plastic parts to cap the bone ends. Knee replacement is done to patients who have incurable arthritis or a severe knee injury.

Types of Arthritis that can damage the knee joint, sometimes making knee replacement surgery necessary, include:

• Osteoarthritis- It is a degenerative joint disease which causes the joint cartilage and the adjacent bone in the knee to break down. This is the most common reason for knee replacement, which usually affects middle aged and older adults. 
• Rheumatoid arthritis- It causes inflammation of the synovial membrane, leading to excessive synovial fluid which results in severe pain and stiffness.
• Traumatic arthritis- In this, cartilage of the knee gets damaged due to an injury, which results in arthritis.

Knee Anatomy

Knee is the largest joint in the human body. It is necessary for the knee to work properly in order to perform everyday activities. It is basically made of two long bones which are joined together by muscles, ligaments and tendons. It includes- femur- lower end of the thigh bone, tibia- upper end of the shin bone and patella- the kneecap. All of these bones have a covering of cartilage which absorbs shock, protects the knee and enables them to move easily within the joint. The remaining knee surface is covered with a thin lining called synovial membrane which releases a fluid for lubricating the cartilage thus resulting in nearly zero friction in a healthy knee.

In a healthy knee, all of these components are present in the appropriate amount and work in harmony to carry out daily activities. However, arthritis or any other injury can disrupt this harmony which leads to pain, weakness and improper knee function.

How Do You Know If You Need A Knee Replacement Surgery?

You should consider getting a knee replacement surgery done if you have the following symptoms-

• Knee pain or stiffness, due to which you are unable to carry out day to day activities like- walking, using stairs, sitting down or getting up from a chair.
• Severe knee pain which does not go away even while resting, or at night.
• Deformation of knee- knee bowed in or out
• Knee pain failed to subside even after taking medication, physiotherapy.

Pre-procedure

Preparation for Knee Replacement Surgery-

• Firstly, you will be explained the procedure of the knee replacement surgery followed by which, you should ask all the necessary questions which come to your mind. 
• You might have to undergo blood tests or other diagnostic tests, so that your surgeon can ensure that you are fit for the surgery. And also make sure to notify the doctor about any pre-existing medical condition (if any) or if you are allergic to something.
• Before the surgery, the doctor will ask you to fast for a quarter of  the day (8 hours), generally after midnight.
• Also before you get the knee replacement surgery done,  make sure to make necessary arrangements at your home like- putting safety bars in the bath or shower, arranging help for a week or two after you get discharged from the hospital.

Knee Surgery Procedure

What to expect during knee replacement surgery

A knee replacement surgery usually takes 1 to 2 hours. In partial knee replacement, the surgeon only replaces the damaged parts of the knee with artificial parts made of plastic and metal.

Total knee replacement is a much more elaborate and a major surgery, in which the entire knee joint is replaced with an artificial joint.

• Before the surgery begins, you are given anesthesia, which puts you in a temporary deep sleep or a spinal anesthesia, which allows you to stay awake but makes you unable to feel anything waist down.
• First, the surgeon will bend the knee to expose the entire knee surface of the knee joint. After making an incision (cut) of about 6 to 10 inches on the knee, the patella (kneecap) will be moved aside to cut away the damaged joint surface.
• Now, the surgeon will cut and remove the cartilage and a small part of the bone from the lower end of the femur (thigh bone) and the upper part of the tibia (shin bone) and will cap these ends with a metal implant thus creating a new surface for the joint. If the kneecap is also damaged, it will be replaced with a polyethylene implant.
• Once, the femur, tibia and the kneecap are put together in place, the surgeon will repair all the tissue (which were cut open in the beginning to reach the joint surface) and close the incision.
• A bandage is then wrapped around the knee.

Post Surgery Care

After the surgery is done, you will be shifted to a different room for recovery during which, the anesthesia will gradually wear off and you will be given some pain medicine.

Most patients are kept under observation for one or two days in the hospital. During this time, a physiotherapist will tell you some exercises to strengthen your muscles, increase the blood flow and reduce the swelling for a speedy recovery.

Care At Home

A proper recovery is only possible if you follow all the instructions given by your doctor. They include-

• Not going up and down the stairs until your doctor says so.
• Using a cane, crutches or walker.
• Using safety bars in the bath.
• Using a raised toilet seat.
• Do not put a pillow under the knee while sleeping as it can lead to permanent knee bend.
• Removing anything from the floor that might cause you to trip. Like- slippery rugs, wires, etc.
• Don’t knee on the operated knee for at least 6 months after the surgery.
• For the first few weeks of surgery, it is also advised to ask someone to help you with daily activities.

Activities you should avoid doing permanently even after complete recovery from knee replacement

There are certain things which you cannot continue doing after getting a knee replacement surgery. They include-

•  You should avoid sports that require running, jerking, twisting or pulling like football and soccer. Instead , you can take part in lower impact activities, like swimming, golfing, playing tennis and gardening.
• Do not lift or carry items which weigh more than 9 kilograms, like grocery bags, furniture, large pets, laundry and other things. Doing so can put a lot of pressure on your new knee.
• Don’t jerk the leg that underwent the knee replacement surgery and take small steps while turning.

Risks

Even though a knee replacement surgery is hardly unsuccessful, it still carries some risks, like- 

• Infection
• Blood Clotting
• Nerve Damage
• Stroke
• Loosening of the implant

When to call your doctor?

It is imperative to call the doctor right away if you notice any of the following signs-

• Fever
• Pain at the incision site does not reduce
• Shaking chills
• Swelling, bleeding, redness or drainage at the incision site

In case your knee gets infected, the artificial knee will be removed and you will be given antibiotics to kill the bacteria. Once the infection is gone, a second surgery will be done to put a new knee.

FAQs

Q-1. How much does a knee replacement surgery cost?

Ans. Generally used cobalt chromium in knee replacement surgery will now cost Rs 54,720 as against an earlier MRP of Rs 1,58,324. Similarly, the cost of special metals like titanium and oxidised zirconium have been slashed by almost 70%, to Rs 76,600 from Rs 2.49 lakh.

Q-2. What is the duration of a knee replacement surgery?

Ans. A knee replacement surgery generally takes about one to two hours. After the surgery, the patient is usually kept in the hospital for observation for one or two days.

Q-3. How long does it take to recover from a knee replacement surgery?

Ans. Recovery speed varies from person to person. Generally, it can take upto 3 months to return to your basic activities. And full recovery might take 6 months to one year.

Q-4. What is the best age for knee replacement surgery?

Ans. The need for knee replacement surgery depends upon the condition of the patient (pain). Usually, people who are aged between 50-80 years undergo total knee replacement surgery.

Q-5. Is knee replacement surgery a major surgery?

Ans. Yes, knee replacement is a major surgery. It is performed only when other treatments like- medication and physiotherapy have failed in reducing the pain and improving knee movement.

Q-6. What activities to avoid after getting knee replacement surgery?

Ans. There are certain things that you should avoid after getting a knee replacement. Like- 

• Don’t twist your knee.
• Don’t sit in a cross legged position.
• Always keep the knee straight while lying down on the bed.
• Avoid putting stress or weight on your knee.