Options For Knee Replacements

By Author: sailaja
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Options for Knee Replacements:

Factors for Consideration
• The most common reason for knee replacement is knee pain from osteoarthritis
• Other reasons for knee replacement are Rheumatoid Arthritis & Post Trauma Arthritis
• Age, Obesity, Sedentary lifestyle and Diabetes are the key risk factors
• People who are unable to walk, sleep during nights or perform daily activities due to pain are ideal candidates
• Knee replacements typically last up to 20 years or even more
• Damaged area of the Knee is considered for replacement and not the entire knee always
• Surgeon will suggest the need for replacement according to the severity and disability
• Before proceeding with knee replacement, surgeon may suggest alternative options such as Physical therapy, Oral Medications, PRP Therapy, Hyaluronic Acid Injections, Knee Arthroscopy, Knee osteotomy and Weight Loss.

Total Knee Replacement:

• Counselling from Multidisciplinary Team
o Educating the patient on need for the surgery, advantages and possible complications
o Counselling patient ...
... on precautions and medical advises to be followed before and after surgery
o Counselling on the need for adherence to Medication, Diet, Exercise and abstinence from alcohol and smoking
o Explaining all the available surgical options for correcting the knee pain
o Enlightening sessions on replacement materials available and their pros and cons
o Educating on home safety and personal or adaptive equipment requirements
o Explaining Dos and Don’ts that need to be followed just before the day as well as on the day of surgery
o Providing details on the types of Anaesthesia options that can be elected for the surgery

• Pre-surgery Evaluations:

o Medical History evaluation
o Physical evaluation to understand the pain severity, leg functionality & alignment
o Imaging-1 – X- Ray, provides the details on extent of damage and deformity (long leg view)
o Imaging-2 – MRI, may be advised to understand the extent of cartilage involvement.
o Electrical Activity – Electrocardiogram (ECG)
o Complete blood profile including typing and coagulation panel testing is performed
o Urine Analysis & Metabolic Panel.

• Surgery:
o Entire knee joint including knee cap is replaced with metal-plastic prosthetic parts
o Total Knee replacement surgery typically takes 1 to 2 hours for completion in the Operation Theatre
o The surgery is performed under general or local anaesthesia or nerve block depending on the patient’s health status and standards of practice
o 6 to 10inch long incision is made to access the knee joint. Different incision including muscle
o Knee cap is moved out of position and resurfaced on the lower side to fix a new prosthetic surface
o Damaged cartilage is removed from the bone ends and resurfaced to fit-in the metal –plastic knee prosthetic
o Prosthetic metal surfaces are fixed in place firmly using with bone cement – PMMA or without by press fit approach on resurfaced Femur and Tibia
o A plastic spacer is inserted between the prosthetic parts to enable smooth gliding during knee movement
o The incision is closed once the surgeon ensures that the objective of the surgery is achieved in terms of required motion

• Post-Surgery – @ Hospital Care:
o The patient is monitored and stabilised after the surgery; and provided with medication to support quick recovery without infections and surgery complications
o To avoid deep vein thrombosis in the operated leg, compression socks or boots are used
o Physiotherapy will be initiated in the hospital 24hrs after the surgery
o You may also be provided with a continuous passive motion machine (CPM) to restore early range of motion

• Post-Surgery –@Home Care Dos and Don’ts:
o Wash the incision with water and soap followed by gentle drying; never let the wound soak for long
o Rubbing the incision area or applying non-medicated creams or lotions should be avoided
o Keep needy things accessible in home and also in wash room
o Make necessary arrangements in the bathroom to avoid slips and falls
o Medications prescribed should be adhered strictly
o Sit, walk and exercise just as directed by the surgeon and physical trainer
o Consult your surgeon before start driving even after complete recovery
o Wear compression stocking for 4 to 5weeks
o Take support with cane, walker, crutches or someone’s help for walking and climbing stairs
o Take necessary measures in terms of diet and activities to maintain healthy weight
o Do not carry extra weights in your hand, instead use a back pack and keep your hands free for holding on to a support and maintain balance
o Keep the surgeon informed any kind of discomfort and enquire if hospital visit is needed
o Talk to the surgeon if you are planning to get any other procedure during recovery period

• Post-Surgery –Follow-up Care:
o Wound closure devices like staples are taken off after 2 to 3weeks after the surgery
o Seek medical attention for complications that are causing discomfort, illness or delay in the recovery process

• When to call your Surgeon or Hospital:
o Fever of 100.4°F or higher
o Shivering chills
o Pain or swelling in the calf or leg
o An increase in knee pain
o Unusual redness, heat, or drainage at the incision site
o Chest pain
o Trouble breathing

Partial Knee Replacement:

• Who needs Partial Knee Replacement:
o Individuals with moderate but painful knee joint conditions such as Osteoarthritis, Traumatic injury, Poor Bone density, or poor bone density
o Restricted to individuals who are not morbidly obese
o When one of three compartments of the knee joint is diseased or worn-out (cartilage degeneration) significantly. It could be the inner/medial compartment, outer/lateral compartment or the knee cap and its femoral counterpart / patellofemoral compartment
o Individuals with healthy ligaments in the knee joint

• Counselling from Multidisciplinary Team:
o Educating the patient on need for the surgery, advantages and possible complications
o Counselling patient on precautions and medical advises to be followed before and after surgery
o Counselling on the need for adherence to Medication, Diet, Exercise and abstinence from alcohol and smoking
o Explaining all the available surgical options for correcting the knee pain
o Enlightening sessions on replacement materials available and their pros and cons
o Educating on home safety and personal or adaptive equipment requirements
o Explaining Dos and Don’ts that need to be followed just before the day as well as on the day of surgery
o Providing details on the types of Anaesthesia options that can be elected for the surgery

• Pre-surgery Evaluations:
o Medical History evaluation
o Physical evaluation to understand the pain severity, leg functionality & alignment
o Imaging-1 – X- Ray, provides the details on extent of damage and deformity
o Imaging-2 – MRI, may be advised to understand the health of soft tissues supporting knee
o Electrical Activity – Electrocardiogram (ECG)
o Complete blood profile including typing and coagulation panel testing is performed
o Urine Analysis & Metabolic Panel

• Surgery:
o One of the knee compartments is replaced with metal-plastic prosthetic parts
o Partial knee replacement surgery typically takes 1 to 2hrs for completion in the Operation Theatre
o The surgery is performed under either general, regional or multi model anaesthesia depending on the patient’s preference
o 3 to 5inch long incision is made to access the knee joint
o Knee cap is moved out of position to enable access to damaged femoral and tibial region
o Damaged cartilage & some portion of the bone is removed/ resurfaced from the femoral and tibial ends to fit-in the metal –plastic prosthetic
o Prosthetic metal surfaces are fixed in place firmly with bone cement – PMMA or without bone cement using press fit approach on resurfaced Femoral and Tibial ends
o A plastic spacer is inserted between the prosthetic parts to enable smooth gliding during knee movement
o If the patella is damaged similar resurfacing is done to remove degenerated region and resurfaced to fit in the prosthetic
o The incision is closed once the surgeon ensures that the objective of the surgery is achieved in terms of required motion

• Post-Surgery – @ Hospital Care:
o The patient is monitored and stabilised after the surgery; and provided with medication to support quick recovery without infections and surgery complications
o To avoid deep vein thrombosis in the operated leg, compression socks or boots are used
o Physiotherapy will be initiated in the hospital 24hrs after the surgery
o The patient is typically discharged the same day or within 48hrs from the day of surgery
o You may also be provided with a continuous passive motion machine (CPM) to restore early range of motion

• Post-Surgery –@Home Care Dos and Don’ts:
o Wash the incision with water and soap followed by gentle drying; never let the wound soak for long
o Rubbing the incision area or applying non-medicated creams or lotions should be avoided
o Keep needy things accessible in home and also in wash room
o Make necessary arrangements in the bathroom to avoid slips and falls
o Medications prescribed should be adhered strictly
o Sit, walk and exercise just as directed by the surgeon and physical trainer
o Consult your surgeon before start driving even after complete recovery
o Wear compression stocking for 4 to 5weeks
o Take support with cane, walker, crutches or someone’s help for walking and climbing stairs
o Take necessary measures in terms of diet and activities to maintain healthy weight
o Do not carry extra weights in your hand, instead use a back pack and keep your hands free for holding on to a support and maintain balance
o Keep the surgeon informed any kind of discomfort and enquire if hospital visit is needed
o Talk to the surgeon if you are planning to get any other procedure during recovery period.

• Post-Surgery –Follow-up Care:
o Wound closure devices like staples are taken off after 2 to 3weeks after the surgery.

• Surgery:
o Entire knee join including knee cap is replaced with metal-plastic prosthetic parts
o The revision surgery typically takes 2 to 3hrs for completion in the Operation Theatre
o The surgery is performed typically under general or local anaesthesia or nerve block depending on the patient’s preference and standard of practice
o Line of incision made earlier is used as the access point and fresh incision of required length is made to access the knee joint. The incision during revision may be longer than original
o Knee cap is moved out of position to access the knee joint
o Surgeon will evaluate the nature of the damage or misalignment and take a decision on the type of components that need replacement
o Previously fixed prosthetic is removed. Removal of the earlier prosthetic fixed using bone cement demands longer procedure times
o The bone may need to resurfaced once again causing additional bone loss. To compensate surgeon may use augments or grafts
o Specialised Prosthetic Knee (Rotating Hinge Knee) is fixed in place firmly
o The incision is closed once the surgeon ensures that the objective of the surgery is achieved in terms of required motion

• Post-Surgery – @ Hospital Care:
o The patient is monitored and stabilised after the surgery; and provided with medication to support quick recovery without infections and surgery complications
o To avoid deep vein thrombosis in the operated leg, compression socks or boots are used
o Physiotherapy will be initiated in the hospital 24hrs after the surgery
o You may also be provided with a continuous passive motion machine (CPM) to restore early range of motion

• Post-Surgery –@Home Care Dos and Don’ts:
o Wash the incision with water and soap followed by gentle drying; never let the wound soak for long
o Rubbing the incision area or applying non-medicated creams or lotions should be avoided
o Keep needy things accessible in home and also in wash room
o Make necessary arrangements in the bathroom to avoid slips and falls
o Medications prescribed should be adhered strictly
o Sit, walk and exercise just as directed by the surgeon and physical trainer
o Consult your surgeon before start driving even after complete recovery
o Wear compression stocking for 4 to 5weeks
o Take support with cane, walker, crutches or someone’s help for walking and climbing stairs
o Take necessary measures in terms of diet and activities to maintain healthy weight
o Do not carry extra weights in your hand, instead use a back pack and keep your hands free for holding on to a support and maintain balance
o Keep the surgeon informed any kind of discomfort and enquire if hospital visit is needed
o Talk to the surgeon if you are planning to get any other procedure during recovery period
Post-Surgery –Follow-up Care
o Wound closure devices like staples are taken off after 2 to 3weeks after the surgery.

Virinchi Hospitals,