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A total knee replacement is a prosthesis that is used to replace a knee joint that is affected by arthritis. It consistents of several components:
An upper metal femoral component that is shaped and sized to fit to the contour of the end of the femur bone
A metal tibial component which is flat and has a small stem attached to the under surface of it. It sits on top of the tibia on the opposing side of the knee joint. Both metal femoral and tibial components are made of metal alloys, comprising of cobalt-chrome or titanium. They are both fixed to the bone with a special polymer called “bone cement”
A plastic insert (“polyethylene insert”)which locks in to the tibial component sitting in it’s upper surface. The plastic liner is the bearing for which the femoral component moves against. The plastic is made of a special polymer call polyethylene which has been carefully manufactured to allow it last a long time with out wearing out. However, even with the latest manufacturing techniques, this still is similar to your articular cartilage in that it has a limited life span, and excessive forces are placed on it, it will wear out more quickly
A patellar button which resurfaces the back of your knee cap. This is also made of polyethylene. It is not crucial that this is replaced all the time, and it is at the discretion of your surgeon on whether it is in your best interests to have this performed as well
When is a Total Knee Replacement helpful?
The most important reason for surgery is pain that is interfering with your quality of life and is not adequately controlled by other means (medication, injections, physiotherapy, activity modifications etc). This is a very individual decision and depends on your social requirements and activity demands.
What about minimally invasive surgery (MIS)?
Depending on the size of your knee, the degree of arthritis and deformity, and the amount of preoperative stiffness, you may be a candidate for MIS. This technique minimizes surgical trauma to the quadriceps tendon and allows for faster recovery of strength, improved mobility in the first few weeks and sometimes less pain. Your surgeon will discuss this option with you during your initial consultation.
Procedures
Undergoing a total knee replacement is a major operation. You will require specific tests (blood tests, ECG and other x-rays) and possible review by other specialists to ensure you are in optimal condition prior to your surgery. If you have a pre-existing condition (eg: heart disease or diabetes) you will need to be given the “all clear” by your treating physician before surgery.
Your anesthetist will explain to you the various options with regards to anesthetic during the operation and the anesthetic most suitable for you. In addition, your anesthetist will discuss the most effective post-operative pain relief for you.
What happens on the day of your operation?
You will be admitted to hospital usually the day of your surgery. Your surgeon will visit you to answer any other questions you may have regarding the surgery and also to mark the affected knee with an ink pen.
After your anesthetic has been administered a tourniquet will be applied to your upper thigh and your leg will be painted with antiseptic solution. A routine draping will be performed with sterile sheets to allow exposure only of the knee.
A vertical incision is made on the front of your knee to allow access to the knee joint itself. The arthritic areas of your knee joint are removed and the bones are fashioned to allow placement of the knee prosthesis (comprising a metal femoral and tibial component) and straighten the leg as most people have some deformity (eg knock knees or bow legs). Bone cement is used to help stabilize the prosthesis to the bone. A plastic (polyethylene) insert is placed between the femoral and tibial components and acts as an articulating shock absorbing surface. The decision to resurface the patella (knee cap) will be dependent on its degree of arthritic involvement.
Before completion of the operation, the knee is checked for stability, alignment and degree of motion. Often, a small drain will be left in the knee for 24 hours after the surgery to remove unwanted blood from the knee. Dissolving stitches are used to close the wound, and the knee is then wrapped in a well-padded sterile bandage.
Results
Eighty to ninety per cent of patients are satisfied with their knee replacement surgery and 90% of the prostheses last for at least 15 years. Most people experience better knee function, improved mobility and good pain relief after their recovery. Most also report a significant improvement in their quality of life at six months following surgery.
After recovery, you can enjoy low-impact activities, such as jogging, swimming, golfing or biking. Higher impact activities such as sprinting, contact sports or jumping should be restricted and discussed with your surgeon.
Cost for Knee Replacement Surgery in Allahabad is starting @ ₹ 58,000/- still However, cost depends on multiple factors as price may be between ₹ 58,000/- to ₹ 2,00,000/- and average cost is somewhere between 1,40,000/-
After your operation
You will wake up in the recovery ward where you will be closely monitored until you are ready to return to your ward. Here you will continue to be observed until you are fully awake.
You will spend the first post-operative day in bed. A physiotherapist will visit you to give you breathing exercises for your chest as well as exercises for your leg that can be performed whilst in bed. An x-ray of your knee will be taken the day after surgery to confirm optimal placement of the prosthesis.
Blood thinning medications will be administered daily to reduce the risk of blood clots (DVT) forming in your legs. In addition you will be given special stockings (TEDS) to wear on both of your legs. For the first 24 hours after the operation an inflatable sleeve will intermittently compress your calves to prevent stagnation of blood flow. You will receive intravenous antibiotics for 24 hours after the operation to decrease the risk of infection.
The dressings will be changed 48 hours after the operation. Your knee will be swollen and may have areas of bruising. This is normal. You will be under the daily supervision of a physiotherapist until you are discharged from hospital. The aims of these visits are to optimist motion in the knee, regain ambulation, improve muscle strength and control knee swelling (please refer to education booklet on Total Knee Replacement Rehabilitation).
Once you are mobilizing safely, have regained appropriate motion in the knee and your pain is controlled by tablets you will be discharged home. Some patients require further in-patient care and are transferred to a rehabilitation unit.
What happens after you go home?
Your rehabilitation will continue after you leave hospital to initially maintain and then improve on what you have already achieved. This will take the form of a home exercise program and outpatient physiotherapy visits, which usually lasts 3-6 months.
An appointment will be made to see your surgeon at 6 weeks after your operation. The goals of your knee replacement surgery are to be walking independently, be able to bend your knee to 100-120 degrees and be pain free.
After your anesthetic has been administered you’ll either be unconscious (general anesthetic) or very drowsy (regional anesthetic with IV sedation).
A tourniquet is applied to your thigh and your leg is painted with antiseptic. Your body is covered with sterile drapes, leaving your knee exposed. A urinary catheter may be put in place.
A vertical incision is made on the front of your knee to allow access to the joint. The damaged parts of your knee are removed and the bones are shaped to fit the knee prosthesis. If your knee has been deformed by arthritis, this will also be addressed. The prosthesis is put in place and cemented or screwed into the bones. The patella may then be resurfaced, if necessary.
Before finishing the surgery, your knee is checked for stability, alignment and mobility. Often, a small drain will be put in the knee to remove fluid from the knee. The wound is closed using dissolving stitches or staples, the knee is then dressed with a sterile bandage.
You’re then taken to the recovery room where your vital signs (blood pressure, pulse and breathing) are monitored to ensure they’re stable. Once you are awake and alert, you’ll be transferred to the ward.
Knee replacement is one of the most successful surgeries being performed.
Risks
Most knee replacement surgeries are problem-free but about one patient in 20 may have complications. Most can be successfully treated, although sometimes further surgery is needed. Complication rates vary between countries, hospitals and surgeons.
The most common complications are:
Infection. The risk of infection is very low as an antibiotic is given before and after surgery. Most common are skin and soft tissue infections, which may only require antibiotics. Approximately 1% of patients develop an infection that extends to the prosthesis, and this almost always leads to repeat surgery. To learn more about signs of infection go to Caring for your knee.
Blood clots. Clots may develop within the veins of your calf following knee replacement surgery – this is known as deep vein thrombosis (DVT). In uncommon cases, the clots may travel from your veins to your lungs and cause pulmonary embolism, which can be fatal. To prevent this, your surgeon may prescribe oral medications or injections after the surgery for a period of time. Smoking and obesity increase the risks of DVT and pulmonary embolism.
Blood loss. Blood is inevitably lost during surgery and in some cases, a blood transfusion may be required. A tourniquet is usually used during surgery to reduce blood loss. If you’re taking blood-thinning drugs you may be asked to stop them before surgery.
Stiffness of the knee. This is expected during the first few weeks after surgery and is due to swelling. However, as the wound heals and swelling subsides, scar tissues develop within your knee and this can progress to long-term stiffness. In severe cases, patients may need another procedure to break up the scar tissues.
Injury to nerves or blood vessels is a rare but serious complication of knee replacement. A vascular surgeon may need to repair them. Numbness and weakness of the foot may develop in the event of a nerve injury. In most cases, the nerve recovers after a few months but sometimes additional procedures are needed.
Breaking of the bone around the prosthesis is known as a ‘periprosthetic fracture’. This usually happens as a result of a fall or direct trauma to the knee. Periprosthetic fractures can be fixed with additional surgery.
Long-term complications: After years of use, the prosthesis can loosen or fail due to wear and tear. If this happens, you’ll need to have another surgery to replace the failed parts. Being overweight can increase wear and tear on the prosthesis and reduce its lifespan.
Ask your surgeon about the results and risks associated with your surgery. Also ask about their own rates of patient satisfaction and the rate of complications following the surgeries they’ve performed.
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