When the cartilage covering bone articulation is lost it is called Arthritis. Most common types of arthritis are;

• Degenerative Arthritis: Normally cartilage wears out during any joint activities, for example, brisk walking involving knee or hip joint. There is a microscopic loss of cartilage due to wear & tear. However, living biology has excellent healing mechanism; whatever is worn out is replaced by a biological healing mechanism. Hence, there is a good balance between cartilage wear and replacement by healing in young active persons. With advancing age, healing mechanism slows down and termed as degeneration (lack of regeneration). Primarily, old age-related loss of cartilage is called Primary Osteoarthritis or Degenerative Arthritis.
• Inflammatory Arthritis: It can occur in variable age group. There is a direct destruction of articular cartilage caused by diseases like Rheumatoid Arthritis, Gout arthritis, etc. Arthritic diseases are controlled by medical treatment and surgically treated by joint replacement.
   

The early-stage treatment of knee arthritis involves management of pain with mild medication, weight reduction, and physiotherapy.

However, for end-stage or chronic arthritis which involves a severe decrease in joint space and a consequently significant amount of pain, a surgeon replaces the worn articular cartilage with artificial long-lasting bearing surfaces called modern knee replacement. 
 

Knee replacement or knee resurfacing is a procedure that involves the replacement of worn-out carti-lage (along with a bit of bone) with an implant made up of metallic on one side and special plastic on the other end. A surgeon uses special tools (jigs), to create a shape for properly fixing the implants using special bone types of cement.

These implants offer immediate bone fixation and permit a patient to perform daily activities like walk-ing, load-bearing, etc. with ease and offer very low friction to the joint.

Knee replacement surgery is a very common surgery in India and is considered the most effective and successful treatment in dealing with osteoarthritis. Modern knee implants can withstand wear and last for up to 25 years.
 

Joint pain and weakening of joints can hit anyone at any age and is not merely associated with the process of ageing. Many young people suffer from arthritis at a young age. The major types of arthritis which people might experience include:

Osteoarthritis: It is one of the most common forms of chronic arthritis that generally affects people of old age. The major reason behind its cause is breakage of the cartilage (a protective tissue that covers the two bones in the knee, making it a joint) in the knee that leads to stiffness while moving and pain in the joints. Thereby, adding discomfort for a person suffering from osteoarthritis and abstainment from physical activities.
 

Osteoarthritis is a progressive disease, once the cartilage is lost the underlying bone starts wearing out resulting in bow knee deformity. Usually, it affects bilaterally, and at times a patient can experience severe pain on one side of the knee. A doctor may advise knee replacement surgery only in the following conditions:

• Severe knee pain and difficulty in standing and walking
• Progressive Bowing of knees
• Stiffness and difficulty in climbing stairs
• Crackling and giving way of the knee on walking
• Reduction of overall walking with thigh and leg pain
   

Considered as one the most advanced form of surgery, knee replacement surgery offers the best treatment solution for people suffering from osteoarthritis. However, a patient must strictly follow the before and after surgery precautions which include:

Before the surgery

• A patient has to undertake following diagnostic and imaging tests such as blood tests and X-rays to ascertain the damage in the knee.
•  The surgeon will study your medical history and type of medications you were taking before the surgery for knee pain.
• A doctor will then conclude the information to design the most comprehensive treatment plan for the patient.

During the surgery

• If it is a planned surgery then an anaesthesiologist will evaluate a patient’s condition one day before surgery. This is because the surgery is done under the effect of regional spinal and epidural anaesthesia in selected patients and general Anaesthesia in others.
•  An antiseptic solution is applied to the knee and wrapped with a sterile towel at night before the surgery.
• The surgeon performs the surgery for knee resurfacing of implants using minimum access inci-sion surgical approach with bone preservation at our state-of-the-art surgical suites.
• During the surgery, we do not use suction drain tube to allow drainage of blood. This may cause some discolouration around the knee due to accumulated blood from the surgical site, which becomes normal over 10 days.
• To avoid postoperative pain, knee surgery is performed without a tourniquet.
• However, when bilateral knee replacement surgery is required decision to perform second knee replacement depends on safety parameters after the first surgery.  

After the surgery 

•  A patient is kept in the recovery unit for one hour before getting transferred to to the ward.
•  Oral intake starts approximately after 2-4 hrs of the surgery.
•  A patient will be permitted to walk and move knee joint with the help of the physiotherapy team.
• No urinary catheter is required for single knee replacement. The same protocol is followed with bilateral single-stage knee replacement and patient is made to stand, walk and move knee joints. However, they might require a urinary catheter.
• Recovery 
• For a unilateral or single-stage bilateral knee replacement surgery, the patient can start standing and walking on the day of surgery. However, he/she has to take physiotherapy sessions for better and fast recovery.
• All patients are given complete training for walking and stair climbing before discharge. Unila-teral knee replacement patients are fit to go home on 4th day while single-stage bilateral knee replacement patients go home on the 5th day.
• We have a special postoperative pain control protocol with epidural and I.V. medication pain control pumps.
• Other techniques such as Navigation, Computer Assistance, Minimally Invasive Surgery, Robotic Surgery are useful for treating other deformities in thigh or leg bones.
• Accurate alignment with perfect soft tissue balance is a goal in knee replacement surgery and can be achieved with best surgical expertise.
   

Short- Term Precautions

• Temperature should be monitored. Doctor to be informed if it goes above 100.5 degrees Fahrenheit.
• Inform the doctor if there’s excessive pain.
• If a patient experiences redness around the operated area, excessive swelling, or discharge from the wound then he/she must inform the doctor immediately.
• Walking is recommended until advised otherwise.
• Low chairs or low commodes should not be used.

Long Term Precautions

• Antibiotic cover should be taken while undergoing any dental/surgical procedures. A doctor should be kept informed.
• High impact exercise such as jumping, running etc. should be avoided.
• Inform your doctor if there’s swelling pain or instability.
• Care at home.
• The toilet seat at home should have a high commode attachment or a high commode chair should be used.
• A patient must take physiotherapy sessions regularly to facilitate walking, strengthening of the muscles around the knee and knee bending.
• Cold compress should be applied around the knee.
• Patient should be mobilized as much as comfortably possible.
   

Surgical procedures of any kind carry some of the other risk factors, particularly if a patient is suffering from other medical problems such as obesity, hypertension, etc. Our team has been trained to make sure such risks are minimised and the treatment is carried out safely. However, some immediate com-plications that a patient might experience include:

Infection: Sometimes despite strict precautions,  infection can occur. Superficial infection may occur at the wound site. If a deep infection develops most of the times THR implants need to be removed with subsequent revision surgery after healing of infection.

At Nanavati Super Speciality Hospital we have

• Specially dedicated joint replacement operation theatre.
• Vertically oriented sterile laminar air circulation unit in the surgical zone.
•  For every joint replacement surgery, the surgical team wears sterile space-suit so even breath-ing air from surgeon and assistant do not contaminate surgical field.
• Daily disinfection of OT.
• Specialised infection prevention protocol for all joint replacement surgeries.

Deep Vein Thrombosis (DVT): Despite taking precautions to prevent blood clot (thrombosis) formation in the veins of the leg post-surgery remains a common risk after knee replacement surgery. Rarely, these clots can dislodge and travel through the heart to the lungs. This is known as pulmonary embolism which can cause serious complications in rare cases.

At Nanavati Super Speciality Hospital we take special steps to avoid DVT

• Preoperative workup
• The faster and minimal surgical approach
•  Immediate mobilization and walking on the day of surgery for unilateral or single-stage bilateral THR
• DVT stockings and pump
• DVT prevention Medications

 Aseptic Loosening of the Prosthesis (without infection): It is caused by the weakening of the bond between the new joint and the bone. Although it is expected that the new knee will last for many years, it can become loose earlier than anticipated, particularly if the patient is grossly overweight, if he/she returns to a hectic work schedule early or patient’s joint damage by accidental falling.Loosening of the

Prosthesis:  It is a treatable risk factor which involves replacement of loosened prosthesis with  new implants. It is common to see knee replacements lasting more than 30 years. At Nanavati Super Speciality Hospital we follow most modern technologies for joint replacement surgery protocol with post-surgery management to improve bone quality.

Persistent Pain: The operation may not relieve a patient of all the pain, and he or she may continue to experience some mild discomfort. The most common of all is complex regional pain syndrome, swelling, stiffness and skin changes. Other recognised risks of knee surgery include bone fractures, bruising, and urinary retention.

 

• After single knee replacement, a patient can stand with the assistance of a physiotherapist, 1 day after surgery and start moving with the help of a walking aid.
• 3-4 days after surgery a patient can use slightly raised toilet seat.
• After the discharge, a patient must try to walk, use the washroom independently with the help of a walking aid.
•  A patient must use walking frames or crutches for 2-4 weeks after the surgery.
•  It will take 4 weeks to achieve the full benefits of surgery.
• In case a patient has surgery for replacement of both knees then it might take a few more weeks to recover.
   

Q. Do I need a knee replacement?

A. It depends on the extent of pain and difficulty in walking. Advice is given after analysing X-ray find-ings. It is you who are suffering from pain and you are as much a part of the decision making as your doctor.

Q. Do I need computer-assisted or navigation / MIS for my knee replacement?

A. For routine knee replacement, available jigs are extremely good and accurate. Only in cases of com-plex deformities of thigh and leg bone that computer-aided assistance may be required. Computer navigation is an evolving technology and needs time to achieve perfection in all cases. While long incisions were made earlier, nowadays we utilize smaller incisions with the help of MIS jigs.

Q. Can I get both knees operated at the same time?

A. It depends on how badly both knees are affected and how sound is your medical status. Knee re-placement for both knees can be performed in one sitting if fitness is good

Q. Is knee replacement painful?

A. There are modern methods available for pain relief, such as continuous epidural anaesthesia, patient-controlled anaesthesia (PCA) and a mix of certain drugs that can control pain very effectively. Applying cold compresses around the knee also helps in reducing swelling and pain.

Q. Can I get full bending (flexion) of the knee after surgery?

A. There are reports in the media that some knee implants are capable of giving high flexion or full bending of the knee. The degree of movement achieved depends on your mobility status before surgery, your weight, and good technique of surgery. Surgery is likely to increase your knee movements partially. Implants can only absorb high stress associated with full movement.

Q. Can I sit cross-legged on the floor?

A. Knee replacement implants are bonded to the bone with bone cement. Even though most patients can sit cross-legged, it is not recommended. Preventing excessive stress on the bond increases the life of implant significantly.

Q. Do I need physiotherapy?

A. Physiotherapy is important in achieving early mobility and good knee movement. Physiotherapy starts immediately after surgery. You may need physiotherapy for 4 weeks. This can be organized at your home or a nearby clinic.

Q. How frequently do I need to visit the hospital?

A. You are required to visit the hospital 15 days after surgery for stitch removal. After that, you may be asked to return in 10 days to track your progress. Subsequent visits are required only after 3 months, 6 months and 1 year of surgery - unless medical condition dictates otherwise.

Q. Is knee replacement detected by a metal detector?

A. Yes. You should collect a credit card shaped certificate from the orthopaedic office certifying that you’ve had a knee replacement. This can be shown to the security staff.