What is knee replacement surgery?
Knee replacement surgery (also called knee arthroplasty) is a surgery where the damaged portions of the knee joint are removed and replaced with artificial components.
Knee disorders and knee pain are currently the 2nd and 4th most common causes of outpatient visits and out-of-pocket expenses amongst all non-communicable diseases in India.
Who needs knee replacement surgery?
If you suffer severe knee arthritis that impacts your day-to-day activities and quality of life, and if you have significant pain that interrupts your sleep, you may consider knee replacement surgery. Your doctor will usually recommend this in severe stages of:
- Osteoarthritis: Osteoarthritis is the most common joint disease in India, affecting up to 39% of the population
- Rheumatoid arthritis
- Post-traumatic arthritis
How is osteoarthritis diagnosed?
How does my doctor determine if I require knee replacement surgery?
Your orthopaedician will take a detailed medical history of your symptoms which includes:
- The duration and intensity of your pain
- Whether you experience knee pain at night
- If your knee pain interferes with your sleep
- The extent to which it affects your mobility and day-to-day activities
- Their impact on your quality of life
They’ll do a physical examination of your knee and ask you to get an x-ray. Initially, your doctor may prescribe conservative treatment methods such as medicines, physiotherapy, etc. If these do not provide relief after continuous use (at least 4-6 weeks), surgery may be necessary.
What are some non-surgical options for my knee pain?
Some non-surgical options for knee pain are:
- Conservative therapy: This includes:
- Weight loss
- Using a cast, brace or crutches for support
- Physiotherapy
- Strengthening exercises to maintain your mobility and build up your muscles
- Lifestyle modifications, such as avoiding activities that increase your pain, maintaining good posture, resting and getting enough sleep, avoiding lifting heavy objects, etc.
- Your doctor injects hyaluronic acid or corticosteroids into your joint to reduce inflammation and pain
- Platelet-rich plasma (PRP) therapy: Platelets are rich in special factors, called growth factors, that help relieve pain and promote healing. You’ll be asked to provide your blood sample, which is then centrifuged to separate the platelets from the rest of the constituents of the blood. These platelets are then injected into the affected joint to provide relief
- Stem cell therapy: Stem cells are special cells that can differentiate into many different types of cells. In stem cell therapy, your doctor takes stem cells from your bone marrow and injects them into the affected joint.
What are some alternative surgeries for knee pain?
Some surgical alternatives that can help relieve knee pain are :
- Osteotomy: Your doctor cuts and reshapes the bone in the affected joint to relieve stress and increase the joint space. It’s minimally invasive and carries a short recovery time as well
- Cartilage transplant: In this, the damaged cartilage is replaced by a new one and placed in the damaged joint
What’s the difference between total and partial knee replacement?
When there is extensive damage to all the compartments of the knee, total knee replacement is prescribed. Your doctor removes the entire damaged cartilage and bone and replaces it with an artificial implant.
In case of partial replacement, the damage is usually restricted to a single compartment and your doctor replaces only that part. It’s a good alternative if :
- You’re less than 60 years old
- Your arthritis is restricted to the medial compartment of your knee
- Your knee deformity is not that severe
What are the advantages of partial knee replacement?
Some advantages include:
- It requires a smaller incision
- It preserves all the ligaments in your knee
- It provides you with a better feeling of proprioception and normalcy
- You can walk within a week of surgery
- You can sit cross-legged after surgery
- You don’t need long-term exercises or physiotherapy
Are there any contraindications to knee replacement surgery?
It’s possible that you wouldn’t be a good candidate if:
- You have an infection in your knee joint
- Your ability to extend your knee is very limited
- You have loss of sensation in your joints, which can be as a result of diabetes, leprosy, spinal cord injury, syphilis etc.
- You’re younger than 50 years old
- You’re severely overweight
- You have a physically demanding job
What can I expect before knee replacement surgery?
During the consultation, the surgeon will thoroughly explain the procedure, its outcome, and any potential complications. They will also respond to any queries or worries you might have.
- You’ll sign a consent form giving permission to do the procedure
- Your doctor will ask you for your medical and surgical history, including any bleeding disorders, allergies or sensitivities, along with any family history of illnesses
- A comprehensive history of your medications will also be taken, including blood thinners, over-the-counter and prescription medicines, vitamins, herbal supplements and ayurvedic and homoeopathic medicines
- You’ll undergo a general physical examination where your vital signs like pulse rate, blood pressure, oxygen saturation and respiratory rate will be measured. You’ll also be required to undergo a blood test to know your blood parameters before surgery and ensure everything is normal
- Your doctor will give you specific instructions regarding anything else that needs to be done before the procedure
- You’ll change into a hospital gown and wait in the pre-operative area before your surgery
What happens during knee replacement surgery?
- Your surgery usually takes place under general anaesthesia, and your vital signs are monitored by your anaesthetist
- Your orthopaedic surgeon will slice off all the damaged areas and prepare your bones to take the prosthesis and ensure optimal alignment
- They’ll then close the incision and suture or staple it
- They’ll dress the wound, and you’ll be shifted to the post-op ward
What happens after knee replacement surgery?
The duration of post-op hospitalisation depends on the type of surgery.
- After the procedure, your vitals will be monitored in the recovery room
- Your surgical team will start ankle/foot pump exercises within 6-8 hours of your surgery to minimise the chances of blood clots and also give you a sense of control
- You’ll be started on exercises and physiotherapy the following day and be made to walk with the help of a walker
How long do I need to stay in the hospital post-surgery?
How long does an implant typically last?
What are the complications of knee replacement surgery?
Like any other surgery, this procedure comes with certain risks and complications that include:
- Bleeding
- Infections
- Persistent pain and stiffness of the joint
- Formation of blood clots, which can lead to pulmonary embolism, stroke or heart attack
- Damage to the blood vessels, nerves and tendons around the knee joint
- Fracture
- Wearing down of the implant surfaces
What can I expect after knee replacement surgery?
It’s important to have realistic expectations and understand the limitations of surgery. While your knee pain certainly reduces post procedure, it cannot reverse your arthritis and you won’t be able to completely go back to your pre-arthritic activity levels. You need to avoid any kind of high-impact activities or sports, such as football, basketball, etc., post-procedure. Low-impact activities such as walking, swimming, and cycling are acceptable.
Can I walk normally post-surgery?
Is it possible to replace both knees at the same time?
Yes, if you have severe deformities in both your knees, your doctor can recommend bilateral surgery. It is commonly done in India since most patients have advanced-stage arthritis in both knees. The advantages of having both knees replaced at the same time are:
- Decreased overall cost of surgery and hospitalisation
- Reduced post-op medications
- Shorter duration of rehabilitation and physiotherapy
