Knee Joint Replacement Clinic in Delhi

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FAQ’s about Knee Replacement

What is arthritis and why does my knee hurt?

In the knee joint, there is a layer of smooth cartilage on the lower end of the FEMUR  (thighbone), the upper end of the TIBIA  (shinbone) and the under  surface of the kneecap (patella). This cartilage serves as a cushion and allows for smooth friction less  motion of the knee. Arthritis is a wearing away of this smooth cartilage. Eventually it wears down to bone. Rubbing of  bone against bone causes pain,swelling and stiffness & characteristic sound known as crepitus  .

What are its type?

Broadly they are categorized into .

  1. Osteoarthritis – It is a degenerative (age and wear tear related)disease, and is thost common type of arthritis

characterized by breakdown of joints cartilage leading bones

to rub against each other, causing stiffness, pain/loss of joint

movement.

  1. Rheumatoid Arthritis – It is a blood born arthritis in which our

immune system attacks its joints and damages it. It involves

multiple joints in symmetrical pattern.

Commonly known as “gathia bai”

  1. Posttraumatic Arthritis – It is a form of arthritis that develops

after an injury to the knee. For example, a broken bone may

damage the joint surface and lead to arthritis years after the

injury.

 

How many people suffer from it?

 

 

 

Osteoarthritis (OA) is the second most common rheumatologic

problem and is most frequent joint disease with prevalence of

22% to 39% in India. This is the most common cause of locomotor

disability in the elderly.

 

What is treatment of arthritis?

 

 

Sadly there is no cure for arthritis but there are a number of

treatments that may help relieve the pain and disability it can

cause.

 

 

Is there any non surgical treatment available for it?

 

 

 

Yes! as with other arthritic conditions, initial treatment of arthritis of

the knee is nonsurgical. Your doctor may recommend a range of

treatment options. Like life style modifications, physiotherapy,

assistive devices, losing weight which can be of help in initial

stages.

I am able to just manage with painkillers do is surgery advisable

for me?

.

If you are taking painkiller tablets, not able to walk, are not able to

perform your daily routine activities comfortably, denying the fact

you have a problem is not the solution. Painkillers of

allopathic/ayurvedic/homeopathy is not the solution. These are

temporary methods.

Do pain killer have side effects

 

 

Their excess intake exposes you to the risk of gastric ulcers and

kidney damage. all pain killers cause kidney damage for sure

and prolonged use may damage kidneys irrepairably, thus

forcing one to go for repeated dialysis and kidney transplant.

Gastrointestinal toxicity is present in 50% of NSAIDs (Pain Killers)

users and 5.4% develop a more serious event requiring

hospitalization due to its frequent use.

 

What goals does replacement fulfills?

 

 

 

  1. Permanently relieves pain that does not respond to other

treatment options, so making walking pain free.

  1. Straightens the knee to original position.
  2. Brings back the walking ability.
  3. Improved alignment of deformed joints.

 

When to go for surgery /replacement in arthritis?

 

Ask yourself: Have I tried everything? Is my knee holding me back

from doing the things I enjoy?

Delaying or declining a necessary knee replacement could result

in a less favorable outcome.

But if you are having trouble getting up to answer the phone or

walk to your car, you may be a candidate.

At what age should it be done?

 

 

 

Age is not a deciding factor.

 

 

I have reservations regarding its success?

Knee replacement surgery has a high rate of success in

eliminating pain and restoring range of motion; 90-95% of

patients achieve good to excellent results.

 

 

What is a total knee replacement?

 

 

 

 

Total knee replacement is really a cartilage replacement with an

artificial surface. The knee itself is not replaced, as is commonly

thought, but rather an artificial substitute for the cartilage is

inserted on the end of the bones.

 

 

 

 

Do I need to replace both my knee at same time or not?

 

If your both knee have advanced arthritis going for replacement

of both knee at same time reduces the cost, rehabilitation and

recovery time.

 

If your both knee have advanced arthritis going for replacement

of both knee at same time reduces the cost, rehabilitation and

recovery time.

 

How much pain will I experience after surgery?

 

 

At our center pain management is one of the top priorities. Our

dedicated pain management team uses sophisticated methods

such as spinal epidural catheters patient controlled anesthesia

transdermal patches to keep you virtually pain free in post

operative period. After you have recovered from surgery, you

should experience significantly less pain in your knee.

 

Will I require a blood transfusion for surgery?

A generally not as we do without muscle cutting technique which

furt her reduces blood loss. However one may require if person

is already having less reserve.

 

What is the recovery time?

 

Each patient heals from surgery at a different Pace. We make

the patients walk usually after 48 hrs of operation with walker

support. In most cases, you will be restricted to the use of a

walker for approximately 2-3 weeks. You will be able to climb up

and down stairs with stick at 3 weeks. And will be walking without

any support by 6 weeks time.

What special advantageous technique you use for surgery?

 

At our center we perform minimally invasive (smaller incision)

total knee replacement, no muscle cut technique which further

reduces infection chances and hastens recovery (less blood

loss) and usually we donot use tourniquet for long period so thigh pain is less .

 

Reasons for Total Knee Replacement Surgery (Indications)

A patient suffering from Pain, difficulty in walking, bowing of legs or instability, may benefit from a Total Knee Replacement. The above symptoms may be due to underlying conditions like Osteoarthritis, Rheumatoid Arthritis, Previous injury and various other conditions. Surgery is indicated, if the above symptoms continue to affect your lifestyle, inspite of adequate non-operative treatment.

BENEFITS OF TKR
  • BETTER ALIGNMENT SO NO DEFORMITY
  • FRICTION FREE SURFACE SO NO PAIN
  • STABLE IMPLANT SO NO INSTABILITY

Pain less walking is the goal of total knee replacement

Consultation before Knee Replacement Surgery (Pre-OP)

It is important to discuss with your surgeon, your diagnosis, other options of treatment, the procedure, the post-operative course and possible complications. Please take your medicines with you and you may be advised to stop some of them, before surgery.

You may also be required to see other specialists like the Anaesthetist ( The doctor, who may put you to sleep or otherwise), Other medical specialists like the Cardiologist, if required, the Physiotherapist and the Occupational therapists.

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Anaesthesia for Knee Replacement

The Anaesthetist, in consultation with you, usually decides on the type of Anaesthesia. The options are usually General Anaesthesia, Spinal Anaesthesia, Epidural Anaesthesia and Nerve blocks. Sometimes, a combination may also be employed to provide adequate Anaesthesia during the procedure and adequate analgesia (pain relief) after the procedure.

The Operative Procedure for Total Knee Replacement

It involves a skin incision (surgical cut) on the midline of the knee. By careful dissection, the joint is approached and inspected. The worn out cartilage and bone surfaces are shaved off. The bone ends are prepared meticulously and systematically to accept the selected prosthesis (artificial knee implant). These are usually fixed with a special cement (poly-methyl-methacrylate), but may not be in some implants (uncemented). Apart from the long bone ends (femur and Tibia), the patella may also be re-surfaced, in some instances.
The tissues are carefully repaired back with sutures and clips. Dressings are applied around the knee, at the end of the procedure. Antibiotics are usually administered at the start of the procedure, to minimize the risk of infection. The precautions taken include, maintaining a sterile field, using antibiotic loaded cement and performing the procedure in laminar flow Theatres.

After the procedure, the patient is usually moved to the recovery room for a few hours and subsequently back to the ward.

Post-operative Care after Knee Replacement Surgery

Pain relief after the procedure is adequately provided by various options like epidurals, patient controlled anaesthesia, Nerve blocks, Injections, patches, tablets etc. The Anaesthetist, who may be a part of the pain team, will be responsible for this.

Whilst in the ward, you may be provided with stockings, fitted with compressive stockings and may be given injections or tablets, to minimize the risk of developing clots in the body.

You may have to visit the Radiology department, to get some X-rays of your operated knee, showing the implants. You may a couple of dressing changes, while you are in the hospital.

Post-operative rehabilitation after Total Knee Replacement

The physiotherapist will visit you in the ward and encourage you to start getting up and walking. The sooner a patient is able to do this the earlier the progress in rehabilitation and the earlier the discharge. Initially you may be provided with a walker or a frame and subsequently progressed to crutches or sticks. If you have steps to negotiate at home, they will help you with them, before discharge.

After Discharge from Knee Replacement Surgery

You will be advised to wear your anti-embolic stocking for atleast 6 weeks. You will be advised on the physiotherapy and appropriate exercises. It is important to diligently perform these to get good extension and flexion in the joint.

You will be advised to see the doctor in 2 weeks time, when the clips or sutures on the skin may be removed. Here you will be advised on the progress of your physiotherapy and subsequent review. Success

Total Knee Replacement is an extremely successful operation through out the whole world. It is very good for relieving pain in the appropriately indicated patients. The success rate is reported at 95%.

TOTAL JOINT (KNEE) REPLACEMENT

If your symptoms continue to be bad and you have had no relief from the above mentioned options, your doctor may offer you a Total Knee Replacement. This is a surgical procedure, where the joint surfaces that are worn out are replaced with metal implants and an intervening polyethylene insert. You would need a General or a Regional Anaesthesia for this procedure.

In the appropriately selected patient, Total Knee Replacement, offers excellent pain relief and great improvement in their quality of life. It is one of the most successful of operations, performed through out the world. Most people are extremely happy with the outcome.

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