FAQ

Conventional Total Knee implant allows a person to have good range of motion of knee. High Flex Knees are now available which allow patients to safely bend their knees more than previously possible. Unicondylar Knees are also available. Unicondylar Knees also known as half joint replacement are indicated for very early arthritis and when only one half of the joint is involved. You should discuss the choice of implants with your surgeon. One should remember that the surgeon will choose the implant best suited to your needs.

Total Knee Replacement surgery is an elective procedure. Your doctor will more than likely treat your condition with physiotherapy, pain medicines, anti-inflammatory drugs and injections in the knee. You would be a good candidate to undergo Total Knee Replacement if:

• you have only knee pain(all other causes of pain have been ruled out)
• your pain is severe enough to restrict your work / recreations and also the ordinary activities of daily living
• all non operative methods of treatments have not relieved you pain
• you have significant stiffness of your knee or you have significant instability (constant giving way) of your knee
• you have significant deformity (knock knees or bow legs) causing pain and inability to walk
• You and your doctor are probably the best judge of when you will finally need total knee replacement surgery.

Total Knee Replacement is usually never done in an emergency. you should get the surgery at your convenience. Having said that don’t postpone surgery indefinitely.else your unstable joints may cause a fall and you may have fractures around the knees and the hips because of osteoporotic bones.

Regular consumption of analgesics and anti-inflammatory drugs may cause damage your kidneys and cause ulcers in your stomach

Although knee joint replacement is recommended in older age group, it can be considered in younger patients who are severely crippled due to secondary arthritis of any cause like rheumatoid arthritis or post traumatic arthritis of knees. As such, age is no bar to this operation. All patients irrespective of the age undergo rigorous preoperative evaluation to find if they are medically fit to undergo this surgery

Once your new joint has completely healed, you will reap the benefits of the surgery. These include:

• Reduced joint pain dramatically (may be no pain)
• Increased movement and mobility
• Correction of deformity
• Improved quality of life – the ability to return to normal activities
• Running, jumping, jogging or other high impact activities are discouraged. However, you can resume playing golf, walking, bicycling, swimming and other low impact sports

Science has made remarkable advances in joint replacement technology over the last few decades. The materials are long lasting and durable. The surgical techniques have been fine-tuned and standardized. As a result, the chances for a successful outcome are excellent. We now aim at zero error technique in doing knee replacement surgery. The operation should provide pain relief for at least 10-15 years and more. The major long-term problem is loosening of the prosthesis. This occurs because either the cement crumbles (as old mortar in a brick building) or the bone loosens away (resorbs) from the cement. By the second decade years, 25% of total knee replacements may look loose on X-ray, and about 10% will be painful and require reoperation. These complications are more likely in very obese or hyper active people and really depends upon how careful you are about your artificial knee joint

If both knees are damaged, both can be replaced in the same sitting. It means one time anaesthesia, one time hospital stay, one time medicines and one time physical therapy. It means saving the cost too. Your doctor can advise you for the need of replacing both the knees simultaneously.there are certain conditions in which both knees should not be replaced simultaneously. Discuss these conditions with your doctor.

Following are the essential steps that will help you get into shape before knee replacement surgery:

• Commit to the success of your surgery: Working as a team you and your family must adopt a positive attitude towards the success of your surgery. Together with your doctor you will gain a clear understanding of the common goals and expectations of the surgery.
• Lose excess weight: Because excess weight causes more strain on already damaged joints, losing weight is one of the best ways to improve the condition of your knee and optimize surgical results.
• Your doctor’s approval: Before surgery we would like to make sure that your condition is well enough to undergo this operation and also to exclude certain conditions such as dental infection, ear, nose and throat infection, skin infection, urine infection etc.
• Stop smoking: If you have not already done so, it is suggested that you stop smoking. This will be good for you during and after your surgery. Routinely blood transfusion is not necessary after Single Total Knee Replacement. But if your haemoglobin is less than 10 gm% then you may require 1-2 units of blood for your operation, so kindly arrange donors for this purpose. If both of your knees need replacement in the same sitting, then up to 2-3 units of blood may be required depending on your haemoglobin levels.

• When you have made up your mind for knee replacement surgery, you will be admitted a day before surgery. Your surgeon anaesthetist, physician and physiotherapist will do a complete medical evaluation.
• X-ray images will be taken of your knees that help the surgeon plan your surgery. Chest X-rays, ECG, routine blood tests will be done prior to surgery to ensure that you are fit for surgery.
• You will be required to scrub the surgical area with soap and water a night before and on the day of surgery, after which your leg will be covered with a sterile drape. You will be transported to the operating room in the morning.
• You may have General Anaesthesia or Spinal Anaesthesia with sedation. The duration of surgery for one knee is about just more than half hour. Your doctors will talk to your family after the surgery .
• You will be kept in recovery room for a few hours and then transferred to the room or in some cases to ICU for the monitoring of vital parameters.
• The whole limb will be covered with a bandage. After 3-6 hours depending upon the type of anaesthesia given at the time of surgery, you will start with physiotherapy and normal diet.
• Next morning, you will be transferred to the room and physical therapy usually begins with most of the patients. On first post-operative day we will make you stand and walk around. on 3rd day your dressing will be changed. In some cases, a knee immobilizer will be worn. Walking with support & independently using the toilet will be started from first day on wards. This summary is part of fast track protocol that we follow. Progress of certain individuals may vary from person to person depending on their physical abilities and comorbidities.

The initial rehabilitation generally takes 5-7 days during your hospital stay. It is needed for your weak leg and thigh muscles which have not been used because of your knee problem. The surgery can correct the knee problem, but the muscles will remain weak and need to be strengthened through regular exercises. The therapist also focuses on helping to increase the range of motion of knee with bending exercises.

Physical therapist along with you will work until you meet the following goals:

• Independence in getting in and out of bed
• Independence in walking with walker on a level surface
• Independence in your home exercise program

Your doctor and therapist may modify these goals somewhat to fit your particular condition. If there are no complications after surgery, most patients stay in our hospital approximately for 2 to 3 days after single knee and 3 to 4 days after bilateral knees.

Total Knee Replacement is an elective operation. The decision to have the operation is yours. The surgeon may recommend the operation, but your decision must be based upon you weighing the benefits of the operation against the risks. All your questions should have been answered before you decide to have the operation. If you still have any queries, please do not hesitate to contact us at:

Delhi Institute of Trauma & Orthopaedics, Sant Parmanand Hospital, 18 Sham Nath Marg, Civil Lines, Delhi – 110 054.

Your knee replacement should give you years of service. You can protect it by taking a few simple steps:

• Watch for and prevent infection: Because your new knee is sensitive to infection, you must be diligent about preventing infection. If you suspect infection of any kind any where in the body especially urinary tract and any dental infection, contact your doctor right away.
• Follow-up care: Your regular follow-up visits will ensure the long-term success of your operation. Often, follow-up X-rays will confirm proper placement and alignment of the artificial joint.
• Weight control: Keeping your weight under control. This will reduce the amount of pressure and stress on your new knee. Avoid high impact sports and participate regularly in low impact activities to strengthen your new knees and get the exercise you need to stay fit. Do not attempt to squat or sit cross legged forcefully.

Your first return appointment will be 2 to 3 weeks after the date of surgery for removal of stitches. Second appointment will be after 1 month, at which time you will be examined and have X-rays done. Subsequent appointments will be given based on your progress

Medication:

You will continue to take medicines as prescribed by your doctor.

Activity:

• Continue to walk with crutches/walker.
• Bear weight and walk on the leg as much as is comfortable.
• Walking is one of the better kinds of physical therapy and is good for muscle strengthening.
• The success of the operation depends to a great extent on how well you do the exercises and strengthen the muscles.
• Continue to wear your knee immobilizer as instructed. Our ultimate aim is that you should be able to bend your knee to at least 90degrees (usually more) and be able to strengthen your knee. Within six weeks after surgery, most patients are able to walk with a cane.

Other considerations:

• Do not wet the knee until after the stitches are removed
• You can usually return to work within 2-3 months or as instructed by your doctor.
• You should not drive a car until your doctor has advised you to

Care of the wound:

• Keep the incision clean and dry.
• If there is any swelling, redness or drainage from the incision site, or if you have any pain or fever, report this immediately to your doctor.
• The stitches are removed at about two weeks after the operation.

After Total Knee Replacement, a person can typically walk comfortably and his knee joint will have a good range of motion. Lot of patients are able to sit cross legged on the bed after this surgery. Its not advisable to squat or sit cross legged on the ground. If your body does not have the flexibility then do not try to forcefully bend your knees more than your tolerance limit. Your doctor will advise you on the activities that you will be able to do comfortably