Total Knee Replacement Surgery by Dr. Sanjib Kumar Behera
This blog answers a few important questions about Total knee replacement surgery
What is Total Knee Replacement Surgery?
A surgical procedure where an ailing knee joint is replaced with an artificial one so the joint enjoys the same motion of the knee. The artificial knee composes of metal and plastic materials and is shaped in the same way as a knee to allow free continued motion. Sometimes called Knee joint replacement surgery these are preferred for minimally invasive methods with less pain and no bleeding.
Who needs Total Knee Replacement Surgery?
These conditions result in progressively increasing pain and stiffness and decreasing daily function. However, not everyone is a candidate for total knee replacement. Doctors can diagnose and recommend surgery for patients with few or more of the following symptoms.
- Patients experiencing difficulty in walking especially going up the stairs or while sitting in and standing out of chairs.
- Patients experiencing severe Knee pain that interferes with daily activities and have tried out but not responded to nonsurgical treatments. Non-surgical treatments may include exercises, weight loss, physical therapy sessions, medications, steroid injections, and bracing.
- Some patients experience moderate to severe pain even while resting, affecting their sleep patterns.
- If patients have moderate to severe arthritis in the knee then they can be recommended to go for knee replacement by their doctors after a medical imaging diagnosis.
- In the case of Knee deformities, doctors can recommend knee replacement surgery. Some of these deformities may include and not limited to bow-legs or knock-knees resulting from knee joint degeneration.
- Patients with Knee swelling and inflammation that is not controlled with medication or rest and hindering the daily living of the patient.
Types of Knee Surgery:
- Meniscus Repair
- Meniscus Transplant
- Plica Removal
- Lateral Release
- ACL Reconstruction
- Tendon Repair
- Knee Replacements
Out of the above Partial Knee replacement and Total Knee replacement surgeries are preferred as patients who have been suffering from knee pains most of their lives get pain relief with a renewed knee cap that can be sustained long term.
The Total Knee Replacement Procedure
Total knee replacement surgery includes 5-6 inches incision over the knee with 3-5 days of hospitalization.
Anesthesia is administered to the patients before the surgery. Anesthesia can be general or a spine nerve block.
The knee is bent to 90 degrees for the surgeon to access the joint.
The best knee replacement surgeon can go for incisions of 8 to 10 inches long cutting through deeper tissue to flip the kneecap and access the femur and tibia. Sometimes surgeons can also choose to perform minimally invasive knee replacement with smaller incisions of 5-6 inches using minimally invasive surgical techniques.
A bone saw is used to remove the damaged areas at the bottom of the femur and the top of the tibia and reshaped to fit with the new prosthesis perfectly. A surgeon then resurfaces the back of the kneecap also known as the patella to attach the implant with help of a polyethylene component which acts as a glider for the movement of the patella against the new joint. Fast-drying bone cement or sometimes cementless components can be used to attach the femur, tibia, and patella. Over a period of time bone tissue can grow normally over these components.
A flexible cushion component is attached on top of the new tibia surfaces to act as a shock absorber between the two new prosthetic surfaces.
The doctor examines the fit of the components and the range of motion of the knee. He then straightens the patients’ knees to allow the components to bind.
Any deep tissue cuts will be repaired and incisions are stitched back to finish the total knee replacement surgery procedure.
A patient can be discharged the same day after the anesthesia wears off and is checked by a physical therapist. In a few cases, the doctors can ask the patient to stay in observation for 1 to 2 days before deeming safe for discharge. Recovery depends on the severity of the problem and an individual’s physical therapy routines.
Continuous Passive Motion machine can help speed recovery of the replaced knee. This CPM device can be set to a range of degrees and it constantly moves the knee through that degree of motion. So while the patient is relaxing the device is on its job helping in the movement of the knee.
Patients are recommended to begin ambulation with the help of a walking aid on the same day as their surgery. Some patients may need total rest for a day or two before ambulation as recommended by physicians and physical therapists.
After the surgery, physical therapy is prescribed to begin within a week after discharge. Physical therapy may start with assistive walking using walkers etc and go on to include knee strengthening exercises, exercises to increase range of motion, etc.
With proper physical therapy and proper care, most patients are able to resume normal daily activities within 6 weeks. They can start driving within 3 to 6 weeks. But for best recovery results patients need to check with their doctor and physical therapist from time to time. It may take 4 to 6 months or in some cases a year to fully recover and get back to the original self from knee replacement surgery.
Exercises After Knee Replacement
Exercises after the knee replacement can be prescribed by the physical therapist even after the consultation period. It is always better to keep doing Knee strengthening exercises and make exercise a daily goal to improve the movement of the replaced knee. Some of the exercises can include:
- Knee bending stretch (sitting knee flexion)
- Thigh squeezes (quadriceps sets)
- Heel slides (hip and knee flexion)
- Leg slides (abduction/adduction)
- Lying kicks (short arc quadriceps)
- Straight leg raises.
Please make sure to consult your physician or physical therapist before doing anything rigorously for the first time.
Total Knee Replacement Complications
Relatively fewer complications happen for these replacement surgeries mostly seen in older adults.
Complications might be due to anesthesia, blood clots, infections due to allergy to metal components, implant problems, knee stiffness, wounding, and bleeding complications in certain individuals.
Guidelines for selecting an orthopedic surgeon
The most important part of the total knee replacement surgery process is choosing a good specialized orthopedic surgeon.
A surgeon with experience of a high volume of knee replacement surgeries each year and a hospital that has dedicated resources to perform such technically efficient knee replacements need to be chosen.
A good knee replacement surgeon increases the success of total knee replacement surgery using the latest technology while decreasing complications for the patients and having a well-developed plan for post-operative rehabilitation, which may include a supervised physical therapy program.
Dr. Sanjib Kumar Behera is the most trusted orthopedic surgeon in Hyderabad who has handled more than 900 surgeries in orthopedics with expertise in knee and joint replacements. He is a Clinical Director and HOD, Department of Orthopedic and Joint Replacement Surgery at Care Hospitals, Banjara Hills in Hyderabad, and performs orthopedic surgeries using the latest technological procedures in the country. Apart from being a surgeon, his patients consider him a great human being who takes time out for each of them to mentor and help them with lifelong health changes.
Please visit www.doctorbehera.in for details or give a call on +91-94401 80980 for appointments.