Shri Chimanbhai Patel
Orthopaedic hospital

Dr Kalpit Patel (MS Ortho, FRCS)

(Specialist Joint Replacement Surgeon)

Get to know about YOUR KNEE REPLACEMENT

The general goal of total knee replacement is designed to provide pain-free and unlimited standing, sitting, walking, and other normal activities of daily living.

Know Your Knee Replacement

What is Knee Replacement?

Total knee replacement (TKR), also referred to as total knee arthroplasty (TKA), is a surgical procedure where worn, diseased, or damaged surfaces of a knee joint are removed and resurfaced with artificial smooth and strong materials which are durable and also produce as little friction as possible. The "artificial joint or prosthesis" generally has two components, one made of metal which is usually cobalt -chrome or titanium. The other component is a plastic material called polyethylene


Normal KneeDamaged Knee

The Knee Implant

The general goal of total knee replacement is designed to provide pain-free and unlimited standing, sitting, walking, and other normal activities of daily living.
Nice To Know:
With proper care individuals who have had a total knee replacement can expect many years of knee joint function. Studies show that more than 95 % joints survive for at least 15 years.
The first knee replacement case done in 2005 by Dr Kalpit Patel in India is still satisfactorily enjoying quality life. Till now more than 2000 TKR surgery cases perform successfully at "Naisarg Center".

Who Is A Candidate For Knee Replacement?

If you have a damaged knee joint, you would benefit from a total knee replacement provided:
  • all of the appropriate non-surgical treatments have been tried.
  • painful knee is significantly restricting day to day activities and not allowing you to enjoy life.....more click here for documentary on arthritis
  • Patient is medically fit and above 50 years age.

Counselling by our knee specialist Dr. Kalpit K Patel
X-rays are used to show the extent of damage to the joint and they may suggest a cause for the degeneration.

Blood tests may be required for Rheumatoid Arthritis- RA Factor, CBC & ESR for infection, Serum Uric acid etc

How Is The Knee Replaced?

Once the anaesthesia has been given and the patient prepared an incision approximately eight cm in length is made on the front of the knee. The surrounding muscles and most of the ligaments are cut in such a manner that they can be preserved. The damaged bone and joint surfaces are removed from all 3 bones making up the knee joint. Sometimes, depending on the surgeon, the back of the knee cap is left intact if it is not badly affected by the arthritis.

The lower end of the thigh bone (femur) is resurfaced with a metal cap.
The upper end of the leg bone (tibia) is replaced with a plastic and metal implant with cement and or screws.

The back of the kneecap (patella) is also resurfaced with an all-plastic implant. Highly specialized instruments are used that allow precision cutting of the bone so that the new joint fits perfectly. The type of implant used depends on surgeon's preference and patient requirements.)

Recovery Pattern in "NAISARG" Center for KNEE & HIP REPLACEMENT

The first day you can expect
We prefer spinal anaesthesia, so you will be awake when you are brought back from Operation theater, but Oxygen (O2) will be given for approx. 2 hours for safety reasons
Water and liquids will be started gradually after 3 hours and light diet later on If there is feeling of nausea, anti-emetics will be given Blood transfusion is given if necessary
Effect of spinal anaesthesia and pain block will wear off in about 4-6 hours and then patients’ operated leg will be able to move and feeling of numbness will go away and all sensations including pain comes back.
You will be allowed to sit up and turn in bed and asked to start gentle foot and knee exercises.
Pain medication within safety limits are given by injection or as tablets There will be a tube draining collected blood around knee via negative suction.
The second day you can expect
Full meals are allowed. All intravenous medications are continued as per protocol. The wound drain is removed and patient made to stand up on operated leg with walker support.
Laboratory investigations to check post-operative haemoglobin and kidney status are done.
The Third day you can expect
Wound Dressing is checked, walking and knee bending is started by the physiotherapist Switch over to oral medication from injectables
The fourth day you can expect
Progression of walking and exercises
Instruction on how to dress, get in and out of bed and utilize the bathroom safely
The fifth day you can expect

Plan for going home with necessary medicines and physiotherapy advice.

Advice on discharge

"New Concept" – Self Physiotherapy

At Naisarg Center we are using "Hi-Flex Knee Joint" and special tissue release technique.So no need to do Painful Physiotherapy.

Follow-up schedule :-
12 to 14th days For stitch removal and post operative x ray review
At one month to assess independent walking and stair climbing
At six month to check all activities of daily living
Success Stories.
Activities after TKR
Palathi
Namaz
Cycling
Stair Climbing

A cemented knee is a very reliable procedure with approximately 90to 95 percent expected to enjoy pain-free activities for at least fifteen years beyond surgery. The advantage is that this type of knee replacement is immediately stable and one can walk fully bearing weight immediately following surgery. The disadvantage is that the cement –bone-implant bond eventually becomes loose after 15 years resulting in necessity for repeat surgery ( Revision knee replacement)

How Is The Artificial Implant Fixed To Bone?

The artificial knee implant is fixed to be bone using a glue called bone cement. Bone cement is prepared by a chemical reaction between special type of polymer and liquid reagent.

Frequently Asked Questions

Q: Here are some frequently asked questions related to knee replacement :
Q : What is the average hospital stay recommended after joint replacement?
A : The hospital stay is for five days for joint replacement.
Q : What is the average time taken for joint replacement surgery?
A : The average time taken for joint replacement surgery is one hour.
Q : Can this operation be done in diabetes & High B.P.?
A : Even a person with diabetes,high blood pressure,cardiac disorders can undergo joint replacement surgery under medical supervision.The diabetes or BP must be under control.
Q : What are the common complications after joint replacement?
A : The possible complications after joint replacement are general as in other operations like clots in calf Vein (DVT), dislocation for hips and joint infection. Long-term complications are implant loosening and wear. The infection rate in india averages 5 to 8 per cent but in our naisarg knee and hip center it is less than 1 %.

Deep Venous Thrombosis (DVT)

This term refers to the formation of blood clots (called thrombosis) in the large veins, usually of the legs or pelvis. It can occur after any operation, but is more likely to occur following surgery on the hip, pelvis, or knee. It results from the slowing of the blood flow in the leg during and after surgery.
Our Regime for prevention of DVT
A. Mechanical method
Moving the leg as soon as possible after surgery.
Walking the next day of surgery.
Using pressure stockings to keep the blood in the legs moving. They are worn immediately after surgery and continued for several weeks.
B. Chemical method
Prescribing medications that thin the blood and prevent blood clots from forming. They may be started before surgery or immediately after and continued for a period of time following surgery.

Infection

The chance of getting an infection following artificial knee replacement is 3 – 5 % percent in developing countries. Infection in knee replacement surgery is a disaster because the joint usually does not survive and has to be removed. So, maximum preventive measures are necessary. measures to ensure "ZERO INFECTION RATE".

All patients receive antibiotics for at least 48 hours after surgery to minimize the risk.
Double sterilization of all linen and gowns
Use of single use disposable covers
Clean air operation theater ( class 100 air quality maintenance)

Q : Can these operations be done in any nursing home or hospital?
A : No.This is a specialized surgery which requires a special set-up (airconditioning with special dust filters(HEPA 0.3 micros) and multiple air changes), dedicated operation theater, post-operative intensive care unit, trained nurses and technicians and expert physiotherapists to achieve desired results.
Q : What is the role of physiotherapy and exercises after joint replacement?
A : We have introduced a new concept @ our center called "ZERO" Physiotherapy. This means no more painful and prolonged physiotherapy which was done after knee replacement in the past. Instead we teach simple home based exercises to the patient and relatives which gives excellent post operative recovery and results.
Q : If I have one knee replaced does this indicate I will definitely be in need of replacing the other?
A : No. Often only one knee is affected and the other completely normal. Sometimes the other knee is also affected either as severely or not as badly. The surgeon can inform you of the likelihood if the other knee will need to be replaced in the future.
Q : How soon can one drive again after total knee replacement?
A: It is generally recommended not to drive following total knee replacement till good knee control is achieved.(average 6 weeks)

Preparing For A Knee Replacement

Assessing the Fitness "ALL CLEAR" to undergo Surgery
  • Blood /Urine test - A complete blood count, Liver and kidney function tests, blood sugar testing and any further test as advised by our physician depending on clinical need are done prior to surgery. Because there may be a need for blood transfusion during or after the surgery, blood tests will be needed for blood matching.
  • ECG/ ECHO- Provides information regarding the condition of the heart for surgery
  • Chest x-ray - Provides information about the respiratory status of the individual.

Eating and drinking instructions – you will be asked to stop all food and liquids 6 hours before surgery time. Fluids will be given through
IV line & Medications - The physician, anesthesiologist and nursing staff will need a current list of all prescription and non-prescription medications being taken by you. A sleeping tablet is given the night before surgery. A pre-operative antibiotic dose will be administered to fight against urinary and dental micro-organisms.

Knee Implant Rates As Per NPPA (16_Aug_2017)