Total knee replacement (TKR surgery) also referred to as Knee Arthroplasty, is a surgical procedure done to replace bone and cartilage, damaged by conditions such as osteoarthritis or injury, with a prosthesis. This surgery is considered after medication, physical therapy, and exercise have failed to provide relief. Total knee replacement (TKR) surgery is safe and effective and helps relieve the pain. It also restores the function of the knee joint, thereby helping in movement.
If we look at the statistics, around 70,000 to 80,000 knee replacement surgeries and 20,000 to 30,000 hip replacement surgeries are carried out every year, suggesting that people suffering from arthritis are becoming more aware of surgical treatment options. During the early stages, medication and walking support can prove helpful, but what are your options when the condition of your arthritis has extensively severed? Well, you don’t have to worry because you certainly have great treatment options like Total Knee Replacement (TKR) Surgery to look forward to.
What Does Total Knee Replacement Surgery Encompass?
A lot of people suffering from arthritis lose all hope when their doctor tells them about the extreme destruction of their knees. But little do they know about their treatment options. Total knee replacement surgery is one of the most effective treatment options available. Total knee replacement (TKR) surgery improves the functioning of the knee considerably. It has come as a new hope in the lives of people suffering from arthritis.
Types of Total Knee Replacement Surgery
High Flex Total Knee Replacement
Unlike the conventional implants that allow knee flexion of around 120 to 125 degrees, high flex implants allow increased flexion of about 150 to 155 degrees, thereby giving you a better range of motion and allowing you to perform activities like climbing stairs, squatting, kneeling etc. Owing to the fact that high flex implants are slightly modified to give better flexion, there is a need of 2-4 mm of additional bone resection.
Oxinium Total Knee Replacement
The prosthetic femoral components used in full knee replacement surgery are usually made up of metals like cobalt-chromium with plastic as an articulating surface. However, gradual wear and tear can result in the roughening of the upper surface of the implants and the plastic surface starts to wear out resulting in suspended implant debris in the surrounding areas. This can lead to aseptic loosening. In such cases, using an Oxinium implant is the best option. Use of oxidised zirconium (OxZr) has helped to reduce the incidences of wear and tear by 85 per cent.
Revision Total Knee Replacement
As the name suggests, it is a TKR revision surgery that is performed to replace an existing prosthetic joint, or a part of it, which has been damaged by excessive wear and tear or an accident or injury. Revision knee replacement procedure is similar to primary total knee replacement. Revision knee replacement surgery may also be performed in case of chronic infection at the site of the primary implant.In such cases, the surgery is performed in two different steps which involve the removal of the primary implant and placement of an antibiotic spacer block which is kept there for 6 to 12 weeks. The antibiotics present in the spacer help to clear the infection, after which another surgery is performed to place the new implant.
Preparation For Total Knee Replacement Surgery
What Was Done to my Knee During my Total Knee Replacement (TKR) Surgery?
- When a surgeon commences TKR knee replacement, the safety of the patient is his major concern. The patient bestows his trust in the skills of the surgeon and hence, it becomes important for him to keep up that trust. A good surgeon not only treats his patient effectively but also indulges in an open conversation telling him about the adeptness of the technology used in his treatment and the possible risks involved, further enhancing the transparency between them.
- Total knee replacement surgery (TKR surgery) is performed under Spinal/general anesthesia.
- Once the anaesthesia is administered, the orthopaedic surgeon from BLK-Max Hospital will make an incision and remove the damaged surfaces of the knee joint. This could involve cartilage or bone that has undergone degeneration due to disease or injury. These will be replaced with knee prosthesis made from high-grade polymers or metal alloys.
- The prosthetic knee is attached to the bone and cemented with surgical-grade cement.
- The incision is then closed, and a drain may be placed to remove excess fluid.
Recovery After Total Knee Replacement Surgery
The Best Position to Sleep at Night After TKR Surgery
It is common to expect some pain and soreness immediately following surgery. Most patients take up to 6 weeks to return to normal activities and it may take about 6 months to a year to gain the full benefits of the knee replacement surgery. In the meanwhile, it is important to take the precautions that your doctor recommends. The best position to sleep in is on your back. This allows the leg to stay extended and ensures proper blood flow to the surgical site. You may want to prop up your leg with a rolled-up towel or soft pillow while sleeping.
Walk as Soon as Possible After Total Knee Replacement Surgery
Within three weeks, you can walk without crutches. In the starting, walk for 10 minutes. Gradually with the help of your physical therapist, you can push more.
Exercise To Perform Right After Total Knee Replacement Surgery
Regular breathing exercises, thigh squeezing, knee straightening, moving feet up and down, etc., can be performed.
Best Way to go up and down the Stairs with my cane
- After a total knee arthroplasty surgery, you may be asked to avoid the stairs for a few days.
- Then, as you start to use the cane for support, you will need to go up and down the stairs slowly.
- Hold the banister or the railing with one hand and the cane with the other. Climb up with the non-operative leg and bring the other to join it before you take another step up.
- While climbing down, use your operative foot to step down and bring the other to join it. As your flexibility and strength increase, you may start alternating one step per foot.
Your physical therapist will meet you within 24 hours of your knee TKR surgery and start to work on a PT plan. Some of the exercises after total knee replacement (TKR) include:
- Ankle Pumps: Lay flat on your back with your legs straight and move your ankles up and down.
- Quadriceps Sets: Lay down on your back and tighten the thigh muscles pressing the back of your knees to the bed. Hold for a count of 5 and then relax.
- Gluteal Sets: Lay flat on your back. Squeeze your buttocks together and hold for a count of 5. Relax.
- Seated Knee Exercise: Sit erect in a chair. Now slowly straighten your operative knee. Return the leg slowly to the starting position.
- Assisted Knee Bending: Sit erect in a chair. Now, slowly bend the operative knee as far as it will bend. Use your other leg to support it. When you feel a mild stretch, hold for a count of 5 and return to the starting position.
- Assisted Knee Straightening: Sit erect in a chair. Now, slowly stretch the operative knee as far as it will go. Use your other leg to support it. When you feel a mild stretch hold for a count of 5 and return to the starting position.
Working With a Physical Therapist After Total Knee Replacement Surgery
You must enlist the help of a physical therapist following your surgery. This will help shorten your total knee replacement (TKR) recovery time and help you gain full flexibility and function as soon as possible. The physical therapists at BLK Max Hospital will help you get back to routine activities in a gradually phased manner to avoid damaging or injuring the surgical prosthesis while allowing time for the site to heal.
Your doctor at BLK Max Hospital will recommend the length or duration of physical therapy needed; most patients require at least 4 weeks of formal physical therapy following the surgery.
Minimally Invasive Total Knee Replacement Surgery
The integration of medical science and technology is leaving no stone unturned to relieve patients from their pain. With the intervention of the latest techniques like computer navigation, total knee replacement surgery (TKR surgery) has improved way beyond our imagination. Using these technologies, surgeons are now able to perform pain-free surgeries with great precision.
Not only this, but patient experience has also improved with shorter hospital stays, lesser rehabilitation time, and most importantly reduced pain. An important point to note here is that not only the best knee replacement surgeons but also patients are required to be educated about these procedures as it will help them to collaborate better.
Partial Knee Replacement
In some cases where only a small part of the patient’s knee joint has been damaged, it is futile to replace the whole knee joint. Hence partial knee replacement is the best treatment option for such patients. The procedure involves the replacement of only the damaged part of the joint with a new prosthetic component. The doctor will make an incision on your knee to access the affected joint and the damaged bone and joint debris are removed. A small metallic or plastic component is cemented in its place and the wound is closed.
To restore the functions and relieve the pain of the severely diseased knee joints, operate them with total knee replacement surgery. If you have a fear of pain after surgery, rest assured. It will never be excruciating or intolerable. With the help of an ice machine and compression socks, you can tolerate the pain.
Frequently Asked Questions
1. What is the total knee replacement cost in India?
Total Knee Replacement (TKR) surgery involves replacing parts of the damaged femur and shin bones with an artificial knee. Total Knee Replacement (TKR) cost in India depends on the type of procedure - the average cost for unilateral TKR is lesser than a bilateral TKR. Apart from the knee implant cost, the other deciding factors for Total Knee Replacement (TKR) are:
- The surgeon’s fee.
- The hospital charges.
- The city where the hospital is located.
- The patient’s health condition.
Total Knee replacement cost has reduced significantly after the government placed a cap on the price of knee implants. So, the cost is more reasonable now.
2. When is total knee replacement surgery needed?
Total Knee Replacement is the most commonly-performed Joint Replacement procedure and is most suitable for middle-aged and older people who have arthritis in more than one compartment of the knee. One may also recommend Knee Replacement surgery if there is severe pain, swelling and stiffness in the knee joint, reduced mobility or compromised quality of life due to severe knee pain.
Total Knee Joint Replacement surgery is usually necessary when the knee joint is worn or damaged to the extent that mobility is reduced and one experiences pain even while resting. Conditions that cause damage to knee joints are Knee Deformity, Rheumatoid Arthritis, Gout, Haemophillia, Bone Dysplasia. More than 90% of people who have a total knee replacement still function well 15 years after surgery.
3. What are the conditions treated under total knee replacement surgery?
Some of the major conditions that are treated under Total Knee Replacement Surgery are:
- Severe Osteoarthritis
- Rheumatoid Arthritis
- Ligament Damage
- Infections that cause severe Osteoarthritis
- Gout and ‘Pseudogout’ (Crystal deposition diseases)
- Avascular Necrosis (Loss of blood supply due to death of bone)
- Bone Dysplasias (Disorders related to the growth of bone)
4. What activity should be avoided immediately following a total knee replacement?
Most high-impact, high-risk activities are to be avoided immediately following the total knee replacement surgery(TKR surgery). Squatting, jogging, or any exercise that stresses the knee should be avoided till you are cleared by the physical therapist. You may have to completely avoid high-impact activities. It is best to discuss precautions with your doctor and physical therapist.
5. Can you crawl on your knees after total knee replacement (TKR)?
Even as the healing process starts and you gain both strength and range of motion, there will be certain activities that are best avoided due to the risk of injury or fall. Kneeling may be possible if the physical therapist clears you to. Crawling on your knees, however, carries a risk of damaging the prosthesis and should be avoided.
6. What is the most commonly reported problem after total knee replacement surgery?
Most patients undergoing TKR Operation are happy with the freedom from pain, increased range of movement, and activity levels. There are, however, certain problems that could be reported. These include stiffness of the knee, infection of the surgical site, clicking sound during movement, and wearing out of prosthesis (in the long run). If you are concerned about these, it is best to discuss the risks with your doctor at BLK Max Hospital.
7. How long after total knee replacement will you be pain-free?
Right after surgery, most patients report mild pain for 2-4 weeks. This pain reduces as the knee starts to heal. Some stiffness and soreness can be expected for a few months and total recovery could take up to a year.
8. When can I go back to work?
Normally, it takes 4-6 weeks for patients to resume their desk job after surgery. But, in the case of a physically demanding job, it takes quite a long recovery time.
9. How long will it be before I feel normal?
Within six months, you can resume your normal easy activities and get freedom from all crutches. Generally, it takes a year to regain knee strength and perform all normal activities.
10. When can I do the housework?
For the starting three months, you can only be able to manage light chores like dusting, washing, etc., and can perform in the starting three months. Till then, avoid any heavy activities like vacuum cleaning, etc.
11. Will I have to go back to the hospital?
It takes 4-5 days for a patient to leave the hospital after surgery. Nowadays, some hospitals provide outpatient surgery facilities. You can get discharged within 23-24 hours after this surgery.
12. Will I need another new knee?
The implanted knee can long for 15-20 years. Suppose you have surgery at a younger age. In that case, you usually need to undergo a second operation when the period is over.
13. What type of anaesthesia is used during total knee replacement surgery?
Total knee replacement surgery is typically performed under general anaesthesia or spinal anaesthesia. The choice of anaesthesia depends on factors such as the patient's health condition, the surgeon's preference, and the specific requirements of the surgery.
14. Can you climb stairs after knee replacement?
Yes, after knee replacement surgery and with proper rehabilitation, almost all individuals are able to climb stairs. Physical therapy and strengthening exercises are important in regaining strength and mobility in the knee joint.
The success rate of total knee replacement surgery in Delhi can vary, and it is influenced by various factors such as the patient's overall health, surgeon's expertise, and post-operative care. It is best to consult with a surgeon or healthcare provider for specific success rate statistics.
16. How much does knee replacement surgery average cost Delhi?
The cost of knee replacement surgery in Delhi can vary depending on several factors, including the hospital, surgeon's fees, type of implant used, and additional medical services required. It is advisable to consult with the hospital for an accurate cost estimate based on individual circumstances.
17. Will I be able to bend and straighten my knee fully after surgery?
Most patients can achieve a good range of motion and the ability to bend and straighten the knee fully after total knee replacement surgery. Physical therapy and exercises prescribed by the doctor are crucial in restoring flexibility and function to the knee joint.
18. Will I need physical therapy after total knee replacement surgery?
Yes, physical therapy is an essential part of the recovery process after total knee replacement surgery. It helps improve strength, flexibility, and mobility while aiding in a faster and more effective recovery. Also, a prescribed physical therapy plan is important for optimal results.
19. Can I undergo total knee replacement surgery in both knees simultaneously?
In some cases, both knees can be replaced simultaneously, but it depends on the individual's overall health, the severity of knee damage, and the surgeon's recommendation. It is best to consult with a surgeon to determine if simultaneous knee replacement surgery is suitable for your specific condition.