Knee replacement surgery: What you need to know

About knee replacement surgery

Knee replacement, alternatively called knee arthroplasty, refers to the surgical procedure to repair the knee joint and set right the damage caused by arthritis.

Knee replacement surgery uses a prosthesis, an artificial joint with metal and plastic components. This surgery is performed on patients who have suffered a severe knee injury or arthritis.

Many types of arthritis affect the knee joint.  Osteoarthritis, which mostly affects older and middle-aged adults, is a degenerative disease of the joints. This condition causes the cartilage in the knees to weaken and break down.

Rheumatoid arthritis is a condition caused due to excessive synovial fluid.  Inflammation of the synovial membrane can lead to stiffness and pain.  Arthritis that arises due to injury or trauma to the cartilage in the knee can cause pain and stiffness.

The objective of a knee replacement surgery is to alleviate knee pain that does not respond to any other form of treatment by resurfacing knee parts. Adults between 70 to 80 years are the most likely candidates for successful knee replacement surgery.

Types of knee replacement

• Partial knee replacement
• Total knee replacement
• Complex or revision knee replacement
• Knee cap replacement

Reasons for the procedure

Treatment for disability and knee pain finds a solution with knee replacement surgery. Osteoarthritis happens to be the most common condition that demands knee replacement surgery. In patients suffering from osteoarthritis, the joint cartilage gradually undergoes damage. This breakdown of joint cartilage can result in pain and restrictive movement.

Patients suffering a chronic and degenerative joint disease will not be able to perform normal activities such as climbing stairs or even walking. Patients suffering from this condition will experience a lot of pain. There could be inflammation at the knee and the area may swell up.

Rheumatoid arthritis can also cause degeneration of the knee joint. Further, arthritis that results due to injury to the knee can also lead to knee joint damage. Some other reasons for permanent damage to the knee joint could be ligament tear, torn cartilage, and fractures.

Doctors may recommend other forms of treatment such as reduction in weight, to reduce the stress on the knees. If other forms of medical treatment such as medications for pain, and anti-inflammatory treatment, have not yielded results, doctors recommend knee replacement surgery.  If the use of cortisone injections in the knee joint, physiotherapy, or the use of assisted devices is not satisfactory, knee replacement surgery may be an effective treatment.

Complications of knee replacement surgery

All types of surgery are not hundred percent free of risks or complications. Few complications of knee replacement surgery are as follows:

• Infections
• Stiffness and pain
• Blood clots in the legs or lungs
• Bleeding
• Prosthesis become worn out
• Loosening of prosthesis
• Loosening of replacement knee joint
• Inefficient working of knee joint
• Dislodged knee joint
• Numbness or loss of strength in the area of surgery due to injury to blood vessels and nerves

Reasons when knee replacement is not possible

Patients, whose arthritis is very severe, definitely need knee replacement surgery. Yet, there may be factors that make it impossible for them to undergo this procedure.

Some of the reasons are:

• Deep sore in the skin beneath the knee, which can increase risk of infection
• Weak quadriceps that cannot adequately support the knee joint in the event of a surgery

Preparation

• The surgeon will explain the procedure and you will be given an opportunity to clarify any questions
• Your doctor will want to know the complete medical history. Mandatory diagnostic tests will be required. A physical examination is also on the cards to ascertain everything is okay before the surgery
• Your surgeon needs to know about all the medicines and supplements you are on- both over the counter ones and those prescribed. Information of adverse reactions to any medication or allergy to a medicine or anaesthetic should be passed on to the surgeon
•  If you are on a blood thinning medication and suffer  from a history of bleeding disorders , your surgeon needs to know, so that the team can adequately prepare for the surgery
• Inform your doctor if you are pregnant or suspect the condition
• You will need to stop eating food at least eight hours before the surgery. Doctors may prescribe a sedative to aid relaxation before the procedure

Doctors do conduct a preparatory session with the patients to prepare them for knee replacement surgery. During the session, they advise patients on post-operative care, what to expect before and after the surgery. It is at this time that you can ask all the questions you have and clarify all the concerns regarding knee replacement surgery.

Further, patients can also plan for post-operative convenience at home such as having someone to help. Ensuring that the home is skid-proof, especially the washrooms, and support in the toilet can help reduce stress and pressure on the knee during the recovery phase.

The preparation will also involve discussion with the anesthesiologist.

Types of prosthesis

The prosthesis is generally made of metal and plastic. Cobalt chromium or titanium-based alloys make up the metallic part of the prosthesis. Plastic components are actually medical-grade polyethylene. The implants are typically about 15  to 20 ounces in weight.

Some implants can also be a combination of ceramic and metal. The prosthesis is made up of three  components:

1. Tibial component : used to resurface the top part of shin bone or tibia
2. Femoral component  : helps  resurface the last part of the thighbone
3. Patellar component: helps resurface the lower part of the kneecap. This part rubs against the thighbone

Knee replacement procedure

You will need admission and stay in a hospital for knee replacement surgery. The procedure may differ according to the extent of your condition and the method adopted by the surgeon.

Mostly knee replacement surgery is conducted under general anaesthesia.

The procedure will follow a structured process as mentioned below:

• At first you will have to change into a hospital attire or gown
• The nursing assistant will fix an intravenous link in your arm before wheeling you into the operation room. They may also fix the urinary catheter for you before the start of the surgery. The assisting team will position you and keep everything ready for the surgery
• The area of surgery will be cleaned and hair will be removed if there is an overgrowth. The whole area will be sterilised with the use of an antiseptic solution
• The parameters will be continuously monitored such as blood pressure, oxygen level in the blood, breathing, and heart rate
• The surgeon will make an incision in the area earmarked on the knee. Next the surgeon will do away with all the damaged surfaces in the knee . The knee joint will be resurfaced with the prosthesis.
• The knee prosthesis is of plastic and metal.  Doctors mostly employ the cemented prosthesis and this happens to be the most common type of artificial knee prosthesis. The uncemented variety is not popular.
• The surgeon uses surgical cement to attach the prosthesis to the bone. Surgeons sometimes use a combination of cemented and uncemented prosthesis in knee replacement surgeries.The prosthesis which does not have surgical cement gets attached to the bone along with a porous surface. The bone grows and then attaches to the prosthesis.
• Surgeons close the incision using surgical staples or stitches. To remove fluid, a drain is positioned at the site of incision. The area is bandaged and dressed  to keep it sterile to cut the risk of infection

Post-op care and things to keep in mind

Once the surgery is over, you will be shifted to the recovery room.  This is the period when the healthcare team will observe all the vital parameters such as pulse, breathing, blood pressure, and heart rate. Once everything is stable, you will be moved to your hospital room where you need to stay for a few days.

The physiotherapist will help you with an exercise program during the recovery period both at the hospital and at home. The joint needs to be moved after the surgery. The therapist will use a CPM or a continuous passive motion machine to start the physiotherapy.

This machine will enable movement of the knee as you rest in bed. Medicines to control the pain will be given. Once the recovery is good, you will be allowed to go home although the physiotherapy will need to be continued until the muscle gains strength and a considerable range of motion.

Post-op care at home is as follows:

• You will need to keep your legs in a raised position at home. This will reduce swelling.  If swelling persists, doctors may ask you to keep ice on the knee
• Ensure the surgical area is clean and dry. Care should be taken while bathing
• The doctor may also recommend a pain reliever for pain relief. It is important to take only the medicines advised by the doctor as some medications may elevate the risk of bleeding
• Diet advisory is balanced and normal.  Driving is not recommended for several months. Exercise is as advised by the physiotherapist. Strenuous exercise is forbidden
• Protect yourself from falls. This can cause a huge setback to the knee replacement surgery as it can injure the new joint. Use of an assistive device is recommended by doctors till such time the knee gains its strength and there is an improvement in balance

Small changes to your home can help during recovery. These modifications are:

• An elevated toilet seat to avoid any strain on the knee
• Stair case with strong handrails
• Bath and shower with fitment of safety handrails
• A chair in the shower
• Ensure the floor is free without cords going across
• Do not climb stairs till your doctor permits

It is important to seek medical attention in the presence of the following symptoms:

• Extreme pain at the site of incision
• Bleeding  from the incision site
• Fever
• Redness
• Draining from the site of incision

Best option

Patients must always choose the healthcare services based on a team of expert surgeons and physiotherapists with a good record of accomplishment of successful surgeries. It is important to get a complete solution to knee problems.

goficure offers healthcare services that include everything from consultation to surgery and post-op recovery. We schedule all your appointments, and support you through the procedure, handle the logistics of transportation during consultation and surgery, resolve insurance claims, and offer a pillar of support until complete recovery.

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