Total Knee Replacement in Amravati | Dr. Nilesh Keche

Introduction

A Total Knee Replacement (TKR) or Total Knee Arthroplasty is a surgery that replaces an arthritic knee joint with artificial metal or plastic replacement parts called the ‘prostheses'. The procedure is usually recommended for older patients who suffer from pain and loss of function from arthritis and have failed results from other conservative methods of therapy. The typical knee replacement replaces the ends of the femur (thigh bone) and tibia (shin bone) with plastic inserted between them and usually the patella (knee cap).

Arthritis

Other causes include:

Trauma (fracture)

• Increased stress e.g., overuse, overweight, etc.
• Infection
• Connective tissue disorders
• Inactive lifestyle e.g., Obesity, as additional weight puts extra force through your joints which can lead to arthritis over a period of time
• Inflammation e.g., Rheumatoid arthritis

In an Arthritic Knee

• The cartilage lining is thinner than normal or completely absent. The degree of cartilage damage and inflammation varies with the type and stage of arthritis
• The capsule of the arthritic knee is swollen
• The joint space is narrowed and irregular in outline; this can be seen in an X-ray image
• Bone spurs or excessive bone can also build up around the edges of the joint.

The combinations of these factors make the arthritic knee stiff and limit activities due to pain or fatigue.

Diagnosis

The diagnosis of osteoarthritis is made on history, physical examination & X-rays. There is no blood test to diagnose Osteoarthritis (wear & tear arthritis).

Benefits

The decision to proceed with TKR surgery is a cooperative one between you, your surgeon, family and your local doctor. The benefits following surgery are relief of symptoms of arthritis. These include:

• Severe pain that limits your everyday activities including walking, shopping, visiting friends, getting in and out of chair, gardening, etc.
• Pain waking you at night
• Deformity - either bowleg or knock knees
• Stiffness

Prior to surgery you will usually have tried some conservative treatments such as simple analgesics, weight loss, anti-inflammatory medications, modification of your activities, canes, or physical therapy. Once these have failed it is time to consider surgery. Most patients who have TKR are between 60 to 80 years, but each patient is assessed individually and patients as young as 20 or old as 90 are occasionally operated on with good results.

Pre-Operation

• Your surgeon will send you for routine blood tests and any other investigations required prior to your surgery
• You will be asked to undertake a general medical check-up with a physician
• You should have any other medical, surgical or dental problems attended to prior to your surgery
• Make arrangements for help around the house prior to surgery
• Cease aspirin or anti-inflammatory medications 10 days prior to surgery as they can cause bleeding
• Cease any naturopathic or herbal medications 10 days before surgery
• Stop smoking as long as possible prior to surgery

Post-Operation Course

When you wake, you will be in the recovery room with intravenous drips in your arm, a tube (catheter) in your bladder and a number of other monitors to check your vital observations. You will usually have a button to press for pain medication through a machine called a PCA machine (Patient Controlled Analgesia). Drain comes out next day evening. Sit out of bed and start moving your knee same day evening and walking starts same day evening or second day morning. Dressing reduced on the second day evening. Your rehabilitation and mobilization will be supervised by a physical therapist. To avoid lung congestion, it is important to breathe deeply and cough up any phlegm you may have. Your Orthopaedic Surgeon will use one or more measures to minimize blood clots in your legs, such as inflatable leg coverings, stockings and injections into your abdomen to thin the blood clots or DVT's, which will be discussed in detail in the complications section. A lot of the long term results of knee replacements depend on how much work you put into it following your operation. Discharge is on 3rd day morning. Discharge on walker progressed on stick on or around 6th or 7th day post op. Stair climbing starts on or around 10th day post op. Bending your knee is variable, but by 6 weeks should bend to 110-130 degrees. Bending range depends upon the pre operative range of patient. The goal is to obtain full functional degrees of movement in total 6-8 weeks. Once the wound is healed, you may shower from next day of stitch removal. You can drive at about 6 -7 weeks, once you have regained control of your leg. You should be going for a walk reasonably comfortably by 6 weeks. More physical activities, such as sports previously discussed, may take 3 months to do comfortably. When you go home you need to take special precautions around the house to make sure it is safe. You may need rails in your bathroom or to modify your sleeping arrangements, especially if they are up a lot of stairs. Basically whatever you sit on should be 22 inches of height for 6-12 weeks You will usually have a 2 week check up with your surgeon who will assess your progress and later at completion of month. You should continue to see your surgeon once a year to check your knee and take X-rays. You are always at risk of infections especially with any dental work or other surgical procedures where germs (Bacteria) can get into the blood stream and find their way to your knee. If you ever have any unexplained pain, swelling or redness or if you feel generally poor, you should see your doctor as soon as possible.

Steps of Knee Replacement Surgery

Step 1 : Removal of worn surface of femur (thigh bone)
Step 2 : Removal of worn surface of tibia (leg bone)
Step 3 : Implantation of 2 part tibial component (leg bone)
Step 4 : Implantation of femoral component (thigh bone)
Step 5 : Preparation and implantation of patella under surface (knee cap)