Total Knee replacement in HSR layout
Total Knee Replacement
It is very apt and precise to name this Surgery as Knee Resurfacing Proceedure as this involves only scraping and resurfacing of worn out areas of Knee joint and replacing with metal alloy caps and Ultra High Molecular Weight Polyethylene. So, one myth which can be ruled out is bones are not cut, but only scraped. Joint replacement surgery is one of the most successful option to treat osteoarthritis. It is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities. More than 95% of people who have undergone a total knee replacement surgery experienced a dramatic reduction in knee pain and a significant improvement in performing common daily living activities.
The procedure may also involve replacing the under-surface of your kneecap known as patella) with a smooth plastic dome. Although it is preferred to preserve the natural patella if possible, but at times the conditions may require replacement and this can be decided only during the procedure.
In a normal course the new metal alloy parts are normally cemented in place. In the event cement is not used then the surface of the component facing the bone is textured or coated to encourage bone to grow onto it, leading to a natural bond.
Alternately a mobile plastic bearing is placed, which isn’t firmly fixed to the metal parts. This potentially could reduce the wear on your new joint.
What happens during Surgery??
Once surgery is planned, patient will be given an option whether to opt for regional spinal anaesthesia ( Injection given to lower back and patient will be awake through out surgery) or General Anesthesia ( Patient will be made unconscious). Minimally invasive fast track knee replacement mainly involves 6-10 cm of incision ( skin cut) to open your knee joint & scrape worn out cartilage and bone. Accurate measurements are done to size your bone and apt sized metal alloy caps are fixed to both scraped thigh bone and shin bone ends. An ultra high molecular weight polyethylene spacer is placed between the metal caps which acts like a cushion.
What happens after Surgery??
The patient spends a couple of nights in the hospital. During the hospital stay, you will be given antibiotics and pain-relieving medication and monitor you for complications. Shortly after the operation, our team’s Physiotherapist will start helping with, weight-bearing therapy, including standing and walking, a combination of physical and occupational therapy to help you. Patient will be made to walk the same day and will be able to independently carry out all routine daily activities like walking to washroom from the day of operation. Before you are discharged you will be thorough with 5-6 important exercises which are supposed to be done at home by yourself.
Resuming Activities??
You should resume most routine activities of daily living ( like going to washroom, walking around inside home) from the day of operation. So, Knee replacement doesn’t involve any bed rest until and unless your knee arthritis is neglected for so many years resulting in very weak knee muscles. It’s important to follow your exercise and rehab program without overexerting yourself. Most people with sedentary employment can return to work after 4-6 weeks, but if your job involves heavy lifting, you may need to wait 3 months to resume work. You can resume driving after 4-6 weeks of time depending on your quadriceps strength.
When can Knee Replacement Surgery go wrong??
Although most total knee replacements are very successful, over time problems such as implant wear and loosening may occur which requires a revision procedure to replace the original components. Infection also sometimes plays a spoilsport.
Implant Loosening & Wear-
For a knee replacement to work properly over years, an implant must remain firmly attached to the bone. During the initial surgery, implant is cemented to the bone and is firmly fixed. Over time, however, an implant may loosen from the underlying bone, causing the knee to become painful.
The cause of loosening is not always clear. High-impact activities, excessive body weight, and wear of the plastic spacer between the two metal components of the implant are few factors that may contribute. Younger patients, when they undergo knee replacement, may “outlive” the life expectancy of their artificial knee due to their high activity level and may require revision knee replacement over time.
One of the hypothesis for this loosening is tiny particles which arise out of plastic liner over time may accumulate inside the joint and trigger body’s immune system. Chemical mediators of this reaction can gradually lead to osteolysis ( destruction of bone around the implant) and loosening.
Infection –
Infection is a potential complication in any surgical procedure, including total knee replacement. If proper aseptic precautions are taken during skin preparation and surgery, chances of infection are very less. Unfortunately, even after taking strict precautions sometimes infection sets in due to the virtue of patient’s immune factors. Infection may occur while you are in the hospital or after you go home. It may even occur years later. If an artificial joint becomes infected, it may become stiff and painful. The implant may begin to lose its attachment to the bone. Even if the implant remains properly fixed to the bone, pain, swelling, and drainage from the infection may make revision surgery necessary.
Instability-
Two main ligaments around your knee (MCL & LCL) are involved in balancing the knee joint after Knee replacement. Knee implants are designed to work with the patient’s existing ligaments. Balancing these ligaments at time of surgery is very much essential in providing good stability and longevity to the Knee joint. Improper balancing leads to instability and loosening of implant. Most of the cases can be managed by physiotherapy, where as few cases need revision surgery.
Stiffness-
Sometimes due to development of extra scar tissue in and around the joint after surgery knee joint becomes very stiff and mobility gets hampered. Not following physiotherapy protocols in the initial weeks of surgery is one of the reasons for the development of scar tissue. Most of the cases of stiff knee can be managed by physiotherapy, where as few cases required revision surgery.
Fractures-
Osteoporotic bones around knee implant can sustain fracture due to fall. The plan of management here depends on the type & location of fracture, patient’s bone quality and stability of the implant after fractures. Few cases can be managed with fixation of fracture with plate, where as cases where the bone surrounding implant is shattered and destroyed with implant loosening, need revision surgery with a larger revision knee component.
Experience advanced total knee replacement at Dr. Shetty’s Center of Orthopaedics in HSR Layout, Bangalore. Trust Dr. Akshay Shetty, renowned orthopedic surgeon, for effective treatment and personalized care.