Simply put, any patient who has advanced arthritis of the knee due to any reason , in whom the pain and swelling is not responding to other means of treatment including medicines, physiotherapy, injections etc. and in whom the symptoms are affecting the quality of life and not allowing activities of daily living needs a knee replacement surgery

As a general dictum we try to postpone the knee replacement surgery as much reasonably possible. However the decision of surgery has to be made as per the symptoms and age is secondary.

Post surgery one can expect relief of pain, correction of limb deformity, being able to do activities of daily living without any discomfort

Not anymore. With use of regional anaesthesia, local anesthetic blocks and a combination of new pain killer medicines, pain can be controlled more effectively than before. Aggressive rehab with pain control further enhances recovery of patient

No surgery is free of complications. However the knee replacement surgery has stood the test of time and has given consistent results over more than 30 years now. The surgery has consistently maintained a success rate of 98-99% at 10 years and around 95% at 15 years.

Complications that may be associated are as follows :

• Infection- Infection is a known complication post operatively . World wide the infection rates are noted to be around 1.5%. As a surgeon one takes utmost care to make sure that infection is avoided.
• Deep Vein Thrombosis (DVT) – This is an uncommon complication wherein there is formation of blood clots in the deep veins of the leg which in turn results in pain and swelling of the lower limb. Rarely the clots migrate to the veins of the lungs leading to pulmonary embolism. However in our peri operative protocols we take utmost care to avoid DVT. Early mobilisation, Blood thinner injections/ medicines , faster rehab protocols have reduced the world wide incidence of this problem.
• Wound healing problems- This is generally seen in patients who have an underlying risk factor like morbid obesity, smoking, anaemia, protein deficiency , previous surgeries etc. As surgeons we identify the risk factors and take utmost care peri operatively to prevent this issue.
• Medical complications- These are the rarest of the rare and include cardiac issues like post op Myocardial Infarctions, strokes etc. These are best prevented. Pre operative work up, optimisation of the patient, protocol based monitoring and management of the patient by the surgeon and the anaesthetist and close monitoring post operatively by a physician help to avoid these problems. Knee replacement surgery should therefore be undertaken in facilities where these issues can be identified and tackled at the earliest. Availability of ICU back up in house is therefore important.

A variety of implants are now available in the market. All have their own design rationales, advantages and indications. Choice of implant is a combined decision of the surgeon and the patient as per the patient need

The aim of surgery is to make it as long lasting as possible. With that in mind following activities are discouraged. Sports , jumping, running , skipping, cross legged sitting, squatting and using the Indian style toilets. Cycling, swimming, short treks, brisk walking is perfectly fine

Immediately after surgery- Good rehabilitation and physiotherapy is essential for getting a good outcome after surgery. Bathing is not allowed till sutures are removed. Follow the instructions of your surgeon carefully. Sudden increase in pain, fever, increase in joint swelling, has to be immediately reported

Long term- Maintain a daily routine of walk/exercises. Avoid sports, jerky movements and activities with risk of injury. Cycling, swimming, walking are perfectly fine. If undergoing any other surgery, dental procedure or you have any other systemic infection, its important to let your doctor know that you have undergone knee replacement and take antibiotics as early as possible.

Yes. With proper pre operative optimization and peri operative care patients with these problems can safely undergo knee replacement surgery

After your decision to go in for a knee replacement you should be aware of the basic things to be done before surgery. Such as –

• Suitable prosthesis for you as decided by the surgeon and the patient
• The cost of your prosthesis.
• Total Hospital stay & cost of hospital stay.
• Routine pre operative Blood, Heart , Urine and Chest investigations.
• Get this investigations 2-3 weeks before the date of surgery & get them checked by a physician who then certifies the patient fit for surgery
• It is necessary to confirm that there is no active infection in your body.
• If you have mediclaim facility, you should contact hospital’s mediclaim department at least one week before surgery with your policy documents.
• You should show the drugs which you are already taking. Some types of medicines like steroids & blood thinning medicines are to be stopped 5-7 days prior to surgery.
• For admission in hospital take admission letter from your surgeon.
• You may advised to get admitted 1-2 days prior to the surgery. Take all investigations report, previous medical records & drugs with you.

Yes . In fit patients where all the parameters of selection are fulfilled , they can undergo simultaneous bilateral knee replacements . However this can be done only in limited patients and is not an assumption. In other patients the second surgery can be done after an interval of two days in the same admission or can be done later at six to twelve weeks durations

Partial or unicompartmental knee replacement is basically where only half the knee which is arthritic is replaced as against a total knee replacement where the entire knee is replaced. However this requires that the other half of the knee is normal and the soft tissues like menisci , capsule and ligaments are near normal. It works only in selected patients