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Joint Replacement Knee

Your knee consists of three “compartments” or sections:

  • Medial compartment (inner half of your knee)
  • Lateral compartment (outer half of your knee)
  • Patellofermoral compartment (behind the knee cap)

Osteoarthritis can affect one, two or all three compartments. Osteoarthritis (often abbreviated to OA) is a form of arthritis and a degenerative joint disease characterized by the breakdown and eventual loss of joint cartilage. Cartilage is a protein substance that serves as a cushion between the bones of a joint. With OA, the top layer of cartilage breaks down and wears away, allowing bones under the cartilage to rub together.

What causes osteoarthritis of the knee?

Although the root cause of osteoarthritis is unknown, the risk of developing symptomatic Osteoarthritis is influenced by multiple factors such as age, gender etc. that can affect the shape and stability of your joints.

Other factors can include:

  • A previous knee injury
  • Repetitive strain on the knee
  • Improper joint alignment
  • Being overweight
  • Exercise/sports-generated stress placed on the knee joint

Symptoms of osteoarthritis of the knee include:

  • Pain with standing or walking short distances, climbing stairs, getting in and out of chairs
  • Pain with activity
  • Getting up from a sitting position
  • Sudden pain while sleeping
  • Joint stiffness after getting out of bed
  • Swelling in one or more areas of the knee
  • A grating sensation or crunching feeling in the knee during use

How is osteoarthritis of the knee diagnosed?

Your doctor will begin by reviewing your medical history and symptoms. He or she will observe the natural movement of your knee, evaluate your knee and ankle joint alignment, muscle strength, range of motion and ligament stability in the affected knee. Your doctor may order X-rays to determine how much joint or bone damage has been done, how much cartilage has been lost and if there are bone spurs present. In some cases additional medical imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI) may be ordered for further study of your joint. Your doctor may also order blood tests to rule out other causes of arthritis if required.

How is osteoarthritis treated?

Whether your osteoarthritis is mild or severe, your doctor will most likely recommend certain lifestyle changes to reduce stress on your knee joints such as weight loss. Additional disease and pain management strategies may include: physical therapy, steroid injections, pain medications such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) or topical pain-relieving creams or sprays. Please speak with your doctor if your symptoms aren’t responding to non-surgical solutions, or your pain can no longer be controlled by medication. You could be a candidate for surgery. The most common surgical knee intervention performed for osteoarthritis is a TOTAL KNEE REPLACEMENT. During this procedure, the diseased bone and cartilage is removed and the joint is resurfaced with an artificial implant. This treatment option is usually offered to patients with advanced osteoarthritis of the knee.

Total knee replacement is not always optimal for patients with early- to mid-stage osteoarthritis in just one or two compartments of the knee.

At Vachhani Hospital, we approach your diagnosis and education with open communication and shared decision-making. It is important that you are fully aware of the effects of osteoarthritis, and know all of the options that are available to you.

Traditional Knee Replacement

If it is determined that your knee is too worn, a total knee replacement is the best procedure to treat your arthritic knee. Total knee replacement utilizes precision cutting guides to remove the diseased bone and cartilage from your knee and replace it with an artificial joint. As shown in the picture, an artificial knee consists of a metal cap on the end of your thigh bone (femur), a metal plate on the top of your shin (tibia), and a plastic liner between the two metal parts.  To perform a traditional knee replacement, surgeon use an 8- to 10-inch vertical incision over the front of the knee to expose the joint. The surgeon will then:

Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint.
Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending on the case.
Insert a spacer. A plastic spacer is inserted between the metal components to create a smooth gliding surface.

  • Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
  • Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint.
  • Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending on the case.
  • Insert a spacer. A plastic spacer is inserted between the metal components to create a smooth gliding surface.

you will be up and walking with assistance on the day of surgery or very next day, on the day two you will be climbing up and down the stairs.

You should return to light activity after 3 weeks, and should return to most activities after 3 months. After after 6 months, patients return to full activity and can resume strenuous activities as tolerated. Although the lifespan of a knee replacement is dependent on many factors, a knee replacement should last 15-20 years. Most often, if another operation is required after 15-20 years, it is a simple operation that replaces the worn plastic between the metal parts.

Please call our hospital at +91 7621012785 for more information or make an appointment.

Partial Knee Replacement

Partial knee replacement is an innovative treatment option for those living with mid-stage knee osteoarthritis (OA) that has not yet progressed to all three compartments of the knee. You may be a good candidate for a partial knee replacement if you have:

  • Knee pain with activity in only one part of your knee, usually on the inner knee and/or under the knee cap.
  • X-rays that show arthritis in only one compartment of your knee.
  • Start-up knee pain or stiffness when activities are initiated from a sitting position.
  • Failed to respond to non-surgical treatments such non-steroidal anti-inflammatory medication, therapy and injections.

How does partial knee resurfacing differ from Traditional Joint Replacement Surgery?

In partial knee replacement, only the arthritic portion of the knee is resurfaced. This preserves healthy bone and tissue, giving you more options for the future and a more rapid recovery. Recent advancements in orthopedics have brought revolutionary changes in joint replacement procedures.

How is the procedure performed?

The procedure is performed through a four to six inch incision over the knee. In many case, patients are permitted to walk soon after surgery, drive a car within two weeks and return to normal daily activities shortly thereafter.

Knee Revision Surgery

Hundreds of thousands of knee replacement surgeries are performed in the India each year, and they are highly successful in eliminating pain, restoring mobility and improving quality of life. If a knee replacement is properly done, over 90% of knee replacements will last at least 15 years.

However, problems do occur with knee replacements. When the implant wears out or another problem develops, people often need a second “revision” surgery in which the existing implant or components are taken out and replaced. The surgeon at the Vachhani Hospital is trained in joint replacement and have the expertise and knowledge necessary to evaluate and treat failed or problematic knee replacements. If you have a knee replacement that needs evaluation, we are happy to assist and provide treatment recommendations.

What are the common reasons for revision knee replacement?

  • Loosening of the implant – the knee replacement may become painful after many years because the components have begun to wear and loosen.
  • Fracture – a fall or severe blow can cause a fracture of the bone near the hip or knee replacement that may require a revision of the knee replacement and/or or operative fixation of the fracture.
  • Infection – this can be a very serious complication. If a deep infection develops in a hip or knee replacement, revision is often needed to eradicate the infection and to implant new non-infected components.

Be aware of warning signs that there may be a problem, such as pain that comes on suddenly, trouble walking, a sensation that the knee replacement is loose, or increased swelling or fluid in your knee.

A revision joint replacement is more complicated than the initial operation.

How can you make the replacement last longer?

  • We advise patients to avoid high impact activity such as running, which can shorten the lifespan of the joint replacement. Walking or biking for exercise is better than running.
  • Maintain a healthy weight. Being overweight, especially obese, is a main factor in developing arthritis in the first place. People who are overweight are more likely to experience loosening of an implant.
  • Once the initial healing has taken place and discomfort has diminished, see your orthopedic surgeon if pain develops suddenly. Do not wait to have a problem evaluated.
  • If you develop a bacterial infection in another part of your body after joint replacement, be sure to see your doctor for appropriate antibiotics.
  • Pay a visit to your orthopedic surgeon every few years after hip or knee replacement, even if the joint feels good. The physician can check for early loosening of the implant or another minor problem before it causes a major headache, such as dislocation.

Muscle Sparing Approach to Knee Replacement

Dr. Vivek Vachhani is expert in the “subvastus” muscle sparing approach. We are one of the only practices in the Gandhinagar and Ahmedabad that utilizes this technique. The muscle sparing or “subvastus” technique combines minimally invasive instruments with a surgical approach that leaves key muscles and tendons intact. Instead of cutting the quadriceps tendon, surgeons make a 3-5 inch incision on the knee and split or dissect under a single quadriceps muscle. Because no major tendons or muscles are cut, recovery is faster and less painful.

The main potential benefits of quadriceps-sparing total knee replacement include:

  • More rapid return of knee function. Patients who undergo this procedure seem to get muscle strength and control back more quickly than patients who have had traditional total knee replacement. This is because the quadriceps muscle and tendon are not divided in the course of the surgical exposure like in traditional knee replacement and the kneecap is not everted (flipped out of the way) as it is in traditional total knee replacement.
  • Decreased post-operative pain. This is a function of the smaller incision and the fact that the incision stays out of the important quadriceps muscle/tendon group.
  • Same reliable surgical implants as Traditional Knee Replacement. Much has been learned about implant design in the nearly 40-year history of contemporary knee replacement. Minimally-invasive quadriceps-sparing total knee replacement is an evolution of surgical technique which permits the use of time-tested implant designs. This gives some reassurance that while the surgical approach is new the implants themselves have a good proven track record.

What to Expect Before Knee Replacement Surgery

Joint replacement can help relieve pain and enable you to live a fuller, more active life. If you are deemed a good candidate for joint replacement and decide to have surgery, it is good to be prepared, both mentally and physically before surgery. Planning ahead for the challenges of surgery and recovery will help ensure a more successful outcome. Below are answers to some frequently asked questions before surgery:

  • What tests are needed before surgery? Prior to knee replacement, you will complete a variety of tests such as x-rays, and ECG, and blood tests. These medical studies ensure that you are healthy enough for surgery and enable your providers to ensure the best care after surgery.
  • What type of anesthesia will I receive? Most of our patients receive a spinal block and intravenous sedation for knee replacement surgery. This combination ensures a safe and rapid recovery with a lower likelihood of nausea and vomiting, respiratory complications, prolonged sedation, and other issues often seen with general anesthesia.
  • What type of implant or prosthesis will be used? We use implants with a design that has been shown to have good long-term survival. If you want specific brand names please discuss this with your surgeon before surgery.
  • How long will I stay in the hospital? Most patient stay in the hospital 3-4 days following knee replacement. The majority of patient will go home on day 4 and will continue physiotherapy at home.
  • How long will my recovery take? Most patients will obtain almost full recovery by 3 months after surgery. We advise you avoid high-impact activities such as running after a knee replacement. If you have a sedentary job, you should be able to return to work within 3-6 weeks. More physical jobs often require more time off for recovery.
  • How will my pain be managed after surgery? We use “multimodal” pain management, meaning that we use a combination of medications such as opioid analgesics, and anti-inflammatories as well as ice to control your pain.
  • Do I need physical therapy before surgery? Formal physical therapy is not required before surgery, but physiotherapy done before surgery helps shorten your recovery time.
  • What medications should I stop taking before surgery? You will stop all medications that thin your blood 3 days before surgery such as aspirin and clopidogrel.
  • What if I smoke or drink alcohol? If you smoke, cut down or quit. Smoking affects blood circulation, delays healing and slows recovery. Eat a nutritious, well-balanced diet. If you drink, do not consume any alcohol for at least 48 hours before surgery. If you use any other types of controlled substances, tell your doctor. Narcotics and other drugs can cause complications and impact your surgery.

What to Expect After Knee Replacement Surgery

The day after surgery, you will begin working with physical therapy to become comfortable using your new knee. They will begin basic movements and walking with either a walker or crutches. You will also be started on a “motion machine” called a CPM that helps to decrease swelling and maintain motion in your knee. Physical therapy is a critical component of your recovery, helping to restore joint strength and mobility.

Joint replacement is major surgery and your recovery will take several weeks, but there are steps you can take now to make your time at home safer and more comfortable:

  • If you live alone or have special needs, arrange for someone to drive you home from the hospital and stay with you for several days after your surgery. Do not drive until cleared by your surgeon.
  • Place items that you use frequently within easy reach.
  • Use a walker or pair of crutches to see how well you can maneuver through your home. You may need to rearrange furniture or temporarily change rooms (make the living room your bedroom, for example).
  • Remove any throw or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
  • Consider modifying your bathroom to include a shower chair, gripping bar, or raised toilet seat. Place items that you use frequently within easy reach so that you do not have to reach up or bend down.