What is a Total Knee Replacement

What is Total Knee Replacement Surgery?

Total knee replacement (TKR) surgery is a complex orthopedic procedure. It involves the removal of the whole diseased or damaged knee joint and replacing it with an artificial material known as a ‘prosthesis’. The knee joint is the largest joint in your body and is central to nearly every routine activity. The normal knee acts as a hinge joint that connects the upper leg bone (femur), and the lower leg bones (tibia and fibula). 

Your knee joint is susceptible to injuries that can affect your daily routine activities like standing, walking, climbing stairs, and running.  This is due to the severe pain, swelling, and knee stiffness caused by the trauma. 

When traditional non-surgical treatments (anti-inflammatory medications, steroid injections, and activity modifications) fail to provide relief, TKR surgery is recommended.

There are two types of TKR surgeries:

• Traditional TKR surgery
  • Here, the surgeon uses the standard surgical technique.
  • The incision (8 to 12 inches) is made along the front and middle or along the front and side of the knee. 
  • This technique requires 3 to 5 days of recovery in the hospital.
  • Recovery time at home is about 12 weeks.
• Knee arthroscopy- minimally invasive
  • This is a minimally invasive technique, which requires less trauma to the surrounding tissues, less bleeding, and postoperative complications.
  • Incisions made are 3 to 4 inches in length.
  • The duration of hospital stay is reduced with faster recovery.
  • The types of approaches include: 
    • Quadriceps-sparing approach
    • Lateral approach
    • Computer-assisted surgery (CAS)

What are the Indications of TKR Surgery?

The most common indication for TKR surgery is severe knee pain and instability due to arthritis (joint inflammation).

Following are a few conditions that lead to ‘wear and tear’ of the knee joint.

• Osteoarthritis
  • It is age-related wear and tear of the knee joint, commonly seen in patients above 50 years of age.
  • The inflammation causes the cartilage to soften and wear away.
• Rheumatoid arthritis
  • Autoimmune (your immune system attacks healthy cells in your body) and inflammatory disease of the joints, which affect internal organs like the lungs.
• Post-traumatic arthritis
  • Inflammation of the knee joint caused by injury or trauma.
• Knee deformity
  • Deformities of the knee joint can lead to severe pain and loss of cartilage.
• Haemophilia
  • A genetic blood disorder, in which the blood fails to clot.
• Gout 
  • It is a type of arthritis in which uric acid crystals are deposited in the joints.
• Bone disorders
  • A group of disorders which cause unusual and abnormal bone growth.
• Bone necrosis 
  • Bone death in the knee joint leads to the poor blood supply.

How is The Procedure Done?

Total Knee Replacement surgeries are complex procedures that involve the following steps:

• Before the procedure (Pre-procedure)
  • Your surgeon will record your detailed medical and family history for the presence of any debilitating diseases (like diabetes, high blood pressure). You should inform your surgeon about any allergies that you have or supplements that you are on.
  • Your surgeon will conduct a thorough physical examination of your knee joint.
  • You will be asked to sign a consent form that will allow the surgeon to perform the surgery.
  • You will be asked to discontinue the use of blood thinners (anticoagulation drugs) some days before the surgery.
  • You would be asked to follow a diet as advised by your surgeon for a few days before the procedure.
  • You will be asked not to eat or drink 10 to 12 hours before the surgery (fasting from midnight)
• During the surgery 
  • On the day of your surgery, an intravenous (IV) line will be  started, and a urinary catheter will be put in place.
  • Your vitals will be monitored throughout the surgery (temperature, blood pressure, oxygen level, pulse rate, respiratory rate).
  • The surgical site will be cleaned with an antiseptic solution.
  • According to the surgical technique preferred, your surgeon will make incisions to gain access to the patella (kneecap).
  • The patella will be rotated to gain access to the surgical area, and the femur (thighbone)  will be resurfaced to expose the knee joint. 
  • The damaged bone and cartilage will be excised (removed) from the end of the femur. 
  • The first artificial component (the femoral component) will be fixed using bone cement. Next, the shinbone (tibia) will be resurfaced, and the tibial component will be fixed.
  • The bottom portion of the implant (tibial tray)  will be fixed to the tibia and secured using bone cement.
  • Later, a metal-grade plastic would be placed in between, which will act as a buffer.
  • Finally,  the patella will be placed into its normal position. The incision will be sutured with stitches and staples, and bandaged.
  • Your surgeon will bend and flex your knee to ensure your implant is working properly.
• After the surgery (Post-Procedure care)
  • In hospital
    • You may feel mild pain and discomfort, which can be easily managed through pain medications.
    • Your physiotherapist will make you stand and walk on the same day with the help of crutches.
    • Your nurse will help you bathe, a day after your surgery (if the dressing is water-proof).
    • Your physiotherapist will teach you muscle strengthening and stretching exercises which should be continued even after discharge from the hospital.
    • You will likely get a discharge 3 days post-surgery, depending on your recovery rate.
  • At home
    • By 3 weeks post-surgery, you may require less pain medication.
    • Swelling can be easily managed through ice packs, leg elevation, and compression wraps placed around your operated knee.
    • You would be advised to rest and follow properly a nutritious diet plan.
    • Continue the exercises as instructed by your physiotherapist- quad sets, straight leg raises, knee straightening (extension) and knee bending (flexion) exercises.
    • By week 6 you will be able to resume all your daily routine activities, as well as driving.
    • By week 12, you may resume activities like bicycling, swimming, golf, etc.
    • It takes around 3 to 6 months to recover with your knee being as strong as before.

What are the Complications of the Procedure?

The following are complications associated with a TKR surgery

• Complications from anesthesia such as allergic reactions (itching, redness, shortness of breath), vomiting, drowsiness, nerve injury.
• Risk of infection due to bacteria which may enter the knee joint during or after surgery (secondary infections).
• Intense pain which may not subside even after pain medications.
• Unexpected blood loss during the surgery (for this reason blood thinners are stopped for a brief period before the surgery).
• Increased risk of blood clots such as deep vein thrombosis (DVT). 
• Allergic to metal components may lead to severe pain and bruising around your operated knee.
• Knee stiffness, known as arthrofibrosis. This could be due to excessive swelling around the operated knee.

Prognosis 

Most knee replacements are expected to last at least 15 to 20 years. It provides pain relief, improved mobility and a better quality of life. After recovery, you can engage in low-impact activities such as golf, biking, swimming, etc. However, consult your orthopaedic surgeon regarding high-impact activities which require jumping or contact sports. This may require you to wait a little more until your knee joint recovers completely.

Takeaway

Total knee replacement surgeries are common orthopaedic procedures that replace the damaged or worn-out knee joint with a new implant. Even though TKR is a complex procedure, minimally invasive methods used today make it less traumatic and facilitate faster healing and recovery. We at Medfin are dedicated to being with you at every step of your treatment.

Also Visit To Know More About The Cost – Total Knee Replacement Surgery Cost

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