General introduction

Total Knee replacement is a operative procedure that decreases pain and improves the quality of life in many patients with severe arthritis of the knees. Typically patients undergo this surgery after non-operative treatments have failed to provide relief of arthritic symptoms. Non-operative treatments can include activity modification, anti-inflammatory medications, and knee joint injections.
i have been performing knee replacements since long time generally with excellent results; most reports have ten-year success rates in excess of 90 percent.
Broadly there are two types of knee replacements:

* Total knee replacements and unicondylar or partial knee replacement Both have very good track record

Total Knee Replacement

Total knee replacement involves a 6-7 inch incision over the knee, a hospital stay of 3-5 days, and a recovery period (during which the patient walks with a walker or cane) typically lasting from one to three months. lot of patients report substantial or complete relief of their arthritic symptoms once they have recovered from a total knee replacement.

Partial Knee Replacement

Unicondylar (partial) knee replacements are Less invasive techniques are available to insert these smaller implants but only a minority of knee replacement patients are good candidates for this procedure.

Severe Arthritis Of The Knee Pain

Pain is the most coomon symptom of knee arthritis. In most patients the knee pain gradually gets worse over time but sometimes has more sudden “flares” where the symptoms get acutely severe. Pain getd worse after walking

Stiffness

Difficulty in standing after rest and also difficulty in getting from bed in mornings

Swelling and Warmth

Some swelling and warmth are common recurrent flares because of swelling of layer around knee called synovium and severe swelling and fever and other signs are emergency could be infectious arthritis needs immediate attention

Location

The knee joint has three “compartments” that can be involved with arthritis. Most patients have both symptoms and findings on X-rays that suggest involvement of two or more of these compartments; for example, pain on the outer side and beneath the kneecap .Patients who have arthritis in two or all three compartments, and who decide to get surgery, most often will have to undergo total knee replacement.

Types of knee arthritis

Osteoarthritis

Osteoarthritis is the most common form of arthritis effecting majority . OA may affect multiple joints or it may be localized to the involved knee. Activity limitations due to pain are the hallmarks of this disease.OA patients who have symptoms limited to one compartment of the knee sometimes are good candidates for unicondylar knee replacement

Other form

Rheumatoid , inflammatory arthritis , gout and other forms . these forms effects joint completely and often needs medications initially and if not relieved by medication may need total knee replacement.

What is total knee replacement who needs it?

total knee arthroplasty (TKA) or total knee replacement (TKR) is a common orthopaedic surgery that involves replacing the articular surfaces (femoral condyles and tibial plateau) of the knee joint with smooth metal and highly cross-linked polyethylene plastic TKA aims to improve the quality of life of individuals with end-stage osteoarthritis by reducing pain and increasing function. The number of TKA surgeries has increased in developed countries, with younger patients receiving TKA.

During surgery

  •  There is at least one polyethylene piece, placed between the tibia and the femur as a shock absorber.
  • The prostheses are usually reinforced with cement, but may be left uncemented where bone growth is relied upon to reinforce the components.
  •  The patella may be replaced or resurfaced. Patella reconstruction aims to restore the extensor mechanism.
  •  A quadriceps-splitting or quadriceps-sparing approach may be used.
  •  The cruciate ligaments may be excised or preserved.
  •  There are different types of surgical approaches, designs, and fixations.
  •  A unicondylar knee replacement may also be performed depending on the extent of disease.
  •  Several options of anaesthesia are available, and include regional anaesthesia in combination with local infiltration anaesthesia, or general anaesthesia in combination with local infiltration anaesthesia, with the possible addition of peripheral nerve blocks to either option. A tourniquet may sometimes be used during surgery.
  •  Computer-assisted navigation systems (CAS) or robotic surgery have been introduced in TKA surgery to facilitate surgeon hand motions in limited operating spaces (prospective studies on long term functional outcomes are needed). It allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques.CAS are usually associated with minimally invasive surgery (procedures performed through tiny incisions). It is also sometimes used in certain traditional open surgical procedures.

Who needs TKA

PATIENTS with pain effecting their activities of daily living like standing for half hour or more, walking for short distances like 500 metres., need of pain killer medications daily , and disability and pain since long duration typically months to years.

Post surgery physio

Physio is a part of recovery process and typically lasts for three weeks and to six weeks. Its very important to undergo supervised physio for first few weeks for early recovery.

Discharge:
Patients are usually discharged from the hospital in three days in case of one side surgery or in case of two sided surgery they typically get discharged by 6 th day

Complications:

following TKA surgery, these complications may occur:

  • Infection
  • Nerve damage
  • Bone fracture (intra-operative or post-operative)
  • Persistent pain
  • DEEP VEIN THROMBOSIS (DVT)
  • A common complication after knee or hip replacement surgery that can cause significant morbidity and mortality
  • Incidence of DVT after knee or hip replacement has been reported at 18%
  • Larger studies have reported that patients with hypercoagulable diagnosis / conditions are at greater risk of DVT within 6 months of joint replacement surgery
  • Stiffness
  • Most common complaint following primary TKA
  • Stiffness causes significant functional disability and lower satisfaction
  • Females and obese patients are reported to have increased risk
  • Evidence does not recommend routine use of continuous passive motion (CPM) as long term clinical and functional effects are insignificant and not superior to traditional mobilisation techniques
  • Prosthesis-related complications: loosening or fracture of prosthesis components, joint instability and dislocation, component misalignment and breakdown
  • Total knee replacement is a reliable surgical technique in which the painful arthritic surfaces of the knee joint are replaced with well-engineered bearing surfaces. Pain is substantially improved and function regained in more than 90% of patients who have the operation.