Total knee replacement – what you can expect in three months?

Contrary to public perceptions, driven mainly by apprehensions of outcomes and cost, the number of patients opting for total knee replacement continues to increase in India. It is estimated that more than 1,20,000 patients undergo knee arthroplasty to overcome severe mobility issues arising out of diseased joints. The procedure has undergone massive changes in protocols, with advanced techniques eliminating discomfort and pain significantly. Here is an expert look at the procedure, and the outcomes that one can expect over three months.

The surgery involves removal of parts of the knee joint that are either diseased or damaged, and replaced with artificial parts made of metal or outcomes that one can expect over three months.

Different types of knee replacement procedures

Before we look at details it is important to answer a simple question that we encounter routinely at the department of orthopedics – what are the different types of knee replacement surgery? Essentially, there are two types of replacement surgery; total and partial. Out of these two types, the former is more common, with a smaller section of beneficiaries choosing the latter. The human knee comprises three distinct sections – the inside, the outside and the portion beneath the knee cap. Full knee replacement surgery fixes all the three sections, while the partial replacement fixes a single section.

Total knee replacement is often the last resort

The replacement procedure, in most instances, is not the first choice, but the last resort after other options have failed. For instance, in most cases, the procedure is chosen after other options precede it and have failed in delivering relief. If you have tried out the following and still do not experience partial/full relief, then you could be a candidate for replacement, depending on the condition and suitability.

• Have you tried physical therapy to strengthen the muscles with little effect on pain or mobility?
• Have you been prescribed cortisone shots and drugs that have only offered temporary relief?
• Have you undergone knee arthroscopy and still experience difficulties?

If the answer to the above is Yes, and if the condition is severe, you could consider replacement. It is important to note that replacement is always the last resort. In exceptional circumstances such as trauma or advanced knee disease, replacement may be the only option.

What diagnostics are usually carried out to determine the need or suitability?

Now that we have the basics behind us, it is time to look at the diagnostics required to determine if you need a replacement or if you are suitable for the surgery. Recommendations typically involve a careful screening of medical history, and detailed counselling to determine if the knee problem is severely impacting routine. The surgeon would typically assess if the condition is likely to degenerate or if it can be managed with suitable changes. The assessment will look at the underlying cause of the condition, in addition to carefully examining various parameters such as stability, strength, and the ability to move the knee.

Following this, diagnostics such as X-ray and MRI are used to visualize the anatomy of the knee and to understand the cause of the condition. While there are claims that MRI scans will not help to understand knee complications, it is not entirely true. There are documented studies that prove that MRI scans have revealed findings that are significant in the treatment of knee issues. It is quite likely that MRI scans may help the surgeon to understand that replacement is not required, or vice versa.

Pursuant to the recommendations of the surgeon for the procedure, tests are performed to check if you can undergo the procedure. This includes blood tests, and a dental examination. To many, the suggestion of a dental examination may appear unconnected, however, this is necessary in terms of preventing infections.
The next test is an electrocardiogram that is conducted to check if the heart of the patient is strong enough to undergo the surgical procedure. Finally, a thorough physical examination is also performed to check the overall health of the patient.

What kind of anesthesia is used during surgery to replace knee?

Depending on the condition, and the health of the patient, the procedure may be performed either under general anesthesia or it could also be performed under epidural or spinal anesthesia. Studies have documented that epidural anesthesia comes with clear advantages of lesser complications, such as infections, and blood transfusions. However, suitability and selection are governed by multiple parameters as assessed by the specialist.

At Lords Hospital, the department of orthopedics conducts specialized knee replacement procedures, with impressive outcomes. In addition to being a pioneer of advanced procedures, our patient centric approach and state of the art equipment continue to help us bring relief and smiles to patients who trust the legacy of Lords Hospital.
This is a two-part article on complete knee replacement. The next part will cover details about the procedure and the post-operative care required after the procedure; including the three-month timeline for getting back to routine activities.