An Overview of Knee Replacement Surgery

Overview of knee replacement surgery

Knee replacement surgery is a common orthopaedic procedure that involves the removal damaged or affected parts of the knee joint and the use of artificial components made of metal and plastic to replace them. The surgery is typically performed under general anaesthesia, and the patient may stay in the hospital for few days to recover.

Knee replacement surgery is most commonly performed on patients with severe osteoarthritis or other degenerative conditions that have not responded to other conservative treatments. The procedure can help to reduce pain and improve mobility, allowing patients to return to their normal activities.

Recovery from knee replacement surgery can take several weeks or months, and physical therapy may be included as an additional treatment option to help strengthen the muscles around the knee and regain range of motion. While knee replacement surgery is generally considered safe, it is important for patients to discuss the risks and benefits with their doctor to determine whether the procedure is right for them.

Anatomy of the knee

In the human body, the knee is the largest complex joint, inter-connecting the thigh bone, also called femur to the shin bone, known as tibia and the kneecap or patella. It is a hinge joint that allows the flexion and extension of the lower leg as well as some rotational movements.

The knee joint is surrounded by a joint capsule, which contains synovial fluid that lubricates the joint and reduces friction. There are four main ligaments that help stabilise the knee.

These ligaments are:

• the medial collateral ligament, also known as MCL
• anterior cruciate ligament, also known as ACL
• posterior cruciate ligament, also known as PCL
• lateral collateral ligament, also known as LCL.

The ACL and PCL cross inside the knee joint, while the MCL and LCL are on the sides of the joint.

The knee also has two C-shaped pieces of cartilage, called menisci, that act as shock absorbers between the femur and tibia. The quadriceps muscles in the front of the thigh and the hamstring muscles in the back of the thigh work together to move the knee.
The knee joint is also divided into three compartments: the lateral compartment (outside the knee), the medial compartment (on the inside of the knee), and the patellofemoral compartment (in-between the kneecap and the front of the femur).

Common knee injuries include ACL and PCL tears, meniscus tears, and patellar dislocation, and fracture. Treatment for knee injuries may include physical therapy, bracing, medication, or surgery, depending on the severity of the injury.

Why is knee replacement surgery required?

Knee replacement surgery, also known as knee arthroplasty, is a surgical method that is advised when the knee joint becomes damaged or worn, causing pain and limiting mobility. It is usually performed on patients with severe arthritis, but it can also be needed in cases of a knee injury, a knee deformity, or any other condition that affects the joint of the knee.
The knee joint is the largest and most complex joint in the body, and it is crucial for movement and stability. Over time, the cartilage that cushions the bones in the knee joint can wear away, leading to bone-on-bone contact and pain. Other common causes of knee damage include rheumatoid arthritis, osteoarthritis, and post-traumatic arthritis.

Knee replacement surgery involves the removal of the damaged cartilage and bone from the knee joint and placement of an artificial joint made of plastic and metal component in the knee. The surgery can relieve pain, improve mobility, and restore the knee’s normal function. Most people who undergo knee replacement surgery are able to resume their normal activities and enjoy a better quality of life.

While knee replacement surgery is generally considered safe and effective, it is a major surgery that carries some risks, such as blood clots, infection, and nerve damage. Patients should discuss the potential benefits and risks of the surgery with their doctor to determine if it is the best course of action for their individual case.

Different types of knee surgery

There are several different types of knee surgery, each with its own specific purpose and techniques. Here are some of the most common types:

1. Arthroscopy: A minimally invasive procedure where a tiny camera is inserted into the knee joint to diagnose and treat various knee problems, such as torn cartilage or damaged ligaments.
2. Partial knee replacement: In this surgery, only the damaged or worn-out part of the knee joint is replaced with an artificial implant.
3. Total knee replacement: This surgery involves replacement of the entire knee joint with an artificial joint. It’s typically used for severe arthritis or joint damage.
4. Anterior cruciate ligament (ACL) reconstruction: A procedure in which a graft is used to replace a torn ACL; the graft is usually taken from the patient’s own body or a donor.
5. Meniscus repair or removal: A procedure to repair or remove a torn meniscus, a piece of cartilage in the knee joint that helps cushion and stabilise the joint.
6. Lateral release surgery: A procedure to release a tight or over-stressed lateral retinaculum, a band of tissue outside the kneecap.

The specific type of knee surgery recommended will depend on the individual patient’s condition and the severity of knee problem.

Different designs used for knee surgery

Here are some common types of knee surgeries and their designs:

1. Total knee replacement (TKR): This surgery involves replacing the entire knee joint with a prosthesis consisting of metal and plastic components.
2. Partial knee replacement (PKR): This surgery involves replacing only the damaged portion of the knee joint with a prosthesis.
3. High tibial osteotomy (HTO): This surgery involves cutting and realigning the tibia bone to shift weight off the damaged part of the knee joint.
4. Anterior cruciate ligament (ACL) reconstruction: This surgery involves using a graft from another part of the body to replace the damaged ACL.
5. Meniscus repair/partial meniscectomy: These surgeries involve either repairing or removing the damaged meniscus (a cartilage that acts as a cushion in the knee joint).
6. Patellofemoral replacement: This surgery involves replacing the kneecap and the groove at the bottom of the thigh bone with a prosthesis.

Risks involved

Knee replacement operation is a common procedure used to alleviate chronic pain and disability caused by joint deterioration or injury. However, like any surgery, it involves certain risks, which include:

1. Infection: The risk of infection is relatively low, but it is one amongst the most serious complications that can occur after knee replacement surgery. Antibiotics are usually given before, during, and after the surgery to reduce the risk of infection.
2. Blood clots: Blood clots in the legs or lungs can occur after surgery, especially if the patient is not able to move around much after the procedure. Blood-thinning medications may be prescribed to reduce this risk.
3. Nerve damage: Nerves around the knee can be injured during the surgery, leading to numbness, weakness, or pain. This complication is rare, but it can be permanent in some cases.
4. Allergic reaction: Some patients may have an allergic reaction to anaesthesia, medications, or materials used during the surgery. This can cause a range of symptoms, including hives, difficulty breathing, or even anaphylaxis.
5. Implant failure: In some cases, the artificial knee implant may become loose or dislocated and even fail to function properly. This can cause pain, instability, or a need for revision surgery.
6. Other complications: Other potential risks include bleeding, heart attack, stroke, or damage to nearby blood vessels, muscles, or bones.

To reduce the risks of knee replacement operation, it is important for patients to carefully follow their surgeon’s pre- and post-operative instructions, report any unusual symptoms or concerns, and attend all follow-up appointments.

Things one should know before the surgery

Knee replacement surgery is a major procedure that involves the replacement of damaged or worn parts of the knee joint with artificial components. Before undergoing knee replacement surgery, a patient typically undergoes several steps to ensure the procedure is safe and effective:

1. Medical evaluation: The patient’s medical history is reviewed, and a physical exam is conducted to assess overall health and any pre-existing conditions that may affect the surgery.
2. Imaging tests: X-rays, MRI, or CT scans may be carried out to determine the extent of joint damage and aid in planning the surgery.
3. Preoperative preparation: The patient may need to stop taking certain medications, adjust their diet, and follow instructions for showering and dressing prior to surgery.
4. Anaesthesia: The patient will discuss anaesthesia options with their surgeon and anaesthesiologist and decide on the best type of anaesthesia for their individual needs.
5. Costs of the surgery: Knee replacement cost in India is high, and one might need proper financial planning in order to undergo the procedure.
6. Education: The patient will receive education on the procedure, expected outcomes, and postoperative recovery process.
7. Rehabilitation: Physical therapy may be recommended before and after the surgery to strengthen muscles and improve mobility in the joint.
8. Planning for aftercare: The patient will need to plan for postoperative care, including transportation, home modifications, and support from family and friends during recovery.

Things one should know during the surgery

Knee replacement operation typically involves the following steps:

1. Anaesthesia: The patient is given anaesthesia to numb the area or to put them to sleep.
2. Incision: An incision is made in the knee area to access the damaged joint.
3. Reshaping of bone: The damaged bone and cartilage are removed, and the bone is reshaped to fit the knee implant.
4. Implant placement: The knee implant is secured to the bone with either cement or a press-fit technique.
5. Joint movement: The new joint is tested for proper movement and alignment.
6. Wound closure: The incision is closed with stitches or staples, and a bandage is applied.
7. Recovery: The patient is monitored in the recovery room, and physical therapy is initiated to promote healing and restore joint mobility.

Knee replacement surgery typically takes a few hours to complete and can be performed as an inpatient or outpatient procedure. The specific steps may vary depending on the patient’s individual condition and the surgeon’s approach.

Things one should know after the surgery

After a knee replacement surgery, the following steps are usually involved:

1. Recovery in the hospital for a few days to monitor for any complications and to receive pain management and physical therapy.
2. Use of assistive devices such as crutches or a walker to help with mobility and balance during the initial stages of recovery.
3. Physical therapy and rehabilitation to help regain strength, flexibility, and range of motion in the knee joint. This may involve exercises, stretching, and the use of specialised equipment.
4. Pain management through medications and other therapies to help manage pain and discomfort during the recovery process.
5. Follow-up appointments with the surgeon and physical therapist to monitor progress and make any necessary adjustments to the recovery plan.
6. Gradual return to normal activities and exercise, with guidance from the healthcare team.
7. Long-term management of the knee joint through regular exercise, weight management, and other lifestyle modifications to help maintain the results of the surgery.

Instructions to be followed post-surgery

After knee replacement surgery, it’s important to follow the doctor’s instructions for a successful recovery. Here are some general guidelines to keep in mind:

• Manage pain: Follow the pain management plan stated by doctor.
• Rest and elevate: Rest and elevate the leg as much as possible.
• Physical therapy: Attend all recommended physical therapy sessions and do the recommended exercises.
• Use assistive devices: Use crutches, walkers, or other assistive devices as instructed.
• Dressing care: Keep the dressing on one’s incision clean and dry.
• Avoid certain activities: Avoid high-impact activities, twisting and pivoting on one’s new knee.
• Follow-up appointments: Attend all scheduled follow-up appointments with the doctor.
• Notify doctor of concerns: Notify the doctor immediately if fever, redness, swelling, or increased pain in the knee is experienced.

How long does the knee surgery last?

The duration of knee replacement surgery can vary depending on several factors such as the type of procedure, the patient’s health status, and the surgeon’s experience. On average, the surgery takes about 1–3 hours, but it can take longer in more complex cases or for revision surgeries.

Knee replacement surgery cost in India

The knee replacement surgery cost can vary greatly depending on factors such as the location, type of surgery, and the individual’s insurance coverage. On average, knee replacement cost ranges from INR 1,50,000 to 3,80,000 in India. It is best to consult with a healthcare provider or insurance company for more specific information.

Takeaway
Knee replacement surgery is a safe and effective treatment option for people with severe knee pain and mobility issues caused by arthritis or injury. It can relieve pain, improve joint function, and enhance overall quality of life. However, it is important to carefully weigh the potential risks and benefits before deciding to undergo this procedure.