By: Dr Anil Arora (Head of Unit and Lead Consultant,Department of Orthopaedics Max Super Speciality Hospital, Patparganj, Delhi)
What is Total Knee Replacement?
Total Knee Replacement is a surface replacement where only the damage surface of the thigh bone, leg bone and often the underside of the knee cap are replaced. The new joint has a metal shell on the thigh bone. A metal plate with a polyethylene insert on the leg bone and polyethylene button on the knee cap.
What are the types of Total Knee Replacement?
Besides conventional Total Knee Implant, high-flex Gender specific knee are also available. These varieties of knee have shown equally good results. Now for Unicompartmental Arthritis, Unicondylar Knees are available which replace only one compartment of the Knee joints.
Who needs a Total Knee Replacement?
- A patient with osteoarthritic (degenerative) knee with pain severe enough to restrict activities of daily living.
- A patient with osteoarthritis knee requiring daily intake of analgesics (pain killers).
- A patient with osteoarthritis knee causing stiffness/instability/marked deformity.
- Any inflammation disease like Rheumatoid Arthritis or its variant, or Ankylosing Spondylitis leading to sever degeneration of knees.
- Deranged knees following injury.
Who should carry out Total Knee Replacement and where?
Ideally, Total Knee Replacement should be done by a well qualified and trained surgeon for joint replacement surgery. The operating theatres should provide ‘Ultra Clean Air” with ideal parameters (Exponential Laminar Airflow) where air is changed 25 times per hour. The delivered air is treated by special HEPA (High Efficiency Particulate Air) filters with 99.99% efficiency so that the change of infection is reduced to the level of <1%.
Is blood transfusion required in Total Knee Replacement?
Majority of Unilateral Knee Replacement do not require blood transfusion because they are carried out under tourniquet. These days, drugs are available to reduce intra-operative blood loss. However, a few Bilateral Total Knee Replacements require blood transfusion depending on pre-operative Hemoglobin.
What procedures will be followed during the stay in Hospital?
Patient is admitted a day prior, Anaesthetist, Physican and Cardiologist carry out a compare medical evaluation. Patient is requiring scrubbing the surgical area with antimicrobial solution 3-4 times the right before and on the day of surgery, after which leg is covered with a sterile drape. After anesthesia, the procedure for one knee is about 40 to 60 minutes. Intact rehabilitation starts few hours after surgery as post – operative period is relatively pain free. Walking with support and toilet training is started from 2nd day onward. The patient is discharged on 7th day after proper training of walking, toilet activities and stair climbing.
What happens after discharge?
Patient after discharge may require physiotherapy for a period of 3-6 weeks. However, not all patients require physiotherapy. The post-operative range of movement is at least similar to pre-operative range of movement. However majority attain full movement.
How to take care of Knees after Total Knee Replacement?
- Continue exercises
- Keep weight under control
- Don’t sit on the floor
- Avoid high impact activities
- Regular follow-up with your surgeon.
How long does an artificial knee last?
Surgeons and manufacturers have made remarkable advantages in joint replacement technology over the last few years. The surgical methods have been fine tuned and standardized. As a result the knee may last 20-24 years.
Advancement in Total Knee Replacement (TKR):
Pinless Computer Navigated Total Knee Replacement
What Is Computer Navigated Knee Replacement Surgery?
The technology of knee replacement has undergone sea changes in last one decade. Total knee replacement nowadays gives predictable and excellent results. Millions of Knee joints are replaced annually throughout the world. In orthopaedic surgery, there is a well-recognized relationship between accuracy and outcome. The surgeons experience in patients’ selection, soft tissue balancing, the alignment of the leg, the restoration of the joint line and also the prosthetic design are all possible factors influencing the success of Knee Replacement. With the help of advancements in computer technology, the surgeons and researchers are constantly working towards achieving perfection in each surgery. One such example is Computer Navigated Knee Replacement Surgery.
The procedure of Total Knee Replacement consists of replacing the damaged articular surface of the knee with knee prosthesis (artificial knee). The position of this implanted knee influences the outcome. The positioning of this implanted knee (artificial Knee) has been conventionally performed and assessed with the use of manual alignment jigs. Despite the continuing improvement in mechanical alignment systems, it has been estimated that the error in (tibial and femoral) alignment of over 3° may still occur in total knee replacements, even when they are carried out by well-trained surgeons, using the most up-to-date mechanical alignment tools. This is due to drawbacks of the conventional alignment systems. More recently, computer navigated systems have been developed to improve the positioning of the prosthesis (artificial knee) components, and balancing of the knee, with the goal of improving the alignment, which in turn is aimed to improve the overall survivorship and life of artificial knee. Computer navigated system for knee replacement has shown to markedly reduce outliers of misalignment of artificial knee, when compared to the conventional technique.
This is a big boon for the patients with KNEE DEFORMITIES and LEG DEFORMITIES undergoing knee replacements. Computer navigated knee replacement assures complete correction of these deformities. Computer navigated Knee replacement also decreases the chances of life threatening complication of fat embolism, as one need not drill hole in the medullary canal of the thigh bone.
The latest –state of the art- Pinless Navigation does not require drilling extra holes in thigh and leg bones. The latest state of the art PINLESS Computer navigation is recommended rather than using earlier versions of pins. Use of pinless Computer Navigation avoids risks and complications associated with earlier version i.e. pin computer navigation. Pinless navigation is an effective tool for reducing the proportion of outliers, without significantly increasing the duration of surgery and risks. Prof Anil Arora is using this Pinless Computer Navigation System in his cases. This gives advantages of accuracy without increasing the risk of complications. This is the first Pinless system in North India and it is giving excellent results. Prof Anil Arora specializes in performing Primary, Complex and Revision Knee Replacement and Hip Replacement surgeries.