What is a knee joint?
The knee joint is one of the strongest and most important joints in the human body. It allows the lower leg to move relative to the thigh while supporting the body's weight. Movements at the knee joint are essential to many everyday activities, including walking, running, sitting and standing. It is also known as the tibiofemoral joint. It is a complex joint which connects thigh bone (femur) to the leg bone (tibia). In addition to that, kneecap (patella) articulates with a femur.
What causes knee pain?
Many people think knee pain only affects older people, but it can affect people of all ages. Whether it's due to arthritis or an injury, a knee joint bears a lot of our body weight and can face wear and tear in the cartilage lining which is usually cured by some mobility exercises and medicines. But, in certain cases, due to old age or other ailments joint cartilage usually wears out leading to osteoarthritis, rheumatoid arthritis or any post-injury arthritis, etc.
How is knee pain treated?
In the early stages of knee arthritis or any injury, medication, physiotherapy and weight loss is recommended. But, if a patient has reached the last stage of arthritis and there is a decrease in joint space resulting in severe pain while doing normal activities like walking, sitting, getting up or even while resting then the doctor may recommend to go for knee replacement surgery.
What is knee replacement?
The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone. The removed cartilage and bone are replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or "press-fit" into the bone. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.The knee replacement procedure is also termed as knee surfacing or knee arthroplasty. At BLK, implants from various international companies are available and only the best are used for such procedures.
Uses of Navigation/ Computer Assistance/ MIS surgery
A routine knee replacement procedure does not require navigation. However, the doctor may go for navigation if there are any deformities in thigh or leg bones. In routine cases, available jigs are extremely good and accurate. While long incisions were made earlier, nowadays smaller incisions are utilised with the help of MIS jigs.
What is the surgery process?
- The patient is admitted one day prior to surgery
- Relevant investigations are done
- The patient gets approval from the anaesthesia team
- Knee replacement is usually done under epidural anaesthesia (injection on the back to make the legs numb). This avoids any issues associated with general anaesthesia
- Patient discusses the choice of anaesthesia with the anaesthetist – epidural or general
- The patient is asked to mention if there are other medical issues such as diabetes, hypertension, asthma, etc. so that a physician can be consulted
- The patient is kept on eight hours of fasting after midnight as it is necessary before surgery
- A proper shower is given in the morning and legs are cleaned with soap and water. If required, legs are shaved in the operation theatre
- A couple of medicines may be given in the morning – if required, they’re to be taken with a small sip of water
- The patient is shifted to the preoperative area about an hour before being taken to the operation theatre
- After the operation patient is kept in recovery ward for 4 to 6 hours and then sent back to the room or ICU as necessary
- Following surgery, a bulky dressing is done around the knee, with a small tube (drain) to collect any blood oozing out of the operated knee
- The drain will be removed 24 to 48 hours after surgery
How to prepare for surgery?
- A patient is thoroughly checked for any source of infection in the body, such as skin boils, dental, urine and chest infection.
- Doctors inquire if the patient is taking blood-thinning medicines. These medicines may have to be stopped a few days before surgery.
- Proper measures are taken if a patient has any other medical issues such as diabetes, hypertension, asthma, hypothyroidism to avoid any issue.
What is the recovery process?
- The patient is made to stand with the help of a walker 24 to 48 hours after surgery and is encouraged to walk slowly. This can help in preventing complications like thrombosis.
- The patient is given full assistance and is asked to move foot and ankle up and down as many times as possible to regain power in the legs. This should be carried out throughout the hospital stay. It helps pump the blood up and prevent complications like thrombosis. (blood clot in the veins)
- Upper limb and deep breathing exercises are recommended.
- The patient can shuffle around in bed within the limits of pain. He or she can take half turns and sit on the first postoperative day.
- Sufficient treatment is given for pain relief in the form of epidural pump, patient control analgesia (PCA) and a mix of certain drugs. The patient should inform when in pain. The BLK Pain Management Team is there to offer assistance at any given time.
- If the post-operative progress is fine then the patient is discharged from the hospital 3-5 days after surgery in case of single knee replacement, and 5-7 days if both knees are operated.
What precautions should be taken after surgery?
Short- term precautions
- A close tab has to be kept on the body temperature. Patients are consulted to inform their doctor if it goes above 100.5 degrees Fahrenheit
- In case of excessive pain, immediately contact the doctor
- Excessive swelling, redness around the operated area or discharge from the wound is not a good sign and needs to be checked by the doctor
- Walking is recommended until advised otherwise
- Low chairs or low commodes should not be used
- The antibiotic cover should be taken while undergoing any dental/surgical procedures. The doctor should be kept informed
- Any kind of high impact exercise such as jumping, running etc. should be avoided
- Doctor to be informed if there’s pain, swelling or instability
Care At Home
- The toilet seat has to be re-adjusted and a high commode attachment or a high commode chair should be used
- Physiotherapy should be strictly followed regularly to facilitate walking, knee bending and strengthening of muscles around the knee
- A cold compress is advised to be applied to the knee
- The patient should be mobilized as much as comfortably possible
Are there any risks or complications of the procedure?
There is no surgical procedure which is conducted without risk, but we ensure that the risk is always calculated especially if there are other medical problems such as the patient being overweight, old age, diabetes etc. The team at BLK is highly skilled in overcoming any kind of risks. However, there are some specific risks related to knee surgery that patients need to be aware of. However, chances of immediate complications are less than 2 %.
- Superficial infection: Infection may occur even after proper precautions.
- Deep infection: Infection may occur at an early stage or much later. It is recommended to promptly treat an infection that may develop in any part of the body
- Deep Vein Thrombosis (DVT): Blood clotting or thrombosis is a common risk after knee replacement surgery. Rarely, these clots can dislodge and travel through the heart to the lungs. This is known as pulmonary embolism which can cause serious complications in rare cases
- Loosening of the prosthesis (new joint): Though a knee replacement last more than 15 years but in certain cases weakening of bond may occur earlier due to the patient being overweight, damage to joint by some injury, or hectic work schedule. Though there is a possibility of another replacement then the risks become higher
- Persistent pain: The knee replacement surgery does not ensure 100% relief from all the pain. A patient may continue to suffer from mild discomfort. Complex regional pain syndrome, while uncommon, may be the cause of pain, swelling, stiffness and skin changes
- Other recognized risks of knee surgery include bone fracture, bruising, urinary retention and risks associated with anaesthesia and blood transfusion
What is the recovery time after surgery?
- If a patient has undergone surgery for single knee replacement then the patient can stand with the assistance of a physiotherapist within 1-2 days. He/she can start moving with the help of a walker
- A high-raised toilet seat is recommended for the patient for 3-4 days after surgery
- After reaching home patient can independently use the toilet, of course, with the help of the walking aid
- Crutches/walker is highly recommended for a period of 4-6 weeks
- It will take 8-12 weeks to achieve full benefits of surgery
- In case both knee replacements were done together, the recovery process is a little slower but same principles would apply in this condition as well