TOTAL KNEE REPLACEMENT

Total knee replacement is the treatment of choice for moderate to severe knee arthritis. It involves removing the pain-causing portion of the knee joint and replacing it with an artificial joint (having metallic and polyethylene components). It helps maintain an active lifestyle and decreases the problems associated with a lack of mobility.


Total knee replacement should be considered when :

  • You have severe knee pain
  • The pain interferes with your daily activities (activities can range from walking in the house, to performing sports/cultural arts for highly active people)
  • You have deformity/bending of the knee
  • You have instability/feeling of give away while walking (increases chances of a fall)
  • You have to take pain killers regularly for pain relief
  • Pain is not controlled with medicines and exercises


Advantages of a knee replacement are :

  • Relief from pain
  • Knee becomes straight/deformity is corrected
  • Stability is achieved
  • Long term pain killer intake is avoided (avoiding side effects)


Dr. Ravi Nayak is a fellowship trained knee replacement surgeon in Mumbai. He has done fellowships with the best knee replacement surgeons in India and the USA. He has worked at Lilavati Hospital & Research Centre, Mumbai and at Breach Candy Hospital, Mumbai, which are amongst the best private hospitals in India. He has honed his skills under the able guidance of Prof. Dr. Frederick Jaffe, Chief of Joint Replacement Surgery, at the New York University Hospital for Joint Diseases. He has published papers on knee replacement in international journals of repute and made presentations at various national and international conferences.

In recognition of his work in the field of knee replacement, Dr. Nayak has been awarded the International Surgical Skills Scholarship by the American Academy of Orthopaedic Surgeons, USA. He has undergone advanced training in knee replacement at the AAOS Orthopaedic Learning Center in Chicago.

Dr. Nayak is trained in using computer navigation for knee surgery, which is known to increase accuracy. He also uses quadriceps muscle preserving approaches which improve recovery after surgery and enable the patient to walk earlier. He utilizes the options of using a fixed or mobile bearing prosthesis depending on the condition of the knee as seen during surgery, to give the best possible results to that individual. He has experience of over 2000 surgeries to date, including revision surgery.

      

        

Frequently asked questions on Total knee replacement (FAQs)

 

Q.    What is knee osteoarthritis?

A.    Osteoarthritis involving the knee occurs due to wear/rubbing off of cartilage at the knee joint.

 

 Q.    Why does knee arthritis occur?

A.    The most common cause of knee osteoarthritis is old age.

Arthritis is also the end result of other knee conditions, such as :

- previous ligament injury

- previous fracture within or near the joint

- any familial/hereditary diseases affecting joints like rheumatoid arthritis, gout, etc.


Q.    Can knee arthritis be controlled?

A.    Arthritis is part of the normal aging process and hence, it is unavoidable. However, the severity of arthritis can be decreased by regular exercise,           weight control and proper nutrition to maintain healthy bones and joints.

 

Q.    Does everyone with knee arthritis need a total knee replacement?

A.    NO. Arthritis is divided into mild, moderate and severe depending on the appearance of knee xrays and the patient's clinical condition, eg.                     previous activity level, amount of pain, amount of bending of knees (deformity), feeling of instability,etc.

 

Q.    So, who needs a knee replacement?

 A.    You need a total knee replacement if:

         - You have severe knee pain

         - Your activity levels have gone down. For eg. earlier you could walk for almost 1 hour, but now you find it difficult to walk more than 10                             minutes at a stretch

         - You have severe knee deformity, eg. bending of knees

         - You need to take pain killers regularly

         - You have feeling of instability while walking

         - Pain is not controlled by medicines or physiotherapy

 

Q.    I have heart disease. Can I undergo knee replacement?

A.    Yes, if your cardiac evaluation shows you as fit for undergoing knee surgery.

 

Q.    I have diabetes. Can I undergo knee replacement?

A.    Yes, if your diabetes is well controlled. You may need a short course of insulin to achieve good sugar control before, during and after knee           surgery.

 

Q.    I have rheumatoid arthritis. Can I undergo knee replacement?

A.    Yes, if your medical evaluation shows you as fit for undergoing knee surgery.

 

Q.    Is knee replacement a tough/infrequent surgery?

A.    A good fellowship trained surgeon can draw on his training and experience to perform an optimal total knee replacement. According to the                     Indian Society of Hip and Knee Surgeons (ISHKS), almost 66,000 knee replacement surgeries were performed in India in 2013. In the US,                   almost 719,000 people underwent knee replacement in 2013.

 

Q.    I am obese/fat. Can I undergo knee replacement?

A.    Yes, if your medical evaluation shows you to be fit for undergoing knee surgery. However, you have to keep in mind that your recovery will be             slightly slower than a patient with normal weight.

 

Q.     What tests do I need to get done for total knee replacement?

A.     You will have to undergo regular blood tests to evaluate the functioning of your heart, liver and kidney. These will be prescribed when you                   consult Dr. Nayak. You may have to undergo certain special tests if needed, eg. thyroid tests if you have a thyroid disorder.

 

Q.     Are any special xrays required?

A.     Dr. Nayak prefers to get standard Xrays of both knees and a scanogram which shows alignment of the legs.

 

Q.     What are the implants made of in total knee replacement?

A.     Implants in total knee replacement are made from a special alloy of chromium and cobalt or titanium. The plastic component is of very                            high quality called as ultrahigh density polyethylene (UHMWPE).

 

Q.     How are the implants fixed to bone in total knee replacement?

A.     The implants in total knee replacement are fixed to the bone with special bone cement mixed with antibiotics.

 

Q.     How long does a knee replacement last?

A.     Current studies show that a well performed knee replacement surgery can last for 15-20 years depending on use.

 

Q.     How long does a knee replacement surgery last?

A.      A knee replacement surgery lasts for anywhere from 2-3 hours.

 

Q.      What kind of anaesthesia is required for knee replacement?

A.      Most patients require spinal/epidural anaesthesia in which he/she is anaesthetized from the navel downwards. Some patients may need                        general anaesthesia. This is decided at the time of evaluation for surgery and will be communicated to you at the time of admission.

 

Q.     How long do I need to be admitted for knee replacement?

A.     You need to get admitted one day before surgery. After surgery, if your progress is uneventful, you will be discharged on the fifth day.

 

Q.     Is physiotherapy necessary after total knee replacement?

A.      Dr. Nayak uses a muscle-sparing approach to knee replacement, which enables faster rehabilitation. You will be taught certain exercises before            surgery, which will help you to do achieve good progress after surgery. Dr. Nayak recommends that you follow a good physiotherapy protocol            upto 21 days after surgery to ensure optimal use of you knee replacement.

 

Q.    When will the stitches be removed after knee replacement surgery?

A.     Stitches are usually removed on the 15th day after surgery.

 

Q.    How frequently do I need to see the doctor?

A.     Dr. Nayak recommends that you see him at 2 weeks, 6 weeks, 3 months, 6 months and at 1 year after surgery. After that, it is advisable to                   follow-up every 2-3 years to ensure a proper evaluation.

 

Q.    Are there any medicines that I should take after knee replacement?

A.    It is recommended that you take calcium and vitamin D supplements to keep your bones healthy. If you have any medical condition, you                       should take medications for the same, eg. good sugar control in diabetics.

 

Q.    Should I take any precautions after knee replacement surgery?

A.    In case you need dental work done, you should inform your dentist that you have undergone a knee replacement. He/she will give you                          appropriate antibiotics before the dental procedure. Also, you should inform the doctor in case you develop any infection anywhere in the body. 

 

Q.     Can knee replacement be done in both knees simultaneously (i.e. bilateral knee replacement)?

A.     Yes, knee replacement can be done in both knees simultaneously. However, you will undergo medical evaluation before surgery to find out if           you are fit for the same.


Q.    What is the age at which knee replacement can be performed ?

A.    Knee replacement is the treatment of choice for advanced knee arthritis. Any patient with advanced arthritis, irrespective of age, is a candidate          for knee replacment.


Q.    What the possible complications associated with knee replacement surgery ?

A.    Knee replacement is one of the most succesful surgeries in medical history. However, though very infrequent, complications can occur. These           complications are mostly related to anaesthesia, which can be seen with any surgical procedure. Deep vein thrombosis, infection and wound            issues are other rare complications that may arise following a knee replacement.


Q.    What are the latest advances in knee replacement surgery ?

A.     The latest advances in knee replacement surgery are :

            computer navigation : increases accuracy of placement of components

            - muscle sparing surgical approach : enables faster rehabilitation, lesser pain

            - newer materials : oxinium implants

            - newer designs : mobile bearing knees, high flexion knees

            - pain management techniques : increase patient comfort


Q.   What does a knee replacement surgery cost ?

A.    Knee replacement surgery cost depends on the type of implant used. Dr. Nayak uses imported knee replacement prosthesis, the           cost of which varies from Rs. 60,000 for the basic version to Rs. 2,10,000 for the absolute latest knee design. These designs have been time           tested and shown excellent results in numerous research studies over 15 to 20 years.

          Knee replacement surgery cost also depends on the severity of knee arthritis, which determines if any additional items need to be added to           the knee prosthesis.

          Knee replacement surgery cost varies on the type of room opted for from General ward to Deluxe rooms.

          Dr. Nayak has performed knee replacement surgeries for charity also, in which only cost of implant is charged. For information, contact

          +91 75 065 11 065

        Approximate knee replacement surgery cost : Rs. 1,30,000 to Rs. 4,50,000*


Dr. Nayak performs knee replacement at Mumbai & Thane.


*Conditions Apply (Eg. severity of arthritis, type of implant chosen, hospital room charges, etc.)

 Useful links to help you make a decision :

http://www.aahks.org/care-for-hips-and-knees/do-i-need-a-joint-replacement/total-knee-replacement/
http://orthoinfo.aaos.org/topic.cfm?topic=a00389

Knee replacement
Knee replacement