Did you know a knee joint hold the weight of your entire body?

How many of us really take care of our knees regularly?

We ought to! A knee is the largest joint of the human body which plays a vital role in the proper functioning of body movements as well as helps to withstand the body weight. A healthy and stable knee is necessary for an active lifestyle, hassle-free walking, and to perform everyday activities.

If you are suffering from knee pain and find difficulty in performing regular activities like sleeping, bending of the knee, and lying down, it indicates that the knee joint might have been damaged. Let us have a look at the anatomy of a knee.

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Anatomy of the knee joint:

A knee joint is made up of three bones:

  • The thigh bone (Femur)
  • shinbone (Tibia)
  • Kneecap (patella)

Tendons – connect the knee to leg muscles. These both help in moving of the knee joint.

Ligaments – join the knee bones and provide firmness to the knee.

Quadriceps – A group of muscles located in front of the thigh which helps in running, walking, etc.

When the pain in the knee is severe and doesn’t minimal with your medicine intake, there are chances that the knee is damaged.

What are causes the damaged knee joint?

  • Torn cartilage
  • Loose fragments of bone or cartilage
  • Abnormal alignment or instability of the kneecap
  • Inflammation of the Synovial membrane
  • Torn ligaments – These are the ligaments mostly prone to damage;
    • Anterior circulate ligament
    • Posterior circulate ligament
    • Medial collateral ligament
    • Lateral collateral ligament

Here’s a remedy for the damaged knee joint: Total knee replacement!

As we age the bones of our body tend to face many wear and tears. We start finding it difficult to perform our daily activities. How do we cope up with this condition? We usually consult an orthopedician who diagnosis the symptoms and prescribes exercises or a physical therapy or even a “Total Knee Replacement” if the knee joint is damaged to a level that cannot be repaired.

Total Knee Replacement: What is it?

Total knee replacement or total knee arthroplasty is the surgical procedure for replacing the damaged knee joint. It was first performed in 1968. Since, then surgical methods have been greatly improvised. Total knee replacement surgery is a great advantage for people who suffer from the knee pain caused due to inflammation, swelling, severe pain, difficulty in bending and lying down on knees.

Knee replacement: Who gets this surgery?

  • People who experience severe pain in the knee.
  • People with difficulty in normal walking, performing daily activities, etc.

Age for Knee replacement: 

People from the age gap of 50 to 80 mostly undergo this kind of surgery based on pain.

Conditions that damage the knee joint:

  • Osteoarthritis – causes knee pain, stiffness and swelling.
  • Rheumatoid arthritis-causes arthritis in any joint, can lead to permanent knee damage.
  • Osteonecrosis- causes disruption due to the restricted blood flow from femur/tibia.
  • Meniscal tear- causes damage to the cartilage that cushions the knee. It is mainly caused due to the knee twist.
  • Injury or fracture of the knee joint
  • Bone tumor in the knee joint.

When do we need a knee replacement surgery?

If the knee is severely damaged by arthritis or injury, it is difficult to perform simple activities, such as walking, bending or jogging. The condition when nonsurgical treatments like medications which comprise of painkillers, physical therapy and use of walking supports are no longer helpful one will want to consider total knee replacement surgery.

Knee Arthroscopy/ Total knee replacement surgery:

Knee Arthroscopy

This is a non-invasive surgical method developed with advancements in technology which replaced the open surgery (arthrotomy). During this surgery, an arthroscope is inserted into the knee joint by a small incision about 4mm. This process is also known as Knee endoscopy.

Apart from knee, arthroscopy can also be performed on hip, shoulders, meniscal tears and waists.

More about Knee Replacement!

As discussed in the earlier part of the blog, the knee joint is composed of three parts – lower end of the femur (thigh bone), the upper end of the tibia (shin bone) and patella (knee cap). During the surgical procedure, diseased surfaces of the knee joint are removed and replaced with smooth artificial surfaces. The femoral surface is of curved polished metal and the tibia is usually metal covered with high-density plastic and the kneecap is plastic. These artificial pieces are attached to the bones with bone cement (methyl methacrylate) or special coatings that encourage bone in growth.

Preparing for Knee Arthroscopic Surgery:

Preparing for Knee Arthroscopic Surgery

Evaluation and tests: The patient must visit general physician to check upon his or her wellness of the body. Blood tests, ECG, and other necessary tests are suggested by orthopedic before the surgery.

Anesthesia: Prior to the surgery, local, regional or general anesthesia is given to the patient depending on the time required for the surgery. Local anesthesia numbs just the knee, the regional anesthesia numbs below the waist and with general anesthesia a patient is put to sleep for a short period of time.

What happens during the surgery?

Generally, Knee arthroplasty/Knee replacement surgery follows this process:

  • During a total knee replacement, bone and cartilage from the areas of the thigh bone and shin bone are removed. This is also known as total knee repair.
  • The knee area of thigh bone with a metal implant and the knee area of your shinbone is replaced with a plastic implant. This gives both bones of knee joint smooth surfaces so they bend freely without pain.
  • In many cases, the surgeon also replaces the undersurface of the kneecap with a plastic coating. The damaged knee is implanted with artificial components.

What happens during the surgery

The artificial components:

The artificial components used in total knee replacement are;

  • Tibial
  • Femoral
  • Patellar
  • Plastic spacer

The artificial implants:

The artificial implants used in total knee replacement are implants made up of ceramic, cement, metal and its alloys like Titanium, Zirconium, Tantalum, Zirconium, Cobalt and strong plastic materials are used for artificially replacing the original knee. These implants differ from their fixings and materials because the patient’s knee size, weight, height, etc. differs from person to person.

Brands used for knee replacement:

There are a few well known brands preferred by many surgeons for a total knee replacement surgery across India. Few of them can be named as:

  • Zimmer persona knee by Zimmer Biomed
  • BIOLOX delta by CeramTec (Metal free arthroplasty)
  • Universal Rolflex by Evolutis
  • Freedom total knee system by Maxx medical

Types of Knee replacement surgeries:

It is not really necessary to replace the entire knee if there is damage in the knee joint. Apart from total knee replacement surgery we also have an option to opt for partial knee replacement, kneecap replacement, complex replacement, minimally invasive knee replacement, double knee replacement, and knee cartilage replacement.

  1. Total Knee replacement involves the replacement of surfaces of thigh and shin bone. Partial knee replacement involves a shear or small cut of the knee provided knee ligaments are stronger. In this case, only a portion of knee is resurfaced. It is also called unicompartmental knee replacement.
  1. Kneecap replacement involves replacement of only under surface (patella) of the kneecap. It is also called patella femoral replacement.
  2. Complex or revision replacement is recommended for people with severe arthritis and the one who already had knee replacement surgery.
  3. Minimally Invasive knee replacement involves variably shorter incision to cut open the knee joint. It is the newest/ latest surgical technology for knee replacement. This method is less invasive.
  4. Double knee replacement involves either one or two surgeries. When both the knees are replaced at the same time, it is called simultaneous bilateral surgery, when each knee is replaced at different time it is called staged bilateral knee replacement.
  5. Knee Cartilage replacement involves treating cartilage injuries rather than total cartilage damages.

Advantages of total knee replacement

  • A knee replacement is not a normal knee but an artificial knee.
  • This surgery provides complete, or nearly complete, pain relief.
  • It allows people to carry out the normal activities of daily living after the surgery.

Difficulties with total knee replacement

  • Total knee replacement is a major operation and there can be complications due to anesthesia. Sometimes passing urine will be difficult. Nausea, vomiting, infections in the surgical part might be few symptoms in some patients.
  • To avoid complications, a patient can stay a little longer in the hospital after the surgery.

Coming up with post surgery pain

Immediately after the surgery, painkillers are prescribed which help in subsiding the pain. Swelling is mostly seen after 2-3 weeks of the surgery. Do not panic if you see swelling near the operated knee joint, simple exercising can help healing this. Most of the surgeons suggest ice packs for the patients who suffer swelling for several months as they help in quick pain relieving. The pain might last for several weeks to several months. Along with medications, exercises are recommended by surgeon for speedy recovery.

Blood clotting or bruises may also be seen in and around the part of knee surgery of many patients. Treating bruises with little heat treatment helps reduce the clots which are of purple coloration.

Physical therapy exercises after knee replacement surgery

Physical therapy is an important stage for the recovery from pains quickly that helps in performing everyday tasks, walking and climbing stairs etc. A physiotherapist helps in showing exercises for the betterment of a patient. These exercises are advised as per the rehabilitation protocol framed by the physiotherapist to be followed by the patient on daily basis. A continuous motion machine is used to start the physical therapy. Following regular exercises increases muscle strength.

Precautionary measures to be taken after the surgery

Once the patient is shifted back home from the hospital, the first thing to be maintained is cleanliness and hygiene. This is to avoid post-surgical infections. The surgical area must be maintained dry so that the risk of falling for infections is less. The patient must strictly follow the doctor’s advice, take medications for pain relief and immediately report to the doctor for any complications like fever and nausea persist after the surgery.

The patient should be away from driving, until the doctor suggests and must ensure not to fall after the surgery as it might damage the prosthetic as well as the knee joint. Always use a walker to help with walking and it might take several months to walk as normal as before. A strict diet is to be followed as weight gain could cause a problem.

Knee Replacement Revision Surgery

Although the segments and pieces used in the Knee replacement surgery are designed to stay 20 years longer, it may tear in the mid-way. This mostly happens in the case of athletes, sports persons, obese people where the chances for the fail of the device are high. In this case, when a knee replacement doesn’t function correctly, the older device is replaced with a new one, called Knee replacement revision surgery.

Common arthroscopic procedures for the knee include

  • Removal or repair of a torn meniscus.
  • Reconstruction of a torn anterior cruciate ligament.
  • Removal of inflamed synovial tissue.
  • Trimming of damaged articular cartilage.
  • Removal of loose fragments of bone or cartilage.
  • Treatment of patella (kneecap) problems.

List of Best hospitals for Knee replacement surgery in Bangalore

Below is the list of reputed hospitals which have introduced latest and modern technologies for knee replacement surgeries to serve the best treatments and medical assistance to its patients.

  • Apollo Hospital, Jayanagar / Bannerghatta road
  • Manipal Hospitals, HAL Airport road / Whitefield / Malleswaram
  • Fortis Hospital, Bannerghatta road / Cunningham road / Nagarbhavi
  • Columbia Asia, Whitefield / Hebbal
  • People Tree Hospitals, Yeshwantpur / Yelahanka / Jallahalli, Hanumannagar
  • BGS Global Hospital, Kengeri / Richmond Circle
  • Phoenix Hospital, HSR Layout
  • Sujatha Hospital, Indiranagar / Shivajinagar

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Total knee replacement is proven to be the best surgical procedure worldwide. It is one among the successful modern surgeries. Though it takes several months in complete recovery of a patient along with some risks pertaining to the surgery, a patient must be courageous enough to withstand the pain for some time, post surgery in order to enjoy walking, running and perform other activities like earlier to lead an independent and successful life from pain less knee.

Quick tip: Knee replacement alternatives:

Knee replacement surgery should not be the foremost option for treating knee pain. When medications, knee injections, exercises from physiotherapists fail, a person must consider further taking up the choice of knee replacement surgery.