With age various organs and parts of the body start weakening and needs proper care. Knee is one such part of the body which bears the brunt of daily wear & tear. With age it loses its flexibility due to various factors; the most common is the deteriorating calcium in the body (which strengthens all the joints). Knee is also known as the Tibiofemoral joint and helps us in walking, sitting and standing; allowing our lower leg to move. It is a complex joint which connects thigh bone (femur) to the leg bone (tibia). In addition to that, knee cap (patella) articulates with femur.
Reasons of Knee Pain
- Wear and tear in the cartilage lining
- Old age
- Rheumatoid arthritis
- Any post injury arthritis
Knee Pain Management or Knee Replacement Surgery
In the initial stages of knee arthritis or any injury, doctors mostly suggest weight reduction, physiotherapy & medication. But, if a patient has reached the end of stage of arthritis and there is decrease in joint space resulting in unbearable pain while doing normal activities like walking, sitting, getting up or even while resting then the doctor may suggests to go for knee replacement surgery.
Knee Replacement Surgery: Why is it recommended?
Doctors remove the worn out cartilage along with a bit of bone and fit in an implant with special tools in a knee replacement surgery. The doctors may suggest this surgery in case of knee joint becoming the reason for unbearable pain. The implants are metallic on one side and special plastic on the other and are fixed with special bone cement. The knee replacement procedure is also termed as knee surfacing or knee arthroplasty. Various international companies’implants are available and only the best are used for such mechanisms, are available at BLK Hospital India.
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.
Knee Replacement Surgery and Procedure
Orthopaedic hospital in India, The doctor would advise a patient to get admitted one day prior to the surgery after conducting required investigation.After the patient’s admission anaesthesia team gives green signal for the surgery.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 choice of anaesthesia with the anaesthetist – epidural or general. The doctor will ensure if there are other medical issues such as diabetes, hypertension, asthma, etc. so that a physician can be consulted. The patient is kept oneight hours of fasting after midnight as it is necessary before surgery. Proper shower is given in the morning and legs are cleaned with soap and water. If required, legs are shaved in the operation theatre. Couple of medicines may be given in the morning – if required, they’re to be taken with a small sip of water. Patient is shifted to pre-operative 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.
Preparation for Knee Replacement Surgery
- Doctors inquire if patient is taking blood-thinning medicines. These medicines may have to be stopped a few days before surgery.
- A patient is thoroughly checked for any source of infection in the body, such as skin boils, dental, urine and chest infection.
- Proper measures are taken if a patient has any other medical issues such as diabetes, hypertension, asthma, hypothyroidism to avoid any issue.
- 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.
- 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.
- Patient can shuffle around in bed within the limits of pain. He or she can take half turns and sit on first post-operative day.
- Sufficient treatment is given for pain reliefin the form of epidural pump, patient control analgesia (PCA) and a mix of certain drugs. 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.
Precautions after the Knee Replacement 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 degree 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
Long term precautions
- Antibiotic cover should be taken while undergoing any dental / surgical procedures. 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
- Cold compress are advised to be applied around the knee
- Patient should be mobilized as much as comfortably possible
What are the risks / 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 and Hip replacement surgery in India 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 early stage or much later. It is recommended to promptly treat 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 patient being overweight, damage to joint by some injury, or hectic work schedule. Though, a there are possibility of another replacement but 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.
Recovery from Surgery
If a patient has undergone surgery for single knee replacement then patient can stand with 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 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.