This guide provides information for you and your family regarding total knee replacement surgery.

The benefits and risks, surgical procedure, pre and post operative care and rehabilitation are explained.

Please read and discuss this guide with your family before your surgery.

Our aim is to restore your knee to a painless, functional status, and to make your hospital stay as beneficial, informative and comfortable as possible.
Please feel free to ask questions or share concerns with staff.



THE NORMAL KNEE

The knee is made up of the lower end of the thigh bone (femur), which rotates on the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Ligaments provide stability and muscles across the joint provide the strength.


Smooth cartilage (articular cartilage) covers the ends of the three bones where they touch each other (the joint surfaces).

This provides a cushion. Besides, a membrane surrounding the joint (synovial membrane) produces a fluid to oil the joint, thus significantly reducing friction during movement.



IMPLANT DESIGNS:

THE ARTHRITIC KNEE
You may be suffering from one of these forms of arthritis :
Osteoarthritis
Rheumatoid arthritis
Post traumatic arthritis
Though the mechanisms of articular cartilage destruction are different, the end result is a knee joint with worn off articular cartilage. The cushion is lost, joint surfaces rub against each other. This causes pain.




WHAT IS A TOTAL KNEE REPLACEMENT ?
In this operation, the damaged joint surfaces are removed. The ends of the thigh and shin bone (femur and tibia) are replaced with metal. A plastic insert is placed between the two metal surfaces. The undersurface of the knee cap (patella) may/not be replaced with plastic.

SHOULD I HAVE A KNEE REPLACEMENT ?
It is important to understand that this is a collective decision between you, your family and your Orthopaedic surgeon.

Circumstances in which you may benefit from this operation are :
Severe knee pain - limiting your daily activities, restricting your walking distance significantly, waking you up at night, forcing you to take a high dose of pain relieving medication, and compelling you to use walking aids.

Severe knee pain with deformity, stiffness and chronic inflammation that is not responding to rest, medication and injections.
Your Orthopaedic surgeon would evaluate you and discuss whether a total knee replacement would be the best method to relieve your pain and improve your function. Alternative strategies would be discussed and considered.

An important factor in decision making is an understanding of what the procedure can and cannot do. A vast majority experience a dramatic reduction in knee pain and a significant improvement in their ability to perform activities of daily living. However, there would be certain activities you would be advised to refrain from such as using an Indian toilet.

The success rate at 15-20 years is very high (95-97%) when done at good centres by specialist knee surgeons.

PREPARATION FOR KNEE REPLACEMENT SURGERY
Once a decision to have a knee replacement has been made, you will be given a prescription by your surgeon and receive a date for admission. You would be asked to arrange for blood donors who can donate prior to your admission or the day before surgery.

You would be asked to come empty stomach early morning the day before the surgery. You would report to the hospital reception with the prescription and thereby allotted a room. You would then be attended to by the nursing staff and several doctors. They would make a note of your ailment and medications and conduct some blood tests, an X Ray, an ECG and any other additional tests required for e.g an Echocardiogram (for which you came empty stomach). Finished with the tests, you can now have your breakfast.

You can now relax through the day. Doctors of various specialties will visit you to make sure that you are fit to be operated. You would be advised not to eat or drink anything after 12 midnight.
You would be shifted to the Operation Theatre the next morning.
In the Operation Theatre Complex, a patient typically spends time in three areas - Pre Operation Area, Operation Theatre and Recovery Area. Though the average time for a knee replacement is 90 minutes, you would be in the Operation Theatre Complex for 5-6 hours. Advise your relatives to not be anxious if they do not see you for at least that length of time!

You would then be shifted to the Intensive Care Unit (ICU). This is simply to provide you with one nurse who can constantly monitor you (as against a nurse for every 4-5 patients in the ward). You would have a urinary catheter and a tube coming from your wound.

IT MUST BE VERY PAINFUL!
Not at all. As part of our specialist pain control protocol, we leave a small catheter (which you will not see) in the spine by way of which you would be constantly pain free. In case you feel any pain, please call the nurse and she would adjust the medication dose. This device is removed after 3-4 days by which time you will be pain free in any case.

HOW LONG WILL I BE BEDRIDDEN?
All going well, you will be shifted to the ward the next day. Physiotherapists would make you sit up and take a few steps with the help of a walker support. You would be constipated for 2-3 days and would pass urine by way of the catheter attached. We will encourage you to start eating.

HOW LONG IN HOSPITAL?
Over the next few days, your tubes - the urinary catheter, spinal catheter and wound drain would be removed and you would start walking the ward with the help of our trained physiotherapists. They would also make you perform some exercises regularly. The aim is to make you sufficiently independent such that you can walk to the toilet (which you would use with the help of a mobile commode) and walk the ward with a walker support. This is generally achieved within a week when you are discharged.

At the time of discharge you will be provided with a discharge summary and prescription and medication for a week. We can provide you an Ambulance Service and Paramedic support such that you can reach home safely.

We discourage more than one attendant and strongly discourage visitors during your stay so as to minimise the risk of your developing an infection.

HOW LONG DOES IT TAKE TO RECOVER?
We can help you with a Home Physiotherapist who will meet you daily and help you with strengthening and mobilising exercises. You will be mobilising at home – certainly not bed bound! You would meet us two weeks after surgery. At this meeting, we expect the knee to bend roughly 90 degrees. The stitches would be removed.

Our next meeting would be four weeks post surgery. At this stage you are expected to have good muscle control and would give up the walker for a stick. This stick would keep you company for another two weeks whilst you learn how to negotiate stairs.

You would give up the stick six weeks after surgery. We would then meet every six months.

POSSIBLE COMPLICATIONS
The complication rate following total knee replacements is low. Main risks involved are:
Deep Vein Thrombosis: Commonly known as a blood clot, it is caused by a slowing of the blood within your leg. You will be given medication and stockings to prevent this and be encouraged to mobilise early.

Infection: The risk of an infection developing is less than 2%. Every attempt is made at preventing this major complication.

Major medical complications such as a heart attack or stroke develop even less frequently. Chronic illnesses increase the potential for a complication. Discuss your concerns thoroughly with your surgeon prior to the operation.

DETECTING PROBLEMS
Blood Clot : Follow the surgeon's instructions to minimise the possibility of a blood clot developing. Warning signs of a possible blood clot in your leg include:

Increasing pain in your calf
Tenderness and/or swelling in your calf or thigh
Warning signs that a blood clot has travelled to your lungs include :
Sudden increased shortness of breath
Sudden chest pain Notify your doctor immediately.

Infection : Warning signs of an infection are
Persistent fever (usually > 38C)
Chills
Redness, tenderness or swelling of wound
Wound discharge
Increasing knee pain with activity and at rest.
Notify us immediately.