Knee replacement surgery: All you need to know

knee surgery

Last Updated on February 27, 2024 by Shabnam Sengupta

Knee replacement surgery, also known as knee arthroplasty, is a surgical procedure of replacing a damaged or worn knee joint with an artificial joint made of metal, plastic, or ceramic. The primary aim of the surgery is to relieve pain and restore normal knee function. Knee replacement surgery is a significant decision. It is essential to understand its benefits, risks, and the recovery process before undergoing the procedure.

What are the indications for knee replacement surgery?

Doctors typically recommend knee replacement surgery for patients who experience persistent knee pain that affects their quality of life and limits their ability to perform routine activities. They may recommend surgery in the following conditions:

Osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease that affects millions of people worldwide. It is a chronic condition that causes the cartilage in joints to break down over time, resulting in pain, stiffness, and loss of mobility. One of the most common joints affected by OA is the knee. In severe cases, OA can lead to knee replacement surgery. We will discuss how osteoarthritis can result in knee replacement surgery.

The knee is a complex joint that allows for a wide range of movement, including bending, straightening, and rotation. The joint consists of three bones: the femur (thigh bone), tibia (shin bone), and patella (kneecap). Between these bones, there is cartilage, which acts as a cushion and allows for smooth movement. When osteoarthritis affects the knee joint, the cartilage gradually wears and tears and becomes rough and uneven, causing pain and inflammation. As the condition progresses, the bones may start to rub against each other, causing further damage and reducing mobility.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease. It causes inflammation in the joints, leading to pain, stiffness, and loss of mobility. While RA can affect any joint in the body, it commonly affects the knees. In severe cases, RA can require knee replacement surgery. Here, we will discuss how rheumatoid arthritis can lead to knee replacement surgery.

In RA, the immune system mistakenly attacks the lining of the joints, called the synovium, leading to inflammation and damage. Over time, this can cause the cartilage and bone in the knee joint to break down. This results in pain, swelling, stiffness, and reduced mobility. In some cases, the damage may become so severe that knee replacement surgery is necessary.

Post-traumatic arthritis

Post-traumatic arthritis is a type of arthritis that occurs after an acute trauma to the joints, such as a fracture or dislocation. It can be found in 12% of all osteoarthritis cases and a history of trauma might also be present in patients with chronic inflammatory arthritis. Post-traumatic arthritis can lead to knee replacement surgery in severe cases.

Injury to the knee joint can cause damage to the cartilage and bone, leading to pain, stiffness, and reduced mobility. The injury may also cause inflammation in the joint, which can further damage the cartilage and bone over time.

In traumatic arthritis, the cartilage in the knee joint wears away, leading to bone-on-bone contact. This can cause pain, stiffness, and reduced mobility. The knee joint may also become deformed, making it difficult to walk, climb stairs, or perform other activities of daily living. The decision to undergo knee replacement surgery for traumatic arthritis is usually made after other treatments have failed.

Knee deformities

Doctors may suggest knee replacement surgeries in some cases of knee deformities like bow-leggedness or knock-knees. They recommend surgery when a patient experiences severe pain, stiffness, or reduced mobility due to knee deformities whose management is not possible through non-surgical treatments.

A variety of factors including genetics, trauma and diseases such as osteoarthritis or rheumatoid arthritis can cause knee deformities. These deformities can affect the alignment of the leg and cause uneven wear and tear on the knee joint, leading to pain, stiffness, and reduced mobility.

In some cases, knee deformities can cause the cartilage in the knee joint to wear away. As a result of this, there is bone-on-bone contact, which ultimately causes the need for knee replacement surgery.

Failed previous knee surgeries

In some cases, patients may require knee replacement surgery if they previously underwent knee surgeries that failed to provide relief. Such surgeries are also called revision knee replacement surgery. Revision knee replacement surgery is more complex and carries a higher risk of complications than the initial knee replacement surgery. The recovery period is also longer than the initial surgery. Also, patients may require additional physical therapy and rehabilitation to regain strength and mobility in the knee joint.

What are the different types of knee replacement surgery?

There are different types of knee replacement surgery. The choice of surgery depends on the extent of damage and the specific condition of the patient.

Total knee replacement

Total knee replacement is the most common type of knee replacement surgery. It involves removing the damaged parts of the knee joint and replacing them with an artificial knee joint made of metal. Doctors recommend total knee replacement for patients with severe knee damage caused by conditions such as osteoarthritis, rheumatoid arthritis, or traumatic injury.

Partial knee replacement

Partial knee replacement, also known as uni-compartmental knee replacement, is a less invasive procedure than total knee replacement. It is an alternative to total knee replacement for patients whose disease is limited to just one area of the knee. This procedure involves replacing only the damaged part of the knee joint with an artificial joint, leaving the healthy parts of the knee intact. 

Bilateral knee replacement

Bilateral knee replacement involves replacing both knees with artificial joints during a single surgical procedure. This type of knee replacement surgery is recommended for patients with severe damage to both knees.

Minimally invasive knee replacement

Minimally invasive knee replacement is a newer type of knee replacement surgery. This involves using smaller incisions and specialised surgical instruments to reduce tissue damage and improve recovery time. This type of knee replacement surgery is typically for patients with less severe knee damage and good knee function.

Robotic knee replacement

Robotic knee replacement is another type of knee replacement surgery. This is done using a robotic arm to assist the surgeon during the surgery. The system allows for greater accuracy and precision during the surgical procedure. This may result in better outcomes for the patients. Doctors recommend robotic knee replacement for patients with severe knee damage and limited mobility.

How to prepare for knee replacement surgery?

Knee replacement surgery is a major medical procedure that can improve the quality of life of people suffering from chronic knee pain and mobility issues. However, preparing for knee replacement surgery is just as important as the actual surgery itself. Here, we will discuss several key steps that patients can take to prepare for knee replacement surgery and ensure a successful recovery.

First and foremost, it is important to consult with your doctor or surgeon to understand the specifics of the procedure and what to expect during and after the surgery. This can include discussing any potential risks or complications, as well as reviewing any pre-existing medical conditions that may impact the surgery.

Before undergoing knee replacement surgery, patients will typically undergo a thorough medical evaluation to determine their eligibility for the procedure. The evaluation may include blood tests, imaging studies, and a physical examination. Doctors may ask patients to stop taking certain medications, such as blood thinners, before the surgery.

Another important aspect of preparation for knee replacement surgery is lifestyle adjustments. This can include making changes to your diet and getting plenty of rest before the surgery. Your doctor may also recommend adjusting your medications or temporarily stopping certain medications that can increase bleeding or interfere with the anaesthesia.

Some additional steps:

Lose weight:

If you are overweight or obese, the doctor may advise you to lose weight before the surgery to reduce the risk of complications.

Quit smoking:

Smoking can increase the risk of complications after surgery. Therefore, if you smoke, then doctors may ask you to quit smoking before the surgery.

Exercise:

Doctors may advise you to do exercises to strengthen the muscles around the knee joint, which can help with postoperative recovery.

It is also important to make arrangements for post-surgery recovery. This can include setting up a comfortable recovery area in your home, arranging for transportation to and from the hospital, and scheduling time off work or other obligations to allow for proper rest and recovery. You may also want to consider arranging for help with tasks such as grocery shopping or meal preparation during your recovery period.

Mental preparation is also important for a successful recovery. This can include speaking with a therapist or counsellor to address any fears or anxieties about the surgery, as well as practising relaxation techniques. Staying positive and maintaining a hopeful outlook can also help to reduce stress and aid in a smooth recovery.

It is very important to follow all pre-surgery instructions provided by your doctor or surgeon. This can include fasting before the surgery, showering with a special antiseptic soap, and avoiding certain activities or foods in the days leading up to the surgery. By following these instructions carefully, you can help to reduce the risk of complications and ensure a smooth recovery.

What is the procedure for knee replacement surgery?

Knee replacement surgery typically takes between one and two hours to complete and is performed under general or regional anaesthesia. During the procedure, the surgeon will make an incision in the knee, remove the damaged cartilage and bone, and replace it with an artificial joint made of metal, plastic, or ceramic. The surgeon may also resurface the kneecap to improve its function and reduce pain.

After the artificial joint is implanted, the surgeon will close the incision with stitches or staples and place a dressing on the knee. Patients will then be taken to a recovery room where they will be monitored for several hours.

What can be the complications of knee replacement surgery?

While knee replacement surgery is generally safe and effective, there are potential complications that patients should be aware of. We will discuss some of the complications of knee replacement surgeries.

Stiffness and limited mobility

Stiffness and limited mobility are common complications of knee replacement surgery. Some patients may experience difficulty bending or straightening the knee joint. This can affect their ability to walk or perform daily activities.

Chronic pain

Chronic pain is a potential complication of knee replacement surgery. Some patients may continue to experience pain after the surgery, which can be caused by various factors such as infection, implant failure, or nerve damage.

Infection

Infection is one of the most serious complications of knee replacement surgery. Infections can occur during or after the surgery and can lead to pain, swelling, redness, and fever. In severe cases, infection may require surgical intervention to remove the infected tissue or joint.

Blood clots

Blood clots are a potential complication of knee replacement surgery. They can form in the leg veins, which can lead to swelling, pain, and redness. If a blood clot travels to the lungs, it can cause a pulmonary embolism, which can be life-threatening.

Nerve damage

Nerve damage is a potential complication of knee replacement surgery. The nerves around the knee joint may be damaged during the surgery, leading to numbness, tingling, or weakness in the leg. In some cases, nerve damage may be permanent.

Implant failure

Implant failure is a rare but serious complication of knee replacement surgery. The artificial joint may become loose or dislocated, causing pain and limited mobility. In some cases, revision surgery may be necessary to replace the failed implant.

How is the recovery from knee replacement surgery?

Recovery from knee replacement surgery typically takes several months, depending on the patient’s age, overall health, and the extent of the surgery. Patients will be required to stay in the hospital for a few days after the surgery to receive pain medication, begin physical therapy, and learn how to care for their incision.

Recovering faster from knee replacement surgery requires a combination of proper care, rest, and exercise. Following post-surgical instructions, attending physical therapy, staying active, eating a healthy diet, getting adequate rest, managing pain, and maintaining a positive attitude are all important steps to promote a smooth and speedy recovery.

Recovering from knee replacement surgery can take a lot of time and patience. And that is why discipline and mental strength are very important.

What are the post-surgery recommendations?

Follow post-surgical instructions

It is important to follow all post-surgical instructions provided by your surgeon, such as taking any prescribed medications, using ice packs, and avoiding certain activities or movements. These instructions can help to reduce pain and swelling and promote healing.

Attend physical therapy

Physical therapy is crucial to the recovery process after knee replacement surgery. Your physical therapist can help you perform exercises that are safe and effective for your recovery, and they can also help monitor your progress and adjust your exercise program as needed. It should start within 24 hours of surgery and before discharge for patients who have undergone the surgery. 

Stay active

While it is essential to rest and avoid overexertion in the early stages of recovery, it is also essential to stay active and gradually increase activity levels as tolerated. Walking, swimming, and cycling are all low-impact exercises that can help to promote circulation, reduce stiffness, and improve range of motion.

Eat a healthy diet

Eating a healthy diet that is rich in nutrients can help support the healing process after knee replacement surgery. Foods that are high in protein, such as lean meats, fish, and beans, can help support muscle recovery, while fruits and vegetables can provide important vitamins and minerals that support overall health.

Get adequate rest

Getting enough sleep and rest is essential for the body to recover from knee replacement surgery. It is important to get enough sleep each night and to take breaks throughout the day as needed to avoid overexertion.

Manage pain

Pain management is an important part of the recovery process after knee replacement surgery. Your surgeon may prescribe pain medication or recommend other pain management strategies, such as ice packs or heat therapy, to help reduce pain and discomfort.

Maintain a positive attitude

Recovering from knee replacement surgery can be challenging, but maintaining a positive attitude can help to reduce stress and promote healing. Focus on your progress set achievable goals for your recovery and remember to celebrate your accomplishments along the way.

Which exercises should one perform to recover faster from knee replacement surgery?

Recovering from knee replacement surgery can be a challenging process, but regular exercise can play a crucial role in improving flexibility, reducing pain and swelling, and promoting overall healing. The specific exercises that are most important for recovery can vary depending on the individual patient and their unique needs. However, there are some general types of exercises that doctors often recommend to patients recovering from knee replacement surgery. Here are some examples:

Range of motion exercises

Range of motion exercises are designed to improve the flexibility and mobility of the knee joint after surgery. These exercises typically involve gentle, repetitive movements that gradually increase the range of motion of the knee. Examples of the range of motion exercises may include heel slides, knee bends, and ankle pumps.

Strengthening exercises

Strengthening exercises can help to build up the muscles that support the knee joint, which can improve stability and reduce the risk of future injury. These exercises typically involve resistance training, either through the use of weights or resistance bands. Strengthening exercises may include leg presses, calf raises, and hamstring curls.

Cardiovascular exercises

Cardiovascular exercise can help to improve overall health and fitness, which can aid in the healing process after knee replacement surgery. These exercises typically involve activities that increase the heart rate and breathing, such as walking, swimming, or cycling. It is important to start slowly and gradually increase the intensity and duration of these exercises over time.

Balance exercises

Balance exercises can help to improve stability and prevent falls, which can be a common concern for those recovering from knee replacement surgery. These exercises typically involve standing on one leg or using a balance board or other equipment to challenge balance and coordination.

You must know that the specific exercises that are appropriate for each individual will vary based on several factors, including their overall health, the extent of the surgery, and the presence of any other medical conditions. It is important to work closely with a physical therapist or other healthcare professionals to develop an individualized exercise program that is tailored to your specific needs and goals. Following the prescribed exercise program consistently can help to promote a faster and more complete recovery after knee replacement surgery.

What are the alternatives to knee replacement surgery?

Knee replacement surgery is a standard procedure for treating severe knee pain and stiffness caused by various conditions such as osteoarthritis, rheumatoid arthritis, or traumatic injury. However, surgery is not always the best option. You may also consider alternatives.

Physical therapy

Physical therapy is one of the most common non-surgical alternatives to knee replacement surgery. A physical therapist can help develop an exercise program tailored to an individual’s specific needs, which can help reduce pain, improve flexibility, and strengthen the muscles around the knee joint.

Medications

Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation in the knee joint. However, long-term use of these medications can have side effects such as stomach ulcers, bleeding, and kidney damage. Alternative medications such as acetaminophen or topical creams may also be considered.

Weight loss

Being overweight can put additional stress on the knee joint, exacerbating pain and stiffness. Losing weight through diet and exercise can help reduce the pressure on the knee joint, improving mobility and reducing pain.

Injections

Corticosteroid injections into the knee joint can help reduce inflammation and pain. Hyaluronic acid injections, also known as visco supplementation, can help lubricate the knee joint and reduce pain. However, the efficacy of these injections varies from person to person, and they may not be a long-term solution.

Acupuncture

Acupuncture involves inserting thin needles into specific points on the body to stimulate the body’s natural healing process. Studies have shown that acupuncture can help reduce knee pain and improve knee function.

Bracing

Knee braces can help provide support and stability to the knee joint, reducing pain and improving mobility. However, braces may not be appropriate for everyone, and they may need to be custom-fitted for optimal effectiveness.

Stem cell therapy

Stem cell therapy involves injecting stem cells into the knee joint, to regenerate damaged cartilage and reduce inflammation. However, research on the efficacy of stem cell therapy is still in its early stages, and it is not yet a widely available treatment option.

Remember, knee replacement surgery is not the only option for treating severe knee pain and stiffness. Various non-surgical alternatives can be considered, depending on an individual’s specific condition and needs. It is important to work with a healthcare provider to determine the best treatment plan for each case.

What is the cost of knee replacement surgery in India?

The cost of knee replacement surgery in India can vary widely depending on several factors, including the type of surgery, the hospital or clinic where the surgery is performed, the geographic location of the hospital, and the experience and qualifications of the surgeon. The average cost of knee replacement surgery in India ranges from approximately INR 1,50,000 to INR 5,50,000. But, this may only be a rough estimation of the surgery cost. You will also need to account for doctor consultation charges before and after the surgery. You will also need to spend for diagnostic tests such as X-rays, MRI scans, ultrasounds, CT scans, and an arthrocentesis.

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