Knee Replacement in Gurgaon - Diagnosis, Surgery & Recovery

Types of Knee Replacement Surgery

There are typically 5 types of knee replacement surgeries:

• Total Knee Replacement – Total knee replacement or TKR involves replacing the entire knee joint with artificial components, including the femoral, tibial, and patellar components. It’s the most common type of knee replacement surgery and is typically recommended for patients with widespread knee arthritis affecting multiple compartments of the knee.
• Partial Knee Replacement – Partial knee replacement or PKR involves replacing only the damaged portion of the knee joint, preserving the healthy parts. It’s suitable for patients with localized arthritis limited to one compartment of the knee, offering advantages such as smaller incisions, less bone removal, and potentially faster recovery compared to TKR.
• Revision Knee Replacement – Revision knee replacement or RKR is performed when a previous knee replacement has failed or become worn out over time. Revision knee replacement involves removing the existing implants and replacing them with new ones to restore function and alleviate pain. It’s a more complex surgery than primary knee replacement and may require specialized implants or techniques.
• Bilateral Knee Replacement – Bilateral knee replacement or BKR involves replacing both knees during a single surgical procedure. This approach is suitable for patients with bilateral knee arthritis who require replacement of both knees and may offer benefits such as reduced overall recovery time and rehabilitation compared to undergoing two separate surgeries.
• Minimally-invasive Knee Replacement – This approach involves using smaller incisions and specialized surgical instruments to perform the procedure. This approach aims to minimize tissue damage, reduce blood loss, and accelerate recovery compared to traditional open surgery. 

How to Prepare Before Knee Replacement Surgery?

Before surgery, the patient undergoes a comprehensive medical evaluation, including a review of medical history, physical examination, and possibly additional tests such as blood tests, electrocardiogram (ECG), or imaging studies to assess overall health and identify any underlying medical conditions that may affect the surgery or recovery.

Patients receive detailed information about the knee replacement procedure, including what to expect before, during, and after surgery. This education may cover topics such as anesthesia options, surgical techniques, potential risks and complications, postoperative care instructions, and rehabilitation goals. Preoperative education helps patients feel informed and prepared for their upcoming surgery.

The healthcare team reviews the patient’s current medications and may make adjustments or provide specific instructions regarding which medications to continue or discontinue before surgery. This may include medications to manage chronic conditions, blood thinners, and supplements that could interfere with surgery or anesthesia.

Engaging in preoperative exercises and physical therapy can help strengthen the muscles around the knee joint, improve flexibility, and optimize overall physical fitness before surgery. This conditioning can enhance surgical outcomes, accelerate recovery, and facilitate postoperative rehabilitation.

Proper nutrition plays a crucial role in supporting healing and recovery after surgery. Patients may receive guidance on maintaining a balanced diet rich in nutrients, staying hydrated, and avoiding excessive alcohol and caffeine consumption in the days leading up to surgery.

Patients may need to make arrangements for assistance with daily activities, transportation to and from the hospital, and home modifications to facilitate mobility and accessibility during the recovery period. This may involve setting up assistive devices such as walkers or crutches, arranging for home care services, and ensuring a safe and comfortable recovery environment.

When is Knee Replacement Surgery Needed?

Knee replacement surgery is typically recommended for individuals with severe knee pain, stiffness, and functional limitations who have not responded adequately to conservative treatments such as medication, physical therapy, and lifestyle modifications. Some common indications for knee replacement surgery include:

• Osteoarthritis – The most common reason for knee replacement surgery, osteoarthritis is a degenerative joint condition characterized by the breakdown of cartilage in the knee joint, leading to pain, swelling, and stiffness.
• Rheumatoid Arthritis – Inflammatory arthritis conditions like rheumatoid arthritis can cause chronic inflammation and damage to the knee joint, resulting in pain, deformity, and loss of function.
• Post-Traumatic Arthritis – Severe knee injuries or fractures can disrupt the normal structure of the knee joint and lead to the development of arthritis over time, necessitating knee replacement surgery to restore function and relieve pain.
• Other Forms of Arthritis – Less common forms of arthritis, such as psoriatic arthritis or ankylosing spondylitis, may also cause progressive joint damage and pain that may require surgical intervention.
• Severe Knee Deformity – Individuals with significant knee deformities, such as bowed legs (varus deformity) or knock knees (valgus deformity), that cannot be adequately corrected with conservative measures may benefit from knee replacement surgery to improve alignment and function.
• Failed Conservative Treatments – When conservative treatments such as medication, physical therapy, corticosteroid injections, and joint supplements fail to provide sufficient relief from symptoms or improve knee function, surgery may be considered as a next step. 

The decision to undergo knee replacement surgery is made on a case-by-case basis, taking into account factors such as the severity of symptoms, the impact on daily activities and quality of life, overall health, and individual treatment goals. Orthopedic surgeons carefully evaluate each patient’s condition and medical history to determine whether knee replacement surgery is the most appropriate treatment option to address their specific needs and improve their overall knee function and quality of life.

Recovery After Knee Replacement Surgery

The recovery phase after knee replacement aims at restoring mobility, reducing pain, and regaining strength and function in the operated knee.

After surgery, patients typically spend a few days in the hospital for monitoring and initial postoperative care. During this time, pain management, wound care, and physical therapy begin.

Pain management strategies may include medications prescribed by the healthcare team, such as opioids for acute pain and nonsteroidal anti-inflammatory drugs (NSAIDs) for inflammation. As recovery progresses, pain management may transition to over-the-counter medications and other non-pharmacological interventions.

Physical therapy plays a crucial role in the recovery process, starting soon after surgery. Physical therapists work with patients to restore range of motion, strength, and flexibility in the operated knee through targeted exercises, stretching, and mobility drills. The frequency and intensity of physical therapy sessions may vary depending on individual progress and goals.

Patients are encouraged to begin walking and weight-bearing on the operated leg with the assistance of crutches, a walker, or other mobility aids as directed by the healthcare team. Gradually increasing activity levels and gradually weaning off assistive devices help promote healing and prevent complications.

After discharge from the hospital, patients continue their recovery at home with guidance from the healthcare team. This may involve following a prescribed exercise program, adhering to postoperative precautions (such as avoiding certain movements or positions), and attending outpatient physical therapy sessions as needed.

As recovery progresses and the knee strengthens, patients gradually resume activities of daily living and may eventually return to more demanding activities such as walking, climbing stairs, and recreational sports. The timeline for returning to specific activities varies depending on individual factors such as age, overall health, and the extent of preoperative impairment.

Different kinds of knee implants

Generally, a knee implant is made of four components, i.e., a tibial component, a femoral component, a patellar component, and a plastic spacer. Based on their components, knee implants can be categorized as:

• Metal on plastic – In this type of implant, a metal femoral component is attached to a plastic tibial component. It is the most common, least expensive kind of implant. However, these implants are not preferred as much now because the particles released due to the wearing away of the plastic component can trigger an immune response in the future.;
• Ceramic on plastic – These implants feature a ceramic femoral component on a plastic tibial component. It is used in people who might have an allergy to metal implants. However, they are not preferred for the same reason as the metal on plastic implants.;
• Ceramic on ceramic – In these implants, both components are made of ceramic. They are least likely to trigger an immune response. However, they are not preferred as much because they make a squeaking noise when the patient is walking. Also, they can easily shatter when subjected to very heavy loads.;
• Metal on metal – In these implants, both components are made of metal. These are not widely in use as they release small amounts of metal in the bloodstream as they erode, which can cause inflammation, pain, and even permanent organ damage in the long term.