Knee Replacement and Reconstruction

For a patient considering knee replacement surgery, there are new developments under study which can help enhance their quality of life. These include:

• Use of cementless parts that allow new bone to grow into a porous prosthesis and hold the parts in place, creating a biologic fixation
• Use of bioactive joint surfaces such as hydroxyapatite
• The use of mobile-bearing knee replacement in which a polyethylene insert creates a dual-surface articulation by articulating with the femoral as well as tibial components. This will enhance the life of the implant by reducing wear.
• Development of systems with improved kinematics
• Better fixation

Use of navigation- guided surgery that involves use of navigation –guided instruments with smaller incisions and less tissue damage. Only suitable trained surgeons with various measures offer this procedure.

Indications

Revision knee replacement surgery may be advised to patients if they have one or more of the following conditions:

• Trauma to the knee joint
• Chronic progressive joint disease
• Increased pain in the affected knee
• Worn out prosthesis
• Knee instability or a feeling of giving way while walking
• Loosening of the prosthesis
• Infection in the prosthetic joint
• Weakening of bone around the knee replacement, a process known as osteolysis (bone loss)
• Stiffness in the knee
• Leg length discrepancy
• Fracture

Total knee replacement is the surgical treatment for knee arthritis, where the damaged knee is removed and replaced with an artificial knee implant. Traditionally performed as an inpatient procedure, total knee replacement surgery is now being conducted on an outpatient basis, allowing patients to go home the same day of the surgery. This is made possible with recent advances such as improved perioperative anesthesia, minimally invasive techniques and initiation of rehabilitation protocols soon after surgery. Outpatient total knee replacement is considered when your vital signs are stable, such as heart and respiratory rate, blood pressure and temperature during your post-operative physical therapy session. Moreover, you need to be able to maintain pain control with oral medication and tolerate a regular diet before being discharged on the same day of surgery.

The outpatient procedure is performed using advancements in anesthetic techniques like a femoral regional block, which produces a centralized anesthetic effect and does not require a hospital stay for its effects to wear-off, like traditional general anesthesia.

For more details regarding the surgery please refer the Total Knee Replacement section above.

Knee replacement is a surgery performed to replace parts of a diseased knee joint with an artificial prosthesis. The goal of knee replacement is to eliminate pain and return you to your normal activities. You can help in recovery and improve the outcomes of the procedure by following certain precautions and changing the way you carry out your daily activities.

After knee replacement surgery, once the anesthesia wears off, you will start to experience pain, for which your doctor will prescribe medication. You may have to remain in the hospital for a few days depending on your progress and overall health. Remember to get plenty of rest during this initial phase. Your surgical wounds should be monitored for swelling, inflammation and other changes and frequent dressing changes are performed. A continuous passive motion machine is applied to keep your knee moving, compression boots or elevation of your leg may be recommended to encourage circulation and prevent stiffness, clots and scar formation.

Rehabilitation begins within 24 hours of surgery, where a physical therapist will help you stand up and walk using crutches or a walker. Adhering to the goals of the rehabilitation program is important to help you recover and resume your normal activities. You will be guided to perform strengthening exercises daily and learn to get in and out of bed, and use a bedside commode. When you are discharged from the hospital, you will be encouraged to walk short distances with an assistive device, climb a few stairs, dress, bathe and perform other basic functions by yourself.

On reaching home, have a family member or caregiver assist you with your activities for a few weeks. Taking care of someone following knee replacement surgery requires compassion, awareness and patience. Basic points to follow by your caregiver:

Helping with basic movement and functions as well as emotional support

Having a clear understanding of your medication and ensuring they are administered in a timely manner

Keeping emergency numbers ready

Assisting you with household chores, paperwork and traveling to keep your appointments

Helping and motivating you to perform your rehabilitation exercises

Ensuring that furniture is rearranged so as not to interfere with your movement and cause falls.

To avoid bending or reaching out, items that you use frequently can be placed easily within reach.

Certain instructions that your doctor will brief you about are:

• You may shower once the wound heals, but avoid soaking in a bathtub for at least six weeks.
• Keep the wound clean and dry. Your doctor will let you know when you can shower or bathe.
• Some amount of swelling is normal after knee replacement and may last for more than a month. It can be controlled by icing and elevating your leg for 30 to 60 minutes every day.

By week 3, you should be able to move with minimal assistance and significant reduction in pain. Your physical therapy program will gradually include new and more difficult exercises as you improve in strength and flexibility. By week 7, you should be able to walk independently. To reduce stress, use the opposite knee to lead when climbing stairs and the replaced knee to lead when descending. You will be able to drive a few weeks after surgery when you have sufficient pain control, improved strength and can easily enter and exit a car. Walking and exercising at least 2-3 times a day for 10-15 minutes is recommended for a faster recovery.

You and your caregiver must be aware of the signs of infection. Contact your doctor if you notice any abnormal wound changes or any changes in general health and mental state, or should you have persistent fever, drainage, excessive swelling or other signs of infection.