What is a knee joint?
Knee is the most vital joint of the body and helps us in walking, sitting and standing; allowing our lower leg to move. It is also known as the tibiofemoral joint. 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.
What causes knee pain?
Wear and tear in the cartilage lining occurs in the knee joint, after bearing lot of our body weight although it can be cure by some mobility exercises and medicines. But, in certain cases, due to old age or other ailments joint cartilage usually wears out leading to osteoarthritis, rheumatoid arthritis or any post injury arthritis, etc.
How is knee pain treated?
In the initial stages of knee arthritis or any injury, doctors mostly suggests 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 recommend to go for knee replacement surgery.
What is knee replacement?
- Doctors remove the worn out cartilage along with a bit of bone and fit in an implant with special tools in knee replacement surgery, when the knee joint becomes the reason of 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. At BLK, implants from various international companies are available and only the best are used for such procedures.
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.
What is the surgery process?
- Prior to surgery, patient is admitted.
- Required investigations are done.
- The anaesthesia team gives patient the approval.
- 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.
- Choice of anaesthesia – epidural or general is discussed by the patient with the anaesthetist. – epidural or general.
- Patient is asked to mention if there are other medical issues such as diabetes, hypertension, asthma, etc. So that a physician can be consulted.
- Patient is kept on eight 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 preoperative 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.
How to prepare for surgery?
A patient is thoroughly checked for any source of infection in the body, such as skin boils, dental urine and chest infection. Doctors inquire if patient is taking blood-thinning medicines. These medicines may have to be stopped a few days before surgery. Proper measures are taken if a patient has any other medical issues such as diabetes, hypertension, asthma, hypothyroidism to avoid any issue.
What is the recovery process?
- Walking: 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.
- Circulation Exercise: To regain power in the legs, patient is being given full assistance & is asked move foot and ankle up and down as many times as possible. 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). Advisable Exercises are Upper limb and deep breathing. 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.
- Pain relief: Sufficient treatment is given for pain relief in 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.
- Discharge from hospital: 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.
What safety measures should be taken after surgery?
Short- term safety measures
- 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 safety measures
- 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.
Risks / complications of the Surgical Process
There is no surgery which is carried out without danger, but we ensure that the danger 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 dangers related to knee surgery that patients need to be aware of. Despite that, 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.
How soon does a patient recover 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.