Pawar Hospital
After deciding a date of admission and surgery, usually about 7 or 10 days prior to admission, we advise some Blood and Urine tests and a medical checkup by Physician. This is to make sure that you are fit for anaesthesia and operation. This will also help us detect if, at all, there is any active or recent infection in your body which can be treated before surgery.
Any active skin, dental or urinary infections are to go ahead for surgery and should be treated and documented in Lab reports! Patient is also required to inform the doctor regarding all the medicines being taken so as to stop certain drugs like blood thinner well ahead of surgery! All these reports can be done without any hassle in our hospital only.
You would be admitted to the hospital on the evening/night before the day of operation and would be examined again to make sure that you are fit and well to undergo operation.
Two types of Anesthesia are commonly used for Knee Replacement Surgery. The First type of anesthesia is Spinal Anesthesia with Epidural Analgesia, which is very commonly used, works by numbing your legs, so you do not feel the operation. This is done by placing numbing medicine around the nerves that would go to your legs using a small catheter in your lower back. You are also given medicine to relax you and you may fall asleep, but you can still breathe on your own.
An actual surgical procedure usually takes approximately 50 minutes to 1 hour. However, preoperative preparation time required by an anesthesiologist to prepare you for the surgery and certain procedures after surgery will make you stay in the operation room for about two-to two-and-half hour.
This will depend on your level of Haemoglobin before surgery. With use of tourniquet, blood loss during surgery is usually minimal. So during surgery, usually blood transfusion is not needed. But sometimes, we might advise after surgery, considering Haemoglobin level and the drain output coming out of the operative wound.
It is very likely that you will have pain in your knee for first 2 days. This is normal and you should not be surprised or concerned. Most of the pain that you experience right after surgery is from the surgical incision and dissection. You will be given strong pain medication through your I.V. line and also through the epidural catheter and most of the patients are very comfortable with these pain relieving measures. With our Fast Track Replacement Technique and a use of the latest analgesia protocols, we have been able to make postoperative period quite Pain-free! However, generally any surgery is more or less painful only for first 48 hours and then the patients more likely start getting more and more comfortable.
Physiotherapy is the most integral and unavoidable part of the entire treatment! There is No Scientific Entity like No Physio Knee Replacement!!! BUT, it is not going to be an unpleasant or painful experience!! With our FAST TRACK Technique, physiotherapy can be minimized just to 10 or 15 days after operation under the care and guidance of our expert physiotherapist. Physiotherapy is to strengthen the weakened muscles around knee joint and to improve the movement of new joint to help you learn walking and improving your gait or walking pattern. Sometimes, we may even ask you to start the therapy 1 week or 10 days before the date of surgery in order to make you well versed with the programme and also to make the stiff knee joint softer and smoother!!!
1st Day of Operation
After surgery, you will be shifted back to the room. Your blood pressure, pulse, respiration and temperature will be checked frequently. Although circumstances vary from patient to patient, you are likely to have some or all of the following after surgery:
1) You will find that a large dressing has been applied to a surgical area to maintain cleanliness. This dressing is usually changed 2 days after surgery by the orthopedic surgeon.
2) IV fluids started prior to surgery will continue until you are taking adequate amounts of fluid by mouth on day of surgery. IV antibiotics are frequently administered every eight to twelve hours for the next 48 hours after surgery to reduce the risk of infection.
3) One side effect of spinal anesthesia is often a difficulty in urinating after surgery. For this reason and also to measure the 24 hours urine output, a sterile tube called a urinary catheter will be inserted into your bladder while you are in anaesthesia effect in operation room after surgery. This catheter will be removed in room after 24 to 48 hours considering the patient’s comfort.
4) Diet: You will be allowed to progress your diet as your condition permits; starting with ice chips and clear liquids as tolerated.
5) You will be assisted to sit, get up from the bed and then to walk on the same evening of operation by our physiotherapist. You will also be taught to move both ankles frequently along with some other exercises, to be done as per your comfort and tolerance.
6) You will be given blood thinning pill and if required sleep medication at night.
2ndDay of Operation
On the next day of surgery, IV antibiotics, analgesics and epidural analgesics will be continued. You will be assisted to walk for 2 -3 times a day. Diet and plenty of liquids are encouraged from second day.
3rd Day Onwards
Usually after 2 days of surgery, the pain is reduced and the patient is now much comfortable and confident. Drain from the wound along with urinary and epidural catheters are taken out. IV line is removed. Bulky dressing is removed and a thin sterile dressing strip is applied. Ice packs are advised to be put over the operative area for 4-5 times a day. Most patients start walking with stick on third day. Toilet training and stair activity training are started. Physiotherapy as advised by therapist is advisable to be done on own for 3 to 4 times a day.
On 4th or 5th day after surgery, second dressing is changed. Patient is discharged once diet is normal, urine and bowel habits are routine and patient is able to sit in chair, go to toilet on own, walk for reasonable distance.
1) You will be sent home on prescribed medications to control pain. Plan to take your pain medication 30 minutes before exercises.
2) Continue to walk with walker/stick. Bear weight and walk on the leg as much as is comfortable. Walking is one of the best kinds of physical therapy and for muscle strengthening.
3) If excess muscle aching occurs, you should reduce your exercises.
4) Put ice packs on your operated knee, 3-4 times daily to reduce pain and swelling. When using ice, remember not to get your incision wet before your staples are removed.
5) Keep the incision clean and dry. If you observe sudden increase in swelling and pain, drainage from the incision site, redness around the incision or fever is noticed, report this immediately to the doctor.
6) You should not take bath until staples are removed. Generally, the staples are removed in two weeks.
7) You should not drive a car until the 4-week follow-up appointment.
An artificial knee is not a normal knee, which the nature has provided. However, the operation will provide pain relief for at least 12-15 years. In many patients, their total knee replacement will last their lifetime, but in some it may not last that long. If replacement provides you with pain relief and if you do not have other health problems, you should be able to carry out most of the normal activities of daily living like unlimited standing, sitting, walking etc.
You can do exercises like bicycling, walking and swimming. However, activities that overload the artificial knee like jogging and sports like tennis must be avoided to increase the longevity of the artificial knee. Most of the patients with stiff knees before surgery will have better motion after a total knee replacement.
Almost all modern total knee implants have very similar basic Total Condylar design and have some minor differences in designs. Some of the joints have metallic components fixed to the end of thigh bone(Femur) and Leg bone (Tibia) with bone cement and a plastic insert between the two metallic components (Metal backed Tibial component). It does offer some technical advantages to the surgeon. As against this, some other designs have All-Polyethylene tibial component called all-poly tibia, where the femoral component is metallic and the tibial component consists of only plastic.
Almost all modern total knee implants have very similar basic Total Condylar design and have some minor differences in designs. Some of the joints have metallic components fixed to the end of thigh bone(Femur) and Leg bone (Tibia) with bone cement and a plastic insert between the two metallic components (Metal backed Tibial component). It does offer some technical advantages to the surgeon. As against this, some other designs have All-Polyethylene tibial component called all-poly tibia, where the femoral component is metallic and the tibial component consists of only plastic.
All-poly tibial base plates are more cost-effective to the patient. Some of other available knee implants may include gender specific knees particularly for female patients and high flexion knee designs (Hi-flex knees), which are supposed to provide more knee bending. Long term results regarding longevity and patient satisfaction for these relatively recent designs are, however, not available at this stage.
Therefore, the final choice of the implant should be ideally left to the operating surgeon, who would base his decision keeping in mind the requirements of the patient, suitability of a particular implant in the given patient, survivors hip (longevity and track record) of the implant and also his experience and familiarity with the instrumentation and implant practiced.
In many ways, a total knee replacement is similar to a set of automobile tires. How long the knee replacement lasts is related to the type and amount of use, and not simply how long it has been implanted. A set of automobile tires can last for many years if the car is not driven very much or they can wear out in less than one year if they are driven many miles over rough roads. How long a total knee lasts depends on how much it is used, what types of activities it is used for, how heavy the patient is, age of the patient at time of index surgery and whether the patient is staying in good physical condition.
In many patients, their total knee replacement will last their lifetime and in others, it may not. Total knee replacements are designed to provide painless and unlimited standing, sitting, walking and other activities of normal daily living. They do very well for walking, bicycling and swimming. They are not designed for jogging or sports like tennis or skiing. Total knee replacement surgery is done to improve quality of life and each patient must decide for oneself what makes life worth living for them and pursue happiness through those activities. You should be aware, however, that the longevity of a total knee replacement may be shortened by frequent, vigorous activities.
In the event that a total knee fails, it is possible to implant another knee. Such revision total knee replacement surgery may be a lesser or greater operation than the original total knee surgery. In general, the results of revision total knee surgery are not quite as good or predictable as for primary total knee replacements. Following revision total knee replacement, most patients have good relief of pain and are able to walk as far as they desire.
With most of the current designs of conventional total knee replacements, average 120 degrees of knee bending (flexion) is achieved which is sufficient to perform most daily activities like walking, climbing stairs, getting in and out of car or rickshaw, rising from a chair etc.
However, if your routine daily activities involve kneeling, squatting and sitting cross legged, a high flexion knee joint can be implanted. However, it is not known whether efforts to increase flexion could cause deleterious effect on the implanted joint like early loosening. One should, therefore, be careful about indulging in activities which cause extreme flexion of the knee joint. Also, there are certain criteria which have to be fulfilled for the implantation of the high flexion designs to achieve more than average range of motion of the knee joint after surgery.
As the knee arthritis worsens, the stiffness of the arthritic joint also worsens. This can make the replacement surgery technically more demanding. It may also lead to a longer recovery period and more physical therapy. In severe cases, joint flexibility may never return to normal. By waiting too long, you may not get the full benefits of your knee replacement surgery and such a delay could negatively impact the result of the surgery.
Knee replacement surgery can be carried out even in patients who are above the age of 75-80 years provided they are medically fit and are in good general health and their activities of daily living is restricted by painful arthritis of knee joints.
