Total Knee Replacement

Dr. Amir Sanghavi

Comeback Stories

What Is Total Knee Replacement?

Total knee replacement involves replacing damaged joints with prosthetic joints comprised of metal and high-link polyethylene plastic, which is a breakthrough treatment for knee discomfort caused by damaged joint surface, most typically from age-related arthritis. The availability of alternative treatments for damaged joints was limited in the past, forcing people to accept deformity and disability and live with painful joints. However, thanks to advancements in medical science and engineering, this issue can now be resolved and its advances are evolving since last 75 years offering patients a qualitative second innings of their life.

Knee joint Anatomy

Knee joint is made by lower femur, upper tibia, and The patella bone (knee cap) combine to produce the complex type of knee joint. The lower femur is composed of two convex medial and lateral condyles, while the upper tibia is composed of two concave medial and lateral condyles. This allows the femur to glide over the tibial condyle, allowing for a smooth range of motion. It also allows for some rotational movement, which contributes to the complex nature of the joint.
Smooth cartilage makes up the joint surface. Major ligaments that provide stability to the joint are the ACL (anterior cruciate ligament), PCL (posterior cruciate ligament), MCL (medial collateral ligament), and LCL (lateral collateral ligament). Soft tissue includes the medial and lateral meniscus, which provide a cushion effect to the joint.

In addition to all of these internal knee structures, the muscles around the knee are essential for knee joint mobility and strength. Mainly the quadriceps and patellar tendon (anteriorly) and hamstrings (posteriorly).

Importance of quadriceps mechanism

Quadriceps muscle is formed by Rectus femoris ,vastus medialis ,vastus lateralis and vastus intermedius. These all muscles attached to upper pole and upto anterior half of patella bone. On lower pole of patella bone there is attachment of patella tibial tendon which attached with tibia bone on tibial tuberosity. Combination of all these structure form quadriceps mechanism for knee extension.

Articular surface of the patella glides in trochlea(femoral sulcus) throughout knee range of motion also known as patella tracking which balancing the quadriceps mechanism and knee extension. Tightness of soft tissue surrounding patella bone can be the cause of patella maltracking.
Muscles and ligaments, mainly LCL and MCL, play a major role in the outcome of replacement surgery.

What are the Indication for total knee replacement surgery ?

Osteoarthritis is the most prevalent ailment that necessitates knee replacement surgery.
The degeneration of joint cartilage is the hallmark of osteoarthritis. Damage to the bones and cartilage restricts range of motion and may be painful. Walking and climbing stairs are two common tasks that people with severe degenerative joint disease may find too difficult to perform.
Other forms of arthritis, such as rheumatoid arthritis and secondary arthritis that results from a knee injury, may also lead to degeneration of the knee joint.
Fractures, torn cartilage, and/or torn ligaments may lead to irreversible damage to the knee joint.

Why knee replacement surgery is needed?

When a person’s quality of life begins to decline and for those who are unable to participate in everyday activities as usual, surgery becomes necessary.
Additionally, patients choose this operation when non-operative measures, such as anti-inflammatory drugs and knee joint injections, which have clearly been recommended by an orthopaedic physician, appear to have no effect on their level of alleviation.
However, knee replacement surgery may be required to lessen the need for medications (painkillers), which can harm the kidneys, typically associated with older adults who also have other systemic disorders. The most common group of patients are above 55 years of age.
When all Non operative measures fails like NSAID, physiotherapy, knee braces (OA knee brace), intraarticular knee injection (gel,PRP,steroids).

What should be expected before surgery?

Before surgery, patients should undergo pre-operative preparations such as :

Physician assessment for pre operative assessment.
complete hemogram to check blood parameters (Mainly CBC , S.CREAT , S.ELECTROLYTE , SGPT, coagulation profile)
Investigations to rule out any infection in body.
A thorough cardiac assessment for heart as well as anaesthetic assement to decide whether surgery is performed either under spinal anaesthesia (where only both lower limbs are anesthetized) or general anaesthesia or block anaesthesia (where only single limb is anaesthetized)
An assessment of lower limb vascularity and neurological status if it is being asked by an orthopaedics that totally depends on patient medical condition for a better prognosis and surgery outcome.
Patients should also disclose their complete history, including past surgeries, drug allergies, and previous procedures, to the surgeon so they can take the necessary intra- and post-operative precautions.

How knee replacement is done?

Damaged cartilage and bone is replaced by prosthetic implant consist of three components:

Femoral component (polished metal)
Tibial component ( metal / high linked cross polyethylene)
In between femoral and tibial component there is plastic spacer which is also considered as 4th component.
Patellar component (plastic) : need to be replaced only in 10% of cases

How long does the recovery process take for Knee replacement surgery?

With advancement of technology and techniques that are being used, patients now stay in hospitals for only 4 days, where they can begin to walk on the same surgery day under the supervision of a physiotherapist once the anesthesia wears off and also be allowed to bend their knees.
Each day, the patient has to be tailored to a specific task, which he or she is told to do while hospitalized. upon discharge patients are taught to do stair climbing as well.
Knee rehabilitation is needed at home for coming Back to normal life in stipulated time.

What are the different types of knee replacement surgery available?

Total Knee Replacement

replaces all three compartments of knee

Partial Knee Replacement

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Revision Knee Replacement

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Robotic Knee Replacement

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