Knee arthritis occurs when the protective cartilage covering the ends of the bones in the knee joint deteriorates, exposing the bone surfaces. This results in friction between the bones, causing pain, swelling, and potential joint deformities.
Symptoms of knee arthritis include:
Pain, often worsening with activity
Swelling and inflammation around the joint
Stiffness, especially after periods of rest
Reduced range of motion and flexibility in the knee
Grinding or popping sensations during movement
Deformities, such as bowing of the leg or visible joint enlargement
The diagnosis of knee arthritis is based on detailed medical history of the patients, their symptoms, typical findings on clinical examination of knee and x-rays of their knee.
CT and MRI scans have limited role in the diagnosis of knee arthritis.
Non-surgical (conservative) treatments for knee arthritis include:
Activity modifications: Patients are educated about lifestyle adjustments to alleviate pain, such as avoiding activities like squatting, kneeling, or sitting cross-legged. Using a commode instead of an Indian-style toilet and minimizing repeated use of stairs can also help manage symptoms.
Walking aids: Using a walking stick or single crutch on the same side as the affected knee can reduce stress on the joint, providing stability and improved mobility.
Physiotherapy: Exercises to strengthen the muscles around the knee joint can decrease pain, enhance range of motion, and promote better mobility. Regular exercise is beneficial and can expedite recovery if surgery becomes necessary later on.
Anti-inflammatory and pain medications: Medications prescribed by a doctor can help control pain and inflammation, leading to improved mobility. Different types of medications are available, tailored to each patient's pain intensity and health profile.
Weight reduction: Losing weight reduces the load on the knee joint, which can alleviate pain and improve mobility. Even a small weight loss can significantly reduce stress on the knee.
Chondro-protective agents: Glucosamine and chondroitin sulfate are considered protective for cartilage and can slow down the progression of arthritis, potentially aiding in cartilage regrowth and pain relief.
Visco-supplementation: Injecting the knee joint with hyaluronic acid can improve joint fluid viscosity, cartilage health, and lubrication, reducing friction between arthritic surfaces. This treatment is particularly beneficial for mild to moderate knee arthritis, offering pain relief for several months.
Knee Replacement, also known as Knee Arthroplasty, is a surgical procedure to replace weight bearing surfaces of the knee joint with metal and plastic to relieve pain and disability caused by arthritis.
Depending upon the implant design, the commonly done knee replacements are: Partial Knee Replacment (UKR), Cruciate Retaining (CR) Total Knee Replacement and Posterior Stabilized (PS) Total Knee Replacement
Knee replacement surgery is typically recommended when:
Moderate to severe arthritis causes significant knee pain that interferes with daily activities like walking, climbing stairs, or sitting and standing.
Pain persists despite efforts such as regular pain medication, the use of walking aids, lifestyle adjustments, or physiotherapy.
Adverse effects from pain medications become concerning.
Other conservative treatments like weight loss, visco-supplementation, or steroid injections fail to alleviate pain.
Severe pain significantly impacts social life, leading to a sense of confinement and dependency.
X-rays confirm advanced arthritis in a patient experiencing symptoms.
Indeed, simultaneous replacement of both knees is possible for patients who are medically fit, relatively young, and without severe or complex knee deformities. Bilateral knee replacement presents several benefits:
Cost savings due to the avoidance of separate surgeries and hospitalizations.
Elimination of the need for a second hospital stay.
Similar post-surgery rehabilitation duration compared to single knee replacement.
Faster return to normal life and activities.
The surgical procedure itself typically lasts between 45 to 60 minutes for a single knee replacement. However, when considering pre-operative precautions, preparations, the surgical procedure, and recovery time in the recovery room, the entire process may take 2 to 3 hours in total.
There are three types of anesthesia commonly used for total knee replacement: General, Spinal, or Epidural anesthesia. The choice of anesthesia is determined by the anesthetist based on your physical condition and surgical fitness. The final decision is made after discussing options with you.
Typically, knee replacement surgeries are performed under epidural anesthesia or a long-acting spinal anesthesia with post-surgery nerve blocks. This numbs the area below the waist for the operation. With epidural anesthesia, patients may choose to remain fully awake or receive a sedative injection. Continuous epidural anesthesia via a special catheter tube and syringe pump is often maintained for 2 to 3 days post-surgery, providing effective pain relief. This enables patients to start knee exercises in bed without pain, boosting confidence in physiotherapy and enhancing cooperation and performance.
After your knee replacement surgery, the physiotherapist will assist you in getting up and walking as soon as possible. By the next day, you may be able to sit on the edge of the bed, stand, and even walk with assistance. Initially, you'll use a walker, progressing to crutches as your recovery progresses. The physiotherapist will instruct you on walking to and from the toilet, as well as using the commode. A seat raiser for the commode may be necessary for 2 to 3 months. You'll also receive guidance on navigating stairs with the help of crutches.
It's normal to experience discomfort while walking and exercising, and you may notice swelling in your legs and feet. The physiotherapist will teach you specific exercises to strengthen the knee and provide instructions on precautions to take during your recovery.
While the joint pain you experienced before surgery will disappear immediately, you may encounter a different type of pain resulting from the operation. This post-operative discomfort is temporary and effectively managed with pain-relieving medications, either administered through injections or taken orally in tablet form.
For a single-side knee replacement surgery, your hospital stay typically lasts around 3 to 4 days. In the case of bilateral knee replacement surgeries performed in a single stage, your stay may extend between 5 to 7 days, contingent upon your overall fitness and recovery progress post-surgery.
Upon discharge, you will receive a comprehensive discharge summary containing written instructions regarding medications, follow-up appointments, and guidelines for physiotherapy.
Your physiotherapist will provide guidance on simple home exercises and their recommended frequency. These exercises are designed to strengthen thigh muscles and improve the range of motion in your knee joint. It's essential to incorporate regular walks into your routine. Additionally, applying ice packs to the knee for 20 minutes, 4 to 5 times a day, and keeping the joint elevated during rest periods are important practices. Following these instructions diligently helps prevent overexertion, which can lead to increased pain or swelling.
Before your discharge, your wound will be inspected, and the dressing will be changed as needed. This fresh dressing can remain untouched until it's time for suture removal. Sutures or skin staples are typically removed 14 days after surgery.
You can typically take a bath or shower around 2 weeks after the operation, once your wounds have been inspected for healing and all sutures or skin staples have been removed. Until then, we recommend sponging without getting the operative wound wet.
At 2 weeks after your knee replacement surgery, you'll have a check-up with Dr. Niraj Ranjan Srivastava. During this visit, he will assess your operation site, walking ability, balance, and muscle strength, and Stitches will be removed.
Following this, Dr. Niraj Ranjan Srivastava will schedule follow-up appointments at 6 Weeks, 3 months, 6 months, and 1 year post-surgery. X-rays will be taken during these visits to ensure everything is progressing well.
Subsequent follow-ups are recommended at 5 and 10 years after the surgery, including new x-rays of your knee replacement to monitor for any signs of loosening.
Following knee replacement surgery, it's important to reach out to Dr. Nirajranjan Srivastava if you experience any of the following symptoms:
Fever or chills (temperature of 38°C or 100.4°F)
Persistent warmth or redness around the knee
Discharge (leakage) from the wound
Persistent or increased pain in the knee or calf muscle
Shortness of breath
These signs could indicate potential complications, and prompt communication with your doctor is essential for appropriate management.
During knee replacement surgery, potential risks include:
Risks associated with anesthesia:Allergic reactions to medications. Breathing difficulties
General surgical risks:Blood clots in the legs (DVT - deep vein thrombosis) that may travel to the lungs (PE - pulmonary embolism). Infection, which can affect various areas such as the lungs, urinary tract, and chest. Bleeding
Specific risks of knee replacement surgery:- Infection of the knee joint. Wear of the artificial joint over time. Loosening of the artificial joint. Knee stiffness.Allergic reaction to the artificial joint material. Nerve injury, which may result in numbness in the outer aspect of the knee; typically resolves within 4-6 months, leaving a small patch of numbness that doesn't usually cause discomfort. Injury to blood vessels
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