Doctors recommend knee replacement surgery to help patients get relief from pain, maintain or improve knee function and enhance their quality of life. Still, there are certain doubts people generally have as far as knee replacement surgery is concerned, which have been duly addressed herein by Dr Sumit Mahajan (MS, DNB, M.CH, MNAMS) who heads the Department of Orthopedics at IVY super-speciality hospital, Amritsar.

When is the right time to undergo a knee replacement?

There is no specific answer to this question. But if you are facing difficulty in getting up, going to the washroom, observe changes in your walking pattern, experience pain while walking very short distances and it becomes cumbersome to carry out daily activities involving your legs, then this is when you might consider a joint replacement. A thorough examination by an orthopaedic surgeon should yield a recommendation.

Is there a way to avoid surgery?

For some, lifestyle modifications, physical therapy, medication can help manage knee problems. Also, you may want to speak to your surgeon about other procedures that are commonly recommended before resorting to knee replacement surgery, including hyaluronic acid injections and arthroscopic surgery that addresses the damaged cartilage.

However, delaying or declining a necessary knee replacement could result in a less favourable outcome. Ask yourself: Have I tried everything? Is my knee holding me back from doing the things I enjoy?

What will occur during surgery and how long will the knee replacement operation take?

The surgeon will make an incision on the top of your knee in order to expose the damaged area of your joint. The standard incision size can be as long as 10 inches, but a minimally invasive procedure can result in incisions as short as 6 inches. During the operation, the surgeon moves your kneecap aside and cuts away damaged bone and cartilage, which are then replaced with new metal and plastic components.

The components combine to form a synthetic (but biologically compatible) joint that mimics the movement of your natural knee. Most knee replacement procedures take 30min – 1 hour to complete.

What pieces are used in a knee replacement and how are they kept in place?

Implants comprise metal and medical-grade plastic. To seal these components to your bone, two methods are used: 1) Bone cement, which typically takes about 7-8 minutes to set. 2) Un-cemented one which has a porous coating which gets integrated into the bone, but may take up to 6 weeks to set. The latter has got an advantage of a longer life.

Should I be concerned about anesthesia during surgery?

Any surgery with anesthesia has risks. However, complication rates and mortality for general anesthesia are extremely low. An anesthesia team will determine whether general anesthesia spinal, epidural, or regional nerve block anesthesia is best. So, before going in for surgery, it is important to get the medical fitness first.

How much pain will I experience after surgery?

Although you will experience some pain after surgery, it should diminish quickly—within four or five days max. Your doctor will most likely prescribe medication to help you manage the pain, which will be administered intravenously (IV) immediately after surgery.

After you are released from the hospital, you will be switching to oral painkillers, taken in a pill or tablet form. Your willingness to engage in physical therapy and make lifestyle modifications can have a significant impact on your post-surgery level of pain and adjustment to the implant.

What should I expect immediately following surgery?

You will wake up with a bandage over your knee and, in most cases, a drain to remove fluid from the joint. It is likely that you will wake up with your knee elevated.

A doctor might also insert a catheter so you don’t have to get out of bed to get to a toilet. Your doctor will administer antibiotics intravenously and you may receive blood thinners to reduce the odds of a clot.

What can I expect during recovery and rehabilitation from knee replacement?

Most patients are up and walking within a day or two—with the aid of a walker or crutches. A physical therapist will help you bend and straighten your knee a few hours after your surgery.

After you return home, therapy will continue regularly for weeks and you will be asked to engage in specific exercises designed to improve the functionality of the knee. During the weeks after surgery, your doctor will wean you from pain medication.

What do I need to do to prepare my home for recovery?

If you live in a multiple story house, prepare a bed and space on the ground floor so that you can avoid the stairs when you first return. Make sure the house is free of obstructions and hazards including power cords, area rugs, clutter, and furniture.

Focus especially on pathways, hallways, and other places where you are likely to have to walk through. You may want to add a hand shower and English toilet seat.

Will I require any special equipment?

Your doctor will prescribe mobility equipment that you need, like a walker and commode chair.

What activities will I be able to engage in?

You should be able to resume normal daily activities—such as walking and bathing—within several days. Low impact exercise should also be doable after your rehabilitation period, typically 6-12 weeks.

Consult with your physical therapist about introducing new activities during this rehabilitation period. You should avoid running, jumping and other high impact activities. You can do activities like driving, morning walks and playing golf 6-8 weeks after surgery.

How long will the artificial knee joint last and will I ever require a revision (a second knee replacement)?

Studies show that upwards of 85 per cent of patients still have a functioning artificial joint 20 years after receiving it. However, wear and tear on the joint can adversely affect its performance and lifespan. Younger patients are more likely to have the joint wear out and require a revision during their lifetime. Consult with a doctor about what’s right for you.

Dr Sumit Mahajan (MS, DNB, M.CH, MNAMS) is a Senior Consultant with IVY group of Hospitals and heading the Department of Orthopedics at IVY super-speciality hospital, Amritsar. He specializes in minimally invasive joint replacement surgeries for knees and hips and got specialized training from AIIMS (New Delhi), Germany, Singapore & Bangkok. He has more than 4500 surgeries to his credit.

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