What is Knee Replacement Surgery?
Time to read 17 min
Time to read 17 min
Also called as Knee arthroplasty or Knee resurfacing, Knee replacement surgery, is done to provide pain relief and improved mobility to people who:
In most such cases, the knee joint is eroded, uneven, worn or damaged as the cartilage is worn away, and the knee joint is unable to bear the weight of the body. This condition results in pain, stiffness and a change in body alignment as well. People may not be in a position to move around freely, may give up on walking totally, or may have falls.
When this surgery is done, it restores the knee joint back to such a state that it can bear the weight, and thus, reduce the pain and provide improved movement and flexibility. The surgery involves the reconstruction and/or replacement of the degenerated joints using artificial parts or prosthetics as is seen fit.
There are mainly two kinds of Knee replacements namely, Total Knee Replacement (TKR) and Partial Knee Replacement (PKR). The doctor is the best judge for deciding which kind of knee replacement a person needs.
The implants are made of plastic and metal, and also customized according to each individual for maximum compatibility.
Snippet Highlight: Both TKR and PKR are aimed at improving the quality of life and mobility of the patient. When the damaged knee is replaced either partially or fully, people are able to independently move around, while it is possible that there could still be some minor issues. The hospital stay and recuperation depend on the TKR or the PKR.
Statistics From Around The World
In the United States, over 966,000 knee replacements were performed in 2017, and PKRs were were lesser than the TKRs. According to a report released by iData Research, a leading international medical market research and consulting firm, the increase in the knee replacement surgeries are actually driven by young people.
These people lead an active life and thus end up putting more pressure on the knee. This results in wear and tear, leading to issues. As a result of this, the life of the implants being used is also increasing, as younger patients will expect it to last longer.
India is expected to see one million knee replacements every year by 2022. This is because knee arthritis incidence is 15 times more in India than the Western Countries.
A range of symptoms like knee pain, immobility in the area, swelling, stiffness, inability to bear the weight, walk properly or climb stairs, etc. are seen commonly in people who end up with a surgeon, who will then conduct some tests to determine if the person needs a knee replacement surgery.
Watch out for:
Snippet Highlight: It may be noted that the causes are varied and hence not all knee pain may need surgery. In fact, even for arthritis, the usual course is to try out physiotherapy and medications based on the extent of the damage.
The doctor will conduct a few tests to decide if you are indeed a candidate needing knee replacement. They are:
Procedure Details
Once it is confirmed that a person needs to undergo knee replacement surgery, there will be a few tests and counselling sessions conducted in order to ensure that the patient is fully aware of the procedure and the outcome. The preoperative procedures may include consultations, and diagnostic tests like blood test to determine blood count and blood clotting, and may also involve electrocardiogram (ECG) and urine test.
This surgery is performed under general, spinal, or an epidural anesthetic, depending on the need and the medical record of the patient. Again, depending on whether it is a total or partial knee replacement, the duration of the operation may change. The total knee replacement may last for about 3 to 4 hours. The hospitalization may be about 3 days or slightly more if any specific issue is there that needs to be monitored.
Snippet: For patients choosing knee replacement surgery, it helps immensely to undergo weight management and a strengthening regimen prior to the operation. This helps you recover faster from surgery and prepares your musculature to support you as your knee joints recover.
On The Day Of Surgery
Pre-Op: All supplements to be stopped except for calcium, iron and vitamin D around two weeks prior to surgery. The day prior to the surgery, you can follow your normal diet except for eating any solids late at night, especially after midnight. All prescribed medications also need to be taken, unless told otherwise.
Be sure to specifically check with your doctors/Hospital about medicines used for
On the day of surgery: Clear fluids can be taken up to three hours before surgery or till arrival at the hospital. These include water, broth, Black tea or coffee. However, if you have been specifically asked to avoid any foods, follow those instructions.
Non-citrus fruit juices like apple, cranberry and grape are also allowed. Milk and dairy products and pulpy or citrus juices are to be avoided. Once you get admitted for surgery, they may conduct a few pre-surgery tests to ensure things are in order.
Though there could be some pain and discomfort (at times could be high as well, and in individual dependent), patients would need to start walking with the help of a walker, if required. The pain will decrease gradually as the joint becomes adjusted and flexible, and the muscles start strengthening. The surgeon gives specific discharge instructions which need to be followed to the T. Physiotherapy is part of the rehabilitation process as well. There could be some medicines and supplements prescribed for a while, as also follow-up guidelines. People may also be instructed not to lift weights, or watch out for symptoms of infections, blood clotting or pulmonary embolism, in which case the doctor should be consulted immediately.
The importance of a strict adherence to the rehabilitation process in such cases cannot be highlighted enough, as that is what ensures your recovery and improves your quality of life. The suggested rehab process helps with:
Hence, when a disciplined approach is not taken toward the rehab process, it defeats the whole process of undergoing the surgery. Along with this, nutrition levels need to be maintained as mentioned in the Nutrition section below. Foods containing Vitamin D/B12/Omega 3 fatty acids etc. are to be included in the diet for this.
You may likely feel tired for a while, and this is normal, and you need to plan your rest along with the physiotherapy sessions. For normal healthy people, it takes about six weeks to resume normal activities. For certain people, it may take three months for the pain and swelling to completely go away. In certain cases, it may even take a year for full recovery and the healing keeps happening for up to two years, even if you do not feel much discomfort.
One should be able to get back to driving and normal work after six week, but if doing house chores, only light work should be done and no heavy lifting should be done.
Week 1 - 2
The rehab starts from day one of the surgery and the patients are encouraged to stand up and start walking with assistance, within 24 hours of surgery. You may be assisted to sit up on the bed, and take a few steps by the bedside. The walking will be more on the second day and so on. You may be on antibiotics and anti-inflammatory drugs to control the pain, inflammation and any infections. The pain is expected to be high during the first one week and it will be berable in the second week. As such the physiotherapist will concentrate on motion of the joint with minimal pain and the medicines will help with the pain as well.
Week 3
By this time, you are back home and the pain is definitely bearable and you are able to walk around more freely than in the first two weeks. You may also be able to do so without a full fledged walker and with the help of just a crutch or a walking stick. This basically means that you are indulging in weight bearing walking with neuromuscular control. Physiotherapy and exercises, as suggested is a must at any cost to keep this improvement going. There could still be some medicines for the pain, inflammation and infection.
Week 4 - 6
If you have strictly followed the rehab process and physiotherapy, marked improvement is expected by this period, and you should slowly be able to walk without any assistance. There should be improved flexibility and strength in the knee joint and the physiotherapist will slowly test it as required. Do not try anything that is not suggested, just because you feel confident at this point. Basic routine activities may be started at this point, once you have had a follow-up consultation and the surgeon gives a go ahead.
Week 7 - 12
A person is expected to have recovered to a great extent and be independently doing most basic everyday chores by this time. The rehab exercises at this stage will include stuff like toe and heel raises, partial knee bends, hip abductions, leg balances, step-ups, and bicycling on a stationary bike. All these are to be done under the supervision of the physiotherapist, unless advised otherwise. This happens to the MOST CRUCIAL period for long term recovery.
A range of motion is expected to be gained by the knee joint and people can even do swimming and bicycling by Week 11. This will further improve with continued physiotherapy to include activities like dancing, aerobics, playing football, etc. by Week 12. By this time, almost zero or no pain is expected.
Doctor should be contacted immediately if:
Depending on the hospital, the knee replacement cost in India will be between 2 to 3.5 lakhs for a single knee. This is drastically less as compared to the Western countries and recently the Government has capped the Maximum Retail Price for the knee implants being used, bringing this down even further. For bilateral knee replacement, you may have to shell out anywhere between 4.5 to 6.5 lakhs. As per reports, the Cobalt-chromium knee implants will now be costing Rs.54720 plus GST and titanium and oxidized zirconium implants are priced at Rs.76600 plus GST.
The overall costs may vary depending on hospital accommodation, any other tests and complications, the specialists’ costs, etc.
The quality of life improves drastically for most patients after the knee replacement surgery and they will be able to independently move around and do most jobs that earlier they were not able to do due to their immobile knee. However, it is important to also keep some realistic views about the amount of mobility gained, so that disappointments are avoided. This probably would have been covered during the pre-surgery counselling session.
The artificial knee will not be equivalent to your good old knee before when the issues started. In other words, while it is a good replacement providing you mobility to a great extent, it won’t bend as much as the original knee. Also many activities like kneeling, running, jumping, and any heavy labor like lifting etc. are better avoided. High-impact activities like skiing, running or any other sport can have an effect on the knee implant and its lifespan.
Most knee implants of today last at least 20 years and considering that people usually get operated late, especially in India, this should be good enough for a lifetime. Studies have indicated that only 2% of patients have needed a second knee replacement surgery in their lives. However there are factors like age, activities of the patient, body weight, and certain medical conditions that can affect the longevity of the implants.
The risk factors of the knee replacement surgery can be as below and need to be discussed with the doctor before you go in for the surgery.
Short term risks
Infection: Any surgery has an infection risk and since knee replacement also involves opening of the skin, there is always a chance of infection. Precautions are taken by the surgeons but one should look out for any soreness, swelling or discharge or even fevers and chills.
Bleeding: Again, bleeding after surgery is common, and is usually attended to as required by the doctors. However, in the case of any excessive bleeding, the matter needs to be addressed immediately.
Blood clots: One of the more common and significant risks of surgery are blood clots. Blood clots may form if a blood vessel is damaged during the surgery causing Deep Vein Thrombosis (DVT). This clot can break free and travel to the lungs, causing life threatening pulmonary embolism.
Allergic reaction: Since some foreign implants are put in the body, there is always a chance that the body shows some allergic reactions to it. This can manifest in the form of swelling, blisters, rashes, etc. It may in some rare cases cause headache, weakness, diarrhea, etc. or even a loss of mobility in the area.
Implant failure: Medical technology has improved by leaps and bounds and it is rare that you may find that an implant fails. But there is a minimal chance of that happening, if the implant wears out unexpectedly.
Long Term Risks
While the risks of a revision surgery within 90 days is seen at a 0.2%, the rate is approximately 3.7% within 18 months. The revision surgery could be due to any of the cases mentioned above. As long term risk beyond this, it is mostly only the wear and tear of the knee implant due to the patient activities that causes a revision surgery. This data stands at 6% for five years and 12% for 10 years.
All the above points can be useful in trying to avoid the knee replacement surgery.
Alternatives To The Surgery
A medical professional is the best person to assess your specific condition and recommend the course of action. If they have proposed surgery, it means that the potential benefits of surgery far outweigh the potential complications. You may choose to go in for a second opinion, and it is always beneficial to evaluate your situation thoroughly before making a choice.
Conventional Treatments
Alternative Treatments
In many ways, it is tough to avoid knee replacement surgery if you have caught it too late or when too old. Perhaps when still young, or in the early stages, one can avoid the knee replacement surgery or even work with some alternative treatments like Acupuncture.
Acupuncture Treatment
A study conducted on the topic, has published findings saying that Acupuncture can indeed relieve knee pain due to osteoarthritis. This also becomes a low cost alternative to the replacement surgery.
In this study around 90 patients with an average age of 71, and having severe symptoms and would have been advised surgery, opted for Acupuncture treatment. Marked improvement was seen in many of the patients as 41 of them were continuing after a year, and at the end of two years, 31 were still going for the treatment.
Ayurvedic Treatment
Perhaps there are few diseases and medical conditions for which the ancient Indian system of Ayurveda does not have some remedy or the other. Ayudevda offers herbal treatments, meditation and yoga to cure the knee pain caused due to osteoarthritis and avoid the knee replacement surgery.
As we all know, Ayurveda, follows a holistic approach to treatment, and will not just treat the symptoms, but also the underlying causes, and also adopts preventive medications and practices to help cure the issue. There are many herbs like boswellia, turmeric, ashwagandha, ginger, triphala, guggulu, and shatavari that have been proven to be highly effective as anti-inflammatory agents and these are used for the knee treatment.
Curing the mind, is also a big part of curing the body and as such, meditation along with the conventional treatment helps a lot, as has been proven through a study. It helps allay fears and anxiety by calming the mind, and controlling the pain. Meditation also helps relieve stress to a great extent and that keeps the body healthier.
This can also be combined with Yoga, as a very effective tool to counter the pain and bring in some flexibility in the muscles and joints. There are certain Yoga poses that help strengthen the muscles, improve your flexibility and body balance, and also relieves stress from the joints. It also helps reduce the stiffness and the pain, and also brings with is an emotional wellbeing that also helps.
Nutrition
Nutrition and a healthy, balanced diet is also a big part of the process before as well as after a knee replacement surgery:
For vegetarians, plant based anti-inflammatory foods like olives, turmeric, green leafy vegetables like broccoli, spinach, avocados, etc. can be taken. Fruits and vegetables with Vitamin C like oranges, peppers, leafy vegetables, grapes, etc. also help in the anti-inflammatory part. Dairy products like low-fat milk, cheese, and yogurt, help provide essential Vitamin D and Calcium to the body, that are helpful for bone growth and strengthening.
Unless advised by the doctor to to avoid certain foods, you may plan a balanced diet with all the elements mentioned above.
Movement
Those who have undergone a knee replacement surgery should strictly follow the doctor’s advice as mentioned above. For an immediate period following the surgery, certain movements and travel may be totally prohibited. Recuperative physiotherapy may be need for a while, post which, there could be only few restrictions for the person to move around. The restrictions may also depend on the pre-existing medical conditions, age, nature of the surgery, etc. The idea is to enable mobility and people can move around freely to a great extent.
*Medical Disclaimer - The following information is for educational purposes only. No information provided on this website, including text, graphic, and images, are intended as substitutes for professional medical advice. Please consult with your doctor about specific medical advice pertaining to your condition(s)
