TOTAL KNEE REPLACEMENT

Dr. A.MOHAN KRISHNA M.S.ORTHO, MCh ORTH(U.K)

Consultant Orthopaedic surgeon ,

Trauma, Arthroscopy, Arthroplasty

Surgeon

Apollo hospitals, Hyderabad

Consultant Orthopaedic Surgeon at

www.drmohankrishna.com

www.healthyjointclub.com

www.bonesandjointsclinic.com

NORMAL KNEE JOINT

LARGEST JOINT IN THE

BODY

TAKES HUGE STRESS WITH

DAILY ACTIVITIESCARTILAGE:

• Lining of the joint

• Shock absorber

MENISCUS:

• Cushion in the joint

BONES:

Femur, Tibia, Patella

SYNOVIAL FLUID:

Lubricates the joint

Infections

Injury to the

joint

Rheumatoid

arthritis

Osteoarthritis

Worn-out

cartilage

PROBLEM KNEE JOINT

How common is it? Risk factors

Most commonly affected joint in

the body

15% of general population

Age - Uncommon under 40 years

1 in 5 over 60 years

Overweight / obesity

Runs in families

Joint injury

OSTEOARTHRITIS OF KNEE JOINT

Diagnosis

Clinical

X-rays

COMPLAINTS

Complaints

Get stuck at

times

Can’t go up the steps

Can’t walk for a

small distance

Joint giving

way- Fear of falling

Bow legs

Knock

knees

Can’t sleep at night

Joint pain &

Stiffness

X-RAY APPEARANCE BOW LEGS

X-RAY APPEARANCE

X-RAY APPEARANCE

Treatment

INTEGRATED APPROACH OF HEALTHY JOINT CLUB

Pain Killers/local Gels

Physiotherapy/ Knee

strengthening exercises

Nutraceuticals/

Gluocosamine/

Collagen peptides

Injections-

Steroids/Lubricants

Key Hole

Surgery/Arthroscopy

Osteotomy: Corrects

angle of knee joint

TOTAL KNEE REPLACEMENT

What is Total Knee Replacement?

Replacing the damaged cartilage in the knee joint

with metal (Cobalt chrome) and highly specialised

plastic. These components are stuck to the bone

with cement

METAL

Cobalt-chrome

Stainless steel

PLASTIC

Specialized

polyethylene

CEMENT What’s new?

Oxynium knee

Fixed

The surface of knee joint is

replaced

The knee cap may or may not be

replaced

TOTAL KNEE

REPLACEMENT

The affected part of the knee

joint is replaced. (Not commonly

practiced in INDIA)

PARTIAL KNEE

REPLACEMENT

About 70,000 operations are

carried out every year in the INDIA

Needs General / Spinal anaesthetic

Operation may take up to 1 ½ hours

A cut is made on the front of the knee

joint

The new joint can last up to 15

years

Benefits of TOTAL KNEE REPLACEMENT

Better quality of life

Relief from Pain/Sleep

disturbances

Improves mobility with

daily activities

oWalking,

oClimbing stairs

oCycling

oSwimming

PREOPERATIVE EVALUATION

Blood & Urine tests

• Surgical profile

X-ray ECG & 2D Echo/stress

echo

Medical checkups

• Cardiologist

• Physician

• Anaesthetist

PRE-OPERATIVE ASSESSMENT

Weight / Height (BMI)

Blood & Urine tests, ECG, Chest X-ray,

2D echo /Stress Echo

Check up by a General physician, Cardiologist, anaesthetist

PRE-OPERATIVE ASSESSMENT

Details of medical

conditions/Allergies

Previous operations

List of medicines you are

taking

To stop blood thinning drugs

(ASPIRIN , CLOPIDOGREL)

General examination :

Dental check Discussion regarding operation

DAY BEFORE SURGERY

Continue regular medications

Early light dinner on night before surgery

6 hours of fasting before surgery

Informed written

consent and site marking

of limb

ON THE DAY OF SURGERY

Take routine BP/Thyroid medications as advised by Anaesthetist

IV lines monitors & urinary catheter will be placed in the operation theater

Spinal /Epidural anaesthesia would be given

COMPONENTS / IMPLANTS

SURGICAL STEPS

Replacing the damaged cartilage in the knee joint with metal

(Cobalt chrome) and highly specialised plastic. These components

are stuck to the bone with cement

METAL

Cobalt-chrome

or

Stainless steel

PLASTIC

Specialized

polyethylene

BONE

CEMENT

FIXED

DURING THE SURGERY

SURGICAL STEPS

After surgery

Immediately after

surgery you would be

shifted to ICU and

observed there for 24

hours.

Later on you would

be shifted to ward.

Day 3

Removal of IV lines, Urinary

catheter, allowed to go to bathroom

Continue the exercises

Day 1

Exercises for ankles and toes to

prevent blood clots

You can sit on a chair & take a

few steps with a frame. No diet

restrictions unless specified.

Day 2

Removal of bandage and

drain from the knee joint

Knee exercises –

straightening / bending

Walking with frame /

crutches / stick

You may be able to go home within

3 to 5 days after the operation

After Knee Replacement surgery

BEFORE & AFTER SURGERY

BEFORE & AFTER SURGERY

BEFORE & AFTER SURGERY

EXERCISES AFTER KNEE REPLACEMENT

Frequent deep breathing

Pull your toes towards you and point away

Circle your feet in both directions

Push knee

down

Tighten thigh

muscles

Count to 10

and relax. Do

it 10 times /

hour

Place a rolled towel under your knee. Lift your heel to straighten knee. Count to 10 and do 10 times / hour

Lie flat on your back and lift your operated leg straight of the bed and count 10.

Sit at the edge of bed / chair. Bend the operated knee and straighten slowly. Repeat 10 times/hour

EXERCISES AFTER KNEE REPLACEMENT

RETURN TO NORMAL ACTIVITIES

You can shower/ bath after

removal of stitches / clips

Return to household

work & other day to day

activities in 6-8 weeks

Swelling of the leg may

remain for up to 4-6

months

Stitches / clips removed

at 12 - 14 days

DO’s

DON’Ts

Avoid squatting

Avoid sitting cross

legged

Use western toilets

DIETARY ADVICE AFTER KNEE REPLACEMENT

During recovery in hospital begin normal diet & plenty of fluids

During discharge your doctor prescribes calcium, multivitamin & iron tablets

Try avoid alcohol and smoking

After discharge & recovery try to put down your weight as it may stress new joint.

SPECIAL CONSIDERATIONS

Driving

• Avoid driving upto 6 to 8 weeks

• Start driving after your recovery is full and pain free

Sleeping positions

• You can sleep any desired position on your back, side to side or on your stomach

Metal detectors

• Carry a copy of discharge summary or medical certificate

SPECIAL CONSIDERATIONS

Inform other doctors about artificial joint. As these

joints are risk of bacterial infection from the above mentioned procedures.

Dental procedures

Urological procedures

Endoscopic procedures

Risks of TOTAL KNEE REPLACEMENT

• Neurological risks In previous neurological problems

• Cardiac risks (elderly with uncontrolled blood pressures

• Anaestheticrisks

Infection of joints 2-

3%

Knee stiffness

Clots in legs & lungs

Damage to nerves & blood vessels

Dr.A.MOHAN KRISHNAM.S.Ortho., MCh Ortho(U.K).,

Consultant Orthopaedic Surgeon,

Apollo Hospitals,

Hyderabad.

Appointments: Secretary : 09247258989 / 09441184590

08332936085

www.drmohankrishna.com

www.healthyjointclub.com

www.bonesandjointsclinic.com

Email: bonesandjointsclinic@gmail.com