All you need to know about knee replacement in India

An Overview of total knee replacement surgery:

Total Knee Replacement, also known as total knee replacement implants or knee arthroplasty is the replacement of your knee joints by surgery. This is done to relieve chronic knee pain and disability and to improve knee movement. Patients who need knee replacement have pain while walking, climbing stairs and getting in and out of the chair. The degree of pain varies from patient to patient depending on age, weight, and level of joint degeneration.

Revision Total Knee Replacement or total knee replacement recovery process is revising or redoing a knee that has already had a total knee replacement surgery. A revision or redo is required if the previous surgery’s prosthesis has failed.  In most of the total knee replacement operations, the results are life-enriching, enabling people to be more active and mobile without pain. However, in the unfortunate situation of a failure of the surgery, it becomes swollen and causes enormous pain. The patient may feel stiff or unstable making it difficult for him or her to do routine things like walking or climbing stairs.

Who Needs Total Knee Replacement?

An infographic showing various problems which may require Total knee replacement surgery

A primary reason for the degeneration of the knee joint is osteoarthritis which is a common ailment related to age. Osteoarthritis causes the articular cartilage to wear away, resulting in severe knee pain and stiffness.

Other reasons for wanting a total knee replacement are rheumatoid arthritis, trauma, and deformity of bone or even psoriatic arthritis. There are also various other conditions that necessitate a knee arthroplasty doctor to recommend total knee replacement. These could be cartilage defects, meniscus tear, and ligament tear. Knee Replacement can be total knee replacement or partial knee replacement depending on the patient’s knee condition. 

If your knee replacement is causing pain, stiffness, and instability then your knee arthroplasty surgeon will recommend second surgery which is called Revision Total Knee Replacement Surgery. In this procedure, your doctor removes implants of the previous surgery and replaces them with new ones. Though it may seem similar, revision surgery is more complex compared to the first surgery needing specialized implants and tools along with meticulous planning.

There are different types of Revision Total Knee Replacement. In total there are a total of 3 primary components to Knee Replacement i.e. femoral, tibial and patellar.

At times any one of the knee implants needs to be replaced, whereas in other cases all 3 needs to be replaced with new implants. The bone around the knee has to be rebuilt using augments or bone graft. Damage to the bone necessitates the use of a specialized implant with the longer and thicker stem that will fit deep inside the bone for extra support to ensure the stability of the newly revised implant.

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How is the Total Knee Replacement Procedure performed?

During the procedure, the front of the knee is exposed. The quadriceps muscles are detached from the patella. Patella is commonly called kneecap. The patella is placed on one side of the tibia. Tibia is the main bone below the knee. Your surgeon will remove the worn-out cartilage, knee tissues, and bone that is damaged along with the anterior cruciate ligament.

Thereafter, the bony surface of both the tibia and femur (Bone above the knee) end is resurfaced to fit the prosthesis. Your surgeon will cement up to three prosthetic components into place, including a metal femoral shell (pause), a metal and plastic tibial component, and a plastic patellar component.

During the surgery, any deformity that may have been there being corrected. The ligaments are balanced so that the knee recovers its range of movement making it stable and aligned. Before the incision is closed the surgeon will rotate and bend the knee to ensure that the knee has mobility and will function properly.

Total Knee Replacement Revision is a more complex procedure compared to the primary Total Knee Replacement. It also takes longer compared to the primary Total Knee Replacement.

The incision will be made on the lines of the original Total Knee Replacement incision. After the incision, the surgeon will move aside the Knee cap/patella to one side thus revealing your knee joints. After that, he will examine all the parts and components of the Total Knee Replacement implant.  It’s not necessary to remove all the components of the previous surgery but only the loose or infected parts. He will then remove the knee implants and the cement on the bone surface. After that, he prepares the bone for the new implant. A specialized implant is used for Revision Total Knee Replacement.

At times to give strength to the new implant bone graft may be used to make up for the bone loss in previous surgery and removal of implant thereafter. After the bone is readied, the implant is placed and fixed. For revision, the stem at times is longer to give strength. Metal block and platform block may be added to the main component in case of a bone deficit.  Soft tissue repair may also be required.

After the total knee replacement recovery surgery, the surgeon will check the strength and flexibility that the new implant provides.

What outcome can you expect from the replacement surgery?

This infographic shows the expected outcome after total knee replacement surgery.

The Total Knee Replacement usually lasts 2 hours. After that, you are moved into a recovery room and thereafter to your room. The pain will remain for a couple of days but medicines will help to reduce it. A day after surgery, your therapist will bend your knees and if possible you will be asked to take a few walking steps. Within days you will start walking normally. You will also be able to climb the stairs.

Occasionally the pain will be there but that is part of the recovery process. Knee strengthening exercises are crucial as it strengthens the muscle around your knee as well. It will have completely recovered within 2 months and you will be able to do the usual routine. But you should be careful not to hurt or put unnecessary pressure on your knees by involving an activity that puts pressure on your knee like horse riding.

Patient Testimonial

Know more about Hail Micheal’s experience on his Total Knee replacement Surgery

What are the top 5 causes of failure of Total Knee Replacement Surgery?

  1. Knee Implant Loosening or Wear-out

Though a standard implant is supposed to last 15 to 20 years it may not last that much period. Over time the implant may loosen from the underlying bone. Though it was firmly fixed using cement over a period of time, it may loosen causing knee pain. Loosening of the implant may be caused by high impact activity or excess body weight but it’s difficult to ascertain the exact reason in a patient. At times, the plastic spacer between the two metal components of the implant may wear out. At times a patient outlives the life of an artificial knee that was implanted.

  1. Knee Infection

Infection is always a possibility in surgery including Total Knee Replacement. Infection can occur when in the hospital or once you are back. It can also be contracted years after surgery. If an artificial joint becomes infected then it can become stiff and painful. Eventually, the implant will begin to loosen from its attachment to the bone. Even if the implant remains fixed firmly, the infection can cause swelling and pain making revision surgery necessary. Revision of an Infected knee can be done in 2 ways. Debridement is enough in some cases where the infection is washed out and the metal implant is left in its place. Only the plastic spacer is changed but if debridement is not enough then a staged surgery itself is required.

  1. Knee Instability

Ligament around your knee provides stability to your knee, which is necessary for adequate function like standing, walking and climbing stairs. If the ligament around your operated knee becomes damaged or improperly balanced or loose, then it will make the knee unstable. This will also cause pain, swelling or stiffness. You will always feel that your artificial joint will “give away” or “slip out”. Implants are designed to work with the existing ligaments however, damage or loosening of the ligament will prevent the implant from functioning properly. This will require revision surgery.

  1. Knee Stiffness

Sometimes a Total Knee Replacement may not help in achieving the desired movement that is required for everyday regular activity. It happens due to excessive operative scar tissue build-up around the artificial knee joint area. If your doctor is unable to break down the scar tissue without operation then he will have to recommend Revision Total Knee Replacement to achieve a complete range of motion for your knee.

  1. Knee Fracture

A fracture that occurs around the component of a Total Knee Replacement then it can cause damage or loosening of the implant. These fractures are mainly caused by falls or accidents. When the bone is damaged or when it is weakened by osteoporosis, then the damaged section will need revision surgery and replacement of implant with a specialized and larger component implant.

Treatment Possible for Patients needing Total Knee Replacement

Treatment Possible ensures high-quality total knee replacement surgery is provided while we guarantee the lowest knee replacement surgery cost. Our understanding of the Indian Healthcare market and our valued relation with surgeons enables us to maintain knee replacement costs that are reasonable, affordable and transparent. 

Subsequent to the total knee replacement surgery, you will be wheeled to the recovery room and then to your room. Your Physiotherapist will start your bed-based exercise the very next day. Within a week you will be mobile and doing exercises. As revision is a repair procedure the recovery may take time compared to your primary Total Knee Replacement. You may take anywhere between 1 to 2 months to get into your routine. Still, you should consult your operating surgeon before you get involved in jogging, driving or any other knee intensive activity.

Total Knee Replacement Revision will cost you USD 5500 in a twin sharing room and USD 7000 in a single room. This is standard tariff using standard US FDA approved implant. If a specialized implant is required then the knee replacement surgery cost may increase.

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