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Preparing for Total Knee Replacement Surgery

Dr. Ashutosh P Mavalankar

Preparing for knee replacement surgery

Commit to the success of your surgery. Working as a team, you, your doctor and your family must adopt a positive attitude towards the success of your surgery.

You could begin by losing excess weight. Make sure that you are in good general health and do not have infection anywhere else in the body like dental infection, ear-nose-throat infection, skin infection or urinary infection

Two weeks prior to surgery, some blood tests and examination of urine is carried out along with medical checkup by a physician and an anaesthetist. Urinary tract infections are common, especially in older women, and often go undetected. The teeth need to be in good condition. An infected tooth or gum may also be a possible source of infection for the new knee.

The patient is admitted a day prior to surgery. The operation is carried out under spinal or general anaesthesia.  The operation is performed by making incision over the affected joint.  The diseased joint is replaced with the artificial joint. The patient has to take rest for 48 hours after the operation after which he is allowed to stand. Walking is usually allowed on the third postoperative day, with the aid of a walker. The stitches are removed on around the 16th postoperative day. The patient is required to use a stick for about 6-8weeks following surgery after which the patient can walk unaided. 

What to expect from an artificial knee

An artificial knee is not a normal knee, nor is it as good as a normal knee. The operation will provide pain relief for at least ten to fifteen years. If replacement provides you with pain relief and if you do not have other health problems, you should be able to carry out many normal activities of daily living. Activities that overload the artificial knee must be avoided. About 90 percent of patients with stiff knees before surgery will have better mobility after a total knee replacement.

The following actions must be avoided following surgery:
  • Squatting
  • Use of Indian type toilet
  • Kneeling on both knees
In majority of the patients, the implanted knee will last for 15 years. How long a total knee lasts depends on how much it is used, what types of activities it is used for, how heavy the patient is, whether the patient undergoes regular checkup with the doctor and whether the patient remains in good physical condition. In many patients, their total knee replacement will last their lifetime, but in some, it may not last that long.

Total knee replacements are designed to provide painless and unlimited standing, sitting, walking, and other activities of normal daily living. They do very well for golf, bicycling and swimming. Though they are not designed for activities like jogging, or sports like tennis and skiing, there are patients with total knee replacements who indulge in these activities.

In any case, total knee replacement surgery is opted for to improve quality of life. But patients must be aware that the longevity of a total knee replacement may be shortened by frequent, vigorous activities.
In the event that a total knee replacement surgery fails, it is possible to implant another knee replacement. Generally, the results of revision total knee surgery are not quite as good or predictable as for primary total knee replacements. But following revision total knee replacement, most patients have good relief from pain, and are able to walk as far as they desire.

The role of computer assisted surgery

Computer-assisted surgery aims at increasing the precision of implant positioning and achieving optimal ligament balance. Though computer assisted surgery is supposed to improve the precision of the surgery, it is not known whether using these systems will result in a clinically relevant benefit for the patient. As several of the prostheses widely implanted so far have demonstrated high survivorship rates at 15 or 20 years, the demonstration of a possible superiority is conjectural. However, some of the articles published recently in prominent journals have shown that navigated knee replacement provides some very few advantages over conventional surgery, and the benefits are unclear.

Some facts about High-Flexion Knee Joint Replacement
With most of the current designs of the conventional total knee replacements, 100 to 125 degrees of knee flexion is achieved which is sufficient to perform most daily activities like walking, climbing stairs, getting in and out of car or rickshaw, rising from a chair etc. However, other activities like kneeling, squatting and sitting cross legged require more flexion of the knee joint. It is not known whether efforts to increase flexion could cause deleterious effect on the implanted joint like early loosening.  One should, therefore, be careful about indulging in activities which cause extreme flexion of the knee joint. Also, there are certain criteria which have to be fulfilled for the implantation of the high flex designs to achieve more than an average range of motion of the knee joint after surgery.

Dr.Ashutosh & P. Mavalankar is Consultant Joint Replacement Surgeon, Apollo Hospitals, Ahmedabad.

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