TOTAL KNEE REPLACEMENT

Dr Biren Nadkarni has specialization in performing Total Knee Replacement surgery.

Knee replacement surgery may be done by considering it a partial or complete replacement of the knee. The surgery typically involves replacing the knee’s diseased or weakened joint surfaces with metal and plastic parts shaped to allow the knee to function continuously. Typically, the procedure includes severe postoperative pain, which requires intensive physical therapy. The rehabilitation time can be equal to or longer than twelve weeks. They may need mobility support to enable the patient to return to preoperative mobility (e.g., walking braces, canes, crutches)—roughly 82 percent of overall knee replacements were expected to last 25 years.

Before Total Knee Replacement Surgery

total-knee-replacement-before

After Total Knee Replacement Surgery

total-knee-replacement-after

Conditions

Anteroposterior view (left) and lateral view (right) of the complete knee replacement X-ray. The incision for knee replacement surgery is very often done by individuals that have advanced osteoarthritis, though after traditional therapies have been exhausted, it must be taken into consideration. Complete knee replacement is also an alternative to fix severe knee joint or bone damage in young patients. Similarly, full reconstruction of the knee can improve the valgus or varus’s moderate deformity. The extreme deformity of the valgus or varus should be resolved by osteotomy. It has shown that physical therapy enhances function and can postpone or avoid the need to repair the knee. When doing athletic exercises that involve an extensive range of motion in the knee joint, discomfort is frequent.

Risks

Knee replacement risks and complications are close to those seen with other joint replacements. Infection of the joint that happens in <1 percent of patients is the most severe complication.

Procedure

With removal of a part of the quadriceps muscle from the patella, the exposure of the front of the knee is involved in the surgery. The patella is pushed to one side of the joint, causing the femur’s distal end and the tibia’s proximal end to be exposed. The replacement or retention of the posterior cruciate ligament depends on the type of implant used. Still, there does not seem to be a clear distinction in knee function or range of motion supporting either approach. Polymethylmethacrylate (PMMA) cement on the bone then affects the metal components. Some alternative methods are also there to affix the implant without glue. Osseointegration, like porous metal prostheses, can be used in these cement-less procedures.

Treatment

For the femur, a round-ended insert has been used, mimicking the standard joint shape. The part is flat on the tibia, though it often has a stem that goes down for more support within the joint. High-density surface of polyethylene which is slightly dished or flattened is then inserted into the tibial portion to move the weight of metal to plastic and not metal to metal. Some deformities must be repaired during the process, and the ligaments must be aligned.

These have contributed to increased technical assistance for the implantation of complete knee replacements in recent years. Knee repairs have not been carried out by those used in carpentry but by using mechanical jigs that have been used historically. Vision and human judgment depend on these mechanical jigs.The knee replacements that are navigated offer more precise positioning of knee replacements that are implanted which is based on the mechanical axis, using computer assistance to provide navigation.

Pre Surgery

Anges usually determined before knee replacement surgery are HKA and HKS angles.

The angle of hip-knee-shaft (HKS)

The rise of the hip-knee-ankle (HKA)

The classification of radiographic and severity of symptoms should be essential to indicate knee replacement in the case of osteoarthritis. Weight-bearing X-rays on both knees-AP, Horizontal, and 30 degrees of flexion-should consist of such radiography.

The patient should perform various movement activities to improve the shoulder, knee, and ankle as instructed regularly. Pre-operative checks usually conduct before the surgery: electrolytes, typically a full blood count, PT and APTT to assess chest X-rays, blood clotting, ECG, and for potential transfusion, blood cross-matching. Supplemental iron may be administered to the patient around a month before the surgery to improve the haemoglobin in their blood system. If the pre-op workup is complete in the pre-anaesthetic unit, patients can be admitted on the day of the procedure or report to the hospital one or two days before the surgery. There is still little proof of consistency to justify the application of pre-operational physiotherapy in older people.

Post Surgery

Localized analgesia methods are often used (neuraxial anesthesia or continuous femoral nerve block or adductor canal block). Local pericapsular anaesthesia penetration using liposomal bupivacaine offers potent postoperative analgesia without raising the risk of instability or nerve damage. To achieve multimodal analgesia, a hybrid solution of local penetration analgesia and femoral nerve block is standard.

Precautions

All you have to do is for the recovery is to take proper rest and also follow the instructions given by the doctors. You don’t have to cross your legs and ankles whenever you are sitting or lying down and also you mustn’t bend too far forward from your waist and pull your leg up past your waist and other than that this bending is known as the hip flexion so avoid the hip flexion greater than the 90 degrees and do prescribe exercise properly.

Consultation

Total knee arthroplasty increases the patient’s functional potential and the patient’s ability to return to a pre-disease state, which is to have a pain-free flexible joint, as demonstrated by the increase in the therapeutic score of the post-op knee and the functional score of the knee.

Consult Dr Biren Nadkarni for Knee Replacement Surgery