Total knee replacement surgery is considered for patients whose knee joints have been damaged due to progressive arthritis, trauma or other rare destructive diseases of the joints

During knee replacement surgery, the surgeon takes damaged cartilage and bone out of the knee joint and replaces them with a manmade joint. The operation is also called knee arthroplasty, and its one of the most common bone surgeries.

The primary indication for TKA - total knee arthroplasty is to relieve pain caused by severe arthritis. The pain should be significant and disabling. Night pain is particularly distressing. If dysfunction of the knee is causing significant reduction in the patients quality of life, this should be one of the indications for the surgery.Generally, it is indicated in older patients with more modest activities. It is also clearly indicated in younger patients who have limited function because of systemic arthritis with multiple joint involvement. Young patients requesting knee replacement, especially those with posttraumatic arthritis, are not excluded by age but must be significantly disabled and must understand the inherent longevity of joint replacement.Correction of significant deformity is an important indication

Laboratory studies:

• Complete blood count (CBC)

• Erythrocyte sedimentation rate (ESR)

• Serum electrolytes

• Renal function studies

• Prothrombin time (PT) and activated partial thromboplastin time (aPTT)

• Urinalysis and urine culture

Imaging studies:

• Radiographic views (X-ray) for the assessment of the patient with knee arthritis.

Other operative tests:

• Like ECG, 2D echo, Liver function test, etc., subjective to patient pre-known conditions and comorbidities.

Metal on plastic.

• This is the most common type of implant. It features a metal femoral component that rides on a polyethylene plastic spacer attached to the tibial component. The metals commonly used include cobalt-chromium, titanium, zirconium, and nickel. Metal-on-plastic is the least expensive type of implant and has the longest track record for safety and implant lifespan. However, one problem that can happen with plastic implants is an immune reaction triggered by tiny particles that wear away from the spacer. This can cause bone to break down, leading to loosening and failure of the implant. Advances in manufacturing have greatly reduced the rate of wear in the plastic.

Ceramic on plastic.

• This type uses a ceramic femoral component instead of metal (or a metal component with a ceramic coating). It also rides on a plastic spacer. People who are sensitive to the nickel used in metal implants might get the ceramic type. Plastic particles from this type of implant also can lead to an immune reaction.

Ceramic on ceramic.

• The femoral and tibial components are both made of ceramic. Ceramic parts are the least likely to react with the body. However, ceramic joint prostheses can make a squeaking noise when you walk. In rare cases, they can shatter under heavy pressure into pieces that must be removed by surgery.

Metal on metal.

• The femoral and tibial components are both made of metal. Metal-on-metal implants have been used much less often in recent years because of concerns over traces of metal leaking into the bloodstream. The metal comes from the chemical breakdown of the implant hardware. All metal implants originally were developed to provide longer-lasting joint replacements for younger people. But the traces of metal can cause inflammation, pain, and possibly organ damage. Metal-on-metal implants may be considered only for young, active men, because they may last longer than other materials. Women of childbearing age cant receive these implants because the effects on a fetus are not known.

All patients heal from surgery at their own pace. Your doctor will tell you when it is safe to go back to your normal activities. Here are some guidelines:

• Household chores: 3-6 weeks

• Sex: 4-6 weeks

• Work: 4 weeks or more- depending on your job requirements

• Swimming: 6-8 weeks

• Driving: Before you can drive, you will need to be off pain medicine and be able to get in and out of the car. You may be able to start driving within 2 to 6 weeks even if your driving leg was operated on.

No, for some cases where the disease is limited to only one area of the knee, partial knee replacement can also be considered. Under this process, only one part of the knee surface is replaced in comparison to TKR (Total Knee Replacement) which involves both inner and outer part of damaged bones being replaced with metal implants.

Fast Track Knee Replacement Surgery is an advanced Knee Replacement technique with the following key advantages:

• Same day admission and surgery

• <30 minutes surgical procedure

• Patients typically walk within hours of surgery

• No muscle or tendon cut

• Sutureless - no metal staples used

• Discharge in 3-4 days

• Walk without a stick / walker in 2 weeks

Typically, the patient is made to walk within 12-24 hours of surgery using a walker. For the next 3-4 days, the patient undergoes physiotherapy at the hospital before getting discharged. At the time of discharge, the patient can typically do most activities independently with the help of a walker / stick.

Typically within 3-6 weeks. However, this depends on the effectiveness of physiotherapy and varies across patients.

Typically 30-60 minutes for usual cases. Less time spent in the operation theater significantly lowers the chances of infection.

Yes, Ayu Health hospitals use the latest navigation technology that provides tibial and femoral navigation for total knee arthroplasty in a palm-sized, single-use device compatible with all standard implant systems. This is typically used for cases involving higher than normal damage to the joints.

No, with most modern techniques (including ones employed at Ayu Health hospitals) involving a subvastus approach, there is no need to cut any muscle or tendon.

Ayu Health hospitals use US FDA approved High Flex Implants. Post consultation, the doctor can suggest the appropriate implant based on patient condition and age.

Patients must continue in an outpatient physiotherapy program along with home exercises during the healing process. The physiotherapist will guide the patient with the appropriate exercises.

Some people experience severe knee pain while walking, climbing stairs or even while sitting. The total knee replacement surgery is done for one of the knees to decrease the pain.

There are several reasons for severe knee joint pains. Some of them are:

• Aging

• Arthritis

• Accidents

When the knee joint pain is so severe that the person has trouble walking, climbing stairs etc and the pain hinders the day to day routine, it is important to see a doctor.

After a total knee replacement surgery, your diet should consist of:

• 2-3 litres of water and fluids

• Simple, nutritious, bland food

• An anti-inflammatory diet to reduce swelling in the knees

The steps involved in knee replacement surgery are:

• The patient is given general anaesthesia for the procedure

• The knee is bent to provide complete exposure of the joint

• A 6-10 inch incision is made around the knee

• The damaged parts are cut away and the artificial material is pieces of the joint are placed

• The knee is moved around to ensure that the parts fit

• The incision is sutured and the patient is moved to the recovery area

Regular gentle exercises can help in faster recovery from knee surgery.

Some of the risks of the procedure may be:

• Blood clots

• Infection

• Heart attack

• Stroke

• Urinary Tract infection

• Bleeding

You should seek immediate care if an injury to your knee causing symptoms of ACL injury, like popping sound, pain, swelling, trouble walking or putting pressure on the knee.

Proper training and exercise in sports can help reduce the risk of ACL injury.

The cost of the surgery varies based on the severity or complexity of the procedure, and the procedure chosen. Please refer to the procedure page for more details on Ayu Health packages.

Total knee replacement surgery is considered for patients whose knee joints have been damaged due to progressive arthritis, trauma or other rare destructive diseases of the joints

No, for some cases where the disease is limited to only one area of the knee, partial knee replacement can also be considered. Under this process, only one part of the knee surface is replaced in comparison to TKR (Total Knee Replacement) which involves both inner and outer part of damaged bones being replaced with metal implants.

Typically, the patient is made to walk within 12-24 hours of surgery using a walker. For the next 3-4 days, the patient undergoes physiotherapy at the hospital before getting discharged. At the time of discharge, the patient can typically do most activities independently with the help of a walker / stick.

Typically within 3-6 weeks. However, this depends on the effectiveness of physiotherapy and varies across patients.

Typically 30-60 minutes for usual cases. Less time spent in the operation theater significantly lowers the chances of infection.

Yes, Ayu Health hospitals use the latest navigation technology that provides tibial and femoral navigation for total knee arthroplasty in a palm-sized, single-use device compatible with all standard implant systems. This is typically used for cases involving higher than normal damage to the joints.

No, with most modern techniques (including ones employed at Ayu Health hospitals) involving a subvastus approach, there is no need to cut any muscle or tendon.

Ayu Health hospitals use US FDA approved High Flex Implants. Post consultation, the doctor can suggest the appropriate implant based on patient condition and age.

Patients must continue in an outpatient physiotherapy program along with home exercises during the healing process. The physiotherapist will guide the patient with the appropriate exercises.

You are likely stay in the hospital for four to six days and may have to stay in bed with a wedge-shaped cushion between your legs to keep the new hip joint in place. A physiotherapist will help you exercise the joint from the next day of the surgery to help you recover faster. These exercises should be continued for the next few months.

For the next 6 to 12 months after hip replacement surgery, pivoting or twisting on the involved leg should be avoided. You should also not cross the involved leg past the midline of the body nor turn the involved leg inward and you should not bend at the hip past 90 degrees.

Hip replacement surgery has been performed for years and surgical techniques are being improved all the time. The minimally invasive surgery is considered safer than the traditional procedure.

About 85% of the hip joint implants usually last for 20 years.

The cost of the surgery varies based on the severity or complexity of the surgery, and the procedure chosen. Please refer to the procedure page for more details on Ayu Health packages.

You should seek immediate care if an injury to your knee causing symptoms of a PCL injury, like pain, swelling and instability in the knee.

Proper training and exercise in sports can help reduce the risk of a PCL injury.

The cost of the surgery varies based on the severity or complexity of the procedure, and the procedure chosen. Please refer to the procedure page for more details on Ayu Health packages.

A torn meniscus is a tear in the cartilage in the knee which protects the knee from shock and holds it together.

The medial meniscus is a thick, rubbery layer in the knee that acts as a shock absorber. When there is a significant tear in this cartilage, person need to undergo a medial meniscus tear surgery to repair it.

During any activity, if there is a forceful twist or rotation of the knee, a medial meniscus tear can happen. It is one of the most common injuries among athletes.

When meniscus tear cause pain, swelling, difficulty in moving the knee and sometimes, there is a popping sound when the meniscus tears.

Injuries that occur in parts that have better blood supply have a better chance to heal than those where there is little blood supply. With meniscal injuries, if the knee is stable and if the symptoms do not persist and do not limit lifestyle, nonsurgical treatments are recommended.

If you experience symptoms of a medial meniscus tear, you should visit the doctor immediately to understand the extent of knee damage. Ignoring the symptoms may lead to:

• Severe pain

• Inability to move the knee

• Osteoarthritis

A medial meniscus tear can be diagnosed by a simple physical examination. To understand the extent of damage, the doctor may recommend:

• X ray

• MRI scan

• Arthroscopy - In this procedure, the doctor makes a small cut in the knee. A pencil-sized tool is inserted to examine the extent of damage on a screen.

The treatment for a medial meniscus tear differs based on the size, location and extent of the tear. The tears are graded as 1,2 and 3. If it is a Grade 3 tear, you will need to undergo surgery.For a Grade 1 or 2 tear, the doctor may recommend:

• Rest

• Physiotherapy

• Pain medication

Arthroscopic surgery also called; keyhole surgery is a simple 1-hour surgery to repair the knee.

Flow of the procedure:

• Patient is given local anaesthesia for the procedure

• Small incisions are made in the knee

• A tiny camera is inserted into the incision

• The camera footage is visible on a screen that guides the doctor to perform the surgery

• The torn meniscus is stitched

• The incisions are taped and the patient then shifted to the recovery room.

When the meniscus is damaged to the extent that it cannot be stitched together, this procedure is used to repair the knee.

Flow of the procedure:

• Patient is given local anaesthesia for the procedure

• Small incisions are made in the knee

• A tiny camera is inserted into the incision

• The camera footage is visible on a screen that guides the doctor to perform the surgery

• The torn meniscus is trimmed (partial meniscectomy) or completely removed (total meniscectomy) based on the extent of damage

• The incisions are taped and the patient is taken to the recovery room

One can resume to the normal routine after 2-3 weeks and complete recovery in 3 months.

In this procedure, a large incision is made in the knee to repair the cartilage.

Flow of the procedure:

• Patient is given general anaesthesia for the procedure

• A large incision is made in the damaged knee

• The cartilage is repaired/removed partially or completely through the incision

• The incision is sutured and the patient is taken to the recovery room.

Specific recommendations regarding weight-bearing and exercises will be customized for the patient by the surgeon and therapist.