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Knee Replacement
Overview
Knee replacement surgery — also known as knee arthroplasty (ARTH-row-plas-tee) — can help relieve pain and restore function in severely diseased knee joints. The procedure involves cutting away damaged bone and cartilage from your thighbone, shinbone, and kneecap and replacing it with an artificial joint (prosthesis) made of metal alloys, high-grade plastics, and polymers.
In determining whether a knee replacement is right for you, an orthopedic surgeon assesses your knee’s range of motion, stability, and strength. X-rays help determine the extent of the damage.
One of the most common reasons for knee replacement surgery is severe pain from joint damage caused by wear and tear arthritis (osteoarthritis). Osteoarthritis can erode the slick cartilage that helps your knee joint move smoothly. An artificial knee joint has metal alloy caps for your thighbone and shinbone, and high-density plastic to replace damaged cartilage.
Your doctor can choose from a variety of knee replacement prostheses and surgical techniques, considering your age, weight, activity level, knee size and shape, and overall health.
Why it's done
The most common reason for knee replacement surgery is to relieve severe pain caused by osteoarthritis. People who need knee replacement surgery usually have problems walking, climbing stairs, and getting in and out of chairs. Some also have knee pain at rest.
Risks
Knee replacement surgery, like any surgery, carries risks. They include:
- Infection
- Blood clots in the leg vein or lungs
- Heart attack
- Stroke
- Nerve damage
Signs of infection
Knee replacement surgery, like any surgery, carries risks. They include:
- Fever greater than 100 F (37.8 C)
- Shaking chills
- Drainage from the surgical site
- Increasing redness, tenderness, swelling and pain in the knee
An infected knee replacement usually requires surgery to remove the artificial parts and antibiotics to kill the bacteria. After the infection is cleared, another surgery is performed to install a new knee.
Artificial knees can wear out
Another risk of knee replacement surgery is a failure of the artificial joint. Daily use wears on even the strongest metal and plastic parts. Joint failure risk is higher if you stress the joint with high-impact activities or excessive weight.
Best Knee Replacement Surgeon in Mumbai
Choose Your Implant
The Implant used inside your knee is expected to last at least 15-20 years after the surgery in ideal circumstances. It is a marvel of modern engineering and technology to have a man-made thing last for as many as 20-25 million cycles in a lifetime of a patient. This implant is manufactured by many reputed and well-known international companies. Most of the Implants available in the market are very good and are expected to provide good service over the lifetime of a patient.
The Implant consists of 2 parts: The femoral part which is attached to the thigh bone and the Tibial part which is attached to the leg bone. Sandwiched between the two is a high-quality plastic-like material called UHMWPE (Ultra High Molecular Weight Polyethylene) commonly referred to as poly. Depending on the implant you choose you may get one or multiple of these features.
The Various Advances in Knee replacement surgery are:
1) High Bending Knee: This is a modification of the Implant which safely allows more bending of the knee without causing increasing wear. Most of the implants available in the market have a High Bending Knee in their portfolio. The Cost of this knee is approx 10% more than the standard Model.
High Bending/Flexing Knee Demonstration
2) Gender-Based Solution: This is a Knee joint designed especially for females. The Shape and size of a woman’s knee are very different from a man’s Knee. The Woman’s knee incorporates these changes found in nature in the design of its Knee implant. This results in a lighter and more anatomically conforming design. This knee also allows higher knee bending.
How You Prepare
Tests Before The Surgery (Pre-operation Work-up)
Once you have decided to get operated we should do some blood tests to prepare your body for this surgery. This involves a check-up by an anaesthetist and a physiotherapist. These visits are geared to intimate you about the procedure followed during surgery and prepare you for a faster recovery. We will need to get some tests done. They are:
- Complete Blood Count
- ESR – Erythrocyte Sedimentation Rate
- CRP – C Reactive Protein
- Blood Sugar – Fasting
- LFT – Liver function Test including S. Proteins and enzymes.
- S. Creatinine
- BUN
- S. Electrolytes
- HIV
- HbsAg
- HCV
- Blood Grouping
- Bleeding / Clotting time
- Prothrombin time / Index
- Urine – Routine / Microscopy
- Urine – Culture sensitivity
- ECG
- 2D Echo
- Xrays – Chest PA view – Both Knees – AP standing and lateral
- Special tests: Additional tests
- Blood sugar PP (2 hrs. After Lunch) – Diabetes
- Pulmonary function tests – Asthma
Care to be taken before admission to hospital
I like to prepare my patients well mentally and physically before the surgery. I feel that better preoperative planning gives better postoperative results. The physical conditioning starts with a physiotherapist visit where the procedure is explained in detail and questions answered. The physiotherapist will then prescribe the exercises which are to be done during the preoperative period.
If the patient has diabetes and blood pressure then the medicines are taken diligently. Blood thinners are stopped a week before surgery in Clopedogrel and 2 days if aspirin. I like patients to take the following Vitamins Before surgery. Tab. Celin 500mg – Vitamin C leads to faster recovery and prevents urinary infection, Tab. Fersoft – Iron to help build up blood stores before surgery. Cap. Becadexamine: Multivitamin and Vitamin A – Faster healing of the wound, Cap. Bio D3 (Strong): Vitamin D – makes bones stronger, T Bact Ointment for applying inside the nose and in groins 2 days before surgery. Please take bath with Dettol or Lifebuoy Soap containing triclosan to decrease the chances of infection.
Admission to the Hospital
Click Here To Download the Instructions in PDF Format.
- Do not eat or drink anything from ________ time onward to ________ a date prior to surgery. This includes Water, tea coffee, etc. Do not drink alcohol or smoke 24 hrs before the surgery.
- All Pain medications like Voveran and Brufen should ideally be stopped 7 days before the Surgery. Blood Thinning Medicines like Aspirin (2 Days) or Clopedogrel need to be stopped 7 days before the surgery.
- Please removes all Jewellery before getting admitted to the hospital.
- Please get admitted with a Toothbrush, Tooth Paste, and Dettol/ Savlon Soap. Towel, Glasses, Hearing aids, Reading material, and Dentures.
- Please Get a list of all the medicines that you are taking daily and the time. Also, Get 1 strip of each medicine you are taking.
- Please get a list of the 2 closest relations, their relationship with you, and their Home/Office and mobile contact number and hand it to the sister to put on Indoor Hospital Paper.
- Please bring along all your blood tests and reports and CT/MRI films.
- Please get your Walker / Crutches if needed.
After The Surgery
What to expect after leaving the operating room:
You will wake up in the recovery room. You will be comfortable and usually surprisingly free of pain. You will be in the recovery room for about 2 hours. Some patients are admitted to the Intensive Care Unit (ICU) for 24 hours before being transferred to their room. This does not mean that their condition is critical, but only that Dr. Gauresh Palekar feels the need for closer monitoring because of their age or pre-operative medical problems that increase risk.
Knee Replacement Surgery used to be extremely painful. Thanks to the combination of the “pain cocktail” and minimally invasive surgery it is now almost painless!
Pain Control
Dr. Palekar is fanatical about pain control and does everything possible to keep your pain to a minimum. You will be amazed at how little pain you will have. There are two major reasons for this. The first is that the surgery is minimally invasive, and less tissue is cut that can cause pain. The second is the use of the pain cocktail, which is a mixture of medications that are injected into the knee. The pain-relieving property of this technique is truly “magical”. Many patients have absolutely no pain at all after the operation. As a backup, in case you do have some pain, you will also have the Femoral catheter/ Epidural catheter attached to a Computerized pump which will inject medicines into your body at a predetermined rate to keep you pain-free.
The pump is pre-programmed for your weight and age, so it is not possible for you to over-dose. Most patients also receive an anti-inflammatory medication by IV for 48 hours. After 2 days, the Pump unit will be disconnected because it is cumbersome and impedes your walking progress. If necessary, it may be continued for a few more days. After it is discontinued, pain injections are can be given, every 3 hours if needed. Pain pills are ordered for milder pain.
Other Drugs
Drugs are also ordered for nausea, constipation, and sleep. If you run a fever you will be given Crocin(1000mg)
Note that practically every patient runs a temperature up to 99.5 or even a hundred degrees in the first few days after knee replacement. It is so common as to be considered “normal”. If your temperature goes over 101 degrees it starts to be a source of concern.
All patients get stool softeners, but many patients still develop constipation and need a mild laxative on the second or third day after surgery. All patients are given antibiotics to prevent infection starting just before the operation and for a few days after the surgery.
You must ask for sleeping pills, pain pills, or pain injections because the nurses will not automatically give them.
In order to prevent blood clots from forming some patients who are at higher risk of blood clots are given Coumadin (warfarin)/ Low molecular heparin, which is a blood thinner.
While you are in the hospital, please let the nurses or the internist know if you have calf pain, chest pain, or shortness of breath. These may be signs of blood clots.
If you are put on Warfarin, we may want you to continue it for a few weeks after you leave the hospital. Your blood count (Hemoglobin) will be monitored on a third day morning and you will be given iron supplements and blood transfusions as necessary.
Drainage Tubes
Drainage tubes are usually placed in the wound to remove any blood which collects after surgery. The drains are removed 2 days after surgery. Removal is not painful
Catheterization: Many patients have difficulty passing urine right after surgery and catheterization is then necessary. For this reason, we may insert a urinary catheter (in most patients during anesthesia), and remove it on the second post-operative day. Removal is also not painful. We try to avoid catheters for longer than necessary because urinary infections can develop.
The Operative Wound
The wound is over the front of the knee and will be about four and a half inches in length. The dressings are usually changed after the drainage tubes are removed, and as often as necessary after that.
Physical Therapy
The physical therapist will get you up on the first or second day after surgery and will teach you the right amount of weight to put on your operated leg.
During waking hours you should “pedal” your feet up and down every five minutes or so, the entire time you are in the hospital, to help prevent blood clots from forming.
Special pneumatic pumps will be applied to your legs in the recovery room and will be kept in place for several days. They massage your calves every forty-five seconds. Most patients find them very comfortable. You may also wear special stockings. The pedaling exercise, the pumps, and the stockings all help to prevent blood clots from forming in your legs.
By the time you leave the hospital, we like you to have at least 90 degrees of knee motion and good control of muscles about your knee. Most patients by the second or third day after surgery no longer have an IV and are feeling quite well.
You will be allowed to go home when your temperature is normal and you are able to get in and out of bed by yourself and go to the bathroom by yourself. Some patients reach this goal within 3 days.
Going Home
Be your own doctor. Learn how to take care of yourself at home.
You can expect to return home 3-4 days after surgery on one knee and 6-7 days if both knees were operated on together.
Equipment you will need at home
A stick or a walker to help with walking for about 2-3 weeks after surgery. Crutches are actually easier to handle, but most people feel more secure with a walker.
- A toilet seat extension/toilet chair will be needed so that you do not sit too low on the toilet. Most patients are able to go up and downstairs when they get home.
- You will also need a thermometer.
- A shower stool.
Our aim is to make you independent when you get home, able to dress, and able to get in and out of bed unassisted. Walk as much as comfort will allow you. Get off your walker and cane as soon as you can do so safely.
Physiotherapy - The Road to recovery
We can arrange for a home physical therapist as well as for a visiting nurse to see you at home. Most patients who have had a knee replacement need instruction and visits with a physical therapist for several weeks after they go home.
Usually, this is done 3 times a week for 3 to 4 weeks. It is very important that exercises be done vigorously for the first weeks after surgery so that the knee flexibility can be maximized. These exercises help strengthen the bones and muscles around your knee joint. These exercises also help your knee heal and help you gain confidence after surgery.
You should get off the walker and go to a cane as soon as you can. You should then get off the cane as soon as you can.
Most patients are walking without a walker or cane by the end of two weeks. Many are off all walking aids by the third week after surgery.
Please do the exercises shown here. Continue all these exercises for two months and do numbers 8, 9, and 10 for at least six more months.
Removal of staples/stitches
Wound sutures or staples are usually removed on the fourteenth day after surgery. If you are discharged before that time, they may be removed by a visiting nurse at your home, or you may be asked to come to the Surya Clinic for removal. One day after staple removal you may take a shower. Up to that point, the wound should be kept dry. A shower stool is helpful so as to avoid slipping while taking a shower.
Being at home for the first three weeks
It is not uncommon to develop some swelling of the knee, foot, and ankle in the weeks after surgery. If this occurs, you should elevate your leg on pillows when you are not up and about. Once you get home you are not expected to stay in bed. You should be up and about on your walker or crutches most of the time but rest as much as you need to. You should also do the exercises.
Elastic Stockings
Post-surgery you may need to wear compression stockings. These tight stockings put pressure on your legs after your surgery. Wearing pressure stockings helps blood flow through your blood vessels to help prevent blood clots. When blood clots form in your leg veins and block blood flow, it is called deep vein thrombosis (DVT).
Using ice
Ice causes blood vessels to shrink, which helps decrease swelling, pain, and redness. You may put crushed ice in a plastic bag and cover it with a towel. Place this over your knee for 15 to 20 minutes every hour as long as you need it. Do not sleep with the ice pack on your knee. Doing this may cause frostbite
Preventing falls
Falls can cause bone fractures (breaks). Ask your doctor for more information on how to prevent falls. You may need to use a shoe lift, knee brace, crutches, a cane, or a walker. These items can help you walk, and decrease your chances of falling. Use your crutches, cane, or walker correctly. Ask your physiotherapist for information on how to choose and use crutches, a cane, or a walker.
Problems you may encounter at home
- Excessive swelling of your leg and foot: It is common to develop some swelling in the first few weeks after surgery. If this occurs, you should elevate your leg on a few pillows whenever you are not up to walking. However, excessive swelling of the foot and lower leg can be due to thrombosis (blood clots) in the veins in the leg. We should be notified if swelling is associated with pain or tenderness in the calf muscles, or if the swelling just seems over-excessive, and doesn’t respond to elevation.
- Chest pain, cough, or shortness of breath may be signs of embolism. Please do not ignore these symptoms. Call us right away.
- Drainage from the wound, or increasing redness around the wound, could signify impending infection. You will need to call us, and in most instances, you will need to come in and let Dr. Palekar take a look at it.
- A high fever could also be a sign of impending infection. You need to take your temperature twice a day for a month after surgery. Take it three times a day if it is elevated over 99 degrees. If you get two readings, at least three hours apart, of over 100 degrees, you need to notify us immediately.
- Increasing knee pain. Pain should be decreasing from day today. If it seems to be steadily increasing, let us know. In general, this leg should be getting better with each passing day. If you are getting worse in any way, please give us a call.
What to do to help your wound heal
Do not drink alcohol. Drinking alcohol can also make you more likely to get an infection after your surgery.
Eat healthy foods. Eat a variety of healthy foods to give you more energy and help your wound heal faster. Some healthy foods are fruits, vegetables, whole-grain bread, low-fat dairy products, beans, lean meat, and fish. Being overweight or obese may delay your wound healing. Eating the right foods can help you lose weight. Consult a dietitian to help you find the best eating plan for you.
Do not cross your ankle over your knee while sitting. When you are sitting, do not cross your legs so that your ankle is placed resting on the knee where you had surgery. This position causes your implant to move out of place.
Stop smoking. Smoking harms the heart, lungs, and blood. You are more likely to have a heart attack, lung disease, and cancer if you smoke. Smoking can also delay wound healing. You will help yourself and those around you by not smoking.
Have supplementary vitamins. Vitamin C and E, and minerals such as zinc may help wounds heal faster. They help repair tissues and help your body fight infection.
If you have diabetes, keep your blood sugars in control. It may take longer for your knee to heal if you have high blood sugar levels. Ask your caregiver for help managing your blood sugar levels.
Emergency Contact if,
- You have a fever.
- You are not able to do the exercises that you have been told to do.
- You have trouble stretching your leg and moving or bending your knee.
- Your wound begins to drain the fluid again after it has stopped.
- You have trouble sitting or getting up from a chair, walking, or climbing stairs.
- You have back pain or lower leg pain when you flex (bend) your foot upwards.
- Your leg is swollen, painful, or feels warm to the touch.
- You have chest pain or trouble breathing that is getting worse over time.
Seek Care Immediately if,
- You are unable to walk or move your leg, or your knee feels very stiff.
- You fell and hurt your knee.
- You have chest pain when coughing.
- You feel that your heartbeat is faster than it usually is.
- You have fainted (passed out).
- You suddenly feel lightheaded and have trouble breathing.
- You have new and sudden chest pain. You may have more pain when you take deep breaths or cough.
- You may also cough up blood.
- Your leg feels warm, tender, and painful. It may look swollen and red.
After the first visit to the Surya Clinic
You must call the Surya Clinic after you get home to set a date for an office visit. The first visit after you leave the hospital is usually 2 weeks following the day of surgery. Until then continue all the restrictions which you were taught in the hospital. If any problem develops you will need to come in sooner.
Exercises At Home
Sitting or Back Lying
- Quad Set Exercise
Put a roll of a towel under the Knee. Tighten the muscles on top of the thigh as tightly as possible and hold.
- Pull your toes back.
- Push the back of your knee down to the floor.
- Try to push out and up through the heel.
2. Knee Extension with Leg Lift
Start as above, but with a rolled towel under your heel.
- Push knee down.
- Lock it.
- Lift leg up.
- Then lower to roll.
- Repeat for 2 sets of 10 times.
3. Drake Exercise
Tighten the top of the thigh muscles. Hold this for 2 seconds.
- While maintaining the hold, raise leg 4 ” from the floor.
- Hold this position for 2 counts (1-1000, 2-2000).
- While maintaining tension, lower leg to the floor.
- Hold the tension for 2 counts while the leg is down.
- Rest for 5 counts.
- Repeat for 2 sets of 10 times.
4. Static Hold Exercise
- Place a hard, round object or toilet paper roll under your knee to hold it at a height of 4-6″.
- Keep the back of the knee in contact with an object at all times.
- Lift heel off the table as high as possible.
- Straighten the knee and tighten the top of the thigh as tight as possible.
- Hold for 5 seconds.
- Rest for 5 seconds.
- Repeat for 2 sets of 10 times.
5. Straight Leg Raise
- Tighten the muscles on top of the thigh as tightly as possible and hold.
- Raise the entire leg holding the knee as tight as possible. Hold 5 seconds.
- Lower leg and rest 2 seconds.
- Repeat for 2 sets of 10 times.
- Rest 1 minute between sets.
6. Heel Slide
- Lie on your back with legs out straight and back flat.
- Slide one heel up, bringing the knee toward the chest.
- Then slide the heel back down.
- Repeat for 2 sets of 5 times.
7. Hamstring Set Exercises
- Bend the knee to a height of about 6″.
- Tighten the muscles on the back of the thigh fully by pulling down and back with the heel. The heel should remain stationary.
- Pull for 5-10 seconds, trying every second to pull even tighter.
- Relax for 5 seconds.
- Repeat for 2 sets of 5 times, resting 60 seconds between sets.
8. Flexion and Extension
- Sit on something high enough to keep your foot off the floor.
- Bend the knee as far back as possible.
- Straighten your knee as far forward as possible and hold it straight.
- Then relax. (Like pumping on a swing.)
- Repeat for 3 sets of 10 times.
9. Assisted Knee Flexion
- Sit as above.
- Place the ankle of the good leg over the ankle of the operated leg.
- Gently push ankles back, bending knees.
- Hold and then relax.
- Repeat for 2 sets of 5 times.
10. Assisted Knee Flexion
- Lying on your stomach, bending the involved knee up.
- Use an uninvolved leg to help push the knee into more flexion.
- Hold for 10 seconds.
- Repeat for 2 sets of 5 times.
Long Term Care Of The Knee
Medicines for the long term
- Keep a written list of the medicines you take, the amounts, and when and why you take them. Bring the list of your medicines or the pill bottles when you see your doctors. Learn why you take each medicine. Ask your doctor for information about your medicine. Do not use any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to a doctor.
- Always take your medicine as directed by a doctor. Call your doctor if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you discuss them with your Doctor. If you are taking medicine that makes you drowsy, do not drive or use heavy equipment.
- Antibiotics: This medicine helps prevent or treat an infection. After a total knee replacement, you are at a higher risk of getting infections. Your doctor may tell you to take antibiotic medicine before you have dental work, such as a tooth filling or root canal. You may need to take antibiotics before having other procedures, such as a colonoscopy. You may need to do this for three or more years after surgery.
- Anti-clotting medicines: This type of medicine is given to help prevent blood clots from forming in your legs. Medicine may also be given to help clots break apart. This type of medicine makes it easier for you to bleed and bruise. Use a soft toothbrush to help keep your gums from bleeding. If you shave, use an electric shaver.
- Nonsteroidal anti-inflammatory medicine: This family of medicine is also called NSAIDs. Nonsteroidal anti-inflammatory medicine may help decrease pain and inflammation (swelling). NSAIDs may also be used to decrease a high body temperature (fever). This medicine can be bought over the counter with or without your doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people.
- Pain medicine: You may be given medicine to decrease or take away the pain. Your doctor will tell you how much to take and how often to take it. Do not wait until the pain is too bad before taking your medicine. The medicine may not decrease your pain if you wait too long to take it.
How To Enjoy Your Knee Joint Lifelong
The longevity of your knee replacement can be increased by:
AVOIDING stressful activities such as all types of impact sports including:
- running
- jogging
- tennis
- racquetball
- badminton
- football
- baseball
- horseback riding
- other activities
Heavy lifting, weight-lifting, jumping from heights, falls and some exercise machines for the legs are dangerous for you. Never lift or carry more than forty pounds.
It is important that you not become overweight, since excess weight increases the stress on the knee replacement, and can cause loosening.
The possibility of infection occurring around the replacement is another concern.
Allowable Activities After Knee Replacement
The keyword is commonsense. Your knee will probably last for your entire lifetime if it is subjected to no stresses at all! The aim is therefore to minimize stress. You will be able to take part in physical activities which were impossible before surgery. You can walk as much as you like.
The best-recommended activities are walking and swimming.
You can dance, and ride a stationary or mobile bike. Bicycling on a level surface is quite clearly less stressful than biking in the hill country.
Prevention Of Infection
For the rest of your life if you develop an infection elsewhere in your body (for example bladder infection, infected cuts, boils, dental abscesses) this infection can travel via your bloodstream to the replacement.
Therefore, if you develop an infection you should consult your family physician and have him treat it promptly. Viral infections, such as colds and most sore throats, are not a problem. Dental work can push bacteria into your bloodstream and cause an infection in your joint replacement. We recommend that you take antibiotics if you are to have dental work (other than simple cleaning of your teeth). You will be given a plastic card to keep in your wallet containing information about dosage.
ALWAYS NOTIFY YOUR DENTIST OR ANY TREATING PHYSICIAN THAT YOU HAVE A JOINT REPLACEMENT.
If you are to have cystoscopy, bronchoscopy, or colonoscopy you should also be covered by an antibiotic. Doctors vary in their recommendations as to which antibiotics should be used and for how long.
The following is recommended:
Not Allergic to Penicillin: Cefalexin or amoxicillin: two grams by mouth one hour before the procedure.
Allergic to Penicillin: Clindamycin 600 mg. by mouth one hour before the procedure. Dental procedures that pose an increased risk and should be covered by antibiotics: extractions, periodontal procedures, dental implant placement, root canal work, and dental cleaning where bleeding is anticipated.
Patients with immunosuppression, rheumatoid arthritis, lupus erythematosus, insulin-dependent diabetes, hemophilia, or who have had previous prosthetic joint infections, are especially at risk and should take these precautions for life. A recently published American Academy of Orthopedic Surgeons Advisory Statement suggests that all others are at risk for only two years after a joint replacement operation.
Call your doctor immediately if you develop any infection. Never, ever allow any physician to inject Cortisone or any other medication into or near your artificial joint. It may cause disastrous infections in the knee joint.
Long Term Care Of Your Knee Replacement
After the Knee replacement, you should visit Dr. Palekar at predetermined intervals to get your knee joint checked. Visits to have your knee examined and x-rayed are essential for monitoring the results of your surgery and giving you periodic advice for the care of your knee replacement. The timing of your Post Operative visits should be
1st visit: 15 days after surgery. Removal of stitches.
2nd Visit: month after surgery.
3rd Visit: 6 months after surgery. Please get a new X-ray of your Knee Joint for this visit.
4th Visit: let’s celebrate your birthday of freedom from pain together after 1 year of surgery. Please get a new X-ray before you come.
Thereafter, I would love to meet you every year to say hello to you and your knee joint. Your new knee should be pain-free after 3 months. However, from time to time, especially in the first year, you may have a twinge of pain or warmth in the Knee, especially after activity. This you can ignore. If you have pain that doesn’t go away or seems to increase from day to day, you should come in to see Dr. Palekar for x-rays and evaluation.
Driving is best to avoid until about 6 weeks after the surgery, but avoidance is not essential if the left knee has been operated on and you drive an automatic and are not taking strong pain medications that might cloud your judgment. Driving is not likely to injure the knee replacement, but you may not be able to operate the car as well as needed to prevent an accident.
Returning To Work After Knee Replacement Surgery
You will probably not return to work for 6 to 8 weeks after the operation. Quite a few patients do return earlier, depending on the nature of their work, and depending on how important it is for them to be back at work. Some patients with strong motivation and a suitable job return to work in as little as 2 weeks. Discuss this with Dr.Palekar if you need to be back at work sooner.
The first office visit after you leave the hospital is usually 2-4 weeks after surgery. You should call Dr. Palekars secretary at 9920820005 to schedule an appointment.
FAQ
Most frequent questions and answers
Modern knee replacement implants are marvels of engineering. As with most manmade objects sensible and judicious use can prolong the life and utility of the implant If used sensibly knee replacements are designed to last for at least 15 years. The implants used 15 years ago have lasted in 97% of people as per reports available. So it is expected that the incorporation of the ADVANCES of the last 15 years, will prolong the life of implants EVEN FURTHER. In many people, the implants will last a lifetime.
In most people, a Knee replacement is needed after the age of 60 years. However, for people who are suffering pain very badly and have exhausted all other non-surgical options, it is cruel to deny a patient a knee replacement on basis of his/her age. Sometimes knee replacement may be required in very young or very old individuals.
Mr. Shivnath Yadav is 95 years young. He is very fit and does exercises every day. He was healthy in mind and body But his life was dramatically altered due to pain in his knees which would not allow him to walk even to his bathroom. He could not go to the toilet unassisted. He had given up on life and had reconciled himself to restrict himself to his home. He decided to get operated on at the age of 85years. Today after 10 years of surgery He climbs 3 floors twice a day so he can attend Satsang and walks every day for 3 to 5 Km.
Hip replacement can be done any time after the age of 18 years. Unfortunately in diseases such as Juvenile Rheumatoid arthritis, Chondro epiphyseal dysplasia and hemophilia and tumors the the patient is faced with the option of staying in bed for their life or undergoing surgery and resuming a fulfilling lifestyle.
Since younger patients are more active, they will wear out a replacement at an earlier age. In such a condition, there is a chance that they will require a knee replacement again. This procedure called revision Knee replacement Is done very successfully even today. However, this event is at least 15-20 years from now, and if such a surgery is required then by that time I expect a lot of revolutionary changes and technological advances which will make the follow-up procedure easier safer, and even longer-lasting. The advantage is that the patient can lead an active life rather than that of an old person starting today.
Usually, if you get operated on a single side then you are discharged 3rd -4th day after surgery. Doing Both knees together, people usually go home 5-6 th day.
On the day of the surgery, by evening you can sit in bed and are encouraged to move your knees. The next day, You will stand and take a few steps. On the third day, all the Intravenous medicines and catheters are removed and you can start walking with a walker. Depending on your age and activity level, you will need a stick or a walker for a few days.
Patients with these conditions can safely undergo knee replacement. These conditions need to be well-controlled prior to the surgery.
The recovery after surgery differs from patient to patient. Most people can fully recover in 1 month. See Mr. Yusuf Cheerewala walk and ride a motorcycle after 1 month of surgery.
Knee replacement is beneficial at any age and any activity level all I ask is that the patient should be willing to undergo this surgery and have a desire to get better. In such a patient the benefits are tremendous and patients make amazing recoveries. I give you two examples Mrs. Gaurabai Gaikwad (age 69yrs) and Mr. Babulal Shah ( Age 78), Both were bedridden and could not get up even for the toilet.
A knee replacement surgery allows you to be as active as you would have been if you had natural knees. All the activities that you love doing but you cannot do now due to knee pain are possible. I would like you to meet Mrs. Natalia Menezes Who has been operated on both knees 5 years back she is now 68 yrs old. She regularly travels in local trains in the rush hours from Virar to churchgate carrying with her fruits and vegetables grown at her farmhouse in Virar. She is a regular participant in the senior citizens run for the Mumbai marathon and has done parasailing, and motor scootering on the visit to Bangkok. She loves climbing mountains and is an amazing woman.
The limp in a patient with knee pain is due to loose ligaments and pain while walking. After the surgery, both are corrected, and The limp vanishes.
Do not worry. After the surgery, you will have straight legs.
Replacement surgery does not weaken bone. So If you fall, then the chances of developing a fracture is the same and depends on the severity of the fall.
Knee replacement techniques and Implants have changed for the better and this is a continuous process. Modern techniques and Implants allow a normal knee movement and can bend their knee fully within 2 mths of surgery. A lot of my patients can bend their artificial knees more than my natural knee. You have to remember that the knee replacement Implant is manmade and cannot compare to a natural knee. So you have to use it carefully.
The Indian Custom of sitting on the ground and using of Indian commode places a lot of strain on the implant and is best avoided. You can sit cross-legged on a couch but not on the ground. Having said that, sitting on the ground rarely for an occasion is acceptable.
As with any surgery, the chances of infections are 1%. Infection control starts before the surgery. We will do certain tests to localize the site of infection that is present in skin, urine, or teeth. Longstanding infection in these areas has to be eliminated. If any dental/ urinary surgery is required is performed or delayed for 6 months till after knee replacement.
I am a great believer in physiotherapy. The physiotherapist is a paramedical professional who does a lot of essential activities. He/she plays the following roles.
- Motivates the patients and encourages activity
- Answers questions the patient may have about the procedure and post-operative period
- Develops a friendly and approachable relationship with the patient
- Looks for red flag signs suggestive of problems and notifies the doctor
- Dressing changes and removal of stitches
- Shows patient stairs climbing other activities of daily use
- Accompanies patient on roads till they regain confidence
- Co-ordinates with a doctor for medicines and informs recovery of the patient
Usually, a patient will require 7 sessions of physiotherapy once a day after surgery, then 7 sessions on alternate days to recover from this surgery.