Who needs a TKR?
In the 21st century, we are enjoying the healthy life with more life expectancy than the previous era. With an increase in longevity, senior citizens are facing more problems related to mobility, And the most common are Arthritis ……among all major joints, Knee joint is bearing more weight and hence suffering from comparatively major wear & tear, which leads to painful & altered movements.
Initially, physicians can manage such problems by conservative treatments like medicines, exercise, weight reduction, Steroidal injections(which is not so popular nowadays), Physical therapy etc. but after certain limit these conservative treatments are also not that much beneficial & leads to increased dependency of seniors for movements. Also long administration of painkillers has their own side effects like kidney & liver damage, gastric irritation. In the sixties of such patient now, Medical science gives this golden opportunity of “Knee replacement surgery” to improvise living of such patient.
There are quite a few treatments for early arthritis of knees like weight reduction, anti-inflammatory medications, steroid injections (rarely used nowadays) and physical therapy which can include localized treatments (Hot /Cold fomentation, Massages) and exercises.
When these conservative modalities fail to give pain relief or improve movement and start interfering with the quality of life then Total Knee Replacement could be considered as an option.
Also, if the deformity is such that it starts affecting the other joints, like the same side hip or the opposite side knee, then your doctor could advise a knee replacement surgery for you.
Minimal Invasive Subvastus Tissue Preserving Total Knee Replacement
Total Knee Replacement Surgery is a reliable operation to relieve pain and suffering due to disabling arthritis of the knee. However, many patients have reservations due to its prolonged recovery and a need for physiotherapy. Inability to squat and kneel after the operation, which is particularly important to Indian patients also acts as the deterrent.
Techniques that have been developed today, have drastically cut the recovery time down. Many patients after subcastes MI TKR have been able to walk without even holding a walking stick on the third day post surgery. The need for physiotherapy also has become mush less. With the superior quality of joints available, activities such as kneeling and squatting are possible in selected patients. These benefits are enjoyed due to an advanced surgical technique that involves a minimal incision on the front of the knee. This cut is typically less than 4 inches. Former incision lengths were around 9 to 12 inches.
In subcastes MI TKR no cut is made On the underlying thigh muscle called the quadriceps. Instead, the joint is approached from sides of the muscle. This has huge advantages such as not Weakening the thigh muscles at all and this is the reason that the patients are able to walk even without holding on to any walking aids almost immediately after the operation. Mini Subvastus Approach The earlier approach involved cutting the Quadriceps. If the quadriceps are cut, the patients typically need walking aids for 3 to 6 weeks to allow this cut to heal. Moreover, cutting the quadriceps causes more pain and delays the recovery from the operation. The subvastuive approach reduces requirements of pain killers, extensive physiotherapy….so postoperative recovery is much faster as compared to traditional knee replacement…
Intra-operative images for subvastus approach.
Mini-Incision The instruments to implant the joint and the surgical techniques Have been suitably modified so that the new knee joint can be implanted accurately through an incision less than 4 inches. This has advantages, as the lesser the cut on the skin, lesser is the pain and earlier the recovery. Incision Less Than 4 Inches Reduced pain during recovery
The mini TKR through subvastus approach Coupled with advanced postoperative analgesia reduces the pain associated with recovery after the operation. This allows the patients to bend the knee and walk freely early in the post-operative period.Full Bend of the knee The ablity to achieve full bend of the knee requires the joint to be Implanted perfectly.Care is taken intra-operatively to ensure that the joint is bending fully on the operation table. This allows mobilization of the knee to begin immediately after the operation and to eventually achieve full flexion. The high flex and mobile joints that are available help in achieving this aim.
X-Ray after Surgery
Frequently asked questions about Total Knee Replacement Surgery.
For the patient to totally recovery after bi-lateral knee replacement (both knee) is around 2- 3 months while for unilateral (single knee) 1-2 months.
Whole idea of knee replacement surgery is to get relief from disabling knee pain and deformity. Post Surgery the knee pain is completely alleviated and patient can walk independently.
As a surgeon, we expect completely painfree normal life after surgery. The ultimate results usually very from patient to patient
With the invention of painless and stitch-less surgery hospital stay has reduced significantly.
For Uni-lateral surgery (single knee) hospital stay varies from 2 to 3 days
For Bi-lateral surgery (both knee) hospital stay varies from 4 to 5 days
Dr. Shailendra Patil take every effort to save natural ligaments during the replacement. However, it highly depends on the patients medical condition.
With advent of newer techniques like painless and stitchless surgery rate of complication has drastically reduced. Patient who undergo TKR using traditionally techniques have witnessed complications like Infection, DVT, pulmonary immobilization, peri-prosthetic fracture, etc.
Knee replacement is very successful surgery providing consistent results irrespective of patients past condition. However, the outcome of surgery highly depends upon the surgeon’s experience, skill, techniques and hospital environment
Partial or total knee surgery completely decided on how much is the damage to the knee joint and the age and activity level of the patient. However, it is best to allow the treating surgeon decide the procedure.
With the invention of painless and stitch-less surgery patients can resume the official work as early as 2 to 3 weeks after surgery.
Post Knee replacement surgery patient can brisk walk and Jog (for short distance & with adequate breaks) . However, heavy loading activities like skipping, all out running should be avoided. If one witness any knee pain, patient must consult with the doctor immediately.
There are no such things like side effects of TKR. However, before surgery patients must get a metal allergic test done. This will make sure that the implant used does not cause inflammation post surgery and should be ruled out before surgery.