The knee joint is formed by the lower end of the thigh bone (femur) and the upper end of the shin bone (tibia). The knee cap (patella) sits in the tendon of the quadriceps muscle, which is connected to the tibia by the patella tendon. It forms a third joint with the femur. Arthritis is a degenerative condition of the cartilage on the surface of a joint. The cartilage normally provides a low friction, impact resistant, bearing that contributes to efficient pain free stability in posture and locomotion. High pressure or repetitive loading can damage cartilage, like any other tissue or material.
Why do I need a Knee replacement?
Most serious knee problems occur when the cushioning cartilage of the knee joint begins to wear out. When this happens the bones of the knee will eventually rub together causing stiffness and pain.
The knee replacement operation is designed to relieve pain and enable you to improve your movement and make activity easier. Your doctor will always try other treatments first before they consider surgery, such as painkilling tablets.
What is a total knee replacement?
This is where the worn out surfaces of the bone that make up the knee joint are replaced with metal and plastic components. With the new joint it is the interlocking shapes of the metal and plastic replacements that give the knee its stability. The new joint aims to relieve pain and decrease stiffness, allowing you improved mobility and flexion within the knee.
What are the benefits of total knee replacement?
The direct benefits of replacing the knee joint include:
• The relief of pain and in some cases eliminates it all together.
• Corrects deformity
• The indirect benefits are just as important and, by restoring the ability to walk and function, knee replacement allows you to improve your fitness and improve the quality of your life.
What are the alternatives?
As yet there are no surgical alternatives for this operation, however other therapeutic treatments are available. This may include physiotherapy, pain management alternatives and aids to help your daily tasks. Please talk to your doctor about any of these alternatives.
You will be seen by an anaesthetist to start with, who will discuss the different types of anaesthetics with you. This may be a general anaesthetic, in which case you will fall asleep, or an epidural, which makes you lose all feeling from the waist down. In the operating theatre you will be given your anaesthetic and you will be placed on your back for the operation.
At surgery, an incision measuring about 8 to 10 inches long will be made either on the front or side of your knee. The surgeon, Dr. D.K. Das will remove small amounts of worn bone from the lower end of your femur and the upper end of your tibia, so that flat surfaces can be created to fasten your new prosthesis to. Some patients require computer navigation to ensure optimal fit. Once your surgeon is satisfied that the prosthesis fits properly it will be secured in place. Please not that only the world’s best and most preferred brand of prosthesis will be used to avoid any post-operation hitches. When your surgeon is ready to close the incision, a tube may be inserted to drain excess fluid.
All operations carry risks and total knee replacement is no exception. Risks vary according to your general health.
After the operation.
When you leave the operating theatre, you will usually have an intravenous drip in your arm, this is to give you any fluid or drugs you may need. There may be suction tubes connected to bottles/drains in your knee, to help remove fluid from around the wound as the body heals. You may also be wearing an oxygen mask to help you wake up, and you may also have leads to monitor your heart rate, blood pressure, pulse and respiration.
The area from the knee to the ankle will be covered in up to 3 layers of cotton wool and crepe bandaging in an effort to keep the knee straight for a short period of time. This dressing is usually removed after a 24 to 48 hour period.
You will be taken to the recovery room and kept there until you are fully awake and in a stable condition, then transferred back to the ward. You will be given pain relief, usually before you leave the operating theatre, to keep you comfortable. It is usual to feel some pain and discomfort after major surgery, however every effort is made to minimise this.
The drips and drains are usually removed after 24 to 48 hours. You will then be able to start walking with a frame, then progress on to crutches or sticks according the advice of your physiotherapist. How quickly you get back to normal depends on many factors, including your age, your general health, the strength of your muscles, the amount you can bend your knee and the condition of your other joints. Metal staples and stitches that will be holding the knee wound together, will be removed by a member of Dr. D.K.Das’ team at your home after 10 to 12 days.
Physiotherapy and Occupational Therapy.
The Physiotherapist will help get your knee bending and you moving freely and advise you on exercises to strengthen your muscles. Both the Physiotherapist and Occupational Therapist will be able to advise you on any aids or help that you may need at home.
When can I go home?
Most people can use the stairs and bend their knee sufficiently for them to be ready to leave the hospital within 5 days of being admitted. When you leave the hospital you will be given an appointment to attend the outpatients department for a routine check-up and to monitor your progress.
During your stay in Hospital, you will meet members of Dr. D.K. Das’ team.
Initially your leg will be swollen and there may be some pain, but this will improve as you become more active and start to move about.
However, if the wound is:
• Hot, inflamed or feels hot to touch;
• Leaking any excessive type of fluid through the dressing,
Please let Dr. Das’ team know immediately.
If you have any of the following complaints please go to A&E immediately;
• High temperature or fever
• Swollen, tender and painful calf
• Shortness of breath when sitting
• Leg is suddenly twisted or shortened
• Marked and sudden increase in pain.
Where can I get further inform
Profile of Dr. D.k Das:
Senior Consultant Orthopaedic & Joint Replacement Surgeon