Total Knee Replacement Surgery

Based on how the bearing surface is fixed on to the components, knee replacement can be mobile bearing or fixed bearing. However, studies have not shown any significant difference in clinical outcome between the two types of knee replacement. In my practice, I use fixed bearing total knee replacement.

Based on the number of ligaments preserved during the surgery, knee replacement can be classified into cruciate-retaining (preserving posterior cruciate ligament) and cruciate sacrificing (removing posterior cruciate ligament). Although this largely depends on the surgeon’s preference, studies have not shown any significant difference between these two types of knee replacement. In my practice, I generally use cruciate-retaining knee replacement for most cases.

Risks and Benefits

Overall, total knee replacement is a very successful operation in modern-day surgery. In my practice, the success rate of a total knee replacement is 90% or higher. Pain relief and improvement in the quality of life is substantial in the vast majority of patients. It improves mobility and alleviates pain during day-to-day activities. It also helps patients maintain an independent life with little/no dependence on carers/family.

Risks of total knee replacement include infection (around 1%), bleeding, DVT (clots in your leg), PE (clots in your lung), stiffness, loosening, wear, persistent pain (around 1%), medical and anesthetic complications. Precautions are taken in order to minimize all the above risks e.g. use of antibiotic prophylaxis and specialized laminar airflow theatres to minimize the risk of infection, use of blood-thinning medications, and mechanical methods to reduce the risk of clots, etc. Post-operative exercises are extremely important to decrease the risk of post-operative stiffness.

Rehabilitation and Recovery

You are generally admitted to the hospital on the day of surgery. The average length of stay in the hospital is 3-4 days. During the hospital stay, a multi-disciplinary team including an orthopedic team, ward doctor, nursing staff, physiotherapist, and occupational therapist, treats you. Once you and the team are happy with the progress, you are discharged from the hospital.

Post-operative mobilization includes the use of walking aids like walkers or crutches, to begin with. You can subsequently use a walking stick/s until independent mobility can be achieved.

You can expect some swelling and redness around the wound and of the lower leg for a few weeks. Generally, by 6 to 12 weeks, functional recovery can be expected in most patients. Most patients can expect to drive around 6 weeks mark.

Implants of My Choice

I choose the implants for knee replacement very carefully for each patient. The type of knee replacement used in my clinical practice has a very long track record (>20 years) with excellent long-term survival. Currently, my preferred implants are PFC Sigma (manufactured by Depuy Synthes) and Nexgen (manufactured by Zimmer).

• Artificial Joint Replacement of the Knee
• Osteoarthritis of the Knee
• Viscosupplementation for Osteoarthritis of the Knee

Frequently Asked Questions

Q1. What happens in total knee replacement surgery?
In a total knee replacement, a surgeon removes the damaged cartilage and bone from the ends of your thigh bone, shin bone, and the back of your kneecap, and then replaces them with an artificial knee joint made of metal and plastic.

Q2. How painful is a total knee replacement?
A total knee replacement causes temporary, but often significant, pain and swelling for the first few weeks, with the most intense pain typically during the second week.

Q3. What is the recovery time for a total knee replacement?
Total knee replacement recovery typically involves: 6-12 weeks for the initial recovery and return to most normal activities, with full improvement and healing continuing for up to a year or more.

Q4. Are there any permanent restrictions after knee replacement?
Yes, there can be permanent restrictions after a knee replacement, primarily a need to avoid high-impact activities like running and jumping to protect the artificial joint’s longevity.

Q5. How is life after knee replacement?
Life after knee replacement involves a recovery period focused on pain management, gradual increase in mobility through physical therapy, and a return to normal activities, including low-impact sports and driving, typically within a few months.

Q6. How long after knee replacement can you climb stairs?
You can often begin climbing stairs with physical therapist guidance within a few days of knee replacement surgery and may be discharged from the hospital with this ability. While you may start with an assistive device and strict one-step-at-a-time technique, your independence and ability to climb stairs naturally will improve over the first several weeks and months of recovery.

Q7. What are the hardest days after total knee replacement?
The first one to two weeks after a total knee replacement are typically the hardest, as patients experience the most intense pain, swelling, and stiffness while their bodies begin to heal and adapt to the new joint.

Q8 .What is the best age for knee replacement surgery?
There isn’t a single “best” age for knee replacement surgery, as the decision depends on individual pain, mobility, and lifestyle, not just age. While the average age is between 60 and 70, and younger patients may face higher revision surgery rates, many people in their 40s, 50s, and 80s have successful outcomes.

Q9. What are the side effects of knee replacement surgery?
Side effects of knee replacement surgery include blood clots, infection, nerve damage, and stiffness or limited range of motion. While rare, heart problems, implant loosening, or blood vessel damage are also potential risks.

Q10. Is knee replacement surgery a good option?
Yes, knee replacement surgery is a good option for those with severe, pain-causing knee arthritis or injury, offering significant pain relief and improved mobility, with high success rates and a high likelihood of returning to daily activities and low-impact sports.

Q11. Who is a bad candidate for knee replacement?
Bad candidates for knee replacement include those who are too young, severely overweight, or have serious, uncontrolled medical conditions like advanced heart disease, uncontrolled diabetes, or active infections. Other factors like poor skin quality over the knee, underlying nerve or blood vessel disease, and a history of smoking also increase surgical risk.

Q12. Which type of knee replacement is best?
There isn’t a single “best” knee replacement; the ideal type depends on the patient’s unique needs, focusing on factors like the extent of damage, age, and activity level. Partial knee replacement (PKR) is often preferred for its more natural feel and faster recovery if only one part of the knee is damaged and ligaments are intact.

Q13. What is the new alternative to knee replacement?
Newer alternatives to knee replacement include regenerative treatments like bone marrow concentrate (BMAC) or platelet-rich plasma (PRP) injections, and hydrogel injections like Arthrosamid®, which aim to reduce inflammation and stimulate healing.

Q14. How much bone is removed in a knee replacement?
In a total knee replacement, a few millimeters of diseased bone and cartilage are removed from the ends of the thigh bone (femur), shin bone (tibia), and the underside of the kneecap (patella) to fit artificial components.