Knee Replacement Surgery

Types of Knee Replacements

Total knee arthroplasty, is a surgical procedure in which a damaged or worn-out knee joint is replaced with an artificial implant. It is commonly performed for severe arthritis (such as osteoarthritis, Rheumatoid arthritis or post traumatic arthritis) or knee injuries that cause chronic pain and mobility issues.

Procedure Overview

– Anaesthesia – The patient receives either general or spinal anaesthesia.
– Incision – A surgeon makes an incision (typically 6–10 inches) over the knee.
– Bone Preparation – Damaged cartilage and bone are removed from the femur (thigh bone) and tibia (shin bone).
– Implant Placement – Artificial components made of metal and UHMWPE plastic are attached to replace the joint surfaces.
– Patella Resurfacing (if needed) – The kneecap may also be replaced or reshaped.
Closure – The incision is stitched or stapled, and the knee is bandaged.

Recovery & Rehabilitation

– Hospital stays: usually 2-4 days
– Physical Therapy: Starts immediately to restore motion and strength and patient start to walk within 24 hours.
– Full Recovery: Takes 3–6 months, but it can take up to a year for complete healing.
– Long-Term Outcomes: Most implants last 15–20 years.

Benefits

– Significant pain relief
– Improved mobility and quality of life
– Increased joint stability
– Long-Term Effectiveness

Risks

– Infection
– Blood clots
– Stiffness or limited motion
– Implant wear or loosening over time

Alternative options for mild to moderate knee pain

– Physical Therapy
– Medications
– Injections

Partial Knee Replacement Surgery

Uni-compartmental knee replacement or Partial Knee Replacement is a surgical procedure where only the damaged part of the knee joint is replaced with an artificial implant, rather than replacing the entire knee. It is typically an option for patients with osteoarthritis that is limited to one compartment of the knee.

Procedure Overview

– A small incision is made over the knee.
– The damaged cartilage and bone are removed from the affected area.
– A metal and plastic implant is placed to restore smooth movement.
– The incision is closed, and recovery begins.

Recovery & Rehabilitation

– Hospital Stay: Usually 2-3 days.
– Weight-Bearing: Walking with assistance within 24 hours.
– Physical Therapy: Starts immediately and continues for weeks
– Full Recovery: 3-6 months, but varies by patients.

Benefits

– Smaller incision and less tissue damage
– Faster recovery compared to total knee replacement
– Less pain and blood loss
– More natural knee movement

Risks

– May not last as long as a total knee replacement
– Risk of arthritis developing in other parts of the knee, possibly requiring further surgery

Who is a candidate

– Osteoarthritis affecting only one part of the knee (medial, lateral, or patellofemoral).
– Intact ligaments, especially the ACL.
– Good range of motion and stable knee.
– No significant deformity or inflammatory arthritis

Knee Osteotomy

A High Tibial Osteotomy (HTO) is a surgical procedure used to treat knee osteoarthritis, particularly in younger, active patients with misalignment of the knee joint. It is commonly performed for medial compartment osteoarthritis, where the inner part of the knee wears down due to excessive weight-bearing stress.

Types of HTO

– Opening Wedge HTO: A wedge-shaped gap is created in the tibia, often filled with bone graft.
– Closing Wedge HTO: A small bone segment is removed, and the tibia is compressed for realignment.

Procedure Overview

– Preoperative Planning:
– X-rays, MRI, or CT scans help determine the amount of correction needed.
– Surgical Steps:
– A controlled cut (osteotomy) is made in the upper tibia (shinbone).
– The bone is then either opened (opening wedge osteotomy) or closed (closing wedge osteotomy) to realign the knee.
– A plate and screws stabilize the bone until it heals.

Recovery & Rehabilitation

– Hospital Stay: Usually 1–2 days.
– Weight-Bearing: Partial weight-bearing with crutches for 6–8 weeks.
– Physical Therapy: Begins early to restore range of motion and strength.
– Full Recovery: May take 3–6 months for return to normal activities.

Benefits

– Delays or prevents the need for total knee replacement.
– Preserves natural knee structures.
– Allows for continued sports and active lifestyle.

Risks

– Longer recovery compared to total knee replacement.
– Risk of non-union. (bone not healing properly)
– Possible over- or under-correction of alignment.

Alternative options for Knee Osteotomy

– Knee Bracing & Physical Therapy, Medications and injections. (for mild cases)
– Uni-compartmental Knee Replacement.
– Cartilage Repair Procedures. (for younger patients with focal defects)

Criteria for HTO

– Medial compartment osteoarthritis (wear and tear on the inner knee)
Varus deformity (bow-legged alignment)
– Active patients under 60 years who wish to delay total knee replacement
– Unilateral knee pain (pain on one side of the knee)
– No significant arthritis in the lateral or patellofemoral compartments