Total Knee Replacement Surgical Procedure

By Dr. Althuri Mohan Krishna | Published: Apr 2015

A short presentation on total knee replacement surgical procedure. This short presentation gives brief idea of the procedure, preparation for the surgery and post surgery management.

Krishna Dr. A. Mohan Krishna, M.S. Ortho, MCh Orth(UK) is currently a consultant orthopedic surgeon at Apollo Hospitals, Jubilee Hills. He is part of the orthopedic team and he specializes in fracture management, arthroscopy, primary hip and knee arthroplasties, and paediatric orthopedics. He has presented papers in the orthopedic specialty.
Presentation used with permission from Dr. A. Mohan Krishna.

Presentation Transcript

  1. TOTAL KNEE REPLACEMENT
  2. Dr. A.MOHAN KRISHNA M.S.ORTHO, MCh ORTH(U.K) Consultant Orthopaedic surgeon , Trauma, Arthroscopy, Arthroplasty Surgeon Apollo hospitals, Hyderabad Consultant Orthopaedic Surgeon at www.drmohankrishna.com www.healthyjointclub.com www.bonesandjointsclinic.com
  3. NORMAL KNEE JOINT LARGEST JOINT IN THE BODY TAKES HUGE STRESS WITH DAILY ACTIVITIES CARTILAGE: • Lining of the joint • Shock absorber MENISCUS: • Cushion in the joint BONES: Femur, Tibia, Patella SYNOVIAL FLUID: Lubricates the joint
  4. Infections Injury to the joint Rheumatoid arthritis Osteoarthritis Worn-out cartilage PROBLEM KNEE JOINT
  5. How common is it? Risk factors
    • Most commonly affected joint in the body
    • 15% of general population
    • Age - Uncommon under 40 years 1 in 5 over 60 years
    • Overweight / obesity
    • Runs in families
    • Joint injury OSTEOARTHRITIS OF KNEE JOINT
  6. Diagnosis Clinical X-rays
  7. COMPLAINTS Complaints Get stuck at times Can’t go up the steps Can’t walk for a small distance Joint giving way- Fear of falling Bow legs Knock knees Can’t sleep at night Joint pain & Stiffness
  8. X-RAY APPEARANCE BOW LEGS
  9. X-RAY APPEARANCE
  10. X-RAY APPEARANCE
  11. Treatment INTEGRATED APPROACH OF HEALTHY JOINT CLUB Pain Killers/local Gels Physiotherapy/ Knee strengthening exercises Nutraceuticals/ Gluocosamine/ Collagen peptides Injections- Steroids/Lubricants Key Hole Surgery/Arthroscopy Osteotomy: Corrects angle of knee joint TOTAL KNEE REPLACEMENT
  12. What is Total Knee Replacement? Replacing the damaged cartilage in the knee joint with metal (Cobalt chrome) and highly specialised plastic. These components are stuck to the bone with cement METAL Cobalt-chrome Stainless steel PLASTIC Specialized polyethylene CEMENT What’s new? Oxynium knee Fixed
  13. The surface of knee joint is replaced The knee cap may or may not be replaced TOTAL KNEE REPLACEMENT The affected part of the knee joint is replaced. (Not commonly practiced in INDIA) PARTIAL KNEE REPLACEMENT
  14. About 70,000 operations are carried out every year in the INDIA
    • Needs General / Spinal anaesthetic
    • Operation may take up to 1 ½ hours
    • A cut is made on the front of the knee joint The new joint can last up to 15 years
  15. Benefits of TOTAL KNEE REPLACEMENT Better quality of life
    • Relief from Pain/Sleep disturbances
    • Improves mobility with daily activities
      • Walking,
      • Climbing stairs
      • Cycling
      • Swimming
  16. PREOPERATIVE EVALUATION Blood & Urine tests • Surgical profile X-ray ECG & 2D Echo/stress echo Medical checkups • Cardiologist • Physician • Anaesthetist
  17. PRE-OPERATIVE ASSESSMENT Weight / Height (BMI) Blood & Urine tests, ECG, Chest X-ray, 2D echo /Stress Echo Check up by a General physician, Cardiologist, anaesthetist
  18. PRE-OPERATIVE ASSESSMENT
    • Details of medical conditions/Allergies
    • Previous operations
    • List of medicines you are taking
    • To stop blood thinning drugs (ASPIRIN , CLOPIDOGREL)
    • General examination : Dental check
    • Discussion regarding operation
  19. DAY BEFORE SURGERY Continue regular medications Early light dinner on night before surgery 6 hours of fasting before surgery Informed written consent and site marking of limb
  20. ON THE DAY OF SURGERY Take routine BP/Thyroid medications as advised by Anaesthetist IV lines monitors & urinary catheter will be placed in the operation theater Spinal /Epidural anaesthesia would be given
  21. COMPONENTS / IMPLANTS
  22. SURGICAL STEPS Replacing the damaged cartilage in the knee joint with metal (Cobalt chrome) and highly specialised plastic. These components are stuck to the bone with cement METAL Cobalt-chrome or Stainless steel PLASTIC Specialized polyethylene BONE CEMENT FIXED
  23. DURING THE SURGERY
  24. SURGICAL STEPS
  25. After surgery Immediately after surgery you would be shifted to ICU and observed there for 24 hours. Later on you would be shifted to ward.
  26. Day 3
    • Removal of IV lines, Urinary catheter, allowed to go to bathroom
    • Continue the exercises Day 1
    • Exercises for ankles and toes to prevent blood clots
    • You can sit on a chair & take a few steps with a frame. No diet restrictions unless specified. Day 2
    • Removal of bandage and drain from the knee joint
    • Knee exercises – straightening / bending
    • Walking with frame / crutches / stick You may be able to go home within 3 to 5 days after the operation After Knee Replacement surgery
  27. BEFORE & AFTER SURGERY
  28. BEFORE & AFTER SURGERY
  29. BEFORE & AFTER SURGERY
  30. EXERCISES AFTER KNEE REPLACEMENT Frequent deep breathing Pull your toes towards you and point away Circle your feet in both directions Push knee down Tighten thigh muscles Count to 10 and relax. Do it 10 times / hour
  31. Place a rolled towel under your knee. Lift your heel to straighten knee. Count to 10 and do 10 times / hour Lie flat on your back and lift your operated leg straight of the bed and count 10. Sit at the edge of bed / chair. Bend the operated knee and straighten slowly. Repeat 10 times/hour EXERCISES AFTER KNEE REPLACEMENT
  32. RETURN TO NORMALACTIVITIES You can shower/ bath after removal of stitches / clips Return to household work & other day to day activities in 6-8 weeks Swelling of the leg may remain for up to 4-6 months Stitches / clips removed at 12 - 14 days
  33. DO’s
  34. DON’Ts Avoid squatting Avoid sitting cross legged Use western toilets
  35. DIETARYADVICE AFTER KNEE REPLACEMENT During recovery in hospital begin normal diet & plenty of fluids During discharge your doctor prescribes calcium, multivitamin & iron tablets Try avoid alcohol and smoking After discharge & recovery try to put down your weight as it may stress new joint.
  36. SPECIAL CONSIDERATIONS Driving • Avoid driving up to 6 to 8 weeks • Start driving after your recovery is full and pain free Sleeping positions • You can sleep any desired position on your back, side to side or on your stomach Metal detectors • Carry a copy of discharge summary or medical certificate
  37. SPECIAL CONSIDERATIONS Inform other doctors about artificial joint. As these joints are risk of bacterial infection from the above mentioned procedures. Dental procedures Urological procedures Endoscopic procedures
  38. Risks of TOTAL KNEE REPLACEMENT • Neurological risks In previous neurological problems • Cardiac risks (elderly with uncontrolled blood pressures • Anaesthetic risks Infection of joints 2- 3% Knee stiffness Clots in legs & lungs Damage to nerves & blood vessels
  39. Dr.A.MOHAN KRISHNA M.S.Ortho., MCh Ortho(U.K)., Consultant Orthopaedic Surgeon, Apollo Hospitals, Hyderabad. Appointments: Secretary : 09247258989 / 09441184590 08332936085 www.drmohankrishna.com www.healthyjointclub.com www.bonesandjointsclinic.com Email: bonesandjointsclinic@gmail.com
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