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Total Knee Replacement (TKR)

Your knees work hard during your daily routine, and arthritis of the knee or a knee injury can make it hard for you to perform normal tasks. If your injury or arthritis is severe, you may begin to experience pain when you are sitting down or trying to sleep.

Sometimes a total knee replacement is the only option for reducing pain and restoring a normal activity level. More than 400,000 knee replacements are performed each year in the United States to replace worn and arthritic knee joints. If your and your doctor decide a total knee replacement is right for you, the following information will give you an understanding about what to expect.

A total knee replacement involves replacing the damaged bone and cartilage of the knee joint, which provides articulating surfaces.

The total procedure takes approximately an hour to hour and a half to perform and recovery time varies between patients. Correct rehabilitation following surgery significantly improves outcomes.

Knee Replacement - Doctors

Healthbase Customer Testimonials

Susan W - Colorado - Knee Replacement

As an American without health insurance my options for a knee replacement here at home were not available. Ive heard of medical tourism and began doing some research on line for options outside of my country. I came upon the Healthbase web site and was quite impressed with all of the comprehensive information and options available. I submitted my phone number and received a call from Moe. I was instantly put in a state of ease speaking with him. There was no pressure to act, he was warm, friendly and there to help and guide me. He wanted my medical history of injuries and any x-rays and MRIs of my damaged knee. He also was clear that total knee replacement was a last resort and perhaps a less invasive procedure would be indicated. I sent Healthbase my info and within a few weeks I heard back with the diagnosis that a TKR would be necesary in my case.
Knee-Replacement-Surgery-Colorado-Patient-Dr-Sanjay-Pai-Wockhart-Hospitals-Banglore-India

We spoke about different places to receive surgery. Mexico has a highly recommended surgeon just across the border, but the cost was $13,000. Thailand offered TKR for $9,000, but in India Moe highly recommended Dr. Sanjay Pai and the cost there was $7,000. Price was definitely a factor but more important was finding a first rate hospital renouned for joint replacement. Going on line I read Dr. Sanjay Pais bio and his 20 plus years of experience. I felt confident in my choice for this critical surgery. My sister Ruth volunteered to travel with me. Moe guided us through the process of procurring our Indian visas, plane tickets, and reservation for a weeks stay at the Woodrose Health Club and Hotel following the week I would spend in Wockhardt Hospital. I dont believe I would have gone through with this were it not for Moes action as intermediary. He was excellent every step of the way.

When we arrived in India, Suhas who is the Director of Public Relations for Wockhardt Hosptal was there to take us from the airport to the hospital. Without traffic jams, (which is rarely the case,) the drive is a full hour. We were taken to our comfortable and roomy hospital room which included two beds, a desk with computer, table and two chairs.

The entire medical trip was organized and functional. And the hospital cost for everything including, transportation, preliminary x-rays, MRIs on both of my knees, TKR on one knee, ICU, 6 days in my own room with a whole team of Doctors checking on my daily progress, three meals a day for both myself and my sister Ruth, excellent nursing care, medication for the week in the hospital as well as the week at Woodrose, a week of Physical Therapy, ( the second week of PT as an out patient was not included) and a very usable and necesary cane which I brought home, was the unbelievably reasonable cost of $7000. Im very grateful to Healthbase for arranging this medical journey and the entire team at Wockhardt Hospital for their excellent care.

-- Susan W

Patient Memoirs

Video about Healthbase Knee Replacement Patient


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Implant Components

Medical Tourism - Healthbase - Total Knee Replacement

In the total knee replacement procedure, each prosthesis is made up of four parts. The tibial component has two elements and replaces the top of the shin bone (tibia). This prosthesis is made up of a metal tray attached directly to the bone and a plastic spacer that provides the bearing surface.

Thefemoral component replaces the bottom of the thigh bone (femur). This component also replaces the groove where the patella (kneecap) sits.

he patellar component replaces the surface of the kneecap, which rubs against the femur. The kneecap protects the joint, and the resurfaced patellar button slides smoothly on the front of the joint. This may or may not be replaced depending on the condition of the patient.

Advantages of Total Knee Replacement

Medical Tourism - Healthbase - Total Knee Replacement - ImplantThe most important advantage is that this operation produces very effective and long lasting relief from joint pain. It also gives a joint which functions normally. The recovery period from the operation is very short and the patient is able to walk from the second or the third day after the operation. Walking support that is needed can often be discarded by around a month's time. The patient regain a normal lifestyle and mobility with significant improvement in quality of life.

Exercise Program and Physical Therapy/ Rehabilitation after Knee Surgery

Physical knee rehabilitation is crucial to a full recovery. In order for you to meet the goals of total knee surgery, you must take ownership of the rehabilitation process and work diligently on your own, as well as with your physical therapist, to achieve optimal clinical and functional results. The knee rehabilitation process following total knee replacement surgery can be quite painful at times.

Animation about the knee anatomy - Smith and Nephew





Video about Knee Surgery - Smith and Nephew



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Medical Tourism - Healthbase - Capsule of right knee-joint (distended). Lateral aspect.

Your knee rehabilitation program begins in the hospital after surgery. Early goals of knee rehabilitation in the hospital are to reduce knee stiffness, maximize post-operative range of motion, and get you ready for discharge.

When muscles are not used, they become weak and do not perform well in supporting and moving the body. Your leg muscles are probably weak because you haven't used them much due to your knee problems. The surgery can correct the knee problem, but the muscles will remain weak and will only be strengthened through regular exercise. You will be assisted and advised how to do this, but the responsibility for exercising is yours.

Your overall progress, amount of pain, and condition of the incision will determine when you will start going to physical therapy. You will work with physical therapy until you meet the following goals:

1.Independent in getting in and out of bed.
2.Independent in walking with crutches or walker on a level surface.
3.Independent in walking up and down 3 stairs.
4.Independent in your home exercise program.
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Your doctor and therapist may modify these goals somewhat to fit your particular condition.

In your physical therapy sessions you will walk, using crutches or a walker, bearing as much weight as indicated by your doctor or physical therapist. You will also work on an exercise program designed to strengthen your leg and increase the motion of your knee.

Your exercise program willinclude the following exercises:

Medical Tourism - Healthbase - Quadriceps Setting
Quadriceps Setting
The quadriceps is a set of four muscles located on the front of the thigh and is important in stabilizing and moving your knee. These muscles must be strong if you are to walk after surgery. A "quad set" is one of the simplest exercises that will help strengthen them.

Lie on your back with legs straight, together, and flat on the bed, arms by your side. Perform this exercise one leg at a time. Tighten the muscles on the top of one of your thighs. At the same time, push the back of your knee downward into the bed. The result should be straightening of your leg. Hold for 5 seconds, relax 5 seconds; repeat 10 times for each leg.

You may start doing this exercise with both legs the day after surgery before you go to physical therapy. The amount of pain will determine how many you can do, but you should strive to do several every hour. The more you can do, the faster your progress will be. Your nurses can assist you to get started. The following diagram can be used for review.
Terminal Knee Extension
Medical Tourism - Healthbase - Terminal Knee Extension This exercise helps strengthen the quadriceps muscle. It is done by straightening your knee joint.

Lie on your back with a blanket roll under your involved knee so that the knee bends about 30-40 degrees. Tighten your quadriceps and straighten your knee by lifting your heel off the bed. Hold 5 seconds, then slowly your heel to the bed. You may repeat 10-20 times.

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KneeFlexion
Medical Tourism - Healthbase - KneeFlexion Each day you will bend your knee. The physical therapist will help you find the best method to increase the bending (flexion) of your knee. Every day you should be able to flex it a little further. Your therapist will measure the amount of bending and send a daily report to your doctor.

In addition, your therapist may add other exercises as he or she deems necessary for your rehabilitation.

Straight Leg Raising
Medical Tourism - Healthbase - Straight Leg Rasing This exercise helps strengthen the quadriceps muscle also.
Bend the uninvolved leg by raising the knee and keeping the foot flat on the bed. Keeping your involved leg straight, raise the straight leg about 6 to 10 inches. Hold for 5 seconds. Lower the leg slowly to the bed and repeat 10-20 times.

Once you can do 20 repetitions without any problems, you can add resistance (ie. sand bags) at the ankle to further strengthen the muscles. The amount of weight is increased in one pound increments.

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Use of heat and ice

Ice: Ice may be used during your hospital stay and at home to help reduce the pain and swelling in your knee. Pain and swelling will slow your progress with your exercises. A bag of crushed ice may be placed in a towel over your knee for 15-20 minutes. Your sensation may be decreased after surgery, so use extra care.

Heat: If your knee is not swollen, hot or painful, you may use heat before exercising to assist with gaining range of motion. A moist heating pad or warm damp towels may be used for 15-20 minutes. Your sensation may be decreased after surgery so use extra care.

Long-Term Knee Rehabilitation Goals
Once you have completed your knee rehabilitation therapy, you can expect a range of motion from 100-120 degrees of knee flexion, mild or no pain with walking or other functional activities, and independence with all activities of daily living.

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Guidelines at Home - What happens after I go home?

Medication
  • You will continue to take medications as prescribed by your doctor.
  • You will be sent home on prescribed medications to prevent blood clots. Your doctor will determine whether you will take a pill (Warfarin or coated aspirin) or give yourself an injection. If an injection is necessary, your doctor will discuss it with you, and the nursing staff will teach you or a family member what is necessary to receive this medication.
  • You will be sent home on prescribed medications to control pain. Plan to take your pain medication 30 minutes before exercises. Preventing pain is easier than chasing pain. If pain control continues to be a problem, call your doctor.
Activity
  • Continue to walk with crutches/walker.
  • Bear weight and walk on the leg as much as is comfortable.
  • Walking is one of the better kinds of physical therapy and for muscle strengthening.
  • However, walking does not replace the exercise program which you are taught in the hospital. The success of the operation depends to a great extent on how well you do the exercises and strengthen weakened muscles.
  • If excess muscle aching occurs, you should cut back on your exercises.
Other Considerations
  • For the next 4-6 weeks avoid sexual intercourse. Sexual activity can usually be resumed after your 6-week follow-up appointment.
  • You can usually return to work within two to three months, or as instructed by your doctor.
  • You should not drive a car until after the 6-week follow-up appointment.
  • Continue to wear elastic stockings (TEDS) until your return appointment.
  • No shower or tub bath until after staples are removed.
  • When using heat or ice, remember not to get your incision wet before your staples are removed.
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Your Incision
  • Keep the incision clean and dry. Also, upon returning home, be alert for certain warning signs. If any swelling, increased pain, drainage from the incision site, redness around the incision, or fever is noticed, report this immediately to the doctor. Generally, the staples are removed in three weeks.
Prevention of Infection
  • If at any time (even years after the surgery) an infection develops such as strep throat or pneumonia, notify your physician. Antibiotics should be administered promptly to prevent the occasional complication of distant infection localizing in the knee area. This also applies if any teeth are pulled or dental work is performed. Inform the general physician or dentist that you have had a joint replacement. You will be given a medical alert card. This should be carried in your billfold or wallet. It will give information on antibiotics that are needed during dental or oral surgery, or if a bacterial infection develops.
Frequently Asked Questions
  • Who is a candidate for a total replacement?
  • What are the risks of total knee replacement?
  • When do I return to the clinic?
  • Should I have a total knee replacement?
  • Who develops a more severe or an earlier arthritis?
  • When can I return home?
  • What measures should be taken after the surgery/operation (Post operative instruction)
  • What activities should I Avoid after Knee Replacement?
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1. Who is a candidate for a total replacement

Total knee replacements are usually performed on people suffering from severe arthritic conditions. Most patients who have artificial knees are over age 55, but the procedure is performed in younger people. The circumstances vary somewhat, but generally you would be considered for a total knee replacement if:
  • You have daily pain.
  • Your pain is severe enough to restrict not only work and recreation but also the ordinary activities of daily living.
  • You have significant stiffness of your knee.
  • You have significant instability (constant giving way) of your knee.
  • You have significant deformity (knock-knees or bowlegs).

2. What are the risks of total knee replacement

Total knee replacement is a major operation. The most common complications are not directly related to the knee and usually do not affect the result of the operations. These complications include urinary tract infection, blood clots in a leg, or blood clots in a lung.

Complications affecting the knee are less common, but in these cases the operation may not be as successful. These complications include:

  • some knee pain
  • loosening of the prosthesis
  • stiffness
  • infection in the knee

A few complications such as infection, loosening of prosthesis, and stiffness may require reoperation. Infected artificial knees sometimes have to be removed. This would leave a stiff leg about one to three inches shorter than normal. However, your leg would usually be reasonably comfortable, and you would be able to walk with the aid of a cane or crutches, and a shoe lift. After a course of antibiotics the surgery can often be repeated to give a normal knee.

3. When do I return to the clinic

Even if everything is fine, it is advisable to return every three years after the surgery for a review.

4. Should I have a total knee replacement

Total knee replacement is an elective operation. The decision to have the operation is not made by the doctor, it is made by you. All your questions should be answered before you decide to have the operation.

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5. Who develops a more severe or an earlier arthritis

One who has family history (this having a strong hereditary influence), who has history of injury in the joint (e.g. a fracture or a ligament/meniscal injury in the knee), who has deformity of knees and the one who is overweight. Medicines are not the treatment for this form of arthritis. Weight reduction, regular exercises, local heat therapy help in early stages. Physiotherapy is the mainstay of the treatment. Painkillers should be used only occasionally as they adversely affect our kidneys, cause intestinal ulcers and bleeding.
Another form of Arthritis is Inflammatory arthritis (Rheumatoid or its variants). This does need medical treatment (DMARD's), which changes the course of the disease and prevents further damage to joints. Surgical treatment is needed when structural joint changes have taken place. Before and after the surgery, the patient should remain under care of a Physician/Rheumatologist.
Post Traumatic Arthritis can follow a serious knee injury. A knee fracture or severe tears of the knee's ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

6. When can I return home

You will be discharged when you can get out of bed on your own and walk with a walker or crutches, walk up and down three steps, bend your knee 90 degrees, and straighten your knee.

7. What measures should be taken after the surgery/operation (Post operative instruction)

The success of your surgery also will depend on how well you follow your orthopaedic surgeon's instructions at home during the first few weeks after surgery.
Wound Care you will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed several weeks after surgery. A suture beneath your skin will not require removal.
Avoid soaking the wound in water until the wound has thoroughly sealed and dried. A bandage may be placed over the wound to prevent irritation from clothing or support stockings.
Diet some loss of appetite is common for few days after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength.
Activity Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within three to six weeks following surgery. Some Pain with activity and at night is common for several weeks after surgery.
Your activity program should include:

  • A graduated walking program to slowly increase your mobility, initially in your home and later outside.
  • Resuming other normal household activities, such as sitting and standing and walking up and down stairs.
  • Specific exercises several times a day to restore movement and strengthen your knee. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery.
  • Driving usually begins when your knee bends sufficiently so you can enter and sit comfortably in your car and when your muscle control provides adequate reaction time for braking and acceleration. Most individuals resume driving about four to six weeks after surgery.
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8. What activities should I Avoid after Knee Replacement

Even though you may increase your activity level after a knee replacement, you should avoid high-demand or high-impact activities. You should definitely avoid running or jogging, contact sports, jumping sports, and high impact aerobics.
You should also try to avoid vigorous walking or hiking, skiing, tennis, repetitive lifting exceeding 50 pounds, and repetitive aerobic stair climbing. The safest aerobic exercise is biking (stationary or traditional) because it places very little stress on the knee joint.

Source: Wockhardt Hosptials

Doctors

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Everything you may like to know about Knee Replacement Surgery

Introduction

The knee joint is among the strongest, largest and most complex joints of the human body. Whenever you walk, sit, turn around, dive or perform simple movements, you are depending on the knee for support and mobility. It is the largest joint in the human body and also bears the full weight of the body. On an average a 150 pound human will exert about 460 pound of force on the knee during sports such as football, basketball and running.
You know its importance of the knee when it starts to become painful, stiff and your activities are restricted. At that time you realize the worth of freedom of movement.

How our knee joint functions

The knee is a complex joint, which is made up of the lower end of femur (the thigh bone), and the upper end of tibia (the leg bone).The femoral condyles usually glides smoothly on the tibia plateau, allowing for smooth, painless motion of the lower limb. The knee joint is a hinge joint. It consists of three bones:

  • Thigh bone (Femur)
  • Leg bone (Tibia)
  • Knee cap (Patella)

For a knee to function normally, the quality of smoothness where each bone moves upon the other becomes important in the function of the knee joint. The surfaces of all three bones coming into contact with each other are normally covered with a smooth gliding surface known as articular cartilage, a smooth substance that cushions the bones and enables them to move easily. Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and decreases functions of the knee. All remaining surfaces of the knee are covered by a thin, smooth tissue liner called the synovial membrane. This membrane releases a special fluid that lubricates the knee which reduces friction to nearly zero in a healthy knee.

Common causes of knee pain and loss of knee function

The most common cause of chronic knee pain and disability is arthritis; of which Osteoarthritis, rheumatoid arthritis, and arthritis following injuries are the most common forms.

Osteoarthritis usually occurs after the age of 50 and often in an individual with a family history of arthritis. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another causing knee pain and stiffness. Rheumatoid Arthritis is a disease in which the synovial membrane becomes thickened and inflamed, producing too much synovial fluid, which over-fills the joint space. This chronic inflammation damages the cartilage and eventually causes cartilage loss, pain and stiffness.

Post Traumatic Arthritis can follow a serious knee injury. A knee fracture or severe tears of the knees ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

Is total knee replacement (TKR) for you?

Are you experiencing any of the following ?

  • Severe knee pain that limits your everyday activities, including walking, going up and down stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker.
  • Moderate or severe knee pain while resting, during the day or night.
  • Failure to obtain pain relief from drugs. Their effectiveness in controlling knee pain varies greatly from person to person. These drugs may become less effective for patients with severe arthritis and may also have serious side effects with prolonged use.
In summary, in the early stages when the arthritis is mild to moderate, pain is relieved by conservative means like physiotherapy, medications or injection etc. In the advanced stage however when the pain is severe and medication etc dont relieve the pain anymore and your daily activities become very restricted, you need the operation of total knee replacement.

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Benefits of knee joint replacement

Your Orthopaedic surgeon is the right person to decide for the surgery. After undergoing the surgery, you will reap the benefits of the surgery.
These include:

  • Relief from joint pain
  • Increased mobility
  • Correction of deformity (straight legs)
  • Increased leg strength (if you exercise)
  • Improved quality of life ability to return to normal activities.
  • Most likely running, jumping, or other high impact activities will be discouraged.

The orthopaedic evaluation

The Orthopaedic evaluation consists of several components:

  • A medical history, in which your Orthopaedic surgeon gathers information about your general health and asks you about the extent of your knee pain and your` ability to function.
  • A physical examination to assess your knee motion, stability, and strength and overall leg alignment.
  • X-rays to determine the extent of damage and deformity in your knee.
  • Your Orthopaedic surgeon will review the results of your evaluation with you and discuss whether total knee replacement would be the best method to relieve your pain and improve your function.

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Preparing for surgery

Medical Evaluation If you decide to have total knee replacement surgery, you will be asked to have a medical check-up twothree weeks before surgery to assess your health and to rule out any conditions that could interfere with your surgery. Medications Tell your Orthopaedic surgeon about the medicines you are taking. He/She will tell you which medicines you should stop taking and which you should continue to take before surgery.
Urinary Evaluation A preoperative urological evaluation should be considered for individuals with a history of recent or frequent urinary tract infections. Blood Requirement Your surgeon will inform you prior to the surgery to arrange for blood, if required during the procedure.
Home Planning Some modifications at your home are suggested, to make your recovery easier post surgery. Consider the following:

  • A stable chair for your early recovery with a firm seat cushion (height of 18-20 inches), a firm back, two arms, and a footstool for intermittent leg elevation.
  • Removing all loose carpets and cords.
  • A temporary living space on the same floor, because walking up or down stairs will be more difficult during your early recovery.
  • After surgery you will be requested to use only western style toilet to avoid sitting on the floor or squatting.

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Time for your surgery

You will most likely be admitted to the hospital a day before your surgery. After admission, a nurse takes your vital signs. You will be evaluated by a member of the anesthesia team. The most common types of anesthesia are:-

  • General anesthesia, in which you are asleep throughout the procedure.
  • Spinal or epidural anesthesia, in which you are awake but your legs are anesthetized.
The epidural anesthesia is better for knee replacement because it provides pain relief for two-three days after operation. The procedure itself takes about 75 minutes.

A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with artificial implant. The knee is a hinge joint, which provides motion at the point where the thigh meets the leg. During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The end of the leg bone(tibia), is also removed and replaced with a channeled plastic piece with a metal stem.Depending on the condition of the knee cap (Patella) portion of the knee joint, a plastic "button"may also be added under the surface of knee-cap. Many different types of designs and materials are currently used in total knee replacement surgery.
After surgery, you will be moved to the recovery room, where you will remain for one to two hours, while your recovery from anesthesia is monitored. After that you will be taken to your allotted hospital room.

Your stay in the hospital

After surgery, you will feel some pain, but medication will be given to you to make you feel as comfortable as possible. Walking and knee movement are important to your recovery and will begin in a day or two after your operation.
To avoid lung congestion after surgery, you should breathe deeply and cough frequently to clear your lungs.
Your Orthopaedic surgeon may prescribe one or more measures to prevent blood clots and decrease leg swelling e.g. elastic stockings. Foot and ankle movement are encouraged immediately following surgery which increase blood flow in your leg muscles to help prevent leg swelling and blood clots. Most patients begin exercising their knee the day after surgery.
A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement to allow walking and other normal daily activities after your surgery.

Possible complications after surgery

The complication rate following total knee replacement is very low. Serious complications, such as a knee joint infection, occur in less than 0.5 percent of patients.
Preventing Infection The most common causes of infection following total knee replacement surgery are from bacteria (germs) that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your knee replacement site and cause an infection. Blood Clots or thrombosis or DVT in the leg veins is a potential complication of knee replacement surgery. Your Orthopaedic surgeon will outline a prevention program,which may include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings, and medication to thin your blood.

Avoiding Falls

A fall during the first few weeks after surgery can damage your new knee and may result in a need for further surgery. Stairs are a particular hazard until your knee is strong and mobile. You should use a cane, crutches, a walker, handrails, or someone to help you until you have improved your balance, flexibility, and strength.
Your surgeon and physiotherapist will help you to decide what aides will be required following surgery and when those aides can safely be discontinued.

Your recovery at home

The success of your surgery will depend on how well you follow your Orthopaedic surgeons instructions at home during the first few weeks after surgery. Note: You will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed two weeks after surgery. A suture beneath your skin will not require removal. Wound Care Avoid soaking the wound in water until the wound has been thoroughly sealed and dried. A bandage may be placed over the wound to prevent irritation from clothing or support stockings.

A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Activity / Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within three to six weeks following surgery. Some pain during an activity and at night is common for several weeks after surgery. Diet Some loss of appetite is common for several weeks after surgery.

Specific exercises several times a day to restore movement and strengthen your knee.
You probably will be able to perform the exercises without help, but you may have a physiotherapist to help you at home or in a therapy center the first few weeks after surgery.


Resuming other normal household activities, such as sitting and standing and walking up and down the stairs.
Weight control keeps your weight under control, it will also reduce the amount of pressure and stress on your new knee.

How your new knee is different

You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities. Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon.

The motion of your knee replacement after surgery is predicted by the motion of your knee prior to surgery. Most patients can expect to nearly fully straighten the replaced knee and to bend the knee sufficiently to go up and down the stairs and get in and out of a car. Occasionally, you may feel some soft clicking of the metal and plastic with knee bending or walking. These differences often diminish with time and most patients find these are minor compared to the pain and limited functions of knee joint, they experienced prior to surgery. Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated. Your activity program should include:

  • A graduated walking program to slowly increase your mobility, initially in your home and later outside.
  • Participate in regular light exercise programs to maintain proper strength and mobility of your new knee.
  • Take special precautions to avoid falls and injuries.
  • Notify your dentist that you had a knee replacement. You should be given antibiotics before all dental surgery for the rest of your life.
  • See your Orthopaedic surgeon periodically for a routine follow-up examination and X-rays,usually once a year.

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Glossary of terms

Here are definitions of some medical terms related to knee replacement:
Ambulating : To walk from place to place, mobile, walking.
Arthroplasty : An artificial joint or implant.
Articular Cartilage : The smooth lining that covers and protects the bone ends inside a joint.
Osteoarthritis : Degenerative disease of the joint in which the cartilage begins to wear away.
Emboli : The plugging of pulmonary arteries with (Pulmonary Embolism) fragments of a blood clot after surgery.


Source: Apollo Hospitals
DISCLAIMER:This brochure has been prepared for making you familiar and informative about the knee replacement in general. Persons with questions about treatment must consult a physician who is informed about the condition and the various modes of treatment available.

Arthroscopic surgery

Also known as:
  • Knee scope - arthroscopic lateral retinacular release
  • Synovectomy
  • Patellar debridement

Arthroscopic surgery on the knee involves inserting a small camera, less than 1/4 inch in diameter, into the knee joint through a small incision. The camera is attached to a video monitor, which the surgeon uses to see inside the knee. In some facilities, the patient can choose to watch the surgery on the monitor as well.
For a simple surgical procedure, a local or regional anesthetic is administered, which numbs the affected area. The patient remains awake and able to respond. For more extensive surgery, general anesthesia may be used. In this case the patient is unconscious and pain-free.
After the camera is inserted, saline is pumped in under pressure to expand the joint and to help control bleeding. Some surgeons also use a tourniquet to prevent bleeding.
After looking around the entire knee for problem areas, the surgeon will usually make 1-4 additional small incisions to insert other instruments. Commonly used instruments include a blunt hook to pull on various tissues, a shaver to remove damaged or unwanted soft tissues, and a burr to remove bone. A heat probe may also be used to remove inflammation (synovitis) in the joint.
At the completion of the surgery, the saline is drained from the knee, the incisions closed, and a dressing applied. Many surgeons take pictures of the procedure from the video monitor to allow the patient to see what was done.

MRI
Magnetic resonance imaging (MRI) uses radiofrequency waves and a strong magnetic field rather than x-rays to provide remarkably clear and detailed pictures of internal organs and tissues. The technique has proven very valuable for the diagnosis of a broad range of pathologic conditions in all parts of the body including cancer, heart and vascular disease, stroke, and joint and musculoskeletal disorders. MRI requires specialized equipment and expertise and allows evaluation of some body structures that may not be as visible with other imaging methods


Meniscectomy is the surgical removal of all or part of a torn meniscus, which is a common knee joint injury. Orthopedic surgeon who performs meniscectomies will make surgical decisions based on the meniscus's ability to heal, as well as patient age, health status, and activity demands.

Sources:

Implant Manufacturers

  • John & Johnson DePuy LCS Complete is a Mobile-Bearing Total Knee System is one of the gold standards in total knee replacement. Originally implanted in 1977, the LCS mobile-bearing knee underwent extensive and rigorous clinical trials to gain FDA approval in the early 1980s and was released for worldwide implantation in 1985. Since 1977, more than 400,000 LCS mobile-bearing knees have been implanted in the US and internationally. Long-term clinical success has been demonstrated with survivorship exceeding 96% at 20 years in some studies.
    LCS Patellofemoral Joint (PFJ) Replacement Prosthesis from DePuy Orthogenesis offers the orthopaedic surgeon a treatment option for those patients severely disabled with pain from isolated patellofemoral arthrosis. In select patients, the LCS PFJ prosthesis offers a more conservative solution compared to total knee arthroplasty. LCS Complete Knee System surgical technique document (99 pages) explains in detail the surgical technique for LCS Complete Knee System.
  • The Rotating Platform Knee from Johnson and Johnson DePuy is based on a revolutionary technology, the mobile bearing knee, which DePuy Orthopaedics pioneered 30 years ago. Today, nearly 1,000,000 mobile bearing knees have been chosen by surgeons and patients around the world. The Rotating Platform Knee is the only FDA-approved mobile bearing knee implant available in the United States.
    Video about Rotating Platform and Fixed Platform from Johnson & Johnson DePuy.
  • A growing number of surgeons are using computer systems to help them apply their skills to the utmost advantage for patients undergoing knee replacement. The goal is to assist surgeons to operate with smaller incisions and greater precision. Medical Tourism - Healthbase - Computer-Assisted Knee Replacement Surgery
  • The Zimmer Gender Solutions High-Flex Knee - The First Knee Replacement Shaped to Fit a Womans Anatomy
  • Zimmer High Flex Knee Replacement Prosthetic Knee accommodates a higher degree of bending for Total Knee Replacement recipients
  • Zimmer UniSpacer Knee Replacement The UniSpacer Implant is designed to help relieve arthritic pain and improve the joint stability by establishing appropriate ligament tension and knee alignment while at the same time preserving the natural bone. The UniSpacer Implant is designed to self-center within the knee and actually move with the knee. It adapts to the natural motion of each individual knee.
  • Zimmer's Knee Replacement Considerations explains the goals of joint replacement. A primary goal of joint replacement is to reduce pain. Though most patients experience some pain during recovery from surgery, they find that the long-term relief is a welcome liberation from the pain caused by diseased knee joints.
  • Zimmer's Frequently Asked Questions (FAQ) on Knee Replacement

Arthritis Types

Arthritis is the number one cause of chronic disability in the United States. Affecting nearly 40 million Americans, it refers to more than 100 diseases that cause pain, stiffness and swelling from the inflammation of a joint or the area around joints. The three basic types of arthritis that may cause hip and knee pain: osteoarthritis and inflammatory arthritis (most commonly rheumatoid arthritis), and traumatic arthritis.
Osteoarthritis The most common type of arthritis affecting about 16 million Americans, usually middle-aged and older people. This is a noninflammatory degenerative joint disease characterized by the breakdown of the joint's cartilage. Cartilage that cushions the bones of the hip starts to erode, eventually allowing the bones to grind or rub together and causing hip pain and stiffness.The exact cause of osteoarthritis is unknown.
Rheumatoid arthritis This chronic disease results when, for unknown reasons, the immune system mistakenly attacks the tissue that lines and cushions the joints. As cartilage wears away, the knee often becomes stiff and swollen. A well-known example is rheumatoid arthritis.
Inflammatory arthritis This chronic disease results when, for unknown reasons, the immune system mistakenly attacks the tissue that lines and cushions the joints. As cartilage wears away, the knee often becomes stiff and swollen. A well-known example is rheumatoid arthritis.
Traumatic arthritis A serious hip injury or fracture that can lead to a condition called avascular necrosis. In avascular necrosis, the blood supply to the ball portion (the femoral head) of the thighbone is cut off and the bone begins to wither. As a result, the surrounding cartilage begins to deteriorate, producing pain and other symptoms.
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Major cities overseas offering TKR:

Total knee replacement in Tijuana, Mexico

Total knee replacement in Monterrey, Mexico

Total knee replacement in Chennai, India

Total knee replacement in New Delhi, India

Total knee replacement in Mumbai, India

Total knee replacement in Bangalore, India

Total knee replacement in Goa, India

Total knee replacement in San Jose, Costa Rica

Total knee replacement in Panama City, Panama

Total knee replacement in Bangkok, Thailand

Total knee replacement in Brussels, Belgium

Total knee replacement in Ghent, Belgium

 

Affordable knee hospitals abroad:

Knee surgery at Apollo Hospitals, India

Knee surgery at Wockhardt Hospitals, India

Knee surgery at Max Healthcare Superspeciality Hospitals, India

Knee surgery at Bangkok Hospital Medical Center (BMC), Thailand

Knee surgery at Piyavate Hospital, Thailand

Knee surgery at Hospital Clinica Biblica, Costa Rica

Knee surgery at Hospital Punta Pacifica, Panama

 

Knee replacement surgery testimonials:

Uninsured American`s knee replacement surgery experience in Bangalore

 

Other knee procedures

Knee arthroscopy

ACL repair and ACL reconstruction

MCL Repair and MCL Reconstruction surgery

PCL Reconstruction surgery

Kneecap surgery

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