Total Knee Replacement Surgery in Mumbai, India | TKR Surgery Preparations & Procedure

Overview

Total knee replacement (TKR) is a surgery in which some or all parts of the damaged, diseased or worn bone and cartilage of the patient's knee joint are replaced with an artificial joint to correct any leg deformities and relieve pain.

Severe knee damage resulting from an injury or conditions like osteoarthritis or rheumatoid arthritis can make everyday activities such as walking, climbing stairs, sitting or lying down painful and challenging. The doctor may recommend total knee replacement if options such as medications, injections, modification of activities or using walking supports do not help.

Total knee replacement surgery, also known as knee arthroplasty, knee resurfacing or knee replacement, is a procedure that helps repair an injured or damaged knee. Typically, in a total knee replacement, the bones forming the knee joint are capped with plastic or metal parts or a prosthetic (artificial) knee shaped as a joint is implanted. This helps relieve pain and allows the person to move their knee properly and resume their everyday activities.

In India, over 2.5 lakh people undergo knee replacement surgery annually. And, in the last five years, the number of knee surgeries has increased by 2.5 times.

Types of Total Knee Replacement

There are many different types of knee replacement surgeries, but the 2 main types are partial knee replacement and total knee replacement. There are many different types of total knee replacement surgeries including:

Traditional knee replacement

This technique uses an 8-10–inch incision. In the traditional TKR, the quadriceps tendon is cut into and the kneecap is turned over to expose the knee joint. This technique takes around 3-5 days of recovery in the hospital.

Minimally invasive knee replacement

In this technique, the incision made is much smaller, around 4-6 inches, which requires lesser cutting of the ligaments and tendons and, thus, lesser blood loss, trauma to the tissue and post-operative pain, quicker recovery and a shorter hospital stay.

Other minimally invasive knee replacement

Techniques include quadriceps-sparing techniques—subvastus and midvastus—and the lateral approach.

Robot-assisted surgery

Robot-assisted knee replacement surgery method utilises computed navigation, 3D models of the knee and special robotic tools to perform both traditional, as well as minimally invasive knee replacement surgeries. The method offers several benefits including better precision, smaller incisions, quicker recovery, better fit of the knee joint and lesser wear and tear.

Who Needs Total Knee Replacement Surgery

Typically, total knee replacement surgery is recommended for people having:

Severe pain in the knee or stiffness that affects mobility and makes it very difficult for them to go about their daily routine tasks such as walking, climbing stairs, sitting on and getting up from a chair and getting into and out of vehicles.
Severe knee pain that does not get better, even while resting or sleeping and that interferes with sleep and hampers quality of life.
Knee pain and looking for long-lasting relief.
Severe knee swelling and inflammation that does not get better even after resting or taking medications.
Knee deformity (arch outside or inside the knee).
No other options because all other non-surgical options such as medications haven’t worked.
Depression due to the inability to go about routine or social activity.

Preparing for Total Knee Replacement Surgery

A person can do a few things that can help in a successful surgery with no or very few complications and hasten the recovery such as:

Reducing or stopping smoking because smoking can slow down recovery and healing, affect circulation and increase post-surgery infection and deep vein thrombosis (DVT) risk.
Avoiding drinking for at least 48 hours before the surgery, as alcohol can influence the effects of anaesthesia.
Eating a nutritious, balanced diet.
Losing weight before the knee surgery to prevent placing stress on the new knee joint.
Exercising before the TKR can help to strengthen the body, improve endurance and range of motion, help in managing joint pain and for quick recovery.
Stopping or reducing medications such as non-steroidal anti-inflammatory drug, aspirin, steroids, blood thinners, immunosuppressants and opioid medications before the surgery.
Undergoing all preoperative tests such as blood pressure checks, blood tests and other tests required.
Preparing their home and appointing a person who can take care of them before and after the surgery.

Diagnosis or Test for Total Knee Replacement Surgery

Before the TKR surgery, the doctor will usually perform the following tests:

Check the knee for pain, tenderness, swelling and bruising.
Determine how far the person can move the lower leg in various directions.
Pull and push the joint to check the strength and integrity of the knee structures.
Imaging tests such as X-ray, CT scan, MRI or ultrasound to check for problems and blood tests to determine the condition of the soft tissues and bones of the knee.

A few common pre-operative tests such as blood tests, electrocardiogram (EKG), chest X-ray and urine test are also done for the surgical team to determine if the knee replacement surgery is safe for the person and predict any potential problems.

Total Knee Replacement Surgery Procedure

Surgical Approach and Techniques

In TKR, the ortho surgeon replaces the medial (inside), lateral (outside) and patellofemoral (kneecap) portions of the knee joint. There are two surgical approaches – traditional knee replacement and minimally invasive knee replacement.

Anaesthesia and Incision

The patient is usually administered a spinal block that numbs the lower part of the body. Alternatively, the surgery may be done under general anaesthesia. The surgeon may also administer a pain-numbing medicine around the joint or nerves to block pain post-surgery. The surgeon will then make a vertical incision (around 8-10 inches in a traditional surgery and 4-6 inches in a minimally invasive surgery) in the front of the knee for the procedure.

During the Surgery Procedure

Once the incision is made, the damaged bone and cartilage at the ends of the tibia and femur are removed.
These are then replaced with a prosthetic knee joint.
A plastic spacer is placed between the metal parts to provide cushioning and ensure smooth movement.
Finally, the patella (kneecap) is cut and resurfaced.

After the Surgery Procedure

After the surgery, the patient is moved to the recovery area. Depending on their health condition, they may be discharged the same day or may have to spend 1-2 days in the hospital.
To prevent the risk of blood clots, the patient:

Must sit up and walk with some help soon after the surgery.
May have to wear compression socks to prevent the pooling of blood in the leg.
May have to take blood thinners.

After the surgery, the person must increase their physical activity gradually and do physical therapy to exercise their knee.

Total Knee Replacement Surgery Benefits

People suffering from knee problems such as severe pain, stiffness and swelling can find it extremely difficult to walk, move around and do their daily tasks. TKR offers multiple benefits such as:

Pain Relief and Improved Mobility

TKR surgery replaces damaged or diseased knee joints with prosthetic joints, providing patients with pain relief and helping them regain mobility. It lets them walk, climb stairs and carry out all their routine tasks and physical activities without any hassles.

Enhanced Quality of Life

Total knee replacement also plays a vital role in improving patients’ quality of life. It can improve sleep, mobility and independence and reduce pain medication. They can take part in more leisure and social activities.

Recovery and Rehabilitation

Usually, complete recovery after a knee replacement surgery takes about 6 months to 1 year, but typically, a person can resume most of their regular activities in around 6 weeks after the surgery. However, recovery of the patient will depend on factors such as age, overall health and level of activity before the surgery.

Hospital Stay and Postoperative Care

Hospital stay post total knee replacement depends on several aspects. Typically, most patients will need to spend 1-2 days in the hospital after the surgery; however, if the person is doing well after the surgery, then they may be allowed to go home on the same day.

Here are a few things the patient can do after knee replacement surgery:

Keep their knee elevated by placing it on pillows or cushions while lying down or sitting.
Ice their knees a few times a day to reduce swelling and pain.
Keep the incision site covered, clean and dry.
Do the exercises recommended by the surgeon to prevent stiffness of the knee joint and strengthen the muscles around it. This will help quicker recovery and ensure that joint mobility is regained.

Physical Therapy and Exercises

After the knee replacement surgery, generally, the surgeon will get the patient to walk a bit using a walker or crutches. It is recommended that the person start physical therapy after a week of the surgery, which will continue for a few months. The physical therapist will teach the patient exercises to strengthen the knee, reduce scar tissue and increase range of motion. The patient must do at least 30 minutes of knee exercises a day.

Risks and Complications Associated with Total Knee Replacement Surgery

Patients may experience some complications after knee replacement. Some of the common complications include:

Infection and Blood Clots

Infections are quite rare in knee replacement surgery; however, since an incision is made, the risk of infection exists. To prevent this, the patient must keep the wound dry and clean and take antibiotics prescribed by the doctor.

Blood clots or DVT are common occurrences after a knee replacement surgery. A blood clot that remains in the legs is not problematic, but if it travels via the bloodstream to the lungs or heart, it can cause a block, which can be serious.

Implant Wear and Loosening

Another complication of knee replacement surgery is the implant may get worn out over time and some parts may break off. The implant could also become unstable or loose over time, especially if it is misaligned or does not adhere properly to the bone. If these issues occur, then the person may require a revision or follow-up surgery to fix the issue.

What Does Total Knee Replacement Surgery Encompass?

Typically, TKR surgery is done to rebuild the load-bearing surfaces of the knee joint that is worn, diseased or damaged with prosthetic parts made of metal or polyethene plastic. The surgery helps relieve pain and regain mobility and function.

The process of total knee replacement surgery involves the following:

The patient undergoes all pre-operative processes and procedures.
The anaesthetist administers the anaesthetic to the patient and monitors the blood pressure, heart rate, blood oxygen levels and breathing throughout the surgery.
The surgeon then cleans the area of surgery with antiseptic solutions and makes an incision in the knee.
The damaged portions of the knee joint are removed and resurfaced with a cemented prosthesis. The prosthesis consists of 3 parts – the femoral part, the tibial part and the patellar part. The prosthesis is fixed to the bone using surgical cement.
The incision is then closed with surgical staples or stitches.
The surgeon may place a drain in the surgery site to remove any fluid.
Finally, the incision site is covered with a sterile dressing or bandage.

Why Choose Nanavati Max Hospital for Total Knee Replacement in Mumbai

If an individual is on the lookout for the best hospital for total knee replacement in Mumbai, then undoubtedly, Nanavati Max Super Speciality Hospital emerges as the No. 1 option. Nanavati Max sets the gold standard in TKR, combining technology, know-how and a patient-centric approach to ensure that every individual receives nothing but the best care.

Some reasons why Nanavati Max Hospital is the best for total knee replacement in Mumbai:

The knee replacement unit of Nanavati Max Hospital offers complete treatment and care for a broad range of common to rare musculoskeletal problems.
The hospital strives to deliver the highest quality care, keeping to the best standards of excellence in the industry in TKR procedures.
The hospital’s professional team of highly qualified and experienced knee replacement surgeons specialise in addressing all types of knee conditions and issues to ensure the most suitable treatment for every patient.
The hospital uses the most advanced, state-of-the-art technology and cutting-edge techniques and procedures such as minimally-invasive surgery and computer-aided navigation for orthopaedic surgeries to ensure higher precision and better outcomes. The advanced techniques enable reduced discomfort and quicker recovery times for patients.
The hospital employs a multidisciplinary, patient-centric approach to care and focuses on personalised care to ensure optimal outcomes.

Exercise to Perform Right After Total Knee Replacement Surgery

Regular exercise is extremely important after a TKR surgery. This will help the knee regain its strength and mobility and enable the person to return to their daily activities very quickly. It is generally recommended to exercise for about 20-30 minutes a day or 2-3 times a day and walking around 30 minutes, 2-3 times a day.

Soon after the surgery, the patient must walk short distances using a walker or crutches. They can also climb up and down stairs, which are excellent for building strength and endurance.
Exercising during the early recovery stage will help to boost the circulation in the feet and legs and prevent blood clots. Exercises such as straight leg raises, quadriceps tightening, ankle pumps, knee straightening, supported knee bends and bed-supported knee bends can help strengthen the muscles and enhance knee movement.
After a few days, the person can do advanced exercises such as standing knee bends, assisted knee bends, knee exercises with resistance and stationary cycling.

Minimally Invasive Total Knee Replacement Surgery

The surgical process of minimally invasive knee surgery is similar to that of total knee replacement. However, the minimally invasive TKR involves a smaller incision and lesser cutting of the tissue around the knee joint. This helps minimise damage to the blood vessels and muscles. As a result, the patient experiences lesser pain, reduced blood loss and quicker recovery.

Other types of minimally invasive knee replacement surgery techniques include:

Quadriceps-sparing techniques

In this, the incision made is very small, causing very little trauma to the quadriceps muscle. The 2 variations of this technique include subvastus (the joint is accessed from below the vastus muscle) and midvastus (this splits the vastus muscle in the middle).

Lateral approach

Not a very commonly used method; in this method, the knee joint is accessed laterally (from the side of the knee joint). This technique is usually used for outward bent knees.

Frequently Asked Questions

1. Who is a Candidate For a Total Knee Replacement?

Any individual having severe pain in the knees that makes it difficult to walk, sit, work or climb stairs and has not had any success with nonsurgical treatments like medications, physical therapy, steroid injections, weight loss or bracing is a candidate for TKR.

2. What is The Typical Cost of Total Knee Replacement Surgery in Mumbai?

Typically, the cost of total knee replacement in Mumbai varies between INR 1,50,000 to INR 3,50,000.

3. How Long Does The Implant Last in a Total Knee Replacement?

A TKR knee implant can be expected to last between 15-20 years.

4. What is The Difference Between Total Knee Replacement and Partial Knee Replacement Surgery?

In a partial knee replacement, only the damaged portion of the knee is replaced, whereas in a total knee replacement, all the 3 compartments i.e., lateral (outside of the knee), medial (inside of the knee) and patellofemoral (front of the knee) of the knee are replaced.

5. Where Can I Find Experienced Surgeons for Knee Replacement in Mumbai?

If you’re looking for a surgeon for total knee replacement for you or a loved one, then Nanavati Max Hospital in Mumbai is among the best hospitals with a team of top-notch knee replacement surgeons in the city.

6. Can I Kneel Comfortably After a Total Knee Replacement?

Although doctors say that it is fine to kneel after a TKR, many people find it difficult and painful to do so. It may take a year before you can kneel comfortably.

7. How Soon Can I Drive After a Total Knee Replacement?

It is recommended to wait around 6-8 weeks after TKR before you can start driving.

8. What is The Typical Follow-Up Schedule After Total Knee Replacement?

The typical follow up schedule after a TKR includes:

After 2-3 weeks to check the wound
6-week: X-rays of the knee joint to evaluate recovery
3-6 months: Follow-up checkup
1-year: Follow-up checkup. This is considered the time for full recovery of the knee joint.
More than 1 year: Annual checkups
More than 10 years: Annual checkups. If there are any signs of wearing of the knee joint, then more frequent checkups.

Total Knee Replacement (TKR) Surgery in Mumbai, India