About knee pain
What is a Knee Joint?

Knee is a complex joint that connects thigh bone (femur) to the leg bone (tibia). In addition to that, knee cap (patella) articulates with femur.

Normally, joint surfaces are lined with very fine articular cartilage, which ensure movement with minimum friction. There are also other specialized structures inside the knee like the meniscus, which help in knee motion and act as shock absorbers

What causes Knee Pain?

If for any reason the cartilage gets worn out, surface of the joints become rough and movement may become painful.

Joint cartilage usually wears out because of the ageing process, leading to osteoarthritis. Wearing out can also be caused by different forms of arthritis, such as rheumatoid arthritis, post injury arthritis, etc.



How is knee pain treated?

In early stage of knee arthritis, pain can usually be controlled with weight reduction, physiotherapy and mild medication.

During end stage of arthritis, when degeneration or arthritis advances too much, there is severe decrease in joint space resulting in significant amount of pain while walking, getting up from chair, and sometimes even while resting. In such a scenario, surgery may be required to replace the knee.

What is knee Replacement?

Knee replacement is a misnomer. It is better to  describe it is knee resurfacing or knee arthroplasty. The procedure involves removal of worn out cartilage along with a bit of bone. Then with special tools (jigs), a shape is created to properly fit in an implant. Special bone cement is used to fix implant to the bone.

Implants help the joint move with very low friction, almost like the original joint. They are metallic on one side and special plastic on the other. Implants from various international companies are available and I use the best suitable implant.

PINLESS Computer Navigation / Computer Assistance / MIS surgery

I use Modern Pin-lessNavigation based on Gyroscope Principle.

With this technique, Implants can be positioned more accurately, blood loss is less, chances of other complications like embolism are also reduced. In cases of Knee Arthritis associated with complex deformity of thigh and / or leg bone, Pinless Navigation may be especially useful However, for routine knee replacement, available jigs are extremely good and accurate.

While long incisions were made earlier, nowadays smaller incision are utilized with the help of MIS jigs.

How to prepare for surgery?
  • I, with your help, will make sure that you don’t have any source of infection in the body, such as skin boils, dental, urine and chest infection
  • If you are taking blood-thinning medicines, please inform me. These medicines may have to be stopped a few days before surgery
  • If you have any other medical issues such as diabetes, hypertension, asthma,hypothyroidism, etc., ensure that the appropriate measures are taken to control the same before surgery
What is the surgery process?
  • You will be admitted one day prior to surgery
  • Relevant investigations will be done
  • You should mention if there are other medical issues such as diabetics, hypertension, asthma, etc, so that a physician can be consulted
  • You will be seen by a member of the anaesthesia team
  • You can discuss choice of anaesthesia with the anesthetist-epidural or general
  • Knee replacement is usually done under epidural anaesthesia (injection on the back to make the legs numb). This avoids certain problems associated with general anaesthesia
  • You shouldn’t eat or drink anything after midnight. Eight hours of fasting is necessary before surgery
  • Shower should be taken in the morning and legs cleaned with soap and water. Legs are not shaved in the room. If required, it is done in the operation theatre
  • Couple of tablets may be given in the morning if required. They’re to be taken with small sip of water
  • You will be shifted to preoperative area about an hour before being taken to the operation theatre
  • After the operation you will be kept in recovery ward for 4 to 6 hours and then sent back to the room or ICU as necessary
  • Following surgery, a bulky dressing is done around the knee, with a small tube (drain) to collect any blood oozing out of the operated knee
  • The drain will be removed 24 two 48 hours after surgery
What is recovery process?

You will be made to stand with the help of walking frame 24 to 48 hours after surgery and encouraged to start walking.

Circulation exercise
  • You should start moving foot and ankle up and down as many times as possible after you regain power in the legs following recovery from anaesthesia. This should be carried out throughout the hospital stay. It helps pump the blood up and prevent complications like thrombosis (blood clot in the veins)
  • Upper limb and deep breathing exercises are recommended
  • You can shuffle around in bed within the limits of pain. You can take half turns and sit on first post-operative day
Pain Relief
  • We use special technique of injecting local anaesthetic and other drugs into tissue during surgery which leads to great reduction in pain after surgery
  • Other measures taken may be in the form of epidural pump, patient control analgesia (PCA) and a mix of certain drugs. You should inform when in pain. Pain Management Team is there to offer assistance at any given time
DVT prevention
  • Adequate measures are taken for prevention of thrombosis, such as DVT pump, (pressure cuff around the calf), certain drugs and early mobility
Discharge from hospital
  • You may be ready for discharge from the hospital 3-5 days after surgery in case of single knee replacement, 5-7 days if both knees are operated
Care at home after discharge from hospital complications of the procedure?What are the risks /
  • Temperature should be   monitored, Please inform if it goes above 100.5 degree Fahrenheit
  • Please inform if there’s excessive swelling, redness around the operated area or discharge from the wound
  • Cold compress should be applied around the knee
  • The toilet seat at home should have high commode attachment or a high commode chair should be used
  • Use of waking aid is recommended until advised otherwise
  • Physiotherapy should be done as advised to facilitate waking, knee bending and strengthening of muscles around the knee
  • Mobilize as much as comfortably possible
How soon can you expect to recover from surgery?
  • After single knee replacement you can stand with assistance of a physiotherapist, 1-2 days after surgery and start moving with the help of a waking aid
  • You can use toilet seat (raised) 3-4 days after surgery
  • By the time you get home, you should be able to go to toilet independently with the help of a waking aid
  • You will need to use crutches or waking frame for 4-6 weeks
  • It will take 8-12 weeks to achieve full benefits of surgery
  • In case both the knees were replaced together, recovery process is a little slower but same principles would apply in this condition as well
Long Term Precautions
  • Antibiotic cover should be taken while undergoing any dental /surgical procedures.Doctor should be kept informed
  • High impact exercise such as jumping, running etc., should be avoided.
  • Please inform if there’s pain, swelling or instability
What are the risks / complications of the procedure?

A l l  s u r g i c a l p r o c e d u r e s a n d anesthetics carry some risks, particularly if there are other medical problems. Our team has been trained to make sure such risks are minimized and the treatment is carried out safely. There are some specific risks related to knee surgery that patients need to be aware of. However, chances of immediate complications are less than 2%

These will be discussed with you in detail
  • Superficial infection :
  • Deep infection
  • Deep vein thrombosis (DVT)
  • Pulmonary Embolism
  • Loosening of the prosthesis (new joint)
  • Persistent pain
  • Other recognized risks of knee surgery include fracture, bruising, some other less common complications like Complex Regional Pain Syndrome etc. and risks associated with anaesthesia, blood transfusion.
Frequently asked question
Q Do I need knee replacement?

It depends on the extent of pain and difficulty in walking. Advice will be given after examining you and analyzing x-ray findings. It is you who is suffering from pain and you are as much a part of decision making as me.

Q Can I get both knees operated at the same time?

It depends on how badly both knees are affected and how sound is your medical status. Knee replacement for both knees can be performed in one sitting if required.

Q. Is knee replacement painful?

There are modern methods available for pain relief, such as continuous epidural anaesthesia, patients controlled anaesthesia (PCA) and a combination of certain drugs that can control pain very effectively. I inject a special mix of drugs in knee joint at the time of surgery which is very helpful in reducing pain. Applying cold compresses around the knee also helps in reducing swelling and pain

Q. Can I get full bending (flexion) of knee after surgery?

A.There are reports in the media that some knee replacements are capable of giving high flexion or full bending of knee. The degree of movement achieved depends on your mobility status before surgery, your weight and good technique of surgery. Surgery is likely to increase your knee movements partially. Implants can only absorb high stress associated with full movement.

Q.Can I sit cross-legged on the floor?

A. Knee replacement implants are bonded to the bone with bone cement. Even though most patients are able to sit cross-legged, it is not recommended. Preventing excessive stress on the bond increases the life of the implant significantly.

Q.Do I need Computer Assisted or Navigation / MIS for my knee replacement?

A. I use Modern Pin-less navigation based on gyroscope principle.

With this technique, Implants can be positioned more accurately, blood loss is less, chances of other complications like embolism are also reduced.

In cases of Knee Arthritis associated with complex deformity of thigh and / or leg bone, Pinless Navigation may be especially useful

However, for routine knee replacement, available jigs are extremely good and accurate.

Q.Do I need physiotherapy?

Physiotherapist will teach you exercises and way to mobilize. Very soon you can do your own exercises.

Q.How frequently do I need to visit the hospital?

A.You are required to visit the hospital 10days after surgery for stitch removal.After that you may be asked to return in 2-4 weeks to track your progress. Subsequent visits are required only after 3 months and 1 year of surgery unless medical condition dictates otherwise.

Q. Is knee replacement detected by a metal detector?

A.YesYou should collect a credit card shaped certificate from my secetary certifying that you’ve had knee replacement.This can be shown to the security staff.