Knee Replacement


Bangalore, July 28, 2010: Fortis Hospitals conducts Asia’s first Custom Fit Knee Replacement Surgery in Bengaluru (formerly Bangalore). 56 and 59-year-old women suffering from degenerative disease of the knee brought to Fortis Hospitals with complications, underwent Asia’s first Custom Fit Knee Replacement Surgery. Patients were discharged within five days of the knee replacement operation. Patients started walking normally within a fortnight, unlike the usual 6-8 weeks required before resuming normal activities in the conventional surgery.

Dr. Sanjay Pai - Lead Orthopedic Surgeon, India

Dr. Sanjay Pai - Lead Orthopedic Surgeon, India

Lead orthopedic surgeon Dr. Sanjay Pai and his team at Fortis Hospitals Bangalore performed this revolutionary surgery by literally remodeling the anatomy of the patient’s knee and recreating or customizing a knee with the right kind of technology and expertise. The new custom fit knee replacement technology designs a perfect instrumentation system that matches the patient’s knee and ensures lesser pain, less tissue damage and faster mobilization.

According to Dr. Pai, “The two operations for knee replacement have been performed for the first time in Asia using the custom fit knee replacement technology. This is indeed a medical breakthrough and likely to revolutionize the way knee replacement surgeries are performed in India. We are glad to be the first adopters of this technology.”

Why Custom-Fit Knee
While conventional knee replacement surgeries retro-fit predetermined sizes of prosthetics on to the patients’ knee, this procedure is very different because it works on the principle that no two patients’ knees are similar. With this technology the patient’s knee is digitally recreated with 3D image mapping after taking into account the bone structure, weight ratios, gender, age and even mechanical alignment. Based on this 3D model the customized knee is created. Something, that just fits them right. This technology ensures far greater accuracy and reduces the operation time by almost 40% and also results in less loss of bone & tissues.

How Custom Fit Knee Works
In short there are 4 steps to building and fitting a Custom-Fit Knee:

  • Step 1: Understanding your knee
    The process starts with a CT Scan of the whole leg from the hips to the ankle which is then used to create an advanced 3D image of the leg structure. The age, weight and gender are also taken into account, creating a complete patient imaging.
  • Step 2: Processing and planning
    With the 3D plan of the leg structure in place, an anatomical model is created to determine the mechanical alignment – the basic philosophy on which the entire process rests. Virtual instrumentation is then done and the surgery is planned accordingly.
  • Step 3: Recreating the knee
    Once the surgery is approved, the Custom Fit instruments are manufactured at state-of-the-art dedicated manufacturing centers. Even the individual patient name and data are etched on each unit to confirm identification during the surgery
  • Step 4: Fitting the knee
    With the Custom Fit instrumentation in place, the knee bone is chiseled to perfection so that the prosthetics fit exactly without any requirement for later corrective surgeries. After a 60 minute surgery, the patient ill have the knee that fits you perfectly.

Benefits of Custom Fit Knee Replacement Surgery

  • Smaller incision
  • Less soft tissue damage
  • Lesser pain
  • Early and better mobilization
  • Better and pain free range of motion
  • Improves alignment and sizing by using computer generated images of the patients anatomy to determine bone cuts and implant positioning preoperatively
  • Better life span of the processes because of the accurate fit and alignment

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Getting a New Knee or Hip? Do It Right the First Time

An informative article on joint replacement by Lesley Alderman appeared in the New York Times recently. It talks about the things that a patient should keep in mind if considering a joint replacement (hip replacement or knee replacement) surgery. Following is the article as it appeared on the NY Times website.

THERE is nothing like a new hip or knee to put the spring back in your step. Patients receiving joint implants often are able to resume many of the physical activities they love, even those as vigorous as tennis and hiking. No wonder, then, that joint replacement is growing in popularity.

In the United States in 2007, surgeons performed about 806,000 hip and knee implants (the joints most commonly replaced), double the number performed a decade earlier. Though these procedures have become routine, they are not fail-safe.

Implants must sometimes be replaced, said Dr. Henrik Malchau, an orthopedic surgeon at Massachusetts General Hospital in Boston. A study published in 2007 found that 7 percent of hips implanted in Medicare patients had to be replaced within seven and a half years.

The percentage may sound low, but the finding suggests that thousands of hip patients eventually require a second operation, said Dr. Malchau. Those patients must endure additional recoveries, often painful, and increased medical expenses.

The failure rate should be lower, many experts agree. Sweden, for instance, has a failure rate estimated to be a third of that in the United States.

Sweden also has a national joint replacement registry, a database of information from which surgeons can learn how and why certain procedures go awry. A registry also helps surgeons learn quickly whether a specific type of implant is particularly problematic. “Every country that has developed a registry has been able to reduce failure rates significantly,” said Dr. Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn.

A newly formed American Joint Replacement Registry will begin gathering data from hospitals in the next 12 to 18 months.

Meanwhile, if you are considering replacing a deteriorating knee or hip, here are some ways to raise the chances of success and avoid a second operation.

EXPERIENCE COUNTS Choose – or request a referral to – an experienced surgeon at a busy hospital. “The most important variable is the technical job done by the surgeon,” said Dr. Donald C. Fithian, an orthopedic surgeon and the former director of Kaiser Permanente’s joint replacement registry.

Ask for recommendations from friends who have had successful implants and from doctors you know and trust. When you meet with the surgeon, ask how many replacements he or she does each year.

VOLUME MATTERS A study published in The Journal of Bone and Joint Surgery in 2004 found that patients receiving knee replacements from doctors who performed more than 50 of the procedures a year had fewer complications than patients whose surgeons did 12 procedures or fewer a year.

The researchers documented a similar trend when it came to hospital volume. Patients at hospitals that performed more than 200 knee replacements a year fared better than patients at hospitals that performed 25 or fewer.

ADJUST EXPECTATIONS Not everyone with joint pain will benefit from a joint replacement.

An implant can help reduce pain and improve mobility if the joint surface is damaged by arthritis, for instance. But a new joint will not help pain caused by inflammation of the surrounding soft tissue, said Dr. Berry, who is also vice president of the board of the American Academy of Orthopaedic Surgeons.

Some people with mildly arthritic joints, for instance, can manage well with the judicious use of medication. “Surgery comes with complications and risks, and should not be approached lightly,” Dr. Berry said.

Joint replacement is not a minor operation. If you have uncontrolled high blood pressure or another serious chronic condition, a joint operation may simply be too risky for you.

NARROW YOUR OPTIONS “There is no one best joint,” Dr. Berry said. “A successful replacement depends on selecting the right implant for the patient.”

A good surgeon will recommend an implant that makes sense for your age, activity level and the shape of your joint. Younger or very active people who place more physical demands on the implant, for instance, may benefit from newer hard-on-hard bearing surfaces, like those made of ceramic, said Dr. Joshua J. Jacobs, chair of orthopedic surgery at Rush University Medical Center in Chicago.

In general, be wary of the latest, most advanced new joint. There is little evidence to support the use of more expensive designs over basic ones, said Dr. Tony Rankin, a clinical professor of orthopedic surgery at Howard University. One recent study found that premium implants fared about as well as standard implants over a seven- to eight-year period.

Be skeptical, too, of advertising gimmicks. “I had a 78-year-old patient with a perfectly good knee replacement come in and ask if she should have gotten the ‘gender knee,’ which she had seen advertised on TV,” Dr. Rankin recalled. “She was doing well, but was swayed by the idea of a knee made just for women.”

GATHER THE DATA Once you have a recommendation or two from a surgeon, find out how well the joint has performed in others and if there are known complications. The newer metal-on-metal hip implants, for instance, are somewhat controversial and may cause tissue and bone damage in certain patients.

Ask if the hospital has a registry that tracks joint replacements. If so, ask to see the data on the implants you are considering.

It is also helpful to understand what the operation involves, including the materials that will be used and how the surgeon plans to fix the joint to the bone. You can learn more about your operation at the American Academy of Orthopaedic Surgeon’s patient information Web site, orthoinfo.org.

If you want to delve deeper, look at a large national registry from another country, like Australia. The annual report of Australia’s registry lists knee and hip implants that had a “higher than anticipated revision rate.”

A caveat: the information can be difficult to parse for a layperson. “A surgeon can provide perspective on information that, taken out of context, could be misleading,” Dr. Rankin said. So discuss it with your surgeon.

PLAN YOUR RECOVERY To avoid complications during your final stage of recuperation, discuss with your doctor in advance the support you will need when you return home, Dr. Berry advised.

Recovery takes a different course for each patient, depending on the type of procedure and implant. In general, expect mild to moderate pain for the first few weeks. Some patients are able to return to work in one to two weeks, but full recovery can take six to 12 months, Dr. Jacobs said.

Make sure you have the help you need in the initial stages of recuperation. Since you may have difficulty getting around and won’t be able to drive right away, you may want to have a friend or family member stay with you. You may even need to hire an aide or visiting nurse.

Follow your doctor’s orders, and don’t rush your recovery. You don’t want your new joint to fail because you couldn’t resist carrying loads of laundry up and down stairs, or felt compelled to rearrange the patio furniture.

If the new joint is given time to heal, you will find plenty of opportunities for all that in the future.

Related links

  • Affordable joint replacement surgery overseas
  • Cost of knee replacement or hip replacement surgery
  • What joint replacement surgery patients are saying
  • Medical tourism
  • Healthbase, the leading US-based medical tourism provider, has partnered with a JCI accredited German hospital in order to bring wider options and greater convenience to Americans, Canadians, Europeans and others looking for affordable, timely and high quality medical and dental treatments.

    Healthbase Online Inc., the leading and award-winning medical tourism facilitator based in Boston, MA, has announced partnership with a Joint Commission International accredited hospital in Germany. With the addition of this JCI accredited hospital, Healthbase now has a network of over 100 health care and dental care providers spread across 18 countries. For the medical tourist it means more choices, wider variety and greater convenience.

    According to Saroja Mohanasundaram, CEO of Healthbase, “With growing demands from our consumer base for a quality tertiary medical care center in Europe, we are excited to have our newest Germany-based healthcare provider onboard. Our new member provider is JCI-accredited thereby giving the peace of mind to our patients regarding the high standards of quality that will be delivered by it. Our German provider offers a full complement of services and is an excellent choice for patients looking for orthopedic, spinal and bariatric treatments at a much discounted rate compared to USA and much faster access to service compared to that offered by public health care systems in Canada or the UK.”

    For patients from Europe, especially from the European Union (EU), this would be as good as going to a local hospital with the advantage of high or higher standard of service and without the inconvenience of the infamous waitlists as seen in government-sponsored healthcare systems such as the National Health Service or NHS in the United Kingdom.

    The hospital offers procedures like joint replacement procedures (such as hip replacement surgery and knee replacement surgery), spinal procedures (such as spine fusion surgery and artificial disc replacement surgery), and weight-loss procedures (such as lap band surgery, gastric bypass or RNY procedure and gastric sleeve surgery), among hundreds of other procedures.

    The favorable geographical location of Germany means that for patients coming from North America the flight times are shorter compared to other famous medical tourism destinations such as those in Asia. For those traveling from other European countries it is at a stone’s throw.

    Mohanasundaram adds, “We have carefully chosen our German provider after a rigorous selection process keeping in mind all aspects of affordable, safe and top quality medical tourism care. Patients can expect as much as 50 to 70% less cost compared to the cost of care in other developed countries such as the United States. Also, the staffs at our German provider speak English, thus, making communication easy.”

    Healthbase has the biggest and geographically most expanded network of healthcare and dental care providers in the industry. Patients have a wide selection of destinations to choose from for their low cost high quality medical care and dental care needs. These include Germany, India, Thailand, Singapore, South Korea, Malaysia, Philippines, New Zealand, Jordan, Turkey, Hungary, Belgium, Spain, Costa Rica, Panama, Brazil, Mexico, and USA.

    Healthbase serves the American, Canadian, European, African, Asian, Middle-Eastern and Asia Pacific markets, and offers more than 200 procedures.

    About Healthbase Online Inc.:
    Healthbase, an award-winning US-based medical tourism and dental tourism facilitator, is a one-stop source for global medical and dental choices, connecting patients to leading internationally accredited healthcare providers in 18 countries including India, Thailand, Singapore, South Korea, Turkey, Germany, Panama, Costa Rica, Mexico and USA. Healthbase caters to individual consumers, self-funded businesses, insurers, benefits plan consultants, third party administrators and those using Consumer Directed Healthcare Plans (CDHPs) or voluntary benefit plans. Healthbase coordinates over 200 procedures in various categories like orthopedic, spinal, cardiac, bariatric, urology, oncology, dental, cosmetic and general surgery. Some of the common procedures offered are Birmingham hip resurfacing, total hip replacement, knee replacement, ACL repair, rotator cuff surgery, spinal fusion, spinal disk replacement, heart bypass surgery, lap band, gastric bypass, cancer treatment, liposuction, dental implants, crowns, bridges, etc. for a fraction of the cost in the US with equal or superior outcomes. To ensure that patients receive the best care possible, Healthbase works mainly with hospitals that have international accreditations like JCI. To learn more, call 1-888-691-4584, email info.hb @ healthbase.com or visit http://www.healthbase.com.

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    Healthbase has helped an uninsured American patient get double hip resurfacing surgeries in India. The high cost of Birmingham hip resurfacing surgery in the United States plus the lack of expertise in this procedure in the country continues to drive scores of Americans to India.

    Nov. 21, 2008, Boston, MA. Healthbase Online Inc., an award-winning medical tourism facilitator based in Boston, Massachusetts, helps an Arizona-based former ballet dancer treat her hip osteoarthritis in India. 53-year old Katharine Frey who had arthritis in both her hips traveled to Apollo Hospitals, Chennai to have her hips resurfaced and availed of the 85% discount on the cost of the surgery.

    “I have appreciated everything we have experienced and received at the Apollo Hospitals . Everyone has been very kind, supportive and helpful,” says Katharine after her hip resurfacing surgery last winter. She was so happy with the quality of care she received at her overseas hospital that she went back a few months later to have her second hip resurfaced.

    Being uninsured, the $60,000 required to have a single hip resurfaced in the US seemed out of reach for Katharine. This led her into researching her other option – surgery overseas – and contacting Healthbase who coordinated both her surgeries in India for $8,000 each. The price included doctor’s fees, physical therapy and a week in the hospital.

    According to Saroja Mohanasundaram, CEO of Healthbase , “Our clients prefer going abroad for Birmingham hip resurfacing because it is a fairly new procedure in the US but has been in use, say, in India, for many years. Being a major procedure it demands years of practice on the surgeon’s part to gain proficiency. The fact that Katharine went back to have her other hip resurfaced in India speaks volumes about the high level of satisfaction with our service and that of our partner hospitals and surgeons.”

    Katharine Frey taking off on a paragliding flight just weeks after her hip resurfaicng surgery in India
    Katharine Frey taking off on a paragliding flight just weeks after her hip resurfacing surgery in India

    Katharine returned to work merely two and a half weeks post operation and to teaching ballet twenty days post operation. Katharine actively participates in swimming, yoga, hiking, paragliding, and cross-country road trips. “She has no pain in her hips and is moving and functioning like a normal human. I am so grateful and am enjoying watching Katharine return to life,” remarks Scott Martin, Katharine’s husband.

    Katharine was operated upon by Dr. Vijay Bose and his team. Dr. Bose, a specialist in Birmingham Hip Resurfacing, Joint Replacement and Sports Medicine, has over a thousand BHR surgeries under his belt.
    “Beyond the cost savings, the attention given was remarkable. Dr. Bose and his qualified staff will always be remembered for this,” adds Katharine.

    Impressed by the high quality of care in India, even Scott, who accompanied Katharine to India addressed some of his periodontal issues through dental scaling and crowns at Apollo Hospitals while Katharine recuperated after her second Birmingham hip resurfacing surgery.

    “It has been a positive life changing process for both of us. Thank you, Healthbase, for being so receptive, supportive and professional,” acknowledge Katharine and Scott.

    Healthbase connects patients from across the globe to health care facilities in India, Singapore, Thailand, Malaysia, South Korea, Philippines, Turkey, Belgium, Hungary, Costa Rica, Panama, Brazil, Mexico and United States. Healthbase has over 45 providers on its network.

    About Healthbase Online Inc.:

    Healthbase, an award-winning Boston-based medical tourism and dental tourism facilitator, is a one-stop source for global medical and dental choices, connecting patients to leading healthcare providers around the world. Healthbase coordinates over 200 procedures in various categories like orthopedic, spinal , cardiac, bariatric, urology , oncology , dental , cosmetic and general surgery . Some of the common procedures offered are Birmingham hip resurfacing , total hip replacement , knee replacement , ACL repair , rotator cuff surgery , spinal fusion , spinal disk replacement, heart bypass surgery , lap band , gastric bypass , cancer treatment , liposuction, dental implants, crowns, bridges, etc. for a fraction of the cost in the US with equal or superior outcomes. Healthbase’s partner healthcare facilities are located in Thailand, India, Singapore, Malaysia, Philippines, South Korea, Turkey, Belgium, Hungary, Costa Rica, Panama, Brazil, Mexico and USA, and are expanding to Canada, UK, Jordan, Taiwan, Argentina, New Zealand, Australia, El Salvador and Guatemala. To ensure that patients receive the best care possible, Healthbase works mainly with hospitals that have international accreditations like JCI, JCAHO and ISO. Healthbase caters to the needs of individual consumers, self-funded businesses, insurance carriers, benefit consultants, insurance agents, and third party administrators seeking affordable medical travel and dental travel options. To learn more, call 1-888-691-4584, email info.hb @ healthbase.com or visit http://www.healthbase.com.

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    Unicondylar Knee Replacement

    Provided by Wockhardt Hospital
    Brought to you by Healthbase

    Most people are aware of the total knee replacement surgery. This involves replacing the unhealthy surface of the entire knee joint with metal and plastic implants. It is a very successful operation with good long term results. However a large percentage of patients have arthritis limited to one part of the joint alone. Replacing the whole joint in these patients is overkill and unnecessary.

    Knee ReplacementMany middle aged men and women develop osteoarthritis of the knee. Osteoarthritis of the knee affects the inner half or medial compartment to start with and then proceeds to affect the outer half or lateral compartment.

    In this operation only that part of the knee, which is unhealthy, is replaced. The normal surfaces are left alone. This operation has several advantages over total knee replacement surgery.

    • It can be done through a very small incision.

    • It is minimally invasive and hence tissue damage is far less.

    • The patient gets complete pain relief and the implant lasts long

    • The knee feels more natural as ligaments are preserved

    • Range of movement is full and it allows squatting and sitting crosslegged

    • Post operative hospitalization is reduced and return to normal is much faster than total knee replacement surgery.

    Dr. Kaushal Malhan is a Joint Replacement and sports surgeon at the Wockhardt hospital. He was the first surgeon in India to do the mobile bearing oxford unicompartmental knee replacement and has been in the forefront in the field of full bending knee replacement surgery.

     

     

     

     

     

     

     

    Frequently Asked Questions

     

    • What is unicondylar arthroplaty, or partial knee replacement?
    • What are the advantages unicondylar arthroplasty?
    • How is it different from total knee replacement?
    • You mentioned recovery is faster. What does that mean?
    • What does the surgeon do during a unicondylar arthroplasty?
    • How do I know if I am a candidate for this surgery?
    What is unicondylar arthroplaty, or partial knee replacement?Partial knee replaces only the area of the knee that is worn out, sparing patients the more medically complicated and involved total knee replacement surgery.

     

    What are the advantages unicondylar arthroplasty?With a partial knee replacement, there is a dramatically shorter recovery time due to less surgical trauma, less scarring and fuller range of motion.

     

    How is it different from total knee replacement?

    During total knee replacement, surgeons typically make a 7 to 8-inch incision over the knee, patients stay in the hospital for approximately four days, and there is a recovery period of up to three months. During minimally-invasive partial knee surgery, a part of the knee to be replaced through a small, 3-inch incision. There is minimal damage to the muscles and tendons around the knee and the required hospital stay is up to two days. The recovery period is about one month.

     

    Total Knee Replacement

     

    You mentioned recovery is faster. What does that mean?

    Patients often walk unassisted within a week or two of the operation. Even those who have both knees done at once are able to walk without the assistance of a walker or cane fairly quickly.

     

    What does the surgeon do during a unicondylar arthroplasty?When a knee replacement is performed, some bone and cartage are removed using precise instruments to create exact surfaces to accommodate a metal and plastic prostheses.

     

    How do I know if I am a candidate for this surgery?

    Candidates for this surgery are generally younger, more active patients. The partial knee replacement allows for symptoms of pain or discomfort. The procedure allows younger patients to buy time before they need a full knee replacement. The procedure is also effective for older patients if they have disease localized to one half of the joint.

     


    Brought to you by Healthbase www.healthbase.com info@healthbase.com1-888-MY1-HLTHHealthbase is the trusted source for global medical choices, connecting patients to leading hospitals around the world, through secure and information-rich web portal. To learn more, visit: http://www.healthbase.com Login to get FREE quote. Access is free.

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    Total Knee Replacement

    Provided by Wockhardt Hospital
    Brought to you by Healthbase

    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. 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.

     

    Implant Components

     

    Total Knee ReplacementIn 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.

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

    The 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

     

    The 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

     

    Knee replacement surgery is a complex procedure, and 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.

    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.

    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 will include the following exercises:

     


    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
    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.

     

    Knee Flexion
    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
    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.

     

    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.

     

     

    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.

     

    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?

    Q 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).

    Q 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.

     

    Q 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.

     

    Q 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.

     

    Q 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.

     

    Q 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.

     

    Q 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.

     

    Q 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.

     


    Brought to you by Healthbase www.healthbase.com info@healthbase.com 1-888-MY1-HLTHHealthbase is the trusted source for global medical choices, connecting patients to leading hospitals around the world, through secure and information-rich web portal. To learn more, visit: http://www.healthbase.com Login to get FREE quote. Access is free.

    Brought to you by Healthbase www.healthbase.com info.hb@healthbase.com 1-888-MY1-HLTH


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    Total Knee Replacement

    Provided by Wockhardt Hospital
    Brought to you by Healthbase

    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. 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.

     

    Implant Components

     

    Total Knee ReplacementIn 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.

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

    The 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

     

    The 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

     

    Knee replacement surgery is a complex procedure, and 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.

    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.

    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 will include the following exercises:

     


    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
    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.

     

    Knee Flexion
    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
    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.

     

    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.

     

     

    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.

     

    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?

    Q 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).

    Q 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.

     

    Q 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.

     

    Q 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.

     

    Q 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.

     

    Q 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.

     

    Q 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.

     

    Q 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.

     


    Brought to you by Healthbase www.healthbase.com info@healthbase.com 1-888-MY1-HLTHHealthbase is the trusted source for global medical choices, connecting patients to leading hospitals around the world, through secure and information-rich web portal. To learn more, visit: http://www.healthbase.com Login to get FREE quote. Access is free.