What is the success rate of knee replacement surgery?
Knee replacement has a success rate more than 95%. Less than 3% of patients will have problems if any. These problems are infection (around 1%), deep vein thrombosis or pulmonary embolism (less than 1%) , stiffness, fracture etc.
How long does a knee replacement last?
90% of implants that are used last for around 20 years. These have been validated through variety of scientific studies all across the world.
What is rapid recovery?
One thing that has changed in the world of joint replacement surgery in the past 10 years is probably rapid recovery following the surgery. Patients are made to walk within four hours following their operation. This has been possible because of multiple factors. One of them is to start pain killers before the operation and give patients spinal anaesthesia from which they recover very fast and we also put a combination of injection inside the knee joint which makes them relatively pain-free on day one. We also give them a combination of painkillers in the post-operative period so that the patients remain very comfortable. Even when the patients have had both knee replacement done at the same time we make them stand up on the same day. This has resulted in patients being much happier, more confident and recovering very fast following these operations.
What is the sequence of events following the operation?
Patients are made to walk four hours after surgery with the help of a walker. The physiotherapist will come and guide the patience for various exercises. Usually on date of operation, the patients takes a few steps and then we make him climb a couple of stairs. Patients who have had both knee replacements will be using the walker for at least 2 to 3 weeks and then they will gradually start using a stick. More than 90% of patients following the operation will be discharged on third or fourth day post operation. So the total hospital stay is approximately four days for both knee replacements. Majority of the patients will be able to travel in their own vehicle following discharge or short duration of travel. Patients have to visit a doctor for removal of stitches and a physiotherapist will visit them usually for about one month following surgery.
What are the best implant materials that can be used for me?
We tend to use the implants that are proven over time and have been researched over a long period of development. The period of time to make sure that they have worked successfully in patients currently the majority of the new replace new replacements are made up of a cobalt chrome material for the femoral component and the titanium component for the Tibia component. Majority of these knee replacements have been used for 20 to 25 years and we have found that they lost in 90% of patients at around 20 years’ time.
What is the role of technology in knee replacement surgery?
There has been a lot of hype and marketing around knee replacement surgery all across the world. We need to understand that the knee replacement surgery lasts longer if they are aligned well in the leg, and if the ligaments around the knee joints are balanced. The alignment of the leg can be perfected by an experienced surgeon using traditional tools used by more than 90% of the surgeons worldwide. It is proven that an experienced surgeon does not need any extra tools for perfecting the alignment.
Computer navigation is used for the last 20 years for improving alignment in the leg. Several studies have been published in a variety of scientific journals comparing knee replacement done with the help of computer navigation Vs. Standard tools. They have not shown any difference in the short or the long term between the outcomes following knee replacement surgery.
Robotic knee replacement surgery is hyped in the recent past. Unfortunately, several myths are surrounding robotic surgery. Patients have been told that a robot will come and perform the surgery; unfortunately, such technology does not exist. This technology has marginal improvements over computer navigation technology because a robotic arm will help the surgeon achieve cutting of bone precisely. These are the technologies that have been available only in the last few years, and they have not shown any benefit over the standard surgery using tools or computer navigation.
Robot‘s knee replacement is a slow procedure as it takes added time compared to standard knee replacement procedures. Any advice otherwise that robotic knee replacement is faster is false. Lasers cannot be used in performing knee replacement surgery, this is another myth that has been propagated in the standard population, so one needs to understand that there is no leisure in robotic knee replacement surgery. The next myth about robotic knee surgery is about having a smaller cut on the skin to perform the surgery. Another myth is that robotic surgery has a rapid recovery following this operation. Unfortunately, this is not true and rapid recovery following the knee replacement surgery is dependent on various factors, including what kind of pain relief was used what kind of anaesthesia was used and how motivated the patient is, and the quality of surgery which an experienced surgeon can achieve very consistently with a concise operation with excellent result in the quick and in the long term
The next myth that is been propagated about robotic knee replacement surgery is that it leads to less blood loss. This again is not true and the blood loss following knee replacement surgery again depends on variety of factors and the most important of which is handling of the soft issues and which again boys down to the experience of the surgeon and not dependent on the technology that has been used.
So we have seen that achieving alignment in the leg is only one part of knee replacement surgery and the knee replacement surgery consist of several steps which are not held by either computer navigation And robotic knee replacement procedure.
The robotic knee replacement surgery still remains experimental, it has not shown any benefit in the short term for patient recovery and we know that improving alignment only by using either computer navigation or for that matter robotic surgery will not make any difference in the long-term survival rate following a knee replacement surgery
What are the common things to be noticed in the post-operative period?
Patient usually feel some amount of pain for around 2 to 3 months at a time. Patients need to take medication to control this pain is very regularly so that they don’t suffer and are recovering faster following surgery. Lack of sleep is again very common for any replacement surgery and I am a person needs to be told that the sleeping pattern will return to normal within a couple of months time. Patience also note is a patch of numbness I’m just on to the side of the skin Cut and again it needs to be to explain to the patient that this is not something to worry about. Stair climbing is an ability which only comes over a longer duration of period and patient should not be unduly worried about distress either in climbing Up or down the stairs. If a patient has had both knee replacements done there will be differences in the tony joins for the short duration of time following surgery. And ultimately the outcome will be pretty much similar for both the knee joints. It is very common to have swelling around the knee joints and the lower limbs for a considerable duration of time following surgery and if the patient is unduly worried I am or there is persistent tenderness around the car then we get an ultrasound scan of the legs to rule out a clot formation in the calf area.
When can I start driving?
We advise patients to start driving six weeks following the surgery. I usually recommend avoiding driving a two-wheeler, which is very common in India, for at least three months following surgery.
What sports can I play following knee replacement surgery?
Patients can return to swimming, cycling within two months of surgery. They should avoid impact sports such as badminton, jogging football as it is likely that these activities may lead to increased wear and tear of their meal replacement. Patients can play doubles tennis, tennis on walls where there is a lower probability of knee twist or any other knee injury.
Can I sit cross-legged or squat on the floor following knee replacement surgery?
The ability to squat or sit on the floor depends on the range of movement at the knees joint and the patient’s general flexibility. High flexion knee replacements cannot guarantee that the patient will easily sit on the floor. The data available to us about hip and knee replacement longevity is based upon information from the western population. Western populations do not sit on the floor, and therefore, the data about the knee joint replacement for sitting on the floor cross-legged is unknown. There is a possibility that by squatting, we might damage the knee replacement joint, and we may not be able to guarantee the 15 to 20-year joint health following the knee replacement operation.
Will my knee replacement implant trigger an alarm at the airport?
As the implants are made of metal, they will set up an alarm at the airport screening area. We give our patients a card like a credit card to keep with them, providing all the necessary details of the metallic implant they have in their body. This can be shown to the security personnel, but most people are aware of metallic implants in patient’s body.
What does hip replacement surgery involve?
Total hip replacement surgery involves replacing the hip joint with an artificial joint made of metal, plastic or ceramic materials. The doctor makes a six- to ten-inch incision on the side or back of your hip. Materials used in making your artificial joints are strong and designed to last a long time inside your body.
How should I sleep at night to keep my hip comfortable and safe?
Placing a pillow between your legs should help keep your hip comfortable and stable. You may sleep on your back or on either side, depending on what makes you most comfortable.
Can I sleep on one side post hip replacement surgery?
You may sleep on your operative side whenever you feel comfortable. You may sleep on your nonoperative side at four weeks with a pillow between your knees.
What activities should I avoid after hip surgery?
It’s important to keep your new joint moving. However, you should return to normal activities gradually. You will be instructed by your joint replacement care team to avoid specific positions that could put stress on your new joint. Avoid high-impact activities.
Will I Notice Anything Different About My Hip?
Patients with hip replacements think that the new joint feels completely natural. We recommend avoiding extreme positions, high-impact or physical impact activities. The leg with the new hip may feel longer than it was before. This is because of the shortening due to hip disease. After surgery, the leg is restored to its original height and this makes it feel longer than before. Most patients get used to this feeling in a short time. Some patients have aching in the thigh with weight bearing for a few months after surgery. You may have a small area of numbness to the outside of the scar. This may last a year or more and is not serious or cause for concern.
Will I need a walker, crutches or cane?
Yes. You will start with a walker until your muscle strength returns after surgery.