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What is a knee joint?

The knee is a complex joint made up of three bones in a hinge formation: the patella (kneecap), the end of the femur (thigh bone), and the top of the tibia (shin bone). These bones articulate with each other forming the three 'compartments' of the knee. In a healthy knee a highly specialised and naturally lubricated cartilage covers the surface of the bones in the joint and lets the joint surfaces glide smoothly over each other. This joint is controlled by groups of powerful muscles of the thigh and the leg.

What are the commonest causes of knee pain?

A large number of diseases and injuries can damage the knee to the point where it becomes painful or will not function properly.

Although a large number of diseases can cause knee pain, the following are the most important ones: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis

  • Osteoarthritis: This is an age-related 'wear and tear' type of arthritis. It usually occurs in people 50 years of age and older.
  • Rheumatoid arthritis: This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and bone leading to pain and deformities.
  • Post-traumatic arthritis: This can follow major fractures of the bones surrounding the knee or tears of the knee.

In an arthritic knee the joint cartilage gets degenerated and the normally protected nerve endings in the bone gets exposed giving rise to severe pain. Also secondary effects like inflammation of synovium (soft tissue lining the joint), joint effusion, muscle spasm are present. Ultimately the joint end up in permanently deformed and a painful state restricting not only work and recreation, but also ordinary daily activities.

What is Total Knee Replacement?

The surfaces forming the joint are removed and a highly polished metal prosthesis is inserted. The metal glides smoothly on a high grade plastic insert. The soft tissue imbalance is also corrected and any deformity is also corrected simultaneously.

What are the alternatives to TKR?

Arthiric knee has four grades. In earlier grades non-surgical modalities are tried :

  • You may benefit from some gentle exercise such as walking, massage swimming, bicycle or other forms of physical therapy
  • Weight loss can be very helpful in reducing pain from arthritic knees by reducing the stress
  • Intraarticular cortisone injection
  • Knee cap/braces
  • Anti-inflammatory medications and pain medications that can help you live with arthritis. Corticosteroids, injected directly into the knee may give pain relief
  • A cane or a crutch may be required in order to walk
  • Some of the surgical options available are:
    • Ostetotomy: By surgically changing the alignment of the leg, the axis of weight is shifted to the other compartment, thus slowing down the disease progression
    • Unicompartmental Knee Arthroplasty: When the arthritic process is in the early stages and has involved only one of the three compartments in the knee, replacing only that compartment by this minimally invasive technique will address the goals of pain relief, quick clinical recovery and early return to daily activities

Unfortunately in spite of all these measures, the arthritis is progressive in most cases. In case of grade 4 arthritis, bone rubs against bone giving rise to severe pain, in which case, surgical management is the only option.

Why do i need a knee replacement?

As already pointed out, various modalities of managing the pain and preventing disease progression are available. But in advanced stages the joint worsens and no intervention is successful. Someone who is in constant pain, wheelchair bound, not able to walk without stick and not responding to non-surgical treatment should consider the option of replacement. The ultimate aim of total knee replacement is complete pain relief and restoring joint movement.

What is the prognosis?

In many ways, a total knee replacement is similar to changing a set of car tyres. How long the tyres lasts depends on how much the car is used, on what types of roads the car is driven, how heavy the car is, and whether or not the car is properly serviced and maintained. Similarly, how long a total knee lasts depends on how much it is used, what types of activities it is used for and whether you have regular follow-ups.

Average life of Total Knee replacement is 12-15years.

Why Kokilaben Dhirubhai Ambani Hospital?

If you want world class facilities, dedicated team to perform your surgery, latest technology and proven track record, then Kokilaben Hospital is for you!

Following are some examples:
  • High Efficiency Particulate Air (HEPA) Filters: OT environment is strictly controlled with these filters, eliminating the minutest of particles.
  • Total Body Exhaust Suit:  OT personnel use special suits for reducing the chances of infection.
  • Cementing: The prosthesis is fixed to the bone using special, antibiotic impregnated cement. Processing the cement has a huge impact on the results, sometimes deciding the success or failure of the surgery. We are the only hospital in the city to use ‘vacuum mixing’ of the cement, in all our patients, giving it the best chance to last a life-time.
  • Pulse Lavage: Pulse lavage has proven to be the best method for thorough irrigation of the surgical wound, which in turn is essential for preventing infection.
  • Post Operative Care: Our specialist Anaesthetist ensures a pain free post operative recovery through use of nerve blocks and patient controlled analgesia.
  • Team: An experienced team of surgeons, technicians and nurses dedicated to perform only joint replacement surgeries.

What are the latest innovations in Total Knee Replacement?

  • High Flex Prosthesis: This highly evolved prosthesis goes beyond pain relief and aims at restoring a near normal range of movement of the knee. Sitting cross-legged is possible after 6 months.
  • Gender Specific Prosthesis: Women have different anatomy compared to men. So prosthesis designed specifically for women are used.
  • Computer Assisted Navigation: Here the computer collects data regarding the morphology of the bone and guides the surgeon in performing the surgery with sub-millimetre accuracy.
  • Patient Specific Instrumentation: A pre-operative MRI scan is done to collect data and instruments customised for the patient are used.  This enables performance of surgery with very high precision. 
  • Minimally Invasive Surgery (MIS): Small incisions which causes very minimal surgical trauma are used to perform the surgery.
  • Oxinium Implants: This special material developed for joint replacement is preferred for younger patients. It is known to increase the life of the prosthesis by reducing the rate of wear.
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