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An Overview to Knee Replacement Surgery

Total Knee Replacement (TKR) is a surgical procedure to treat pain and disability caused by damaged knee. The procedure aims to relieve pain and restore movement in patients suffering from severe knee arthritis or other bone related conditions.

Knee replacement in India is a popular procedure that is offered at all the apex hospitals across various cities including Delhi, Mumbai, Chennai, Bangalore and others.

Every year, more than 120000 knee replacements are performed in India. The success rate of knee replacement has reached the zenith in today’s time. This is majorly attributed to the latest technological developments and improvements in quality of implants. The surgery was earlier thought to be only favourable for elderly but with improved technique is now being increasingly performed for younger patients.

Knee replacement in India is done with world’s most updated technology and has reached a highest benchmark. The new-age techniques which are used now a days has replaced the traditional methods which were more painful and involved longer recovery time. The new technology used by the orthopedic surgeons in India have reduced postoperative pain and recovery time after the surgery.

This latest advancement also eliminates the complications and side effects associated with the traditional knee surgery. Use of Hi-flexion implants for the surgery allows patients patients to have full flexion, similar to that of a healthy knee joints.

The technology such as patient-specific instrumentation (PSI) has improved the alignment and sizing by utilizing the computer-generated images of the patient’s knee to determine where the precise bone cuts have to be made and implant position for the surgery.

The major benefits of the latest technology for knee replacement surgery is that it results in less surgery time, less postoperative discomfort and complications and a speedy recovery.

Advancements in Knee Surgery:-

Computer navigated Total Knee Replacement (TKR)-

Computer navigation system for TKR is performed uses a highly specialized software with infrared camera and trackers. The trackers are attached to the bones of the patient’s knee temporarily and it sends the data to an infrared camera. This information is then processed by the computer which provides real time 3-Dimensional images of the patient’s knee joint and about the leg alignment. The orthopedic surgeon then uses this information to determine the bone cuts, adjust tension for soft tissue, customization of implant position. This enables the doctor to insert the artificial knee implant accurately. The precise positioning of the joint reduces chances of joint wear and optimizes the lifespan of the artificial joint.

This technique is an important part of Robotic knee replacement surgery. The benefits of computer navigation system include improved patient satisfaction, better alignment, better clinical outcomes, minimal blood loss and less blood transfusion rates. Also there is a lesser likelihood of postoperative inflammation which reduces pain and swelling leading to early recovery and movement.

High Flex Knee Replacement:- This technique allows the patient to bend up to 155 degrees, kneeling, sitting cross legged as well as squatting.

Gender Specific Knee Replacement (females – Zimmer Implant) : This technology is specifically designed to suit the female body as there are significant anatomical differences in the knee of men and women.

Attune Rotating Platform Knee Replacement :- This is a first of its kind in technology available in India. This knee replacement used along with Minimally Invasive Subvastus technique offers benefit of alleviating the fear in the patient. This procedure enables the patients to feel their knee as a normal knee in regards to mobility, stability and function. It is a personalised knee procedure as it provides versatility in size and perfect match to the patient’s anatomy.

Enhanced (fast track) Recovery After Surgery (ERAS):

The ERAS protocol is a multi-disciplinary approach involving a team of specialists including orthopedic surgeons, anaesthetist & rehabilitation expert. This is a comprehensive care method for patients to help them attain an early recovery. It reduces the hospital stay, improve results and limits complications. These specific techniques involve minimally invasive surgical methods which results in avoidance of surgical drains, better pain management, balanced fluid administration and early recovery. This allows the patients to drink and eat on the same day of operation. Whereas with the classical approach, patients have to stay in the hospital for more than 5-6 days after surgery.

As the number of total knee replacements performed in India continues to increase, the advanced techniques such as computer navigation ensure accuracy and precision in the procedure. This helps in early mobilization of the patient after surgery. The regular use of these techniques has improved the clinical outcomes and reduce complication rate for joint replacement surgeries.

Minimal invasive knee Surgery: – Minimally invasive knee replacement is a surgical technique that allows surgeons to make smaller incisions than the ones used during traditional surgery. This surgical technique involves smaller incisions of four to five inches only in comparison to that of traditional surgery. This results in less scarring and damage to the tissue, less blood loss, reduced postoperative pain, faster recovery and a shorter hospital stay.Minimally invasive knee replacement surgery in India is available at a fraction of the cost that is offered in the western countries. The procedure has become increasingly popular and people from all around the world want best Minimally invasive knee replacement surgery in India. Minimally invasive knee replacement technique is also known as quadriceps-sparing knee replacement in which an incision of typically only 3-4″ in length is used and the recovery time is much quicker. 

Minimally invasive total knee replacement is a modification of the traditional surgical approach. As the name suggests, it is less invasive than traditional surgery in the terms that smaller size incisions are made in this procedure. The traditional method of surgery involves making an incision that has an average size of 8 to 10 inches long while with minimally invasive knee replacement surgery, the size of incision is just 4 to 6 inches in length. As this involves a lesser damage to the tissue around the knee joint, patients with minimal invasive procedure are expected to have a shorter hospital stay, a faster recovery, and less scarring of the tissues.

The procedure is meant to reduce the tissue trauma during the surgery and another main purpose of minimally invasive knee replacement is to improve knee function with added advantage of less postoperative pain and lesser risk of surgery related complications.

Here are some of the benefits of minimally invasive knee replacement over traditional surgery:

  • Better healing and faster recovery after the surgery
  • Less discomfort post-surgery as smaller incision are made
  • Reduced duration of hospital stay due to a speedy recovery and rehabilitation
  • Minimal blood loss and post-operative pain
  • Uses the same high quality surgical implants as with Traditional Knee Replacement.

Procedure

As this technique is less invasive, it causes less damage and disruption to the adjacent tissues which results in minimal scarring, reduced pain after the surgery and early recovery.

Types of approaches used for minimally invasive knee replacement are:

Quadriceps sparing approach

It is also known as the subvastus approach. This method prevents the quadriceps muscle from getting cut during the surgery and eliminates the risk of trauma to the thigh muscles. Small incision of 3 to 4 inches is made and the knee joint is accessed by cutting the fibrous tissue layer in the upper thigh which is attached to the quadriceps muscle known as retinaculum. The quadriceps muscles are then kept aside from the way rather than cutting them. Then the replacement implant is inserted in place.

Using special knee replacement instruments, the bone is prepared before placing the implant. Because there is little or no damage to the quadricep muscles, this technique speeds up the rehabilitation process and makes it easier for the patient to resume walking and other activities sooner with reduced pain and minimal scarring.

Lateral Approach Knee Replacement

In this procedure, the knee joint is accessed from the lateral part. The incision is made on the lateral side of the knee joint, and therefore the knee cap and surrounding muscles are not manipulated. With this approach, the chances of muscle injury are eliminated and improves the knee cap functions. However, this is a less used technique.

 Knee arthroscopy or total knee replacement is a common joint replacement procedure that is an effective solution for arthritic knee pain. 

With advancing age, a large percentage of the population gets affected by problems like osteoarthritis, bone degradation and other diseases that causes severe knee pain and restrict the range of movement. When the pain and disability becomes severe enough to prevent a person from performing their daily activities, such as walking, climbing stairs, bending and many more, surgery is recommended by the doctor. It aims to provide relief from the pain and restore the functionality of the knee. 

A number of patients benefit from this surgery as it improves the quality of life of the patients and enable them to have an active lifestyle.During a knee replacement surgery, the damaged knee joint is removed and artificial prosthetic are implanted in their place. The artificial prosthetic implants are usually made of metal, plastic or ceramic. This restores the normal functions of the knee and allows the patient to move the joint properly. 

How long is the duration of stay in hospital and in India?

Generally, the patient is required to stay for 2-4 days at the hospital after the surgery. Physical therapy starts from the same or the next day after the procedure. It is recommended to stay for a week or two in India so that it gives enough time to recuperate before travelling back to the home country. During this time, there will be scheduled follow ups with the orthopedic surgeon and a regular physical therapy is continued to strengthen the muscles and improve knee movement. 

What is the minimally invasive knee replacement surgery cost in India?

The cost of minimally invasive knee replacement surgery in India depends on several factors, such as the type of implant, experience of the surgeon, room category, the quality and location of the hospital where you choose to undergo the surgery. 

 

The minimally invasive knee replacement cost in India starts from USD 5,000 and may vary depending on the basis of the above mentioned factors.

 

Author: 

Dr. Suneet Singh  

Dr. Suneet holds a post-graduate degree in Hospital and Healthcare management from Tata Institute of Social Sciences (TISS) and works as an International Patient Coordinator at Lyfboat.

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