TOTAL KNEE REPLACEMENT - DR SANTOSH KUMAR

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Total knee replacement or arthroplasty is realigning of the joint(bone end surfaces), with artificial parts called prostheses. Total knee replacement is actually a surface replacement whre in the lower end of the thigh bone is capped, the upper end of tibia(shin bone) is capped . the cartilage which gets worn and torn and the bony surfaces which which rub against each other are thus replaced. There are three components used in the artificial knee . The femoral component is made of metal and covers the end of the thigh bone. The tibial component covers the upper surface of tibia and both the components are usally cementd to their respective bones. The third component, the patella or knee cap is made up of polyethylene.

Patients with severe arthritis of both knees can be offered replacements of both knees together after a thorough medical evaluation.

Radiogram of knees after a bilateral knee replacement done by dr santosh kumar

Hi-Flex Knees : a new design, called high flexion knees are being commonly used. These allow patients, near complete range of movement at the knee. The patients can sit cros-legged on the bed. It is suiable for patients with slim legs.

Unicondlyr Knee Replacement

In some patients only one half of the knee joint is worn out and onl one side may be replaced after proper judgement. This process is called Unicondylar Knee Replacement.

Dr Satosh Kumars protocol for Preparation for surgery

• A detailed medical history is collected.
• A detailed medical check up is done.
• Patients taking oral medicines for diabetes are converted to insulin injections. I always ensure a strict sugar control before and after surgery.
• I always rule out any source of infection like urinary infections, sore throat etc . and if any is found, postpone the surgery till the infection is cured.
• The patient may need blood transfusion before surgery depending on pre- operative haemoglobin levels. Some patients prefer to donate their own blood a few days before the operation, which is transfused back to them on the day of the operation.
• I amit the patent in the hospital two days beore surgery to enabe a proper work up before surgery.
• I operate most people under epidural anesthesia where in my patient is awake and only the legs arenumbed. A fine tube is put in back through which complete pain relief is achieved after the operation too.

Recovery

Dr Santosh Kumars protocol for putting you back on tracks

• I encourage my patients to start in bed exercises within 24 hours of operation and after the first or second day the i encourage them to sit bedside with the legs supported.
• My patients generally stand and walk using a walker in 3-4 days, by 5-6 days, they go to toilet with a high seat.
• I give my patients an option to leave the hospital (discharge ), by seven to eight days after the operation, and the rest of care can be taken at home, however for them whose homes are not in the city, they can stay in the hospital till stitch removal. The stitches are removed 2 weeks after the surgery.
• I allow my patients to walk with a stick three weeks after the operation.
• My patients are trained to climb stairs 4-6 weeks after the surgery.
• 12 weeks post operative, one can start driving vehicles with due precautions.
• One is advised not to squat or sit cross legged after the surgery, particularly on the floor.
• The post operative rehab schedule gets slightly extended if the surgery is performed simultaneously on both the knees.

Follow Up

I advise my patients to come and see me at six weeks, three months, and twelve months after the surgery. Further they are requested to come and see me once a year if possible, even if there is no problem. Any infection particularly that of urine, skin and dental must be promptly treated.

Understanding the risks

Problems and aspirations of each individual patient difer and these must be discussed with me in details. You must realise that you should not squat on the ground even with the new high flex knees.
Revsion knee the life span of a god implant should be 15-20 years. This however may vary under individual circumstances.