Q. How long should a patient remain in hospital after a knee replacement?

A. After a total knee replacement, one week’s hospitalization is required. This is to provide pain relief, anticoagulants early mobilization. After a bilateral total knee replacement the patient will remain for a week after the second operation, so that makes two weeks of admission in hospital.

Q. When can the patient stand up after a knee replacement?

A. You can do so within 24 – 48 hrs after the operation.

Q. Do I do operate on both knees simultaneously?

A. If you are young & fit, then both knees can be done  in one sitting( Bilateral simultaneous TKR). Other wise I operate on the second knee after a few days or months after the first knee and you have had time to recuperate. Many elderly patient's health condition allows a sequential knee replacement.

Q. For how long will I have to use a walker?

A. You may need a walker for about 15 days and a cane or crutches for another fortnight. Then you can walk without any aids.

Q. How long is the waiting time for surgery?

A. Fortunately I can operate on patients with notice of a day or two for simple and straight forward knee and one week for revision knees.

Q. What prosthesis do I use?

A. I use only standard prosthesis made in the US. These are all imported to India by the same companies that operate the world over. The costs of the prosthesis are cheaper here than outside. These are

a) NexGen prosthesis from Zimmer

b) Genesis from Smith and Nephew

c) PFC from Depuy( Johnson & Johnson)

d) LCS from Depuy

e) IB from Zimmer

For Unicondylar knees, I use the Oxford prosthesis from Biomet and the Allegra knee from Zimmer

Q. When will the patient be pain free after surgery?

A. Post operative pain is controlled to tolerable levels by excellent multi modal anesthesia with an epidural block and analgesics. Two to three weeks of pain medication are required for most people.

Q. How long does the operation take?

A. A primary total knee replacement takes between about an hour to 90 minutes. Anesthetic induction time is about 30 minutes. Extubation and shifting takes another 15 minutes. The turnaround time is thus about 3 hours  A difficult knee may take about two hours.

Q. What anesthesia will I receive?

A. You can have the operation done under general anesthesia (fully unconscious) or a regional anesthesia( spinal or epidural) in which you will be sedated but not knocked out. Regional anesthesia is a safe mode for diabetics and elderly people.

Q. I am diabetic. Can I have the operation?

A. Many of my patients are diabetic. I endeavor with the help of a good diabetologist to bring your sugar levels to within normal levels. My anesthetist is very competent at epidural anesthesia and hence the operation is pretty safe. Wound healing is good in well controlled diabetes. If not, control is achieved and then I operate.

Q. What kind of physical activity can I do after the operation?

A. Non impact sports like walking, golf are allowed. You can walk as much as you want. This is the purpose of the operation to allow you to regain mobility.

Q. When can the patient go back to work?

A. This depends on the nature of the job. A sedentary or desk top person will find it possible after a month. If the job involves a lot of time on the legs or walking, then it takes about two months.

Q. Can I travel overseas after the operation?

A. In the case of overseas patients, you can do so after three weeks. You need to spend only a week in the hospital for your recovery and enjoyably  spend the rest  in a resort nearby. This is to ensure that you have recovered fully well after the operation and are fit to travel. I review my patients at one week, two weeks and after a month initially after the surgery.

Q. Can I drive a car after surgery?

A. You can certainly drive a car when you are ready to give up crutches. This varies but the earliest that my patients have done so is at 3 weeks. With the  less  invasive techniques that I practice, patients recover faster and hence can become independent earlier. If you need to use aid for longer then it is advisable to self drive after you are support free.

Q. What is the ideal age for a knee replacement?

A. The ideal age is more than 60 years after you have exhausted all conservative measures like painkillers (analgesics), a cane and shoe inserts. However I have done knee replacements for a few patients under 50 years and my youngest is a 34 year old with post traumatic arthritis. For young people with advanced x- ray changes and severe pain, I have no other option but to offer them a TKR. In the elderly patient with one half involvement alone, I offer them a half knee replacement (unicondylar knee)

Q. What are alternatives to knee replacement in younger people?

A. Where suitable, I do perform cartilage surgery by arthroscopic and open methods. Abrasion chondroplasty and microfracture are arthroscopic procedures. An osteotomy is advisable you have mal alignment,  if your job is strenuous and the cartilage wear is one sided only (Seen on weight bearing x rays).

Q. How much bend can I get in the knees post-operatively?

A. With the NexGen legacy Flex knee or the LCS knee, you can get about 155 degrees. This is required by people from India, Pakistan, and the Middle East. Even people from the UK prefer to have more than 90 degrees of knee bending. Off course you must be willing to go the extra mile to gain this amount of movement by physiotherapy. The other knees allow about 110 degrees of bending.

Bilateral Total Knee Replacement

Q. What is a Bilateral Total Knee Replacement?

A. When the cartilage has worn away in both knees, artificial knees (called prostheses) can take their place. The surgery to resurface both knees is  termed a bilateral Total Knee Replacement.  The knee replacement recreates almost normal function of the knee, and its main goal is to relieve pain. It may also help to restore motion of both knees and straighten the limbs.

Q. What is a Simultaneous Bilateral Total Knee Replacement?

A simultaneous procedure means that both knees are replaced on the same day, under one anesthesia. This takes place as a single surgery, within one hospital stay and is followed by a single rehabilitation period.

A. What is a Sequential bilateral total Knee Replacement?

The staged procedure means that the knee replacements are performed as two separate surgical events. Surgeries are typically performed several days or months apart.

Q. Who should have a Bilateral Total Knee Replacement?

A. The most common reason for a Bilateral Total Knee Replacement is severe arthritis in both knees which are symptomatic  interfering with the patient's activities of daily living and  reducing the quality of life. Usually complaints are worst with weight bearing activities, as standing and walking. Untreated, knee arthritis is usually painful, functionally limiting, as it progressively compromises the patient's independence over time. Another indication is significant deformities in both knees, a situation in which failure to correct both knees deformities at the same time would compromise the clinical result.

Q. What are the advantages of a Simultaneous Total Knee Replacement?

A. The advantages of having a simultaneous procedure include: only one surgical event, a single anesthesia, a shorter overall hospital stay, and the possibility of rehabilitating the patient symmetrically.

Q. What are the disadvantages of a Simultaneous Total Knee Replacement?

A. The disadvantages of having a simultaneous procedure include a probable risk increase in cardiovascular complications and a higher possibility of requiring banked blood after surgery. This procedure is not available to every patient with arthritis in both knees, because it implies a high stress for the cardiovascular system. Only patients in good health condition are appropriate candidates. Also the initial rehabilitation is slightly more difficult as you literally have "no good leg to stand on".

Q. What are the advantages of a Staged Total Knee Replacement?

A. The advantages of having a staged procedure include apparently lower stress level for the cardiovascular system, fewer complications related to the heart, a lower incidence of blood clots within the deep veins, as well as lower possibility of requiring banked blood after surgery. This is an excellent choice for patients with cardiac, vascular or pulmonary diseases or above 80 years old.

Q. What are the disadvantages of a Staged Total Knee Replacement?

A. The disadvantages of having a staged procedure are that it requires two hospital stays, two anesthesias and delays full return from disability. However a sequential bilateral knee replacement done a few days apart, obviate these negative points. The total duration of the hospitalization will be about 14 days.

Q. What are the results in terms of function and relieve of pain?

A. In both type of procedures, Simultaneous and Staged, results are excellent and equivalent in terms of relieve of pain and daily activities. Patients should expect a greater than 95% chance of success at 15 years.

Q. Is there any contraindication for a Simultaneous procedure?

A. Yes. There are some contraindications and this is why we believe that the selection of the appropriate patient determines the outcome of the simultaneous procedure. The usual contraindications for knee replacement include an active knee infection, or severe neurologic compromise of the leg. This procedure is also relatively contraindicated in patients with significant cardiac, lung and/or vascular disorders that may increase the possibilities of potential problems. Patients above 80 years old typically are not recommended to have a simultaneous procedure due to the risks that it involves.

Q. Who would be the ideal candidate for a Simultaneous procedure?

A. The ideal candidate for a simultaneous Total Knee Replacement should be younger than 80 years old, without associated cardiac, pulmonary or vascular diseases. This patient should also complain of severe arthritic pain equally symptomatic in both knees, that interferes with his/her activities of daily living and significantly reduces the his/her quality of life.