The first TKR surgery was done in 1968
The first TKR surgery was done in 1968
Since then it total knee replacement surgery [TKR] has become one of the most successful procedures in
all medicine. Hundreds of thousands of patients with severe knee pain undergo TKR every year
worldwide.
The normal knee
The largest joint in the body, healthy knees are required for doing mostly everything. It is a hinge like
joint, made of the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the
kneecap (patella). The ends of these three bones where they touch are covered with cartilage, a smooth
substance that protects the bones and enables them to move easily. There is a thick viscid fluid between
the cartilages, which makes movements smooth and jerk free.
The cartilages attached to the femur and the tibia are called the menisci. They are C-shaped wedges and
act as ‘shock absorbers. Large ligaments hold the femur and tibia together and provide stability. The
long thigh muscles give the knee motility. All inner surfaces of the knee joint are covered by a thin lining
called the synovial membrane. This membrane secretes and holds the synovial fluid, which reduces
friction.
Diseases like osteoporosis, arthritis or injury damage the cartilages and bone and disrupt smooth
movement of the joint. This results in pain, muscle weakness, reduced motility and even instability.
Causes of painful knees
The most common reason for knee pain is arthritis. The commonest types of arthritis are osteoarthritis,
rheumatoid arthritis, and post-traumatic arthritis.
Osteoarthritis: This is age-related and ‘wear and tear’ type of arthritis. Occurs in people 50 years and
older. The cartilage that cushions the bones of the knee wears away, the bones rub against each other
and this results in knee pain and stiffness.
Rheumatoid arthritis: Here the synovial membrane that lines the joint internally is inflamed and
thickened. This damages the cartilage and the result is as above.
Post-traumatic arthritis: This may follow a serious knee injury. Fractures of the bones surrounding the
knee or tears of the knee ligaments may damage the cartilages, and over time result in knee pain and
reduced motility.
What does TKR do?
A total knee replacement (aka Arthroplasty) doesn’t replace the whole lower end of femur and the
upper end of tibia, only their articulating surfaces are covered with artificial implants.
Do you need TKR?
TKR has been described as ‘Quality of Life Improvement Surgery’. The daily knee pain, sometimes severe
but mostly reduced by medicines, will be gone. Then you can walk, play golf, swim gently, drive a car or
a two wheeler and generally do all things you did before your knee pain began.
Painless knees help you exercise, the most important ‘Quality of Life’ improvement. Painful knees
may lead to a sedentary life and weight gain and a vicious cycle of more pain with more weight.
You must get TKR Surgery when…
Your knee has become bowed due to arthritis
You cannot sleep at night because turning over causes knee pain
Severe knee pain or stiffness that limits walking, climbing stairs, and getting in and out of chairs
Pain even while resting
Swelling that does not improve with rest or medications
Instability of the knee joint
When alternative knee pain therapies like medications, cortisone injections, lubricating injections,
physical therapy have failed
Ideal TKR Candidates
While people older than 100 years have undergone TKR, there are also those young adults who needed
knee replacement because of a severe injury. But most patients are 50+.
Evaluation of your knee
Your physical examination to test for knee motion, stability, strength, and overall leg alignment
Your general health is checked, diabetes, high blood pressure, skin conditions etc are checked and
treated
A chest X-Ray, ECG, Echocardiography etc may be done before surgery
Blood and urine tests to check if you have any other diseases which need to be treated before
surgery
X-ray images to determine the extent of damage and deformity in your knee
Rarely advanced imaging like magnetic resonance imaging (MRI) or CT scan may be needed
At Race Knee Clinic, we review the results of your evaluation and discuss whether total knee
replacement is really the best method to relieve your knee pain and improve your mobility, reduce
stiffness and swelling and generally help you stay fit. Other treatment options like medicines, injections,
physical therapy, or other types of surgery will also be considered and discussed.
The risks and rarely occurring complications of total knee replacement will be explained to you.
Reasonable Expectations after TKR
More than 90% of people who undergo TKR experience a dramatic reduction of knee pain
They can significantly perform their daily activities better
But remember, TKR will not allow you to do more than your capabilities before you developed knee
pain
How long will the new knee last?
Excessive activity or weight may speed up the gradual wear of the prosthetic knee. So we advise against
activities like running, jogging, jumping, contact or impact sports etc.for the rest of your life after
surgery.
But you can walk, swim, play golf, drive, go light hiking or biking, gentle dancing and such low-impact
activities.
With appropriate activities, knee replacements can last for 20-35 years.
Possible Complications of Surgery
Complication rate after TKR is low.
Serious complications, such as a knee joint infection, occur in fewer than 2% of patients. Major medical
complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase
the potential for complications. Although uncommon, these complications can prolong or reduce
recovery.
Anesthesia
The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural,
or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The
anesthesia team, with your input, will determine which type of anesthesia will be best for you.
After surgery
You are observed in the recovery room. After you wake up, you will be taken to your hospital room.You
will most likely stay in the hospital for a few days.
Pain
Pain is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which
can help you recover from surgery faster.
Physical therapy
Foot and ankle movement also is encouraged immediately following surgery to increase blood flow in
your leg muscles to help prevent leg swelling and blood clots. Exercise begins the day of surgery or the
day after surgery under the guidance of a physical therapist.
At Home
The success of your surgery will depend largely on how well you follow your doctor's orders at home.
Wound Care
Your TKR wound will have stitches or staples or a suture beneath your skin. They will be removed weeks
after surgery. Avoid soaking the wound in water until your skin has completely closed and dried. You
may bandage the wound for comfort.
Activity
You underwent TKR so that you could walk! So exercise is a critical part of home care particularly during
the first few weeks after TKR. You should be able to resume most normal activities of daily living within
4 weeks following surgery.
Call Race Knee Clinic immediately if suffer from…
Persistent fever (higher than 100°F orally)
Shaking chills
Increasing redness, tenderness, or swelling of the knee wound
Drainage from the knee wound
Increasing knee pain with both activity and rest
Extend the life of your knee implant
More than 90% of implants are still functioning well 15 years after the surgery. However, as time passes,
more and more patients are exceeding 15 years. To do that, dot he following:
Do not run or jump
You may dance slowly without stamping your feet
If you want to use a two-wheeler, do not use the kick start, use a self start
Do not squat, either for toilet ablutions or for any other purpose
The western style commode is best for passing stools
Get hand rails or handles fixed in areas in your home where you need support to get up, like near
the toilet seat or in the staircase
Sit with folded legs only if you must and you feel comfortable
Do not sit on the floor
Remember, the more care you take of your new artificial joints, the longer they will last.
For more information please contact Dr.Dhiraj Marothi Jain at 09408142999
Visit : www.r2r.co.in
For Appointments Call at +91-9081977001
Since then it total knee replacement surgery [TKR] has become one of the most successful procedures in
all medicine. Hundreds of thousands of patients with severe knee pain undergo TKR every year
worldwide.
The normal knee
The largest joint in the body, healthy knees are required for doing mostly everything. It is a hinge like
joint, made of the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the
kneecap (patella). The ends of these three bones where they touch are covered with cartilage, a smooth
substance that protects the bones and enables them to move easily. There is a thick viscid fluid between
the cartilages, which makes movements smooth and jerk free.
The cartilages attached to the femur and the tibia are called the menisci. They are C-shaped wedges and
act as ‘shock absorbers. Large ligaments hold the femur and tibia together and provide stability. The
long thigh muscles give the knee motility. All inner surfaces of the knee joint are covered by a thin lining
called the synovial membrane. This membrane secretes and holds the synovial fluid, which reduces
friction.
Diseases like osteoporosis, arthritis or injury damage the cartilages and bone and disrupt smooth
movement of the joint. This results in pain, muscle weakness, reduced motility and even instability.
Causes of painful knees
The most common reason for knee pain is arthritis. The commonest types of arthritis are osteoarthritis,
rheumatoid arthritis, and post-traumatic arthritis.
Osteoarthritis: This is age-related and ‘wear and tear’ type of arthritis. Occurs in people 50 years and
older. The cartilage that cushions the bones of the knee wears away, the bones rub against each other
and this results in knee pain and stiffness.
Rheumatoid arthritis: Here the synovial membrane that lines the joint internally is inflamed and
thickened. This damages the cartilage and the result is as above.
Post-traumatic arthritis: This may follow a serious knee injury. Fractures of the bones surrounding the
knee or tears of the knee ligaments may damage the cartilages, and over time result in knee pain and
reduced motility.
What does TKR do?
A total knee replacement (aka Arthroplasty) doesn’t replace the whole lower end of femur and the
upper end of tibia, only their articulating surfaces are covered with artificial implants.
Do you need TKR?
TKR has been described as ‘Quality of Life Improvement Surgery’. The daily knee pain, sometimes severe
but mostly reduced by medicines, will be gone. Then you can walk, play golf, swim gently, drive a car or
a two wheeler and generally do all things you did before your knee pain began.
Painless knees help you exercise, the most important ‘Quality of Life’ improvement. Painful knees
may lead to a sedentary life and weight gain and a vicious cycle of more pain with more weight.
You must get TKR Surgery when…
Your knee has become bowed due to arthritis
You cannot sleep at night because turning over causes knee pain
Severe knee pain or stiffness that limits walking, climbing stairs, and getting in and out of chairs
Pain even while resting
Swelling that does not improve with rest or medications
Instability of the knee joint
When alternative knee pain therapies like medications, cortisone injections, lubricating injections,
physical therapy have failed
Ideal TKR Candidates
While people older than 100 years have undergone TKR, there are also those young adults who needed
knee replacement because of a severe injury. But most patients are 50+.
Evaluation of your knee
Your physical examination to test for knee motion, stability, strength, and overall leg alignment
Your general health is checked, diabetes, high blood pressure, skin conditions etc are checked and
treated
A chest X-Ray, ECG, Echocardiography etc may be done before surgery
Blood and urine tests to check if you have any other diseases which need to be treated before
surgery
X-ray images to determine the extent of damage and deformity in your knee
Rarely advanced imaging like magnetic resonance imaging (MRI) or CT scan may be needed
At Race Knee Clinic, we review the results of your evaluation and discuss whether total knee
replacement is really the best method to relieve your knee pain and improve your mobility, reduce
stiffness and swelling and generally help you stay fit. Other treatment options like medicines, injections,
physical therapy, or other types of surgery will also be considered and discussed.
The risks and rarely occurring complications of total knee replacement will be explained to you.
Reasonable Expectations after TKR
More than 90% of people who undergo TKR experience a dramatic reduction of knee pain
They can significantly perform their daily activities better
But remember, TKR will not allow you to do more than your capabilities before you developed knee
pain
How long will the new knee last?
Excessive activity or weight may speed up the gradual wear of the prosthetic knee. So we advise against
activities like running, jogging, jumping, contact or impact sports etc.for the rest of your life after
surgery.
But you can walk, swim, play golf, drive, go light hiking or biking, gentle dancing and such low-impact
activities.
With appropriate activities, knee replacements can last for 20-35 years.
Possible Complications of Surgery
Complication rate after TKR is low.
Serious complications, such as a knee joint infection, occur in fewer than 2% of patients. Major medical
complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase
the potential for complications. Although uncommon, these complications can prolong or reduce
recovery.
Anesthesia
The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural,
or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The
anesthesia team, with your input, will determine which type of anesthesia will be best for you.
After surgery
You are observed in the recovery room. After you wake up, you will be taken to your hospital room.You
will most likely stay in the hospital for a few days.
Pain
Pain is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which
can help you recover from surgery faster.
Physical therapy
Foot and ankle movement also is encouraged immediately following surgery to increase blood flow in
your leg muscles to help prevent leg swelling and blood clots. Exercise begins the day of surgery or the
day after surgery under the guidance of a physical therapist.
At Home
The success of your surgery will depend largely on how well you follow your doctor's orders at home.
Wound Care
Your TKR wound will have stitches or staples or a suture beneath your skin. They will be removed weeks
after surgery. Avoid soaking the wound in water until your skin has completely closed and dried. You
may bandage the wound for comfort.
Activity
You underwent TKR so that you could walk! So exercise is a critical part of home care particularly during
the first few weeks after TKR. You should be able to resume most normal activities of daily living within
4 weeks following surgery.
Call Race Knee Clinic immediately if suffer from…
Persistent fever (higher than 100°F orally)
Shaking chills
Increasing redness, tenderness, or swelling of the knee wound
Drainage from the knee wound
Increasing knee pain with both activity and rest
Extend the life of your knee implant
More than 90% of implants are still functioning well 15 years after the surgery. However, as time passes,
more and more patients are exceeding 15 years. To do that, dot he following:
Do not run or jump
You may dance slowly without stamping your feet
If you want to use a two-wheeler, do not use the kick start, use a self start
Do not squat, either for toilet ablutions or for any other purpose
The western style commode is best for passing stools
Get hand rails or handles fixed in areas in your home where you need support to get up, like near
the toilet seat or in the staircase
Sit with folded legs only if you must and you feel comfortable
Do not sit on the floor
Remember, the more care you take of your new artificial joints, the longer they will last.
For more information please contact Dr.Dhiraj Marothi Jain at 09408142999
Visit : www.r2r.co.in
For Appointments Call at +91-9081977001
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