A short presentation on total knee replacement surgical procedure. This short presentation gives brief idea of the procedure, preparation for the surgery and post surgery management. Total knee replacement in India Total knee replacement in hyderabad Knee surgery in hyderabad knee replacement in hyderabad Knee specialist in hyderabad,

1. TOTAL KNEE REPLACEMENT

2. Dr. A.MOHAN KRISHNA
M.S.ORTHO, MCh ORTH(U.K)
Consultant Orthopaedic surgeon ,
Trauma, Arthroscopy, Arthroplasty
Surgeon
Apollo hospitals, Hyderabad
Consultant Orthopaedic Surgeon at
www.drmohankrishna.com
www.healthyjointclub.com
www.bonesandjointsclinic.com

3. NORMAL KNEE JOINT
LARGEST JOINT IN THE
BODY
TAKES HUGE STRESS WITH
DAILY ACTIVITIES
CARTILAGE:
• Lining of the joint
• Shock absorber
MENISCUS:
• Cushion in the joint
BONES:
Femur, Tibia, Patella
SYNOVIAL FLUID:
Lubricates the joint

4. Infections
Injury to the
joint
Rheumatoid
arthritis
Osteoarthritis
Worn-out
cartilage
PROBLEM KNEE JOINT

5. How common is it? Risk factors
Most commonly affected joint in
the body
15% of general population
Age - Uncommon under 40 years
1 in 5 over 60 years
Overweight / obesity
Runs in families
Joint injury
OSTEOARTHRITIS OF KNEE JOINT

6. Diagnosis
Clinical
X-rays

7. COMPLAINTS
Complaints
Get
stuck at
times
Can’t go
up the
steps
Can’t
walk for a
small
distance
Joint
giving
way- Fear
of falling
Bow legs
Knock
knees
Can’t
sleep at
night
Joint
pain &
Stiffness

9. X-RAY APPEARANCE BOW LEGS

10. X-RAY APPEARANCE

11. X-RAY APPEARANCE

12. Treatment
INTEGRATED APPROACH OF HEALTHY JOINT CLUB
Pain Killers/local Gels
Physiotherapy/ Knee
strengthening exercises
Nutraceuticals/
Gluocosamine/
Collagen peptides
Injections-
Steroids/Lubricants
Key Hole
Surgery/Arthroscopy
Osteotomy: Corrects
angle of knee joint
TOTAL KNEE REPLACEMENT

13. What is Total Knee Replacement?
Replacing the damaged cartilage in the knee joint
with metal (Cobalt chrome) and highly specialised
plastic. These components are stuck to the bone
with cement
METAL
Cobalt-chrome
Stainless steel
PLASTIC
Specialized
polyethylene
CEMENT What’s new?
Oxynium knee
Fixed

14. The surface of knee joint is
replaced
The knee cap may or may not be
replaced
TOTAL KNEE
REPLACEMENT
The affected part of the knee
joint is replaced. (Not commonly
practiced in INDIA)
PARTIAL KNEE
REPLACEMENT

15. About 70,000 operations are
carried out every year in the INDIA
Needs General / Spinal anaesthetic
 Operation may take up to 1 ½ hours
A cut is made on the front of the knee
joint
The new joint can last up to 15
years

16. Benefits of TOTAL KNEE REPLACEMENT
Better quality of life
Relief from Pain/Sleep
disturbances
Improves mobility with
daily activities
oWalking,
oClimbing stairs
oCycling
oSwimming

17. PREOPERATIVE EVALUATION
Blood & Urine
tests
• Surgical
profile
X-ray ECG &
2D Echo/stress
echo
Medical
checkups
• Cardiologist
• Physician
• Anaesthetist

18. PRE-OPERATIVE ASSESSMENT
Weight / Height (BMI)
Blood & Urine tests, ECG, Chest
X-ray,
2D echo /Stress Echo
Check up by a General physician,
Cardiologist, anaesthetist

19. PRE-OPERATIVE ASSESSMENT
Details of medical
conditions/Allergies
Previous operations
List of medicines you are
taking
To stop blood thinning drugs
(ASPIRIN , CLOPIDOGREL)
General examination :
Dental check
Discussion regarding operation

20. DAY BEFORE SURGERY
Continue
regular
medications
Early light
dinner on
night before
surgery
6 hours of
fasting
before
surgery
Informed
written
consent and
site marking
of limb

21. ON THE DAY OF SURGERY
Take routine BP/Thyroid
medications as advised by
Anaesthetist
IV lines monitors & urinary
catheter will be placed in the
operation theater
Spinal /Epidural anaesthesia would
be given

22. COMPONENTS / IMPLANTS

23. SURGICAL STEPS
Replacing the damaged cartilage in the knee joint with metal
(Cobalt chrome) and highly specialised plastic. These components
are stuck to the bone with cement
METAL
Cobalt-chrome
or
Stainless steel
PLASTIC
Specialized
polyethylene
BONE
CEMENT
FIXED

24. DURING THE SURGERY

25. SURGICAL STEPS

26. After surgery
Immediately after
surgery you would be
shifted to ICU and
observed there for 24
hours.
Later on you would
be shifted to ward.

27. Day 3
Removal of IV lines, Urinary
catheter, allowed to go to bathroom
Continue the exercises
Day 1
Exercises for ankles and toes to
prevent blood clots
You can sit on a chair & take a
few steps with a frame. No diet
restrictions unless specified.
Day 2
Removal of bandage and
drain from the knee joint
Knee exercises –
straightening / bending
Walking with frame /
crutches / stick
You may be able to go home within
3 to 5 days after the operation
After Knee Replacement surgery

28. BEFORE & AFTER SURGERY

29. BEFORE & AFTER SURGERY

30. BEFORE & AFTER SURGERY

31. EXERCISES AFTER KNEE REPLACEMENT
Frequent
deep
breathing
Pull your
toes towards
you and
point away
Circle your
feet in both
directions
Push knee
down
Tighten thigh
muscles
Count to 10
and relax. Do
it 10 times /
hour

32. Place a rolled
towel under
your knee. Lift
your heel to
straighten knee.
Count to 10 and
do 10 times /
hour
Lie flat on your
back and lift
your operated
leg straight of
the bed and
count 10.
Sit at the edge of
bed / chair.
Bend the
operated knee
and straighten
slowly. Repeat
10 times/hour
EXERCISES AFTER KNEE REPLACEMENT

33. RETURN TO NORMALACTIVITIES
You can shower/ bath after
removal of stitches / clips
Return to household
work & other day to day
activities in 6-8 weeks
Swelling of the leg may
remain for up to 4-6
months
Stitches / clips removed
at 12 - 14 days

34. DO’s

35. DON’Ts
Avoid
squatting
Avoid
sitting
cross
legged
Use
western
toilets

36. DIETARYADVICE AFTER KNEE
REPLACEMENT
During recovery in hospital begin normal diet &
plenty of fluids
During discharge your doctor prescribes calcium,
multivitamin & iron tablets
Try avoid alcohol and smoking
After discharge & recovery try to put down your
weight as it may stress new joint.

37. SPECIAL CONSIDERATIONS
Driving
• Avoid driving upto 6 to 8 weeks
• Start driving after your recovery is full and pain free
Sleeping positions
• You can sleep any desired position on your back, side to
side or on your stomach
Metal detectors
• Carry a copy of discharge summary or medical certificate

38. SPECIAL CONSIDERATIONS
Inform other doctors about
artificial joint. As these
joints are risk of bacterial
infection from the above
mentioned procedures.
Dental
procedures
Urological
procedures
Endoscopic
procedures

39. Risks of TOTAL KNEE REPLACEMENT
• Neurological
risks In previous
neurological
problems
• Cardiac risks
(elderly with
uncontrolled
blood pressures
• Anaesthetic
risks
Infection
of joints 2-
3%
Knee
stiffness
Clots in
legs &
lungs
Damage
to nerves
& blood
vessels

40. Dr.A.MOHAN KRISHNA
M.S.Ortho., MCh Ortho(U.K).,
Consultant Orthopaedic Surgeon,
Apollo Hospitals,
Hyderabad.
Appointments: Secretary : 09247258989 / 09441184590
08332936085
www.drmohankrishna.com
www.healthyjointclub.com
www.bonesandjointsclinic.com
Email: bonesandjointsclinic@gmail.com