Procedure for Total Knee Replacement Bilateral (Staged)

Osteoarthritis Statistics

The prevalence of symptomatic knee osteoarthritis is approximately 10% in men and 13% in women in the age group of 60 years and above.

Total Knee Replacement (TKR) surgery is the last treatment option for patients with chronic arthritis. Arthritis is a condition which affects the flexibility of joints leading to acute pain. These symptoms usually occur when the knee cartilage present in the joints is damaged.

The objective of the surgery is to:

• Substitute damaged joints
• Relieve symptoms
• Restore impaired knee functions
• Knee cartilage replacement

In a total knee replacement surgery,prosthesis is used to replace damaged knee joints. These prosthesis are made of ceramic, metal or plastic. A staged surgery is when there is a time gap between the 1st and the 2nd surgery. The time interval between the two operations varies from patient to patient. One week is considered safe and effective.

Advantages of TKR

TKR has many advantages, they are as follows:

• Less anaesthetic exposure
• Fewer renal, pulmonary and cardiovascular complications
• Lower frequency of embolism
• Lower rate of blood transfusions
• Less burden on caregivers, physiotherapists and nurses
• Ideal for patients 75 years of age and above

Disadvantages:

Following are a few disadvantages associated with this procedure:

• Requires 2 hospital stays
• 2 anesthesia
• 2 rehabilitations
• Delays full recovery from disability.
• More expensive

• Acute arthritis
• Damaged joints
• Damaged knees

Indications for Total Knee Replacement Surgery

Total Knee Replacement Surgery is recommended in:

• Symptomatic severe arthritis in both knees interfering with daily activities and impacting lifestyle
• Patients above 65 years of age

Contra-Indications

TKR is generally not indicated in the following instances:

• Active knee infection
• Severe neurological disease of the leg
• Patients with cardiac, vascular and lung conditions, unless and until these conditions are under control

Total Knee Replacement Surgery Complications

1. Immediate Complications

   • Blood loss
   • Cardiac complications
   • Post-surgical infection
   • Incision site incident like nerve damage
   • Deep vein thrombosis
   • Delayed wound healing

2. Delayed Complications

   • Knee stiffness
   • Instability
   • Infection
   • Failure of prosthesis

Post-operative Care

After the surgery following things should be taken care of:

• Medication to cover complications for example: swelling, pain, etc.
• Weight management
• Initiation of physiotherapy to aid in movement and speedy recovery

Post Discharge and Rehabilitation

After the patient is discharged from the hospital, following things should be kept in mind:

• Full knee recovery surgery takes about 3 to 12 months
• Regular physical therapy like walking, climbing stairs, etc and rehabilitation sessions should be taken for at least 6 to 12 weeks as it aids in a fast total knee replacement recovery time.
• Undertake knee-strengthening exercises
• In case of swelling, stiffness, pain or difficulty in moving your knee, contact your physician immediately.
• The second surgery can be timed within a week or as per the patients physical, psychological and financial constraints.