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Dr Vijay Kumar

Total Knee Replacement

Total knee replacement (TKR) or total knee arthroplasty (TKA) is a surgical procedure that involves replacing one end of the thigh bone (femur) and the shin bone (tibia) with artificial components called a prosthesis.

Total knee replacement surgery is a very safe procedure and has been in practice since 1968. It may be recommended by a surgeon when a patient experiences severe pain or stiffness in their knee joint such that it limits their mobility and day-to-day functioning. The patient may be unable to do simple activities like walking, squatting, sitting cross legged or climbing stairs as the pain is unbearable.

The knee joint is usually worn out or damaged by a disease like osteoarthritis, rheumatoid arthritis,  gout, or post-traumatic arthritis. There are cases in which a sports-related injury, cartilage loss, torn cartilage or a bone growth disorder may lead to knee damage of this extent.

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Over the years, there has been immense improvement in the techniques and materials used in the TKR procedure and the success rate is generally very high. Over 90% of patients who have undergone the TKR surgery, reported immediate relief from pain and functioned well for over 15 years. Dr Vijay Kumar, a senior specialist in joint replacement and orthopaedics at MGM healthcare and Mahi Clinic in Chennai, has been successfully performing total knee replacement for almost a decade. In his experience, TKR is one of the most common and successful procedures globally.  

How is the Total Knee Replacement Surgery Done?

The knee joint is one of the strongest and complex joints in the human body. It is made up of the lower end of the femur hinging on to the upper end of the tibia. The patella or the kneecap slides along the groove formed by the femoral condyles (two rounded shapes at the end of the femur). This joint is covered with cartilage that is responsible for dampening shock and distributing them to the underlying bones.

A clinical evaluation and x-rays are done to understand the condition of the knee joint, and the risks involved in the particular case. This is when the suitability of the total knee replacement surgery is also assessed. It is recommended only when other treatments like physiotherapy or anti-inflammatory medications are not effective.

The procedure involves preparing the femur by removing the damaged area at the end of the bones. The end of the femur is resurfaced to fit the artificial material or implant. Similarly, the tibia is also resurfaced after removing the damaged area and the other part of the implant is attached to the bone end. A medical-grade plastic piece is also inserted at the end of the tibia to create a smooth surface between the implants of the two bones. The patella is then prepared or replaced and fitted with an additional component to restore the knee functionality.

Dr Vijay Kumar Sohanlal informs that he uses a special injection which is a mixture of medicines to control the pain during surgery. The surgery usually lasts an hour and the patients are discharged after a few days. Dr Vijay Kumar Sohanlal recommends that it is better to replace both knees at a single sitting if both are damaged, provided the patient is anaesthetically fit. He advises that the patients should get the bilateral total knee replacement surgery done only at centres where this type of surgeries are performed regularly.

Dr Vijay Kumar Sohanlal mentions that due to the recent advancement in surgical techniques and medications, the requirement for blood transfusion has been reduced. Most of the patients operated by him can walk, use the restroom on the first operative day. Patient can climb stairs up and down. Before the discharge, the physiotherapist informs the patients about the exercises required daily to help them recover faster. These exercises are important in strengthening the knee joint and restoring its movement.

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