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All Knee Operations are performed due to arthritis of the knee. Arthritis means there is disorganisation of the knee joint such that normal weight bearing and function becomes difficult. Persistent pain that disturbs life-style, on a regular basis in a person with knee arthritis , would qualify for a Knee Replacement . Obviously , the patient has to be of a suitable age and should be reasonably fit to undergo the operation. The commonest reason why arthritis occurs is degenerative (age and activity related) but it could also be following an injury or due to rheumatoid arthritis or other causes.
We need to ensure that there is no active infection in the body before proceeding for the surgery.
Pre-operative tests
We would commonly do blood tests , urine tests , ECG , 2 D echocardiogram, and specialised knee X-rays before proceeding for surgery. MRI scans of the knee are routinely not required before the operation.
Blood
CBC / ESR
BUN
Blood sugar Fasting/PP
- Creat , electrolytes, albumin, SGOT / SGPT
Bleeding and Clotting profile
Tests for HIV , Hepatitis B and COVID ?
Blood grouping
Urine
Routine
ECG / 2 D Echo
Xrays
Knees – standing AP/ lateral / Skyline / Valgus stress view AP
Scanogram
LS spine AP/lat
Chest PA
Specialised tests like pulmonary function test, Dobutamine stress test, MRI LS spine will be requested if required.
Common questions and Answers before the operation
Common questions and Answers before the operation
Do I need to lose weight prior to surgery ?
If possible – yes. Although it is found that most people who have difficulty in walking, find it very difficult to lose weight unless they employ a very strict diet or start swimming or cycling. There is some evidence that really morbidly obese people have a higher complication rate ( especially infection ) than n0n-obese patients. Despite this , due to the pain and difficulty in getting about, we have to operate on several obese patients, generally with satisfactory results. We have published good results of our specialised technique of mini-subvastus approach for Knee Replacements in Obese patients.
Do I need to take any precautions prior to surgery ?
Yes.. You do. Bacteria are very often present within our own body. The common places are our nostrils, arm pits and over our own skin, especially between skin folds. To reduce this bacterial content of the body we should start anti-infective measures.. This involves the application of mupirocin ( T- BACT ) ointment intra-nasally twice a day and taking a bath with a surgical scrub solution.
Do I need to take any precautions prior to surgery ?
Yes.. You do. Bacteria are very often present within our own body. The common places are our nostrils, arm pits and over our own skin, especially between skin folds. To reduce this bacterial content of the body we should start anti-infective measures.. This involves the application of mupirocin ( T- BACT ) ointment intra-nasally twice a day and taking a bath with a surgical scrub solution.
Nasal application of T-BACT ointment
Wash your face with soap and water. Take a pea size of ointment on a clean cotton swab ( ear bud ) and insert the swab with the ointment, 1-2 cm into each nostril. Rotate swabs against the inside of the nostril for 3 seconds. Apply pressure with a finger to the outside of the nose for 2 minutes. Do this twice a day.
Bath – One should take a bath with a surgical scrub made of 4% CHG liquid soap. ( Available with chemists – Careful: do not use alcohol-based surgical hand rubs or sanitisers ) Avoid using the scrub on the face and the private parts.
General
If there is any other infective focus in the body such as a bad tooth or a urine infection, it will need to be treated prior to Knee Replacement. Infection after a Knee Replacement is a major problem and we must take proper preventive measures to avoid this complication. In case, there is a fever for whatever reason before surgery, the operation will need to be postponed.
Do I need to do pre-operative physiotherapy?
No. This is not required. Simple Knee Exercises as shown in the addendum are sufficient.
How many hours before surgery can I eat ?
Generally, you should finish eating 6 hours before and should not take a very heavy meal. Clear fluids like water can be taken up to 4 hours before surgery.
Do I change any medicines prior to surgery ?
Yes – you may need to. Kindly make a list of all the medicines that you are taking and discuss with us what needs to be changed. In general, blood thinners may need to be stopped or reduced prior to surgery and oral anti-diabetic medicines may need to be stopped when you are nil by mouth. Blood pressure medicines ,thyroid medicines , other neurological medicines etc .will need to be continued.
When do I get admitted ?
At least 6 to 8 hours before the scheduled operation time. This can be the evening prior to the operation date or the day of the surgery.
What do I take to the Hospital ?
You must take all the X-rays and the relevant papers ( Medical notes – Insurance papers – all reports etc. ) apart from toiletries, clothes, cash or credit cards to the Hospital. There should be at least one attendant with you.
When will I start walking again ?
Most patients are able to walk within 4 to 6 hours after the surgery. Some patients are able to walk so well that they will be ready for home the same day of the surgery. This is possible because of the specialised techniques that we have adopted such as mini-subvastus tourniquet less approach, optimum use of tranexamic acid, achieving a well balanced knee and use of advanced techniques to manage post-operative pain such as an adductor canal block.
Will there be too much pain ?
No – With advances in pain management and surgical techniques most patients are surprised as to how little the immediate post-operative pain is, compared to what they expected.
Will I need specialised help ?
Mostly no specialised help will be required unless the patient has multiple problems before the surgery or if there are some complications.
What is the chance of a complication ?
The likelihood of any complication is less than 1 %. The complications can be but are not limited to – infection, venous thrombosis, embolism, heart attack, stroke, wound healing issue, urinary retention, dislocation, continual pain, Nerve or vessel injury or even death.
Will I require a blood transfusion ?
Mostly no- but if both the knees are being operated together or the Hb value is low to start with – it may be required.
What special techniques to you utilise for good results ?
We have pioneered and popularised the tourniquet free mini-subvastus Knee Replacements. We have also worked on painless knee replacements and blood conservation after TKR. Additionally, we have looked at morbidity after the operation. We have been utilising these techniques since the year 2005.
Do you use special computer technology such as robotics or navigation ?
Yes- in required cases where there is a significant femoral bow ( when the bones are excessively bent ) and the standard techniques will not give a good result, we utilise these techniques. We have also published a paper on the use of this computer technology in obtaining excellent results after a TKR.
What about Robotic Knee Surgery ?
This is an exciting field in Knee Replacements where the experience of the world community is growing. Currently, it is believed that it adds costs and time to the operation without adding significantly to the outcome. What this means is that patients operated with and without robotic assistance do equally well. Hence, we are not currently offering robotic surgeries but would soon start. This has been delayed by the Covid outbreak.
( Most of our modifications and research methods have been published in peer reviewed journals and can be accessed by googling Dr. Nilen Shah )
Types of Knee Replacements
We offer two types of Knee Replacements – Partial or Total in the primary setting and also offer Revision Knee Replacements for failed Knee operations