Banner-1 Banner-2

Knee Joint Replacement Surgery

Best Knee Joint Replacement Surgeon – Dr. Shekhar Srivastav

Dr. Shekhar Srivastav is one of the most renowned & pioneer knee joint replacement surgeon in Delhi, India with 25 years of active orthopaedic surgeries experience. He is Chief Surgeon and Head of Joint Replacement Surgery at Delhi Institute of Trauma and Orthopaedics (DITO), Sant Parmanand Hospital, Delhi. He has done more than 10,000 successful orthopaedic surgeries (Total, Partial and Revision knee Replacement) with outstanding results.

Dr. Shekhar as a Knee Replacement Surgeon has presented many research papers in national and international journals. He had trained several DNB students and Orthopedic fellows also. He also serves as faculty for knee and arthoscopic surgery lectures in India and abroad.

Dr. Shekhar Srivastav With Cuvis Robot

What is Knee Joint Replacement Surgery

Knee Replacement Surgery is an elective surgical procedure required for people who have significant pain in their knees as a result of arthritis of the knee. The knee joint, which is the most complex joint in the body, begins to erode due to arthritis. Osteoarthritis, the most common type of arthritis that can affect the knees begins as people enter middle age.

As seen in the diagram below, the knee joint can become severely damaged as the joint cartilage slowly wears away and the person continues to walk and bear weight on the joint.

Total knee replacement surgery involves a surgical operation in which a knee joint made out of special metal materials and inert plastic are inserted into the damaged parts of the knee very similarly to the way a tooth is capped. These components are highly specialized and designed to work in perfect synchrony with your knee.

By essentially replacing the knee joint with an artificial one, a person is given the chance to walk pain free without the use of medication and allow you to exercise, and carry on your daily lives which hitherto had been significantly reduced.

Knee-joint-Replacement

What is Arthritis

Arthritis pain can begin suddenly, but it is most likely to develop gradually over time. You may first experience pain when waking up in the morning or when you stand up after sitting for a while. Eventually you may notice that the pain has taken control over your ability to complete everyday tasks. It may hurt to walk, climb stairs, or even sit down.

You may not be able to bend or straighten your knee as you once could. You may also feel a grinding sensation in your knee or popping and cracking sounds when you walk. Arthritis can even wake you up in your sleep. The appearance of your knee may change and become deformed due to the breakdown of the joint. There may come a time when you decide that you need help.

Please speak with your physician if your symptoms for arthritis are not responding to non-surgical solutions, or your pain can no longer be controlled by medication and is unbearable. The most common surgical knee intervention performed for treatment of OA (Osteoarthritis) is a total knee replacement. During the procedure, the natural knee joint is removed and replaced with an artificial implant. This treatment option is usually offered to patients with advanced osteoarthritis of the knee.

Understanding Arthritis

Knee Arthritis can make everyday life very difficult. There are three types of arthritis that you can have in your knee:
1. Osteoarthritis (OA): This type of arthritis is due to wear and tear on your joints over time. It causes the cartilage to deteriorate and can result in bone rubbing on bone. Understanding Arthritis
2. Rheumatoid arthritis (RA): This type of arthritis is caused by an autoimmune disease that attacks various joints throughout the body. The disease is chronic and inflammatory in nature and damages
ligaments and cartilage while softening the bone.
3. Post-traumatic arthritis (PA): This type of arthritis will develop after a trauma or injury to the knee. It may not develop until years after the injury.

Total Knee Replacement

Total Knee Replacement Surgery is an operation in which we do not remove the whole joint, only the damaged surface of the thigh bone (femur) and shin bone (tibia) are shaved off. Often, underside of the knee cap (patella) is also removed and these surfaces are replaced with artificial parts. The new joint is consists of a metal shell on the end of the femur, a metal plate covered with a plastic trough on the tibia, and if needed a plastic button on the knee cap. It is an operation where a as an Knee Joint Replacement Surgeon resurfaces the damaged knee joint, as is done in capping a damaged tooth.

Partial Knee Replacement

If only one part of the knee is damaged by arthritis, you may be recommended partial knee replacement. This is more so for younger patients. The recovery is quicker and the hospital stay is shorter. however the success of the surgery may not last more than 10 years at which point total knee replacement maybe suggested by your as an Knee Joint Replacement Surgeon.

Complex Knee Replacement

People may have certain deformities of the knee which include bow legs (varus), knock knees (valgus), or even wind swept legs.
In such cases, the surgeon has to be well experiences in handling such cases and should also have had considerable experience with revision joint replacement surgeries as well. See below Images.

Primary-complex-Total-Knee-Replacement-min

Knee-Surgery-for-Deformity-Correction
Knee-Surgery-for-Deformity-Correction-TKR

SOME COMMON KNEE DEFORMITIES

1. Bow Legs (Varus Knee)

Bow-Legs-Varus-Knee

2. Knock Knees (Valgus)

Knock-Knees-(Valgus)

3. Wind Swept Legs

Wind-Swept-Legs-Knees

In such cases, the surgeon has to be well experiences in handling such cases and should also have had considerable experience with revision joint replacement surgeries as well.

Do I need Knee Replacement

Knee Replacement surgery is an elective procedure, your doctor has more than likely treated your condition with physiotherapy, pain medicines, anti-inflammatory drugs, and injections in the knee. You may also have had minor surgeries of your joint in the past.
knee pain-arthritisYou would be considered for knee replacement surgery if ;

  • You have daily pain
  • Your pain is severe enough to restrict not only work and recreational activity, but also ordinary activities of
  • daily living such as climbing up stairs.
  • You have significant stiffness of the knee
  • You have significant instability and constant giving away of your knee
  • You have a deformity of the knee causing pain and inability to walk

Continuing life with all these disabilities is possible. However, your unstable joints may cause a fall and lead to fractures around the knees and hips because of osteoporotic bones. Regular consumption of pain medication and anti-inflammatory drugs may also damage your kidneys and cause ulcers in the stomach.

You and your doctor  or Knee Joint Replacement Surgeon will be the best judge of when knee replacement surgery is best for you.

Benefits of knee replacement surgery

Once your new joint has completely healed, you will reap the benefits of knee replacement surgery.

These include:

  • Dramatic reduction in joint pain. No pain at all is the best outcome.
  • Increased movement and mobility
  • Correction of any deformities
  • Improved quality of life – the ability to return to normal activities
  • Running, jumping, jogging or any other high impact activities are discouraged although one can resume
  • playing golf, swimming, walking, bicycling and other low impact sports.

After total knee replacement using a conventional implant, a person should have a good range of motion which will allow him to walk comfortably however squatting is not advised at all. A person who has very good range of motion after knee replacement surgery may be allowed to sit cross legged but this would also depend if a high flexion implant was used for the surgery. Your surgeon will be able to guide you through what activities you should pursue.

Full Knee Movement After Surgery

Full-Movement-After-Knee-Replacement-Arthritis

Can I Sit Cross Leg Or Squat After Surgery

sitting-cross-leg-after-knee-replacemnt-surgery

Considerations For Knee Replacement Surgery

Knee replacement is a life-changing decision that requires careful planning and consideration.
A person undergoing knee replacement surgery must take into account several factors. While the basic steps of knee replacement surgery are very similar, many factors depend of the patient’s medical history, the surgeon’s experience and preferences, as well as the type of knee implant used.
The person undergoing surgery must also ensure that he or she has support at home after surgery. A person who has undergone total knee replacement surgery will take several months to completely heal and will need assistance at home initially for even the basic activities. However, over time, and with good physiotherapy, the muscles around the knee will strengthen and the person will find that he can do things he or she never thought they could do.

It is a surgery that offers hope and concrete results for those living with chronic pain and disability.

Exercise / Weight Loss

After knee replacement surgery, it is important to keep your weight under control. This will reduce the amount of pressure and stress on your knew knee. Avoid high impact sports and participate regularly in low impact activities to strengthen your knees and get the exercise you need to stay fit.

Frequently Asked Questions (FAQs)

Following Questionaries provides you and your family information regarding Total Knee Joint Replacement Surgery/Operation and answer many of your questions and guide you for a successful operation. It discusses surgical procedure risks and benefits of Surgery, preparation before surgery and post-operative care thereafter.

The knee joints the largest and the most complex joint of the body. It proves us with support and mobility for movements of our daily living such as waking, sting, squatting, turning, running, driving etc.
Healthy knees are taken for granted without giving any thought about stresses it undergoes for all of us. We are forced to restrict our activities only when the knee becomes painful, stiff or swollen. It’s only then we realize how much freedom of movement means to all of us.
Knee-Arthritis
Knee-Implant

Total Knee Replacement is a very successful operation which has changed the lives of millions of people worldwide who are crippled with end stage arthritis of the knee. This operation relieves knee pain, improves walking ability and therefore allows you to resume your social and recreational activities as before.
Fortunately, today’s advanced medical technology makes it possible to replace the knee joint with an artificial one that reduces pain, allows you to strengthen your logs and improves your quality of life.
Advances in design and materials of artificial joints, advances in surgical techniques, better pain management after surgery, and quicker rehabilitation are all factors that have made knee replacement surgery one of the safest and clinically proven procedures. In India alone, approximately 1 lakh knees are replaced every year.
The results of this operation can vary depending upon your preexisting medical conditions such as diabetes, your overall health, obesity and type of arthritis.

Total Knee Replacement is an operation in which Knee Joint Replacement Surgeon do not remove the whole joint, only the damaged surface of thigh bone (femur) and shinbone (tibia) are shaved off. Often, underside of the kneecap (patella) is also removed and these surfaces are replaced with artificial parts. The new joint consists of a metal shell on the end of the femur, a metal plate covered with a plastic trough on the tibia, and if needed, a plastic button on the kneecap. It is an operation where one just resurfaces the damaged knee joint, as is done in capping a damaged tooth.

X-Ray of Replaced Total Knee
X-Ray of Replaced Total Knee
Total Knee Implant
Total Knee Implant
X-Ray of Replaced Uni Condylar Knee
X-Ray of Replaced Uni Condylar Knee
Uni Condylar-Knee-Implant
Uni Condylar Knee Implant

Conventional Total Knee implant allows a person to have good range of motion of knee however now High Flex Knees and Unicondylar Knees are also available High Flex Knee gives full flexion to the patient thereby allowing sitting on the floor. Unicondylar Knees also known as half joint replacement are indicated for very early arthritis and when only one half of the joint is involved You and your Knee Joint Replacement Surgeon can discuss the most suitable implant for yourself.

Every individual’s knees are different and having the precise anatomy and exact measurements of your knees allows us to give you a mare natural fit for your new knee implant. From a CT scan of your legs, we can view your entire knee joint and joint line mechanics three dimensionally in a medial 3D software. Custom ‘manufactured instruments are designed highlighting all the specific requirements of your unique anatomy in order b get a more personalized for the implant.
Using this detailed planning, your surgical operation is customized to:

  • Be less invasive
  • Achieve higher level of accuracy
  • Reduce surgical time
  • Reduce blood loss
  • improve recovery

This surgical technique also recommended for patients that suffer from other morbidities such as coronary artery disease, obesity and diabetes as well as those patients who already have pre-existing hardware in the joint such as presence of nail, screws etc.

Unique Patient Anatomy with Joint Line
Femur & Tibia Measurement

Specialized-Instruments For You Knee

Femur Matched Instrument
Femur Matched Instrument
Tibia-Matched-Instrument
Tibia Matched Instrument
Tibia Matched Instrument-(Top-View)
Tibia-Matched Instrument (Top-View)
Tibial-Matching
Tibial Matching

Total Knee Replacement surgery is an elective procedure Your doctor has more than likely treated your condition with physiotherapy, pain medicines, anti-inflammatory drugs and injections in the knee You may have also had minor surgeries of your joint in the past.
You would be considered for total knee replacement if:

  • You have daily pain.
  • Your pain is severe enough to restrict not only work and recreations but also the ordinary activities of daily living.
  • You have significant stiffness of your knee.
  • You have significant instability (constant giving way) of your knee.
  • You have significant deformity (knock knees or bow legs) causing pain and inability to walk.

You and your doctor are probably the best judge of when you will finally need total knee replacement surgery.
Some Common Deformities
1. Bow legs (Varus)
2. Knowck Knees (Valgus)
3. Wind Swept Legs
You can see illustration and X-Ray images shown above already.

Yes you can, but your unstable joints may cause a fall and you may have fractures around the knees and the hips because of osteoporotic bones.
Regular consumption of analgesics and anti-inflammatory drugs may damage your kidneys and cause ulcers in your stomach.

Although knee joint replacement is recommended in older age group, it can be considered in younger patients who are severely crippled due to rheumatoid arthritis or post traumatic osteoarthritis of knees. As such, age is no bar to this operation.

Yes you can, but your unstable joints may cause a fall and you may have fractures around the knees and the hips because of osteoporotic bones.
Regular consumption of analgesics and anti-inflammatory drugs may damage your kidneys and cause ulcers in your stomach.

  • Reduced joint pain dramatically (may be no pain)
  • Increased movement and mobility
  • Correction of deformity
  • Improved quality of life – the ability to return to normal activities
  • Running, jumping, jogging or other high impact activities are discouraged. However, you can
  • resume playing golf, walking, bicycling, swimming and other low impact sports

Knee Joint Replacement Surgeon and manufacturers have made remarkable advances in joint replacement technology over the last few years. The materials are long lasting and durable. The surgical methods have been fine tuned and standardized. As a result, the chances for a successful outcome are excellent.
The operation will provide pain relief for at least 10-15 years. The major long-term problem is loosening of the prosthesis. This occurs because either the cement crumbles (as old mortar in a brick building) or the bone loosens away (resorbs) from the cement. By 10 years, 25% of total knee replacements may look loose on X-ray, and about 10% will be painful and require reoperation. By 15 years possibly 20% may require re-operation.
These complications are more likely in very obese or hyper active people and really depends upon how careful you are about your artificial knee joint.

Following are the essential steps that will help you get into shape before knee replacement surgery:
Commit to the success of your surgery: Working as a team you and your family must adopt a positive attitude towards the success of your surgery. Together with your doctor you will gain a clear understanding of the common goals and expectations of the surgery.
Lose excess weight: Because excess weight causes more strain on already damaged joints, losing weight is one of the best ways to improve the condition of your knee and optimize surgical results. Your doctor’s approval: Before surgery we would like to make sure that your condition is well enough to undergo this operation and also to exclude certain conditions such as dental infection, ear, nose and throat infection, skin infection, urine infection etc.
Stop smoking: If you have not already done so, it is suggested that you stop smoking. This will be good for you during and after your surgery. Routinely blood transfusion is not necessary after Single Total Knee Replacement. But if your hemoglobin is less than 10gm% then you may require 1-2 units of blood for your operation, so kindly arrange donors for this purpose. If both of your knees need replacement in the same sitting, then up to 2-3 units of blood may be required depending on your hemoglobin levels.

If both knees are damaged, both can be replaced in the same sitting. It means one time anaesthesia, one time hospital stay, one time medicines and one time physical therapy. It means saving the cost too. Your doctor can advise you for the need of replacing both the knees simultaneously.
Smt. Chikara has this immense will to live life to its fullest and has undergone Joint replacement of Both her Knees, both Shoulders & Right Hip. She’s very active and is an example to others that “if there’s a will, there’s a way”
SALUTE TO HER SPIRIT

knee joint replacement Surgeon
Both Knee Replaced Simultaneously By Dr. Shekhar Srivastav at Sant Parmand Hospital

When you have made up your mind for knee replacement surgery, you will be admitted a day before surgery. Your surgeon anaesthetist, physician and physiotherapist will do a complete medical evaluation.
X-ray images will be taken of your knees that help the surgeon plan your surgery. Chest X-rays, ECG, blood and urine test will be done prior to surgery to ensure that you are fit for surgery.
You will be required to scrub the surgical area with soap and water anight before and on the day of surgery, after which your leg will be covered with a sterile drape. You will be transported to the operating room in the morning.
You may have General Anaesthesia or Spinal Anaesthesia with sedation The duration of surgery for one knee is about 2 hours. Your Knee Joint Replacement Surgeon will talk to your family after the surgery to report your progress.
You will be kept in recovery room for a few hours and then transferred tothe room or in some cases to ICU for the monitoring of vital parameters.
You will have drainage tubes at the operative site and the whole limb will be covered with a bandage. After 3-6 hours depending upon the type of anaesthesia given at the time of surgery, you will start with normal diet.
Next morning, you will be transferred to the room and physical therapy usually begins with most of the patients. On 1st post-operative day we will remove the drainage tubes while on 3rd day your dressing will be changed. In some cases a knee immobilizer will be worn. Walking with support & independently using the toilet will be started from 2nd day on wards.

The initial rehabilitation generally takes 5-7 days during your hospital stay. It is needed for your weak leg and thigh muscles which have not been used because of your knee problem. The surgery can correct the knee problem, but the muscles will remain weak and need to be strengthened through regular exercises. The therapist also focuses on helping to increase the range of motion of knee with bending exercises.
Physical therapist along with you will work until you meet the following goals:

  • Independence in getting in and out of bed
  • Independence in walking with walker on a level surface
  • Independence in your home exercise program

Your Knee Joint Replacement Surgeon and therapist may modify these goals somewhat to fit your particular condition. If there are no complications after surgery, most patients stay in our hospital approximately for 1 week or less.

After a conventional implant for Total Knee Replacement, a person can typically walk comfortably and his knee joint will have a good range of motion. However, sitting cross-legged and squatting is not advised. If a person opts for a Hi-Flex knee implant, the range of motion of the knee is better allowing him to sit cross-legged. We (Knee Joint Replacement Surgeon) would generally suggest that you do not squat as it is based on individual muscle strength and fitness level. Your doctor will advise you on the activities that you will be able to do comfortably.

Can I Sit Cross Leg Or Squat After Knee Replacement
After Conventional Total Knee Replacement
Can I Sit Cross Leg Or Squat After Knee Replacement
After Hi-Flex Total Knee Replacement

Medication:
You will continue to take medicines as prescribed by your doctor.
Activity:
Continue to walk with crutches / walker Bear weight and walk on the leg as much as is comfortable Walking is one of the better kinds of physical therapy and is good form us cle strengthening The success of the operation depends to a great extent on how well you do the exercises and strengthen the muscles Continue to wear your knee immobilizer as instructed.
Our ultimate aim is that you should be able to bend your knee to at least 90 degrees (usually more) and be able to strengthen your knee.
Within six weeks after surgery, most patients are able to walk with a cane.
Other considerations:
Do not wet the knee until after the stitches are removed
You can usually return to work within 2-3 months or as instructed by your doctor.
You should not drive a car until your doctor has advised you to
Care of the wound:
Keep the incision clean and dry. If there is any swelling, redness or drainage from the incision site, or if you have any pain or fever, report this immediately to your doctor. The stitches are removed at about two weeks after the operation.

Your first return appointment will be 2 weeks after the date of surgery for removal of stitches. Second appointment will be after 1 month, at which time you will be examined and have X-rays done. Subsequent appointments will be given based on your progress.

Your knee replacement should give you years of service. You can protect it by taking a few simple steps:
Watch for and prevent infection: Because your new knee is sensitive to infection, you must be diligent about preventing infection. If you suspect infection of any kind, contact your doctor right away.
Follow-up care: Your regular follow-up visits will ensure the long term success of your operation. Often, follow-up X-rays will confirm proper placement and alignment of the artificial joint.
Weight control: Keeping your weight under control. This will reduce the amount of pressure and stress on your new knee. Avoid high impact sports and participate regularly in low impact activities to strengthen your new knees and get the exercise you need to stay fit. Do not attempt to squat or sit cross legged after conventional knee replacement.

Total Knee Replacement is an elective operation. The decision to have the operation is yours. The Knee Joint Replacement Surgeon may recommend the operation, but your decision must be based upon you weighing the benefits of the operation against the risks. All your questions should have been answered before you decide to have the operation.
If you still have any queries, please do not hesitate to contact us.