Knee Replacement in India

Overview

Knee replacement, also known as knee arthroplasty, is a surgical procedure performed to replace damaged or diseased parts of the knee joint with artificial components. The knee joint consists of the lower end of the femur, the upper end of the tibia, and the patella (kneecap). Conditions such as osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, and other joint diseases can lead to the deterioration of the knee joint, causing pain, stiffness, and reduced mobility. Knee replacement surgery aims to relieve pain, improve joint function, and enhance the patient's quality of life.

Knee Replacement Diagnosis:

1. Medical History: Doctors begin the diagnosis by reviewing the patient's medical history, including symptoms, previous injuries, and any existing medical conditions like osteoarthritis or rheumatoid arthritis.
2. Physical Examination: A thorough physical examination of the knee joint helps assess the range of motion, stability, and signs of inflammation or deformity.
3. Imaging Tests: X-rays, MRI scans, and CT scans provide detailed images of the knee joint, allowing doctors to evaluate the extent of damage to the bones, cartilage, and surrounding tissues.
4. Blood Tests: Blood tests may be conducted to rule out infections or assess the overall health of the patient before surgery.
5. Joint Aspiration: In some cases, a small sample of fluid may be drawn from the knee joint with a needle to analyze for signs of infection or inflammation.

Symptoms of Knee Problems:

1. Pain: Persistent knee pain, especially during weight-bearing activities such as walking, climbing stairs, or standing for prolonged periods, is a common symptom of knee problems.
2. Swelling: Swelling or inflammation around the knee joint, often accompanied by warmth and redness, can indicate underlying knee conditions such as arthritis or ligament injuries.
3. Stiffness: Difficulty in bending or straightening the knee joint, particularly after periods of inactivity or rest, may suggest degenerative changes or mechanical issues within the knee.
4. Instability: Sensation of the knee "giving way" or feeling unstable during movement, which can be caused by ligament tears, meniscus injuries, or joint laxity.
5. Crepitus: Audible or palpable crunching, clicking, or grinding sensations within the knee joint, typically associated with worn cartilage or bone-on-bone contact.
6. Limited Range of Motion: Decreased flexibility and range of motion in the knee joint, making it challenging to perform daily activities such as squatting, kneeling, or fully extending the leg.

Knee Replacement Types

Knee replacement is primarily classified into two main types based on the extent of joint involvement:

1. Total Knee Replacement (TKR): Total knee replacement is the most common type of knee arthroplasty. It involves replacing the entire knee joint surfaces with artificial components. The damaged portions of the femur and tibia are removed and replaced with metal implants, while a plastic spacer is inserted between them to create a smooth gliding surface.

2. Partial Knee Replacement (PKR): Partial knee replacement is a less extensive procedure suitable for patients with limited knee joint damage. In PKR, only the affected compartment of the knee joint is replaced with artificial components, leaving the healthy portions intact. This type of knee replacement is appropriate when arthritis or damage is limited to a specific area of the knee.

Both TKR and PKR are effective in relieving pain, improving joint function, and restoring mobility in patients with debilitating knee conditions. The choice of the type of knee replacement depends on the patient's individual condition, the extent of joint damage, and the surgeon's evaluation.

Knee Replacement Causes:

1. Osteoarthritis: The most common cause of knee replacement surgery is osteoarthritis, a degenerative joint disease characterized by the breakdown of cartilage in the knee joint.
2. Rheumatoid Arthritis: Chronic inflammation of the knee joint due to rheumatoid arthritis can lead to joint damage and necessitate knee replacement surgery.
3. Post-Traumatic Arthritis: Previous knee injuries or fractures may increase the risk of developing arthritis in the knee joint, eventually requiring surgical intervention.
4. Other Conditions: Rarely, other conditions such as avascular necrosis, hemophilia, or severe bone deformities may necessitate knee replacement surgery to restore function and alleviate pain.

Knee Replacement Process:

1. Pre-operative Assessment: Patients undergo a comprehensive pre-operative assessment, including medical history review, physical examination, and imaging tests, to determine their candidacy for knee replacement surgery.
2. Anesthesia: During the surgery, patients are administered either general anesthesia to induce unconsciousness or regional anesthesia (spinal or epidural) to numb the lower body while remaining awake.
3. Incision: The surgeon makes an incision over the knee joint, exposing the damaged surfaces of the bones.
4. Reshaping Bones: The damaged bone and cartilage are removed from the femur (thigh bone) and tibia (shinbone), and the surfaces are reshaped to accommodate the artificial components of the knee implant.
5. Implant Placement: The artificial components, typically made of metal alloys, plastic, or ceramic materials, are securely attached to the prepared bone surfaces using specialized cement or techniques.
6. Closure: After confirming proper alignment and stability, the incision is closed with sutures or staples, and a sterile dressing is applied.
7. Post-operative Care: Patients are closely monitored in the recovery room and may receive pain medication, antibiotics, and blood thinners to prevent complications.

Knee Replacement Preparation:

1. Medical Evaluation: Patients undergo a thorough medical evaluation to assess their overall health and identify any underlying conditions that may affect the surgery or recovery process.
2. Medication Management: Patients may need to adjust or temporarily discontinue certain medications, such as blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs), before surgery to reduce the risk of bleeding or other complications.
3. Physical Therapy: Pre-operative physical therapy exercises may be prescribed to strengthen the muscles surrounding the knee joint and improve mobility before surgery.
4. Lifestyle Modifications: Patients are advised to make lifestyle modifications, such as quitting smoking, maintaining a healthy diet, and optimizing nutrition, to enhance surgical outcomes and facilitate recovery.
5. Planning for Assistance: Patients should arrange for assistance with activities of daily living and transportation to and from the hospital for the surgery and post-operative appointments.
6. Home Preparation: Preparing the home environment for post-operative recovery, including setting up a comfortable sleeping area, securing assistive devices, and stocking up on necessary supplies, can help ensure a smooth transition from the hospital to home care.

Knee Replacement procedure

During a knee replacement procedure, the damaged portions of the knee joint are replaced with artificial components, typically made of metal alloys, high-grade plastics, and polymers. The surgery is performed under general or regional anesthesia and involves several key steps:

Incision: The surgeon makes an incision over the knee, exposing the damaged joint.

Reshaping the Bone: The damaged ends of the thigh bone (femur) and shin bone (tibia) are carefully removed. The remaining bone surfaces are reshaped to accommodate the artificial components.

Implant Placement: Metal components are secured to the newly prepared bone surfaces using special cement or through press-fit techniques. These components mimic the natural shape and function of the knee joint.

Insertion of Plastic Spacers: A medical-grade plastic spacer is placed between the metal components to facilitate smooth movement within the joint.

Patellar Resurfacing (Optional): In some cases, the undersurface of the kneecap (patella) may also be resurfaced with a plastic component to improve its function.

Closure: Once the components are securely in place, the surgeon closes the incision with sutures or staples.

Recovery and Rehabilitation:

Following knee replacement surgery, patients typically stay in the hospital for a few days for monitoring and initial rehabilitation. Physical therapy plays a crucial role in the recovery process, helping patients regain strength, flexibility, and range of motion in the affected knee.

Postoperative Care:

Patients are advised to follow a personalized rehabilitation plan outlined by their healthcare provider. This plan may include exercises to strengthen the surrounding muscles, as well as precautions to prevent complications such as infection and blood clots.

Long-Term Outlook:

While knee replacement surgery offers significant relief from pain and disability, it is important to understand that the artificial joint may not last a lifetime. Factors such as age, activity level, and overall health can influence the longevity of the implant. However, advancements in implant technology and surgical techniques continue to improve the success rates and durability of knee replacements.

Knee Replacement Risks:

1. Infection: There is a risk of developing an infection at the surgical site, which may require antibiotics or additional surgical intervention.
2. Blood Clots: Blood clots (deep vein thrombosis) can form in the legs after surgery and potentially travel to the lungs, leading to a pulmonary embolism.
3. Nerve Damage: Injury to nerves surrounding the knee can cause numbness, tingling, or weakness in the leg.
4. Joint Stiffness: Some patients may experience stiffness or limited range of motion in the replaced knee joint.
5. Loosening or Dislocation: Over time, the artificial components of the knee replacement may loosen or dislocate, requiring revision surgery.
6. Persistent Pain: While knee replacement surgery aims to relieve pain, some patients may still experience persistent discomfort or pain after the procedure.

Knee Replacement Cost in India:

The cost of knee replacement in India can range from $4000 to $7000, depending on factors such as hospital services and facilities, surgeon's expertise, type of implant used, and post-operative care. The cost of knee replacement surgery in India is significantly lower compared to many Western countries, without compromising on quality. This affordability factor makes India an attractive option for individuals seeking high-quality healthcare at a fraction of the cost they would incur elsewhere.

Knee Replacement Success Rate:

Generally, success rates for knee replacement surgery in India are reported to be quite high, often ranging from 90% to 95% or higher. This indicates that the majority of patients experience significant pain relief, improved mobility, and satisfaction with the outcomes of the surgery.

However, it's important to note that individual experiences may vary, and success rates can depend on factors such as the skill and experience of the surgeon, the quality of the medical facility, the patient's overall health, and adherence to post-operative rehabilitation protocols.

Best Knee Replacement Hospitals in India:

1. Apollo Hospitals, Chennai
2. Fortis Memorial Research Institute, Gurgaon
3. Max Super Speciality Hospital, Delhi
4. Medanta - The Medicity, Gurgaon
5. Manipal Hospitals, Bangalore
6. Artemis Hospital, Gurgaon
7. Sir H.N. Reliance Foundation Hospital and Research Centre, Mumbai
8. Kokilaben Dhirubhai Ambani Hospital, Mumbai
9. Narayana Health, Bangalore
10. Aster Medcity, Kochi

Top Ortho Surgeons in India:

1. Dr. Ashok Rajgopal - Medanta - The Medicity, Gurgaon
2. Dr. Sanjay Pai - Fortis Hospital, Mumbai
3. Dr. Raju Vaishya - Indraprastha Apollo Hospitals, Delhi
4. Dr. Narendra Vaidya - Lokmanya Hospitals, Pune
5. Dr. Manoj Miglani - Max Super Speciality Hospital, Delhi
6. Dr. Shreedhar Archik - Lilavati Hospital and Research Centre, Mumbai
7. Dr. Rajeev K. Sharma - Artemis Hospital, Gurgaon
8. Dr. IPS Oberoi - Artemis Hospital, Gurgaon
9. Dr. Ameet Pispati - Jaslok Hospital, Mumbai
10. Dr. Vijay Bose - Apollo Hospitals, Chennai

Knee replacement surgery, also known as total knee arthroplasty, is a surgical procedure in which the damaged or diseased portions of the knee joint are replaced with artificial components called prostheses. The procedure aims to relieve pain, improve mobility, and restore function in individuals with severe knee arthritis or other conditions that have not responded to conservative treatments.