Knee Replacement


Knee Replacement Surgery is a surgical procedure to reverse knee damage caused by a disease or condition such as arthritis. Also known as arthroplasty or total knee replacement, this procedure involves cutting away the damaged bone and cartilage from the lower end of thighbone and an upper end of shinbone and replacing it with an artificial joint made of metal and plastic polymer.


For those who have severe knee trauma or knee joint conditions, your doctor might suggest a knee replacement surgery as an option to lead a pain-free life. This surgical procedure may be considered for someone with severe arthritis or knee trauma. The goal of knee replacement surgery is to repair the damage caused to the knee joint and relieve the pain when other forms of treatment such as medications do not work.

Knee replacement surgery is a common treatment for Osteoarthritis. When a patient is diagnosed with osteoarthritis, there is a breakdown of joint cartilage. If the cartilage suffers damage, movement becomes restricted and causes immense pain. People with osteoarthritis experience difficulties in performing day-to-day activities such as walking, climbing the stairs, or bending. These activities might strain the knee, causing it to swell or dislocate, as the knee joint is not stable. Another condition that may require knee replacement surgery is Rheumatoid Arthritis. Performed during an advanced stage, Total Knee Replacement has proven to be the most successful procedure that relieves the person from unremitting pain and deformity. With the advancement in science and technology, the medical fraternity has moved from traditional knee replacement surgery to robotic knee replacement surgery. Following is the detailed information on Robotic Knee Replacement Surgery.

What is Robotic Knee Replacement Surgery?

Severe joint conditions such as Arthritis may not have a complete cure yet. But the treatment methods are getting better and the long-term relief factor is improving as well. In traditional knee replacement surgery, the damaged part of the bone is removed and replaced with an artificial joint implant. Robotic knee replacement surgery is not carried out by a robot on its own (a common misconception due to its name). In this procedure, the same process of the traditional knee replacement surgery is carried out, but with the assistance of a robotic arm. This is the ideal treatment for patients suffering from severe knee pain, as the robotic knee replacement surgery offers long-lasting relief with maximum effectiveness.

When can you undergo robotic knee replacement surgery?

If you are eligible to undergo a traditional knee replacement surgery, then you are also eligible for a robotic knee replacement surgery. But, before you go in for the robotic knee replacement surgery, take the opinion of your doctor. For conditions like osteoarthritis and rheumatoid arthritis, your doctor might prescribe other forms of treatment before suggesting the surgery. Depending upon the severity of your condition and pain, they may recommend less invasive methods such as:

  • Anti-inflammatory medications
  • Pain killers
  • Limiting strenuous physical activities
  • Weight loss
  • Healthy diet
  • Physical therapy
  • Cortisone injections
  • Devices to assist walking (cane/walker)
  • Viscosupplementation injection (to make joint movements less painful)

If you do not get relief through these treatments, your doctor will suggest a knee replacement surgery. 

How does the robotic knee replacement procedure take place?

As mentioned above, the procedure is assisted by a robotic arm, while the orthopedic surgeon controls it. The traditional method involves the surgeon manually removing the damaged bone and cartilage, replacing it with an artificial joint. However, the robotic arm in this method helps the surgeon in performing knee replacement surgery with utmost precision.

Before the surgery, a CT is taken, through which a 3D model of the patient’s knee is created. This allows the surgeon to be more accurate while planning for the surgery and thus executing it further inside OT. As per the plan approved by surgeon, the robotic arm performs a series of tasks such as bone registration, bone resection, intra-operative monitoring followed by implant positioning. During the surgery, the robotic arm works in a predefined space by the surgeon during 3D pre-planning, ensuring maximum bone cutting precision and safety as the surrounding tissues are not damaged.

What are the benefits of Robotic Knee Replacement Surgery?

Since this technique is quite new, the long-term benefits of robotic knee replacement surgery are yet to be determined. But, the short-term benefits of robotic knee replacement surgery are plenty and quite promising.

Reduced recovery time: In a traditional knee replacement surgery, an average patient won’t be able to resume physical activities such as walking, driving, or any strenuous activity until 4 – 6 weeks. But with robotic knee replacement surgery, this time is reduced by half. This is due to the comparatively lesser invasive nature of this procedure, involving smaller incisions and great precision, which ensures that there is lesser bone trauma and the nearby tissues aren’t damaged.

Fewer complications: Patients who undergo robotic knee replacement surgery tend to have fewer complications as compared to those who undergo traditional knee replacement surgery. The minimally invasive nature of this surgery ensures lower chances of infection, so that the patient does not have to take another trip to the hospital.

Lower joint awareness: After the completion of the knee replacement surgery and the associated resting period, you should be able to go about your daily tasks without any hindrance. But, for many patients, these day-to-day tasks might be difficult as they may trigger Joint awareness in the form of stiffness, numbness, or pain. Improved accuracy of the robotic knee replacement surgery, reduces the possibility of joint awareness and relieves pain.

Even though robotic knee replacement surgery is a relatively new procedure to treat arthritis and knee trauma, it has been proven to give better results as compared to the traditional procedure. According to studies, robotic knee replacement surgery offers more accuracy, and its less invasive nature prevents damage to the surrounding areas resulting in lesser blood loss and faster recovery. But before you zero down on your final treatment option, consult with your doctor/healthcare provider and analyze the pros and cons of this treatment method to see if it is ideal for your condition.

You might be thinking: “Why do my joints ache when it’s cold?”

Usually, joint pains are symptoms of some injury or an extension of an underlying health condition. But, the winter season does create more muscle stiffness and joint aches if one is spending more time outdoors. It is also true that many people who suffer from chronic joint issues like arthritis and osteoarthritis find that their condition worsens during the winter season. And, as we all know that warmth improves your blood circulation, keeps all tissues well-nourished, cold weather can lead to a drop in blood circulation levels. Though there’s no scientific evidence behind this relationship, taking a few extra measures to ease joint pain may help you tackle problems related to fluctuating temperatures. Let’s now take a brief look and understand the possible reasons for this kind of pain, tips on tackling joint stiffness during cold, and the reason why you should not have a Total Knee Replacement surgery during the winter season.


1. During winters, the protective fluid inside our joints gets thicker leading to stiffening of the joints.

2. Drop in the barometric pressure can cause your muscles, tendons, and surrounding tissues to expand beyond the confined body space which causes pain.

3. Even the nerves become sensitive during the winter season leading to increased anxiety and tension on the muscles and joints.

4. People who are less active in the winter season face issues while maintaining the good health of the joints.

5. During winters, our body circulates less blood to the entire body and even to the central areas of the body causing more pain and stiffness.


During the winter season people who experience chronic joint stiffness and pain, their symptoms get worse due to the cold weather. Taking few measures and extra efforts during winter would help you fight the pain. These tips would not cure your joint pain but help you in causing relief during the winters.

  1. Stay warm

This tip would depend on the area an individual stays in. Depending on the area, if it is too cold they should wear warm clothes and make sure that their hands, legs, and joints that are affected by arthritis are covered at all times. Try to stay indoors whenever possible.  

  • Hydrating is a must

Dehydration makes people sensitive to pain. Drinking lots of water during winter is very important as the dry air makes people feel dehydrated, tired, and achy. Apart from drinking water at regular intervals, drinking warm soups and tea can also help you stay warm.  

  • Take your Vitamin D

Lack of Vitamin D can also be a reason for joint pain. It also raises the risk for osteoporosis. Consult your doctor regarding the best supplement for you.

  • Exercise and be active

People often gain weight during winters. As the weather makes you lazy and you tend to eat more. The excess weight would make your joints pain more as it puts a lot of pressure on it. Hence it is important to stay active and maintain your weight.


Many patients have this question regarding when is the best time to have a Total Knee Replacement surgery. People should always do their TKR surgery during warm weather as it makes the recovery process better for a majority of people.

1. Changing of clothes

Changing clothes during the summer season is less hectic as you put on fewer layers for obvious reasons on your body making it easier for the wound to be untouched for a longer period. It is always advisable to wear clothes that are easy to wear and remove.

2. Sleeping

Sleeping for few weeks just after the surgery can be a big task and hence it is always good to wear light cotton clothes and light bedding for a sound sleep.

3. Air conditioner and heater

The normal temperature will make less unnecessary usage of the heater and air conditioner while you are recovering from the surgery. Warm weather always allows you to get out for small walks and trips without any hassle.

4. Travelling

Post your in-home therapy, you would be often visiting your therapist for offsite therapy and that’s when avoiding unnecessary (traveling in winter season) and load on your surgery site is crucial. Driving by yourself is a strict NO during this period.

5. Work-life balance
Taking days off and resting for an adequate amount of time is paramount and hence deciding on the right surgery time during your long holidays will help you go through it faster and better. It’s always advisable for seasonal workers to have surgery, especially during their off-season.
Several additional factors contribute to one’s recovery, especially total knee replacement. And, despite a successful TKR, rehabilitation will play a key role in a successful recovery. Also, it is important to acknowledge the fact if you are a person that gets affected negatively, then paying closer attention to your diet and supplements becomes of the highest importance. Preparing yourself from the inside out can help you minimize the impact of cold weather in general and also in case of surgery. Consuming vitamin-rich foods and consulting your primary care doctor in case of any difficulty will only in faster recovery.


A condition that is characterized by pain in the front part of the knee and surrounding the patella (kneecap) is called patellofemoral pain syndrome (PFPS). Doctors also refer to this condition as “jumper’s knee” or “runner’s knee.”

The condition is not serious, despite leading to symptoms ranging from sore to very painful kneecap. Just rest and conservative treatment measures can also lead to pain reduction in patients affected by this disorder.

Causes of Patellofemoral Pain Syndrome

  • Knee Overuse: In many cases, PFPS is caused by vigorous physical activities that put repeated stress on the knee —such as jogging, squatting, and climbing stairs. It can also be caused by a sudden change in physical activity. This change can be in the frequency of activity—such as increasing the number of days you exercise each week. It can also be in the duration or intensity of activity—such as running longer distances.

Other factors that may contribute to patellofemoral pain include:

  • Use of wrong sports training techniques or equipment
  • Altered sizing in footwear or playing surface
  • Wrong Alignment of the Kneecap: Patellofemoral pain syndrome can also be triggered by irregular tracking of the kneecap in the trochlear groove. In this condition, the patella is protruded to one side of the groove upon knee bending. This deviation may lead to elevated pressure between the rear of the patella and the trochlea, irritating the soft tissues.

Factors that add to poor kneecap tracking include:

  • Malalignment of the legs between the hips and the ankles. Malalignment may lead to shifting of kneecap which is very far to the outside or inside of the leg, or it may ride very high in the groove of the trochlea—leading to patella Alta.
  • Muscular disparities or weaknesses, particularly in the front thigh muscles (quadriceps). During knee bending and straightening, the quadriceps muscles and tendon aid in keeping the kneecap inside the trochlear groove. Weak or imbalanced front thigh muscles can lead to poor kneecap tracking inside the groove.

Any individual can be affected by this condition, however, athletes more frequently encounter this problem.

Symptoms of Patellofemoral Pain Syndrome

The sure sign symptom of patellofemoral syndrome is a dull, aching pain usually occurring on the front portion of the knee or around the kneecap. The pain may be felt in one or both knees and often deteriorates with movement.

Other painful symptoms are:

  • Pain during exercise
  • Pain during knee bending, including navigation through stairs, jumping or sitting on your heels
  • Pain after sitting for a prolonged period with bent knees
  • Cracking or popping sounds in the knee during stair navigation or post sitting for a prolonged duration

Diagnosis of Patellofemoral Pain Syndrome

Your doctor will inquire about your knee history and apply pressure on your knee areas. He/she will also move your leg in various positions to help exclude other conditions, having similar signs and symptoms.

To determine the exact cause of your knee pain, your doctor may prescribe imaging tests like:

  • X-rays: A small quantity of radiation enters your body to create X-ray images of your body on a screen. Though this tool sees bone well, it is less effective at enabling soft tissue visualization.
  • CT scans. This technique combines images of X-ray from different angles to form thorough images of internal structures. Though CT scans can envisage both bone as well as soft tissues, the procedure carries a much higher radiation dose as compared to plain X-rays.
  • MRI: MRIs create thorough images of bones and soft tissues, such as the knee ligaments and cartilage using a combination of radio waves and a strong magnetic field. However, they are much more costly as compared to the above diagnostic tools.

Treatment of Patellofemoral Pain Syndrome

In many patients, simple home remedies can improve pain in patients affected by this condition.

1) Treatments at home

Changes in daily routine

Discontinue performing activities that hurt your knee, till your pain is sorted out, including alterations in your exercise routine or moving to low-impact exercises. Latter activities may apply less stress on your knee joint. If your body weight is above normal, dropping weight also helps in reducing pressure on your knee.

RICE Method

Opting for the RICE method may go a long way in improving your state. RICE is an acronym for Rest, Ice, Compression and Elevation.

  • Rest: Avoid applying weight on the knee which is paining.
  • Ice: Apply ice packs for 20 minutes at a single time, multiple times in a single day.
  • Compression: Cover the knee lightly with an elastic bandage, leaving a cavity in the kneecap area, to avoid extra swelling. Ensure that the bandage is loose enough to not cause any pain.
  • Elevation: Rest with your knee elevated to a height above your heart, as frequently as possible.


Taking certain NSAIDs like ibuprofen or naproxen can aid in the reduction of swelling and pain. If your pain continues or worsens, preventing knee motion, kindly contact your doctor. Medical treatment for patellofemoral pain syndrome is meant to relieve pain and re-establish the range of knee motion and its strength. In the majority of cases, this pain can be treated by non-surgical means.

2) Non-surgical Treatment

Physical Therapy

Dedicated exercises for improving range of motion, strength, and knee joint endurance can contribute to providing relief in this condition. It is particularly vital to concentrate on strengthening and stretching your front knee muscles as these muscles are the key stabilizers of your kneecap. Experts may also recommend core muscle exercises to build up the muscles in your abdomen and lower back.

Using Orthotics

Orthotics/shoe inserts can contribute to alignment and stabilization of your foot and ankles, withdrawing stress from your lower leg. These devices can either be customized or bought directly.

3) Surgical Treatment

Surgery is very rarely required to treat patellofemoral pain syndrome, only in extreme cases, which are not responding to non-surgical modes of treatment.


During this procedure, your surgeon inserts a small camera, referred to as an arthroscope, into your knee joint. The camera shows images of the knee joint on a screen, which your surgeon uses to guide small surgical instruments in the area to be operated on.

  • Debridement: In some cases, removal of damaged smooth, white tissue covering the ends of bones at the joints (articular cartilage) from the kneecap’s surface can give relief from pain.
  • Lateral release: If the affected muscle is very tight to pull the kneecap out of the trochlear groove, this procedure can relax the tissue and resolve the improper alignment of the kneecap.
  • Tibial tubercle transfer: In some cases, kneecap realignment by shifting the patellar tendon along with a portion of the bony prominence on the shinbone may be essential.

A conventional open surgical cut is needed in this procedure. The surgeon detaches the tibial tubercle, partially or completely, to enable shifting the bone and the tendon to the knee’s inner side. The piece of bone is then reattached to the shinbone using screws. In the majority of cases, this transfer permits better kneecap tracking in the groove of the trochlea.


In more extreme cases, a surgeon may require operating your knee for re-alignment of your kneecap’s angle or to reduce pressure on the cartilage.

To conclude, Patellofemoral pain syndrome is one of the most common causes of anterior knee pain today. And, while there are several treatment options available to treat the syndrome, it is crucial to accept the fact that your knees are absorbing a huge amount of pressure since the time you have started walking. Plus, with regular wear and tear, knee pain is bound to happen and take a toll over a while as even the knee’s two shock absorbers — pads of cartilage called menisci — start to deteriorate with age. But certain steps like regular stretching and mobility drills, wearing good footwear, and practicing correct form while exercising should be paramount if you are looking to age-proof your knees. 

The knee is the human body’s largest joint and its healthy maintenance is required to perform most of the everyday activities, easily. The knee joint is formed by the thighbone’s (femur’s) lower portion, the shinbone’s (tibia’s) upper portion, and the cap of the knee referred to as the patella. The ends of these three bones where they meet are covered with a smooth substance that protects the bones and enables them to move easily (articular cartilage). The C-shaped wedges present between the thighbone and the shinbone are known as menisci. They function as the natural “shock absorbers” protecting the joint. The thigh and shinbones are held together by large ligaments, lending stability to the joint whereas the long thigh muscles make the knee strong. All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane secretes a liquid that moistens the cartilage, minimizing friction to almost zero in the case of a healthy knee. Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and reduced function.

Although there are more than 100 types of Arthritis, the three most common types are Osteoarthritis, Rheumatoid arthritis and Post-traumatic arthritis. In this article, we will majorly focus on Osteoarthritis.

What is Osteoarthritis (OA)?

Osteoarthritis is an age-related “wear and tear” type of arthritis. It generally affects persons aged 50 years or more, but may also affect younger individuals. In this type of arthritis, the cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness. Osteoarthritis (OA) of the knee happens when the cartilage, the cushion between the knee joints deteriorates. This can cause pain, stiffness and swelling. Appropriate treatment can help relieve discomfort and slow the damage. It can also improve your quality of life facilitating you to better keep up with your day-to-day activities.


What are the causes of  Osteoarthritis?

  • Age: The risk of developing OA increases as someone gets older because bones, muscles and joints are also aging. 
  • Joint injury
  • Using the same joints over and over in a job or sport can result in OA.
  • Obesity: Extra weight puts more stress on joint and fats cells to promote inflammation.
  • Weak muscles: Joints can get out of the right position when there’s not enough support.
  • Hereditary: People with family members having OA can also suffer from OA.
  • Women are more likely to develop OA than men.

What are the signs &  symptoms of OA?

  • Joint stiffness and soreness
  • Grating sensation
  • Bone spurs
  •  Loss of flexibility
  • Pain or aching in the joint during activity
  • Limited range of motion that may go away after movement
  • Clicking or cracking sound when a joint bends
  • Swelling around a joint.

How to Diagnose Osteoarthritis?

Osteoarthritis of the major joints is most effectively diagnosed through a combination of medical history, physical examination, and various lab tests including imaging studies such as X-ray. A physician can diagnose most of the cases but in some cases, he may refer you to an Orthopedic surgeon, physiatrist for further evaluation.

Medical History

Medical histories can often be the most useful tool for physicians in diagnosing osteoarthritis. The doctor will look for a family history of the disease as well as the presence of various risk factors to indicate the need for further testing.

Physical Examination

A physical examination will usually follow the medical history as the physician looks for physical signs of the disease. These include signs like swelling and tenderness of the joints, loss of movement in specific joints, or visible joint damage such as bony growths in the surrounding area. The patient may also be asked to perform a variety of physical tasks so the physician can evaluate the range of motion and general joint mobility.

What are the treatment options for Osteoarthritis?

General Management

Patients with osteoarthritis of the hand may benefit from assistive devices and instruction on techniques for joint protection; splinting (a rigid or flexible device that maintains in position a displaced or movable part) is beneficial for those with symptomatic osteoarthritis.

Patients with mild to moderate osteoarthritis of the knee or hip should participate in a regular exercise program (e.g. a supervised walking program, hydrotherapy (water cure) classes) and, if overweight, should follow a healthy and balanced diet. The use of assistive devices can improve functional status.

Medical Management

  • Oral nonsteroidal anti-inflammatory drugs (NSAIDs) – Common NSAIDs are ibuprofen and diclofenac; painkillers.
  • Topical therapies – Topical NSAIDs are applied to unbroken skin where it hurts in the form of gels, creams, sprays, or plasters.
  • Intra-articular injections – A term used to define a shot delivered directly into a joint with the primary aim of relieving pain.

Surgical Measures

Total hip and knee replacements provide excellent symptomatic and functional improvement when the involvement of that joint severely restricts walking or causes pain at rest, particularly at night. Total Knee Replacement is one of the most common surgeries in the world with a large majority of patients going on to lead rich, happy and healthy lives. It requires a surgery of 1-2 hours followed by a hospital stay of 2-3 days.

The knee is the human body’s largest joint and is made up of the lower end of the thighbone, the upper end of the shinbone and the kneecap. A knee replacement includes replacing some or all of the component surfaces of the knee joint with artificial implants. A knee replacement is performed to repair the damaged weight-bearing surfaces of the knee joint caused due to inflammatory diseases or injury. The damage over time leads to extreme pain and can restrict joint mobility. Knee replacement is a major surgical procedure requiring hospital admission for 2 to 3 days.

Depending on the severity of the disease your doctor will suggest the best line of treatment to treat Osteoarthritis.

The Knee and its Structure

The knee is human body’s largest joint and its healthy maintenance is required to perform most of everyday activities, easily. The knee is made up of the lower end of the thighbone which is called the femur, the upper end of the shinbone which is called the tibia, and the kneecap which is called the patella. The ends of these three bones where they meet are covered with a smooth substance that protects the bones and enables them to move easily (articular cartilage). The C-shaped wedges located between the femur and tibia are menisci. These act as “shock absorbers” that cushion the joint. Large ligaments hold the femur and tibia together to provide stability, the long thigh muscles provide strength to the knee. Large ligaments hold the femur and tibia together and provide stability whereas, the long thigh muscles provide strength to the knee. All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage, reducing friction to nearly zero in a healthy knee. Normally, all of these components work in harmony. But disease or injury can disrupt this harmony which results in pain, muscle weakness, and reduced function.

What is Arthritis and different types of arthritis?

The most common disease responsible for disrupting the harmony and causing chronic knee pain and disability is arthritis. Swelling and tenderness in any of the joints of our body, including the knees is referred as arthritis.

Although there are many types of arthritis, mostly knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

  • Osteoarthritis is an age-related type of arthritis. It occurs in people 50 years of age and older but may occur in younger people, too. In this type of arthritis, the cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
  • Rheumatoid arthritis is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”
  • Post-traumatic arthritis is a type of arthritis that can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, leading to knee pain and limiting knee function.

Treatment of Arthritis

Treatment of arthritis concentrates on providing relief from symptoms and improving function of the joint/knee. You may need to try multiple treatments or combine several treatments from the following to help you in getting relief from your arthritis.

  • Lose some weight (in case of overweight or obese patients)
  • Exercise: Muscle strengthening around the knees through exercise restores stability of the knee joint and reduces pain. Stretching of muscles through exercise aids in maintaining the mobility and flexibility of the knee joint
  • Pain-killers: These include over-the-counter paracetamol, naproxen, diclofenac, etc. However, these should not be continued for more than 10 days without your doctor’s consultation.
  • Corticosteroid or hyaluronic acid injections directly in the knee: Corticosteroids act as powerful anti-inflammatory agents whereas hyaluronic acid is a kind of lubricant in the knee.
  • Alternative therapies such as topical counter-irritant creams containing capsaicin, acupuncture therapy or supplementation with glucosamine and others can sometimes help to improve arthritis symptoms.
  • Physical or Occupational Therapy can also aid in teaching you ways of performing routine activity through exercises or alternate ways of performing routine work.
  • Using braces: Devices such as braces can either transfer the weight from the sides of the knee affected by arthritis or even support the entire knee.
  • Surgery: When every treatment from the above options fail to provide relief from arthritis of the knee, your doctor can recommend surgical options such as arthroscopy (removing the debris in the joint through a tiny telescope and other small equipments), osteotomy (altering the alignment of the knee by changing the knee’s shape) or total knee replacement (where the natural worn out knee joint is replaced by an artificial knee joint made of metals or plastic).

Usually, the treatment of arthritis is dependent on the specific type of arthritis present. But, sometimes the patients may need to try several different treatments, or combination of treatments before they determine what works best for them. However, in most cases, an exact diagnosis increases the chances for successful treatment of arthritis. After undergoing treatment, the doctor may recommend some physical therapy to help the patient regain strength in the knee and to restore range of motion making it possible to perform daily activities more effortlessly.