Knee Replacement


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.

The word ‘arthritis’ is used to describe pain, swelling, and stiffness in one or more joints. However, it is not a single condition and there more than 100 types of arthritis and related conditions. The underlying cause varies with specific types of arthritis. It can cause everlasting joint changes and the common joint symptoms may include swelling, pain, stiffness, and decreased range of motion gradually.

These differences may be noticeable, such as lumpy finger joints, but usually, the damage can only be detected on X-ray. Apart from joints, some types of arthritis also affect the heart, eyes, lungs, kidneys, and skin. Although there are numerous types of arthritis, the two most common ones are Osteoarthritis and Rheumatoid arthritis.


Osteoarthritis is a chronic (long-lasting) joint condition, affecting millions of people globally. In this case, the cartilage (protective tissues covering the ends of bones forming a joint) breaks down, causing the bones within the joint to rub together. Other causes may include dislocated joints and ligament injuries.

Signs that you may have Osteoarthritis:

  • Joint stiffness and soreness
  • Grating sensation
  • Bone spurs
  •  Loss of flexibility

Treatment of Osteoarthritis

A) 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.

B) 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.

C) 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 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 overtime leads to extreme pain and can restrict joint mobility. Knee replacement is a major surgical procedure requiring hospital admission for 2 to 3 days.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease; a condition in which your immune system mistakenly attacks your body. It happens when your immune system targets your joints lining. While RA affects joints on both sides of the body such as both hands or both knees, it can also affect your whole body.

Signs that you may have Rheumatoid arthritis:

  • Joint pain, swelling, and tenderness
  • Morning stiffness for at least 30 minutes after waking up
  • More than one joint affected (hands or wrists)
  • Fever

Treatment of Rheumatoid arthritis

The primary objectives in treating rheumatoid arthritis are reduction of inflammation and pain, preservation of function, and prevention of deformity. Success requires early and effective medication. Disease-modifying anti-rheumatic drugs (DMARDs) should be started as soon as the diagnosis of rheumatoid disease is certain and then adjusted with the aim of suppressing disease activity. NSAID drugs are members of a drug class that reduces pain, decreases fever, prevents blood clots, and in higher doses, decreases inflammation and provides some symptomatic relief in rheumatoid arthritis but do not prevent erosions or alter disease progression. They are not appropriate for monotherapy (therapy that uses one type of treatment) and should only be used in conjunction with DMARDs, if at all.

Possible causes of arthritis may include injury, abnormal metabolism, inheritance, infections, or immune system dysfunction. Seek immediate medical care if you have swelling or stiffness that doesn’t go away in a few days or if it becomes too painful to touch your joints. If joint pain isn’t connected to any recent injury, you must immediately consult your doctor.

It’s normal to have joint pain occasionally, but when the pain starts interfering with your daily movements, it’s time to seek medical help. The initial move is to get an accurate diagnosis of what’s causing your joint pain.  You may be later referred to a rheumatologist or orthopedist (Doctors who specialize in arthritis and related conditions). During the medical examination, your doctor may ask questions related to your symptoms and medical history to assess your situation.

Although there’s no particular cure for arthritis, treatments have developed gradually. The treatment for arthritis aims at controlling pain, lessen joint damage, and enhance the quality of life. A variety of medicines and lifestyle changes can help accomplish this and protect joints from additional damage.

Mr. Gonsalves was leading a normal and active life till arthritis crept up and set his life in turmoil. From being an active 60+ grandpa, he soon became confined to his bed and dependent on his walker. After years of physical therapy, medication and non-invasive procedures, the pain simply did not subside. Faced with debilitating pain that prevented the senior citizen from even getting a good night’s sleep, his family doctor and orthopedic surgeon recommended a Total Knee Replacement as the solution to the problem at hand. Six months post-surgery,
Mr. Gonsalves is now a changed man who has gained a new lease at life. Here is his side of the story.

What made you choose to undergo a Total Knee Replacement?

Unfortunately, all the initial efforts at managing my condition like physical therapy, medicine and more, failed and I was left battling the pain and restricted movement. As someone who previously led a very active life, picking up my grandchildren from the bus stop, going for a walk with my friends every morning, this condition started affecting me mentally and emotionally. Lastly, my family doctor and orthopedic surgeon recommended Total Knee Replacement as the solution to my condition.

Was it an easy decision to make?

To be honest, I was a little apprehensive about undergoing the surgery as would anyone who is in this situation. Fortunately, both my family doctor and orthopedic surgeon were very helpful when it came to assuaging my doubts and fears. They told me that this procedure is one of the most common orthopedic surgeries in the world with a vast majority of people experiencing significant improvement in pain and mobility after the procedure. The final decision to undergo the surgery was made cooperatively by me, my family, my family physician, and my orthopedic surgeon. Here I must add that my family physician first referred me to an orthopedic surgeon for a thorough evaluation to determine whether I might benefit from this surgery.

Would you recommend a knee replacement surgery to lakhs of people suffering from knee pain?

Only if your condition is unmanageable through non-invasive means like mine was, will they recommend the surgery.  In fact, your orthopedic or family doctor won’t recommend you undergo one without due cause. In most cases, the patient’s family doctor will recommend the patient to an orthopedic surgeon who will evaluate if the patient is the right candidate for Total Knee Replacement. This was the process that I myself underwent before undergoing the surgery. From what I realized after having spoken at length with my orthopedic surgeon is that they only recommend surgery if:

  • The patient has severe knee pain that restricts their movements. These include regular movements like walking, climbing stairs and sitting in and getting off chairs. The knee pain in such cases is usually so severe that one cannot walk too far without significant pain or the use of a cane or walker.
  • The pain interferes with the patient’s resting or sleeping both during day and night.
  • The inflammation and swelling are severe and do not improve with rest and medications.
  • The knee starts showing signs of a deformity like bowing in and out.
  • Lastly, when everything from anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries have failed.

How is your life post-surgery?

To say that it is incredible is an understatement! I feel as if I have got a new lease in life. The reduction in stiffness was almost immediate after the surgery. The pain took some time to go, but that was because of the surgery itself. Now I can confidently state that I am pain-free and happy! I was able to walk with the help of a walker almost 24 hours after surgery and was driving within 6 weeks. I am back to my old routine and my grandchildren are thrilled to have their grandpa back at school pick-up duty! Going for walks and socializing with my friends is also something I really enjoyed getting back to. All those years of pain and discomfort seem like a bad memory now. I am so glad to have undergone the surgery and would advise anyone in severe and unmanageable knee pain to undergo the surgery instead of waiting for their condition to worsen. I made my choice and I am truly thankful that it was the best one for me!

Are you recovering from Total Knee Replacement or TKR? Congratulations! You made it past the first hurdle! With a little attention and care, you will soon be back on your feet! Can’t figure what is allowed and what is not? Here is a simple guide to post-op healing to help you put your best foot forward!

The knee is 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 overtime leads to extreme pain and can restrict joint mobility. Knee replacement is a major surgical procedure requiring hospital admission for 2 to 3 days.

A knee replacement could be more precisely termed as knee “resurfacing” as this procedure actually involves replacement of the surface of the bones.

What should I particularly pay attention to post surgery?

No surgery is 100% painless and TKR is no different. While the chances of intense pain, complications and inflammation are minimal, there are some things you can do to make the situation more comfortable. The first and foremost thing to remember is to follow your surgeon, medical team and physiotherapist’s orders.

Remember RICE. Rest. Ice. Compression and Elevation should be the new best friend of every post-op TKR patient. The first one needs no explanation. One should rest and that too as advised by the doctor. Keeping the ankle above the heart also helps to decrease the swelling, raise blood circulation and prevent blood clots. Apply an ice pack for 10-20 minutes for 3-4 times a day. If the initial swelling has subsided, you can also opt for a heat pack. Use a compression cloth for additional help.

Do go undergo physiotherapy sessions: Following one’s physical therapist’s orders is paramount to regain one’s health as soon as possible. Perform them just as advised even though it may be uncomfortable at first. Exercise is a great way to get used to your new knee and heal faster too! In fact, post-operative exercises increase circulation which prevents dangerous blood clots. Gentle exercises like quadriceps sets, straight leg raises, ankle pumps, knee straightening exercises and more, are just some of the exercises a post-op TKR patient will be asked to do.

Take the prescribed medications: Adhering to the medical schedule as prescribed by one’s doctor is crucial for one’s healing process. It not only helps in reducing inflammation and pain but also helps avoid infection and blood clots.

Do manage your weight: An increase in weight means more stress on your new knee or even chances of arthritis on your other knee. So keep an eye on your diet and let your body heal itself.

Avoid unnecessary stress to the knee: A healthy body heals faster, more so in case of surgeries like TKR. So while it may not be time to hit the gym yet, one can walk, swim or indulge in other low-impact activities to keep the blood flowing and your body healing. Remember to not twist your knee, sit cross-legged and pick heavy weights of more than 9 kilos at this time.

Consult your orthopaedic surgeon prior to getting any other surgeries: Whether it is a dental surgery or a major operation, it is best to get the green light from one’s surgeon before going ahead as these surgeries may up your infection risk.

Avoid smoking and alcohol: Goes without saying that both these substances can interfere with your healing process and make you more prone to complications. Alcohol especially should be avoided if the doctor has put you on a course of blood thinners or high dose painkillers.

Maintain your posture: Do not engage in activities that jerk your knee or can cause you to fall down. Both these situations must be avoided at all costs.

Don’t hold yourself to milestones: Everybody heals differently. Every patient will progress at their own rate, so don’t be disappointed or stressed if your or your loved one is not progressing as steadily as one would like. Celebrate the accomplishments that you have made and strive for the next.

Warning signs to be on the lookout for

TKR is one of the most common and low-risk surgeries in the world. It sees very few complications with serious complications at a chance of less than 2% and even lesser when it comes to fatal complications. 90% of implant recipients observe a significant improvement in the quality of life and increased mobility. However, there are some risks associated with the procedure that may surface months or maybe even years after the surgery. While there is nothing to be scared of, any chronic significant pain should be discussed with your orthopaedic doctor. Here’s what the pain might signify:

Infection: This is by far the most common complication. An infection is not necessarily postoperative, it can happen months or even years after the main surgery. Sometimes an infection in a different part of the body can affect your implant and cause infection.

Fracture of bone around the knee.

Loosened implant: A loosened implant is not something that happens days or even weeks after the surgery. It can take years to develop and is one of the most common causes of pain post surgery.

Kneecap problems: Issues with kneecaps are a major cause of total knee replacement surgery. However, due to its complex nature, it is difficult to ensure that the new kneecap works just like the original. This requires expertise from skilled surgeons.

Alignment problems: If an implant is badly aligned it may end up not performing as per expectations or indeed exacerbating the issue.

Others: Bursitis, pinched nerves or complex regional pain syndrome are few other rare complications and causes of pain post TKR.

Thanks to advances in technology, TKR patients can now become mobile even faster than before. Adequate rest, exercise, medication and strict adherence to post-op instructions can ensure faster recovery rates and healing outcomes. So go out there and enjoy your new knee without any stress in your mind!

Deciding to get any surgery is an important decision and Total Knee Replacement or TKR is no different. What makes this decision even more vital is the crucial role our knees play in our lives. Needed for the single most common movement in our lives, walking, our knees are a feat of natural engineering. Everything from climbing stairs, running, kicking, squatting and even sitting requires this joint to function smoothly. Which is why it is no surprise that chronic knee issues can make life very difficult for both those who are suffering from the disease and their caretakers or family. In such a scenario, opting for TKR gives the patients and their family a new chance at enjoying an improved quality of life. Wondering if it is the best option for your or your loved ones? Here’s some information that could help your decision-making process.

What is TKR?

One of the most common surgeries conducted in the world today, Total Knee Replacement is a complete replacement of the knee joint with a suitable metal implant. The procedure is conducted under general anaesthesia and takes about 2-3 days of hospital stay. While the final decision rests on you and your orthopaedic surgeon, Total Knee Replacement surgery is advisable for those who are not responding to other treatments, are in significant distress or have been reduced to limited mobility.

The knee is 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 overtime leads to extreme pain and can restrict joint mobility. Knee replacement is a major surgical procedure requiring hospital admission for 2 to 3 days.

A knee replacement could be more precisely termed as knee “resurfacing” as this procedure actually involves replacement of the surface of the bones.

What is the procedure like?

TKR is actually a misnomer which leads people to believe that the entire knee with get replaced. This is certainly not the case! Only the damaged parts of one’s knee are replaced. The surgeon will first remove all the damaged cartilage from the ends of the bones and reshape them. The new implant is then attached to the ends of the bone and a plastic spacer is put between them to reduce friction and ensure smooth movement. If the damage is significant, the surgeon might also replace the back of the kneecap with a plastic button.

Is getting TKR done in India a wise decision?

Absolutely so! In fact, India is fast becoming a hub for TKR, with many foreign patients opting to get operated in India in order to not only save costs but also get treated with the latest tools and technology. What’s more, is that the success rate of TKR in India is deemed to be one of the finest in the world! To add to that, the costs of undergoing TKR in India is significantly less than in other countries. Careful regulation of implant prices by the government also means that TKR need not be a major drain on one’s resources. With a huge pool of trained and skilled orthopaedic surgeons and hospitals equipped with advanced infrastructure, one can rest assured that one’s loved ones are in good hands.

I have heard that TKR recovery involves both pain and inflammation?
Recovering from any surgery requires time, care and precaution, and TKR is no different. As long as you carefully listen to the orthopaedic and follow their instructions carefully, there are very few chances that anything can go truly wrong. To ensure that you or our loved one experience minimal discomfort, here are some things that one can do, like apply an ice pack 3-4 times daily for a minimum of 10-20 minutes. If the cold is an issue, one can also opt for heat packs, but only once the first swelling subsides. Keeping the leg elevated above the heart and performing ankle pump exercises also help to decrease swelling, raise blood circulation, and most importantly, prevent the formation of blood clots. If in case the swelling does not reduce even after regular icing, then it is best to consult your doctor/PT to get a prescription an NSAID medication. Alternatively, one can wear a compression cloth provided by one’s doctor to get relief from the inflammation.

How will TKR benefit my & my loved one’s life?

95% of patients see a significant improvement in the quality of life and mobility post surgery and physi-cal therapy. In the rare 10% of cases, the patient may still end up a degree of pain. That being said, the chances of unsuccessful implantation are pretty rare and complications rarer still and the benefits far outweigh these chances. The biggest benefit of TKR though is the immense quality of life improvement it bestows on the patient. Instead of being bedridden, wheelchair bound or on crutches, they can take on life with a greater enthusiasm and take up their previous hobbies and interests. They can go for walks with their friends and loved ones, attend social gatherings without fear of pain or discomfort and even become more independent. This is especially crucial for older patients as being housebound or having limited mobility reduces their social interactions which can be detrimental to their mental health in the long run.

Is an imported implant better than an Indian one?
Not at all! Indigenous knee implants are not only more cost-effective than their imported counterparts, but they are also a better fit for the Indian knee morphology that is different from those of westerners. Do consult a doctor to get credible solutions for your healthy life.

Many people put off undergoing or discourage their loved ones from undergoing TKR as they feel that medicine and alternative treatments may be better than going under the knife due to the potential complications. Unfortunately, this only makes the patient lead a progressively poorer quality of life. Opting for a TKR with its low complications and the high success rate is not only the right option for those in significant pain and discomfort, but it is also the best way to regain one’s or one’s loved one’s previous quality of life.