Knee & Joint Replacement Surgeon - About Knee Surgery

The knee is one of the largest and most complex joints in the body. The knee joins the thigh bone (femur) to the shin bone (tibia). The fibula, smaller bone that runs alongside the tibia and the kneecap (patella) are the other bones that make-up the knee joint.

Tendons connect the knee bones to the leg muscles that move the knee joint. Ligaments join the knee bones and provide stability to the knee:

  • The anterior cruciate ligament prevents the femur from sliding backward on the tibia (or the tibia sliding forward on the femur).
  • The posterior cruciate ligament prevents the femur from sliding forward on the tibia (or the tibia from sliding backward on the femur).
  • The medial and lateral collateral ligaments prevent the femur from sliding side to side.

Two C-shaped pieces of cartilage called the medial and lateral menisci act as shock absorbers between the femur and tibia.

Numerous bursae, fluid-filled sacs, help the knee move smoothly.

Dr.Aditya khemka has a special interest in ACL Reconstruction using anatomy preserving technology and Knee Replacement Surgery using computerized navigation technology. He is one of the best knee replacement surgeon in mumbai.

Frequently Asked Questions

Why Would Someone Need Total Knee Replacement?

Total knee replacement is often necessary after the cartilage between a patients femur and pelvis wears out. Osteoarthritis often results from the lack of cartilage and leaves patients with severe achy pain and immobility. Typically, a knee replacement is not performed unless nonsurgical methods fail to relieve knee pain. 

 

What Happens During a Total Knee Replacement?

While the patient is under anesthesia, the knee is cut open and the arthritic bone in the socket of the joint is cleaned out. The surgeon also removes arthritic bone from the femur and the tibia, then inserts an artificial prosthesis. The joint is then complete and the surgeon shaves arthritic bone from the knee cap before replacing it and closing the incision. 

The future of Total Knee Replacement Surgery ?

Real-time Computer Navigation is a relatively new approach to Total Knee Replacement Surgery, which helps the patients improve their clinical outcomes. 

What is computer navigation?

It involves the creation of a 3-D model of your knee in real time during surgery. This is done using safe infrared technology and doesn’t, require any CT scan or radiation. The surgeon use temporary pins in the bones and a hand held probe with infrared reflective balls attached to precisely map out the 3-D anatomy of the knee onto a computer. The computer then calculates the optimal alignment. The surgeon is in total control of this process, he can double check the plan and easily make real-time adjustments. Using this technology, it is possible to achieve within half a degree of accuracy, which is more accurate than a human eye can detect. 

Why does alignment matter?

Studies have shown that poor alignment is detrimental to long-term outcomes of knee replacements. It has long been accepted that just 3 degrees of error in alignment leads to an increased rate of failure.  

That all sounds great but does it work?

A comparison I like to use is of navigating when driving a car. The old technology is like using a map and which gets us there safely most of the time. Computer navigation is a bit like a GPS.  The surgeon remains in control but the computer allows choosing the optimum route, gives advice, and if it does go off track, the course can be corrected. Reviews have clearly shown that computer navigation improves the alignment of knee replacements compared to the traditional manual technique and would also lead to better outcomes for patients. No other technology is so versatile and hence this in my opinion is the gold standard for knee replacement surgery.  

Will I Be Pain-Free After My Surgery?

Although patients are sore after surgery, most knee replacement patients report being completely pain-free after 4-6 weeks. Additionally, 95% of knee replacement patients reported having less pain one year after their surgery than before it, according to Total Knee Replacements. 

Can I sit on the floor/squat/crossed legged?

One can sit on the floor now normally six months after the surgery. This clearly depends on how one does the surgery and the use of certain implants. 

But it isn’t advisable to do so after a knee replacement keeping in mind the chances of a wear provided in an artificial joint. 

How Long Will I Have to Stay in the Hospital?

Under the care of Dr. Khemka stay for just 2-3 days, and then are back in the comfort of their own home to recover.  

 

Before you are discharged from care, you will need to accomplish several goals, such as: 

  •  Getting in and out of bed by yourself.
  •  Having acceptable pain control. 
  • Being able to eat, drink, and use the bathroom. 
  • Walking with an assistive device (a cane, walker, or crutches) on a level surface and being able to climb up and down two or three stairs. 
  • Being able to perform the prescribed home exercises. 
  • Understanding any knee precautions you may have been given to prevent injury and ensure proper healing. 

How Long Will I Have to Take Off Work?

It is recommended that patients take 2-6 weeks off of work depending on their occupation. Patients who have a desk job can typically go back to work sooner than patients who have manual labor jobs or have to be on their feet often. 

How Long Will Full Recovery Take?

Patients should be able to move around the house after 4-6 weeks without experiencing pain or using walking aids. After that point, the amount of time that is necessary for a full recovery varies between patients. Some patients recover extremely quickly—within a month or two—while others require a full six months before returning to their pre-surgery levels of activity. 

Will I Need Physiotherapy?

Yes. Physical therapy is an essential part of your total knee replacement recovery process. Physical therapy begins the following day of your surgery and will take place over the course of several weeks. At first, you will do some simple exercises like contracting and relaxing your muscles in order to strengthen your knee. You will also learn new techniques for movements such as sitting, standing, and bending, in order to prevent any possible damage to your knee replacement. Typically patients are in physical therapy for 6-8 weeks and have sessions twice/week. 

How Long Before I Can Drive After Surgery?

Some patients may drive as soon as 2 weeks after surgery, while others may need as long as 8 weeks. During this period, simply getting in and out of a car can be challenging, especially if the cars seats are low to the ground. In order to drive a car safely, patients must meet the following requirements: 

  • The patient must be off of narcotic pain medication while driving. If the patient takes pain medication at night only and not during the day while driving, that is acceptable. 
  • The patient must be able to hit the brake quickly. 
  • The patient must be able to get in and out of the car comfortably and safely. 

In addition, reflexes and muscle strength should have returned to their pre-surgical levels

What Are the Risks of Knee Replacement?

Here is a list of potential post-surgery complications: 

  • Blood clots 
  • Infection 
  • Fracture 
  • Dislocation 
  • Loosening 
  • Need for second knee replacement 

Dr. Khemka and your physical therapists will evaluate your risk for complications and provide specific treatments to avoid these risks. 

 

What is the cost of the Total Knee Replacement Surgery?

The cost of the surgery is normally divided in two parts. One of which includes the hospital stay, operating room charges, use of consumables, pharmacy, surgeon charges etc and the latter which includes implants depending on what is to be used. 

All these costs are normally covered by the insurance company, and we can organise packages with the hospitals where he operates to minimise your burden in the absence of insurance.  

 

Dr. Khemka would be happy to provide all the information to you during consultation

Know About Different Knee Surgeries

Knee arthroscopy is an excellent minimally invasive operation that allows thorough visualisation of the knee joint necessary for diagnosing and addressing various pathology both inside and outside the knee joint.

Knee Arthoscopy

A tumour replaces healthy tissue with abnormal tissue and can weaken the bone causing it to break or fracture.Tumour growth or behaviour will vary according to the type of tumour and depending on whether the tumour is non-cancerous (benign) or cancerous (malignant).

Tumour

Arthritis is often referred to and thought of as a single condition. But it is actually an umbrella term for more than 100 different conditions which affect the musculoskeletal system and joints where two or more bones meet.

Arthritis

The Anterior Cruciate Ligament (ACL) is one of the major stabilising ligaments in the knee. It is a strong rope like structure which is located in the centre of the knee and runs from the femur to the tibia.

ACL Reconstruction

Knee Arthroplasty, otherwise known as Total Knee Replacement, is a surgical procedure which replaces an arthritic knee joint with an artificial joint. The aim is to take away pain, restore function and preserve anatomy.

Knee Arthroplasty

The patella (kneecap) is a thick, circular-triangular bone which articulates with the femur (thigh bone) and covers and protects the anterior articular surface of the knee joint. It is part of the extensor mechanism of the knee (quadriceps muscle).

Patellar Malalignment

The Medial Patellofemoral Ligament (MPFL) is the primary medial stabiliser of the patella (knee-cap).The role of this rope like ligament is to prevent the knee from lateral dislocation (dislocating to the outer side of the knee) and subluxation (partial dislocation of the joint).

MPFL Reconstruction

The Anterior Cruciate Ligament (ACL) is one of the major stabilizing ligaments in the knee. It is a strong rope like structure which is located in the centre of the knee and runs from the femur to the tibia.

ACL Rupture in Children

The tibial plateau is one of the most critical load-bearing areas in the body and is located on the upper extremity of the tibia. It is composed of two slightly concave condyles (the round prominences of a bone) separated by an intercondylar eminence and the sloping areas in front and behind it.

Tibial Plateau Fracture

Knee Arthroplasty, otherwise known as Total Knee Replacement, is a surgical procedure that replaces an arthritic knee joint with an artificial joint. The aim is to take away pain, restore function and preserve anatomy for patients who suffer from osteoarthritis of the knee.

Knee Unicompartmental Replacement

Osteotomy is a surgical operation where a bone is cut to shorten, lengthen or change its alignment. Knee osteotomy is commonly used to realign arthritic damage on one side of the knee. The goal is to shift the patient’s body weight off the damaged area and onto the other side of the knee where the cartilage is still healthy.

High Tibial Osteotomy