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Total Knee and Hip Replacement

What are total knee and hip replacement?

A total knee and hip joint replacement are a surgical procedure that involves replacing the worn-out or damaged joints of the knee and the hip with a prosthesis (artificial joint) made of metal, or plastic. The parts of a knee joint that can be replaced include the femur (the lower part of the thighbone), tibia (the upper part of the shin bone) and patella (the back portion of the kneecap). The parts of the prosthetic hip joint consist of a stem, the ball, and a cup.

Why are total knee and hip joint replacement recommended?

A total knee and hip joint replacement are recommended for patients with severely damaged knee and hip joints due to osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, or injury. Arthritis stiffens the joints making it painful and harder to walk even for shorter distances. The joint replacement of the knee and hip are usually considered when therapies like medications, exercises, or other therapies have not been helpful.  

How is it performed?

Total Knee Replacement: Surgery for replacing the knee joint (also known as total knee arthroplasty) is performed either under general anaesthesia, or spinal or epidural anaesthesia. The knee is opened using an incision of 8 - 10 inches long. The kneecap is moved so that the damaged part of the cartilage at the end of the thighbone and shin bone can be cut and replaced with a metal prosthesis. In between the metal prosthesis, a medical-grade plastic spacer is inserted for a smooth gliding surface. The back portion of the kneecap is replaced with the prosthesis which is usually made of strong plastic. 

Total Hip Replacement: Surgery for replacing the hip joint (also known as total hip arthroplasty) is performed either under general anaesthesia or spinal or epidural anaesthesia. Traditionally, hip replacement surgery uses longer incisions over the hip joint. In a more advanced approach, few smaller incisions on the hip joint are made to access the hip joint (minimally invasive hip replacement). The damaged cartilage and bone are removed and replaced with hip prosthetics made of metal, plastic, or ceramic. The stem is fitted into the femur or the thigh bone, a ball or the head joint is fixed onto the stem and a cup is placed inside the hip joint socket. 

After fixing the knee and hip joint prosthetics, pins, screws, or cement is used to secure the new joint in place. The incision is closed and dressed to prevent infection. 

Manipal Hospital is the best hip replacement hospital in Delhi providing state-of-the-art diagnosis, outpatient treatment and rehabilitation for all types of musculoskeletal conditions.

Advantages of total knee and hip replacement surgery

  • Total knee and hip replacement surgery help relieve knee and hip pain that cannot be treated with medication, exercise, or other treatments.

  • Prosthesis effectively restores the alignment and function of the knee and hip.

  • After a knee and hip joint replacement procedure, the patient is able to lead a normal life and do routine activities independently.

Cause of Total Knee Replacement (TKR)

The most common cause of chronic pain and disability in the knee that leads to total knee replacement surgery include: 

  • Osteoarthritis: It is a type of arthritis that occurs mostly in people over 50 years of age. As a person ages, and with the wear and tear of the bones over the years, the cartilage that protects the knee bones wears away causing the bones to rub against one another leading to pain and stiffness of the knee. 

  • Rheumatoid arthritis: The synovial membrane around the knee joint becomes inflamed and damages the cartilage which cushions and protects the knee joint. 

  • Post-traumatic arthritis: Any injury causing damage to cartilage or bone of joint leading to premature arthritis of the joint.

If you are looking for the best hospital for knee replacement in Delhi then visit Manipal Hospital and consult the best orthopedic surgeons who are an expert in using the latest techniques and technology to improve care for people with musculoskeletal problems.

Cause of Total Hip Replacement (THR)

The most common cause of chronic pain and disability in the hip that leads to total hip replacement include: 

  • Osteoarthritis: It is a type of arthritis that occurs mostly in people over 50 years of age or those with a family history of arthritis. As a person ages, and with the wear and tear of the bones over the years, the cartilage that protects the hip bones wears away causing the bones to rub against one another causing pain and stiffness of the hip.

  • Rheumatoid arthritis: This is an autoimmune disease or inflammatory arthritis in which the synovial membrane around the hip joint becomes inflamed and damages the cartilage which cushions and protects the hip joint.

  • Post-traumatic arthritis: Any injury causing damage to cartilage or bone of joint leading to premature arthritis of the joint.

  • Osteonecrosis: Also known as avascular necrosis, osteonecrosis is caused when the joint of the hip dislocates or fracture, impairing the blood supply to the femoral head leading to the collapse of the bone surface. 

  • Childhood hip disease: In infants and children with hip problems, the hip may not grow normally, affecting the joint surfaces. 

When is surgery recommended?

Total Knee Replacement: Surgery is recommended when other treatments like anti-inflammatory medications, lubricating injections, cortisone injections, or physical therapy have failed to offer relief from knee pain and stiffness in patients who find performing everyday activities like walking, bending, sitting, or standing an ordeal due to severe knee pain and stiffness; when knee pain continues even while resting or sleeping; when knee swelling does not subside with rest and medicines, or those with bowed-knee deformity.

Total Hip Replacement: Surgery is recommended when other treatments like anti-inflammatory medications, or physical therapy have failed to offer relief from hip pain and stiffness in patients who find performing everyday activities like walking, sitting, or standing an ordeal due to severe hip pain and stiffness, and when hip pain continues even while resting. 

If you are looking for the best hospital for hip replacement surgery in Delhi then visit Manipal Hospital and consult the best orthopedic surgeons who are an expert in using the latest techniques and technology to improve care for people with musculoskeletal problems.

The Orthopaedics Evaluation

An orthopaedic evaluation is performed to assess your condition and determine the best treatment that can offer relief from the chronic pain, stiffness, and disability of your knees, or hip. An orthopaedic evaluation usually includes:

  • Medical history: Your orthopaedic surgeon will ask about your general health and about the severity of knee, or hip pain while doing everyday activities. 

  • A physical examination will be performed to assess knee, or hip motion, strength, stability, and overall alignment.

  • X-rays help to assess the severity of damage and deformity of the knee or hip.  

  • Other tests including blood investigations, advanced imaging tests like MRI, etc., may also be performed to assess the bone and soft tissues of your knee or hip.

Outcome

There may be some numbness at the incision site and some level of stiffness which is common and may resolve with some time. Most patients are able to bend their knee or kneel much better than they would before the implantation. You may also feel the clicking of the metal and plastic while bending or walking, which is normal. The new metal implants in your knee or hip may activate metal detectors at airports, malls, etc. Inform the security agent about your knee or hip replacement surgery in such cases.

Precautions after Surgery/Possible Complications

After surgery, you must take some precautions such as avoiding injuries, falls, aggressive motion, etc as they may cause fractures or break a bone which may require more surgeries. Light physical activity or exercises may help strengthen and mobilize your new knee or hip. You may have to contact your orthopaedic surgeon in case of a dental procedure that requires taking antibiotics. Make sure not to miss any of your routine follow-up examination and x-rays. 

Knee and hips surgeries are safe and effective. Complications post knee or hip surgery is usually low. Less than 2% of patients have reported some serious complications like knee joint infection. Some possible complications encountered after knee or hip surgeries are: 

  • Infection: Infection in the incision site or near the implant may occur within days or weeks of surgery or even after years. Major infections may require another surgery while minor infections are generally treated with antibiotics. Infection in other parts of your body can also spread to your knee or hip joint replacement.

  • Blood clots: One of the most common complications of knee or hip replacement surgery or any surgery is the formation of blood clots in the veins of the leg (pelvis, calf, or thigh). They become life-threatening when they reach your lungs or heart via circulation. Medication like blood thinners, early mobilization, stockings, and periodic evaluation of your legs by a doctor can prevent this complication.

  • Leg-length Inequality: Especially after a hip replacement, patients may feel that one leg is longer or shorter than the other. 

  • Dislocation: The risk of the ball coming out of the hip socket, especially during the first few months of surgery, is high. However, this problem can be rectified.  

  • Wear and tear of the Implant: Implant components may loosen, and its surface may wear and tear with time even with advanced and improved implants. Scarring of the knee or hip may occur, restricting the movements.  

  • A few patients continue to have pain even after a knee or hip replacement. However, this is very rare. 

  • Neurovascular injury: Rarely, nerves or blood vessels around the knee or hip can get damaged during the surgery.

Activities to avoid at home/daily routine after both TKR and THR surgeries

Significant improvement in pain relief and the ability to perform regular activities are the benefits of the TKR or THR surgeries. Therefore, due care must be exercised to continue to enjoy these benefits. Avoid gaining weight, lifting heavy weights, or doing high-intensity exercises such as jumping, running, skipping, etc, which may cause the implants to loosen and dislocate. However, you can do activities like walking, swimming, driving, etc regularly. With normal activity, knee or hip replacements can last for several years.

Frequently Asked Questions

1) When is it time for knee replacement?

The decision to have a knee replacement must be taken by you, along with your family, your doctor, and your orthopaedic surgeon. Surgery is usually recommended when other treatments like anti-inflammatory medications, lubricating injections, cortisone injections, or physical therapy fail to offer relief from knee pain. If performing everyday activities like walking, bending, sitting, or standing becomes an ordeal due to severe knee pain and stiffness and if you experience knee pain even while resting or sleeping; or when knee swelling does not subside with rest and medicines, or if someone wants to correct their bowed-knee deformity surgery is performed. Consult the best hospital near you for knee replacement surgery in Delhi NCR.

2) How long will the implants last after TKR and THR surgery?

For most patients, with total knee replacement prosthesis, or hip replacement prosthesis, the implants may last from 10 to 20 years or even longer. 

3) How do I prepare my home for recovery?

Before you go for your knee or hip replacement surgery, setting up your home for recovery is very important and makes your life easier. Prepare your bed a bit low so that your feet touch the floor when you sit on the edge of the bed. Place a firm mattress on the bed and if possible, set your bed on the ground floor so that you can avoid the stairs. Also, make sure you have an attached bathroom as well. Stock up provision and if you are staying alone, arrange for help who can cook, clean, or give you a bath. Keep items like phones, drinking water, etc., nearby so that you will not strain your body by walking to reach those items. Set up your bathroom with sidebars, anti-skid mats, etc, and keep your soap, shampoo, scrub and other things within your reach.    

4) What should I expect immediately after knee replacement?

Immediately after knee replacement surgery, you may wake up with some pain or burning sensation in your legs which is normal. Pain relief medicines are given to make you feel comfortable. You may be asked to slowly sit up and start walking to strengthen your body. Sometimes continuous passive motion machines are used to slowly move the affected leg. Most patients are discharged from the hospital within 1 to 5 days and are able to resume their everyday activities about 6 weeks post-surgery. Complete recovery may take upto 6 months. The most crucial part of recovery is to avoid strenuous activities, regain strength and mobility as soon as possible and avoid complications. Healing may take a bit longer in elderly people, or those with underlying medical conditions, or those who smoke and drink alcohol.   

5) What should I expect immediately after hip replacement?

Recovery after hip transplantation largely depends on how well you care for yourself and follow the instruction of your orthopaedic surgeon. Medications for pain relief after surgery is given to make you feel comfortable. Stitches or staples will be removed after 2 weeks. Take care not to wet the surgical wound. Always keep it dry and free from infection. Loss of appetite is common but make sure to have a balanced diet and plenty of fluids which is important to promote healing. Walking or light exercise is critical for healing. Within 3 to 6 weeks of surgery, you should be able to do your everyday activities. 

6) Can I avoid a hip replacement?

Hip replacement surgery can be prevented by losing weight so that the pressure on the hip joints is reduced and performing exercises like leg lift, stretching, etc to strengthen the gluteal muscles of the buttocks and flexors in the pelvis and increase flexibility.

7) How much pain will I have after the surgery?

Pain after a joint replacement can vary. According to some patient’s experiences, knee replacement surgery is more painful than hip replacement surgery. Post-surgery, due to swelling, the knee becomes a bit stiff and painful to move.

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