After a total knee replacement, 5- 6 days of hospitalization is sufficient. This is to provide pain relief and mobilize you. After a bilateral total knee replacement you will remain for a week after the second operation, so that makes two weeks of hospitalization.
You can do so within 24 – 48 hrs after the operation.
If you are young & fit, then both knees can be done in one sitting( Bilateral simultaneous TKR). Other wise I operate on the second knee a few days or months after the first knee and you have had time to recuperate. Many elderly patient’s health condition only allows a sequential knee replacement.
You may need a walker for about 15 days and a cane or crutches for another fortnight. Then you can walk without any aids.
I can operate on patients with notice of a day or two for simple and straight forward knee and one week for revision knees.
Post operative pain is controlled to tolerable levels by excellent multi modal anesthesia with an epidural block and analgesics. Two to three weeks of pain medication are required for most people.
A primary total knee replacement takes between about an hour to 90 minutes. Anesthetic induction time is about 30 minutes. Extubation and shifting takes another 15 minutes. The turnaround time is about 3 hours A difficult knee may take about two to two and half hours.
You can have the operation done under general anesthesia (fully unconscious) or a regional anesthesia( spinal or epidural) in which you will be sedated but not knocked out. Regional anesthesia is a safe mode for diabetics and elderly people. Both are often supplemented by regional nerve blocks.
Many patients in our practice are diabetic. The diabetologist will try to bring your sugar levels to within normal levels. Our anesthetists are very competent at epidural anesthesia and hence the operation is pretty safe. Wound healing is good in well controlled diabetes. If not, control is achieved and then I operate.
Non impact sports like walking, golf are allowed. You can walk as much as you want. This is the purpose of the operation to allow you to regain mobility.
This depends on the nature of the job. A sedentary or desk top person will find it possible after a month. If the job involves a lot of time on the legs or walking, then it takes about two months.
You can certainly drive a car when you are ready to give up crutches. This varies but the earliest that my patients have done so is at 3 weeks. If you need to use aid for longer then it is advisable to self drive after you are support free.
The ideal age is more than 60 years after you have exhausted all conservative measures like painkillers (analgesics), a cane and shoe inserts. However I have done knee replacements for a few patients under 50 years and my youngest is a 32 year old with severe Rheumatoid arthritis. For young people with advanced x- ray changes and severe pain, I have no other option but to offer them a TKR. In the elderly patient with one half involvement alone, I offer them a half knee replacement (unicondylar knee)
Post op bending achieved is largely dependent on the pre op bend, body mass index (BMI) & your motivation. With the High Flex knee, you can get about 155 degrees. This is desired by people from the Indian sub-continent. Even people from the west now want more than 90 degrees of bending. Off course you must be willing to go the extra mile to gain this amount of movement by physiotherapy. Standard knees allow about 110 degrees of bending.
When the cartilage has worn away in both knees, artificial knees (called prostheses) can take their place. The surgery to resurface both knees is termed a bilateral Total Knee Replacement. The knee replacement recreates almost normal function of the knee, and its main goal is to relieve pain. It may also help to restore motion of both knees and straighten the limbs.
simultaneous procedure means that both knees are replaced on the same day, under one anesthesia. This takes place as a single surgery, within one hospital stay and is followed by a single rehabilitation period.
The staged procedure means that the knee replacements are performed as two separate surgical events. Surgeries are typically performed several days or months apart.
The most common reason for a Bilateral Total Knee Replacement is severe arthritis in both knees which are symptomatic interfering with the patient’s activities of daily living and reducing the quality of life. Usually complaints are worst with weight bearing activities, as standing and walking. Untreated, knee arthritis is usually painful, functionally limiting, as it progressively compromises the patient’s independence over time. Another indication is significant deformities in both knees, a situation in which failure to correct both knees deformities at the same time would compromise the clinical result.
The advantages of having a simultaneous procedure include: only one surgical event, a single anesthesia, a shorter overall hospital stay, and the possibility of rehabilitating the patient symmetrically.
The disadvantages of having a simultaneous procedure include a probable risk increase in cardiovascular & renal complications and a higher possibility of requiring banked blood after surgery. This procedure is not available to every patient with arthritis in both knees, because it implies a high stress for the cardiovascular system. Only patients with good cardiovascular, renal parameters are good are accepted. The initial rehabilitation is slightly more difficult as you literally have “no good leg to stand on”.
The advantages of having a staged procedure include apparently lower stress level for the cardiovascular system, fewer complications related to the heart, a lower incidence of blood clots within the deep veins, as well as a lower possibility of requiring banked blood after surgery. This is an excellent choice for patients with cardiac, vascular or pulmonary diseases or above 80 years old.
The disadvantages of having a staged procedure are that it requires two hospital stays, two anesthesias and delays full return from disability. However a sequential bilateral knee replacement done a few days apart, obviate these negative points. The total duration of the hospitalization will be about 14 days.
In both type of procedures, Simultaneous and Staged, results are excellent and equivalent in terms of relieve of pain and daily activities. Patients should expect a greater than 95% chance of success at 15 years.
Yes. There are some contraindications and this is why we believe that the selection of the appropriate patient determines the outcome of the simultaneous procedure. The usual contraindications for knee replacement include an active knee infection, or severe neurologic compromise of the leg. This procedure is also relatively contraindicated in patients with significant cardiac, lung and/or vascular disorders that may increase the possibilities of potential problems. Patients above 75 years old typically are not recommended to have a simultaneous procedure due to the risks that it involves.
The ideal candidate for a simultaneous Total Knee Replacement should be younger than 75 years old, without associated cardiac, pulmonary or vascular diseases. This patient should also complain of severe arthritic pain equally symptomatic in both knees, that interferes with his/her activities of daily living and significantly reduces the his/her quality of life.