TKR ( KNEE REPLACEMENT ) - PRIMARY & REVISION

What is the role of CAS (computer-aided surgery) or 'navigation' in Joint Replacements?

With the aid of some laser markers put on bones and instruments, a computer software can 'guide' the surgeon regarding the direction of bone cuts, and magnitude of soft-tissue releases. However, apart from a few complicated cases, with the most severe deformities, this computer 'guidance' has not been found to add to the accuracy of surgeons well-trained and experienced in Joint Replacements. On the other hand, it makes the surgery longer (thereby increasing the surgical morbidity and infection rate), and more expensive (the navigation system comes at a prohibitive price!). However, few Orthopedic surgeons find it more comforting to use technology, to be sure of their accuracy, and to convince patients that they are giving the best results, which may not be always the case.

Journal Of Bone And Joint Surgery in November 2012 titled Computer-Navigated Versus Conventional Total Knee Arthroplasty: A Prospective Randomized Trial

By Young-Hoo Kim, MD1; Jang-Won Park, MD1; Jun-Shik Kim, MD1

This RANDOMIZED study clearly shows NO DIFFERENCE in clinical results, alignment and survivorship (life) of knees that underwent computer navigated total knee replacement or conventional total knee replacement WITHOUT USING computer.Furthermore a META-ANALYSIS has been conducted by Tao Cheng, Xiao-YUN Pan, Xin Mao, Guo-You Zhang, Xian-Long Zhang and published in the knee journal in August 2012; which shows computer navigated total knee replacement does NOT lead to clinical results superior to conventional total knee replacement. Click the following link in google to read the above research paper http://www.thekneejournal.com/article/S0968-0160(11)00195-5/abstract

What is the recovery period after a Joint Replacement surgery ?

With the evolution of quality of fixation ,quality of implants (Us/Eu - IMPORTED ) and confidence of surgeons(specifically trained for joint replacement surgery), there is no 'bed-rest' after Joint Replacement surgeries now-a-days.

The patient gets moving the day after the surgery, with the aid of a walker. Bedside exercises are taught by the physiotherapist, and by the time of discharge 5-7 days after the surgery, the patient is relatively pain-free, and can carry out his day-to-day activities without any assistance. Some kind of walking aid is continued for 6 weeks after surgery. It takes 3 months to gain adequate strength, and normal gait after the surgery.

When does a patient stand and when will he walk after knee replacement surgery ?

Patient stands on the second day and walks with a walker on 2/3 rd day .

What is the duration for which any kind of support is required ?

A walker is used for two -three weeks followed by a cane for another 2-3 weeks , followed by walking without any support.

Should we get a bilateral or staged unilateral knee replacement ?

If the patient is young 65 , minimal comorbidties a simultaneous knee replacement is done , other wise a staged knee replacement with a gap of three months is advised and safe .

What is the anaesthesia ?

Usually spinal with epidural anaesthesia is advised for prolonged postoperative pain control.

What is the time taken for surgery ?

Straight forward knee

30 min - anaesthesia induction

90 min- surgical time

30 min - post op

Diffficult knee - UPTO 2 HOURS SURGICAL TIME

WHAT WILL BE THE POST SURGERY PAIN RELIEF MEASURES?

Post surgery 2- 3 days will be taken care by epidural anaesthesia and analgesic coverage(2 weeks) to give you a very good painless period and recovery .

Success rates of knee replacement surgery - Success rates and quality of life improvements for knee replacement patients are reliably very high. Nine out of 10 knee replacement patients experience an immediate relief from knee pain, and 95% report they are satisfied with their procedure. Approximately 90% of replacement knee joints last 10 years, while 80% are good for 20+ years, depending on patient health and activity levels.

Outcomes vary from patient to patient