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M.S. ORTH (Pune),M.Sc., ORTH. (London) Dipl. LAMP (CARDIFF)
Consultant Joint Replacement Surgeon
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  Total Knee Replacement
  What is a total knee replacement ?
 


A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with artificial material. The knee is a hinge joint which provides motion at the point where the thigh meets the lower leg. The thigh bone (or femur) abuts the large bone of the lower leg (tibia) at the knee joint. During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The end of the lower leg bone (tibia) is also removed and replaced with a channeled plastic piece with a metal stem. Depending on the condition of the kneecap portion of the knee joint, a plastic "button" may also be added under the kneecap surface.

The posterior cruciate ligament is a tissue that

 
 
normally stabilizes each side of the knee joint so that the lower leg cannot slide backward in relation to the thigh bone. In total knee replacement surgery, this ligament is either retained, sacrificed, or substituted by a polyethylene post. Each of these various designs of total knee replacement has its benefits and risks.
   
  What patients should consider a total knee replacement?
 


Total knee replacement surgery is considered for patients whose knee joints have been damaged by either progressive arthritis, trauma, or other rare destructive diseases of the joint. The most common reason for knee replacement in India is severe osteoarthritis followed closely by Rheumatoid arthritis of the knees.

Regardless of the cause of the damage to the joint, the resulting progressive pain and stiffness, and decreasing daily function often leads the patient to consider total knee replacement. Decisions regarding whether to undergo knee replacement surgery are not easy. Patients should understand the risks as well as the benefits before making these decisions.A detailed discussion with your surgeon will help arrive at a decision especially when there are so many implant choices now available!

 
 
  Knee replacement
 

This factsheet is for people who are considering having a knee replacement operation.

A knee replacement replaces damaged or worn parts of the knee joint with a prosthesis made up of metal and plastic parts.

Depending on the condition of your knee, a "total" or a "half" knee replacement may be done. In a half knee operation, only the inner or outer half of your knee is replaced.1 A total knee replacement is more commonly done.
   
  Why have a knee replacement?
 

Your knee joint is made up of the ends of the thigh bone (femur) and shin bone (tibia), which normally glide over each other smoothly because they are covered by smooth articular cartilage. The joint is held in place by ligaments and covered at the front by the patella (kneecap).

If the cartilage is damaged by injury or worn away by arthritis for example, the ends of the bones can rub together, causing pain and restricting movement. If this happens, your knee joint can be replaced with a prosthetic one.
   
  Types of knee replacement
 


There are several different types of knee replacement.

Some need special bone cement to keep them in place. Other types of artificial knee parts are coated with a chemical which encourages bone to grow into it to hold the components in place.

Your surgeon will discuss the various options with you.

 
 

An illustration showing the left knee before and after surgery

  What are the alternatives?
 


Surgery is usually recommended only if non-surgical treatments such as taking medicines to reduce pain and inflammation or using physical aids such as a walking stick do not help to reduce pain or improve mobility.

   
  Other surgical options
 


There are alternative operations depending on how badly your knee is damaged - such as an osteotomy, which may help if only one side of your knee joint has worn down. Alternatively, you may have keyhole surgery called arthroscopy.

Your surgeon will explain your options.
 
 
 
   
 
 
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