| Knee replacement in India : overview | | | | unicompartmental knee replacement. Advantage of |
| Knee replacement is a surgical procedure to replace | | | | UKA compared to TKA include smaller incision, easier |
| the weight-bearing surfaces of the knee joint to | | | | post-op rehabilition, shorter hospital stay, less blood |
| relieve the pain and disability of osteoarthritis. It may | | | | loss, lower risk of infection, stiffness, and blood clots, |
| be performed for other knee diseases such as | | | | and easier revision if necessary. |
| rheumatoid arthritis and psoriatic arthritis. The surgery | | | | Risks and complications : |
| can be performed as a partial or a total knee | | | | The most serious complication is infection of the |
| replacement. And if you are looking for a cost saving | | | | joint, which occurs in <1% of patients. Deep vein |
| surgery, India is your destination. Here not only you | | | | thrombosis occurs in up to 15% of patients, and is |
| are getting best facilities provided by the hospitals | | | | symptomatic in 2-3%. Nerve injuries occur in 1-2% of |
| compared to the Western and European hospitals, | | | | patients. Persistent pain or stiffness occurs in 8-23% |
| but also very low cost of surgery package. Knee | | | | of patients. Prosthesis failure occurs in approximately |
| replacement in India is more then half of price that | | | | 2% of patients at 5 years. |
| Western or European hospitals quote. | | | | Deep Vein thrombosis |
| Pre-operative preparation and Technique | | | | According to the American Academy of Orthopedic |
| Knee arthroplasty is major surgery. Before surgery is | | | | Surgeons (AAOS), "blood clots in the leg veins are |
| performed, pre-operative tests are done. They are | | | | the most common complication of knee replacement |
| complete blood count, electrolytes, APTT and PT to | | | | surgery. Your orthopedic surgeon will outline a |
| measure blood clotting, chest X-rays, and ECG for | | | | prevention program, which may include periodic |
| possible transfusion. Accurate X-rays of the affected | | | | elevation of your legs, lower leg exercises to increase |
| knee are needed to measure the size of components | | | | circulation, support stockings and medication to thin |
| which will be needed Medications such as warfarin | | | | your blood." |
| and aspirin will be stopped some days before surgery | | | | Fractures |
| to reduce the amount of bleeding. | | | | Periprosthetic fractures are becoming more frequent |
| The surgery involves exposure of the front of the | | | | with the aging patient population and can occur |
| knee, with detachment of part of the quadriceps | | | | intraoperatively or postoperatively. |
| muscle from the patella. The patella is displaced to | | | | Loss of Motion |
| one side of the joint allowing exposure of the distal | | | | The knee at times may not recover its normal range |
| end of the femur and the proximal end of the tibia. | | | | of motion (0 - 135 degrees usually) after total knee |
| The ends of these bones are then accurately cut to | | | | replacement. Much of this is dependent on |
| shape using cutting guides oriented to the long axis | | | | pre-operative function. Most patients can achieve 0 - |
| of the bones. The lower part of the knee | | | | 110 degrees, but stiffness of the joint can occur. In |
| replacement joint is comprised of a flat metal plate | | | | some situations, manipulation of the knee under |
| and stem that your surgeon will implant in the tibial | | | | anesthetic is used to improve post operative |
| bone. A round ended implant is used for the femur, | | | | stiffness. There are also many implants from |
| mimicking the natural shape of the bone. On the tibia | | | | manufacturers that are designed to be "high-flex" |
| the component is flat, although it often has a stem | | | | knees, offering a greater range of motion. |
| which goes down inside the bone for further stability. | | | | Instability |
| During the operation any deformities must be | | | | In some patients, the kneecap is unstable |
| corrected, and the ligaments balanced so that the | | | | post-surgery and dislocates to the outer side of the |
| knee has a good range of movement and is stable. | | | | knee. This is painful and usually needs to be treated |
| Total Knee Replacement Implants | | | | by surgery to realign the kneecap. However this is |
| A diagnosis of advanced osteoarthritis of the knee | | | | quite rare. |
| will indicate the need for total replacement of the | | | | Infection |
| knee joint. Based upon your age and lifestyle, some | | | | The current classification of AAOS divides prosthetic |
| options are: | | | | infections into four types. |
| 1. Fixed bearing -  The polyethylene cushion may | | | | - Type 1 (Positive intraoperative culture): 2 positive |
| be part of the fixed platform, many people get fixed | | | | intraoperative cultures |
| bearing that dramatically reduce there knee pain. And | | | | - Type 2 (early postoperative infection): Infection |
| any last for many years. | | | | occurring within first month after surgery |
| 2. Medial Pivot - The Medial-Pivot knee replicates the | | | | - Type 3 (acute hematogenous infection): |
| rotating, twisting, bending, flexion, and stability of | | | | Hematogenous seeding of site of previously |
| your natural knee, so it feels more like your natural | | | | well-functioning prosthesis |
| knee. | | | | 1. According to a recent review the following tests |
| 3. Rotating platform and mobile bearing - Knee | | | | can be used in the diagnosis of a periprosthetic |
| implants imitate the motion of your natural knee. In | | | | infection. |
| the Rotating Mobile Knee prosthesis, the polyethylene | | | | - Conventional radiograph: Rule out other conditions |
| insert can rotate slightly around a conical post. It | | | | such as loosening and/or osteolysis. |
| also slides back and forth on the tibial tray. This | | | | - Radionucleotide Imaging: Technetium-99m Sulfur |
| allows the knee to twist and turn, as well as move | | | | imaging combined with indium-111-labeled leukocytes |
| back and forth, flexing and extending. | | | | probably offers improved specificity than either test |
| Partial knee surfacing : Partial Knee Resurfacing is an | | | | alone. Gallium 67 scans alone have low sensitivity for |
| innovative procedure designed to provide quicker | | | | infection. FDG-PET imaging has been shown to have |
| recovery and improved surgical outcome for patients | | | | variable specificity and sensitivity. |
| with osteoarthritis in only one part of the knee. By | | | | - Serology: Elevated serum C-reactive protein (CRP) |
| selectively targeting the portion of the knee that has | | | | and Erythrocyte Sedimentation Rate (ESR) more |
| become damaged by osteoarthritis, surgeons can | | | | than three months following arthroplasty are good |
| isolate and resurface only the arthritic portion of the | | | | screening tests. |
| knee without compromising the healthy bone and | | | | - Joint fluid leukocyte counts: A joint fluid white blood |
| tissue surrounding it. | | | | cell count of more than 500/?l is suggestive of an |
| Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â This procedure is | | | | infection. |
| made possible through a surgeon-interactive robotic | | | | - Frozen sections of implant membranes: More than |
| arm system. This system allows the surgeon to | | | | five white blood cells/High power field is indicative of |
| pre-operatively determine the damaged area of the | | | | infection. |
| bone to be removed and to plan the precise | | | | - Newer tests: Polymerase chain reactions involving |
| alignment and placement of the resurfacing implant | | | | the bacterial 16S rRNA have high rates of false |
| specific to the patient’s anatomy. This level of | | | | positives because they can detect necrotic bacterial |
| consistently reproducible precision enables surgeons | | | | debris even in the absence of active infection |
| to restore knee function by resurfacing the arthritic | | | | Why India: |
| defects rather than replacing the entire knee. so it | | | | Indian medical tourism offers you a complete |
| maybe the alternate solution for knee replacement in | | | | package of surgical treatment in India for specialized |
| some cases. | | | | healthcare sectors. There are ample of knee |
| Partial knee replacement : Unicompartmental | | | | repalcement surgery hospitals in India. which provide |
| arthroplasty (UKA), also called partial knee | | | | international medical healthcare facilities to abroad |
| replacement, is an option for some patients. The | | | | patients. The package shall include: Pre-Operative stay |
| knee is generally divided into three "compartments": | | | | in Specialized Guest Houses, surgical package, which |
| medial (the inside part of the knee), lateral (the | | | | includes domiciliary hospitalization and stay in India, in |
| outside), and patellofemoral (the joint between the | | | | patient care, post operative medical consultancy with |
| kneecap and the thighbone). Most patients with | | | | complete healthcare advice. In cases of emergencies |
| arthritis severe enough to consider replacement have | | | | critically ill patients we have state of the art |
| significant wear in two or more of the above | | | | Ambulances well equipped with life saving equipments |
| compartments and are best treated with total knee | | | | and paramedical forces. In order to facilitate you |
| replacement. A minority of patients have wear | | | | Indian medical tourism helps in visa processing, Airport |
| confined primarily to one compartment, usually the | | | | pick and drop and your local travel, they will guide |
| medial, and maybe the candidates for | | | | you as per your treatment plan. |