What is a Total Knee Replacement?

A total knee replacement is a surgical procedure during which a degenerated knee joint is replaced using an artificial implant.  The knee joint primarily works as a hinge between the thighbone and the leg bone.  During a total knee replacement procedure, the lower end of the thighbone is cut away and replaced by a metal component. Similarly, the upper end of the leg bone is also cut away and replaced with a plastic implant that is mounted on a metallic stem.  If the kneecap is also diseased, a plastic component is placed under the surface of the kneecap.

About the knee joint

The knee is a complex hinge joint which comprises:

• the thighbone
• the leg bone, and
• the kneecap

The knee joint functions normally when the movement of one bone across the other happens smoothly without any friction.  A healthy knee has a smooth cartilage surface on all three bones.  The cartilage has a cushioning effect when the bones are in motion.  The other surfaces of the knee are lined by a tissue called the synovial membrane which releases a lubricating fluid.  It is this fluid that completes the mechanism for smooth functioning of the knee joint.

What medical conditions cause knee pain and degeneration?

The primary cause of constant knee pain and malfunction of the knee joint is arthritis.

The most common forms of arthritis which affect the knee joint are the following:

• Osteoarthritis: This condition is primarily age-related and generally occurs in individuals over the age of 50, who have a family history of this condition.  Osteoarthritis causes the cartilage cushion in the knee to wear away, leading to bone friction and knee pain

• Rheumatoid arthritis: This condition causes inflammation of the synovial membrane, which produces the lubricating fluid for the knee joint.  The inflammation of this membrane causes excessive production of the lubricating fluid which fills the knee joint, damages the cartilage, resulting in pain and stiffness in the knee joint.

• Arthritis caused by knee fracture/trauma:  Fracture of the knee or severe damage to the ligaments in the knee joint can cause degeneration of the cartilage, resulting in knee pain.

Do I actually need a Total Knee Replacement?

You do not need a knee replacement if:

• Pain is not severe and movement is possible even if slightly limited
• Pain during movement is only intermittent and not chronic
• Pain during rest is bearable
• Pain is tolerable with mild, intermittent medication

You will benefit from a knee replacement if:

• Your normal movement is restricted because of knee pain
• Pain is chronic and severe during movement
• Pain is present even during periods of rest
• You have been on painkillers for a long time and are therefore at risk of side-effects

Your surgeon will evaluate you to correlate your symptoms with x-ray images of your knee to confirm degeneration of the knee joint and to verify that you will benefit from knee replacement.

Why is the implant so important? How is the implant type selected?

The selection of the appropriate implant is a very important aspect of the total knee replacement process.  Your surgeon will consider the following while picking a specific implant: your age, level of activity, lifestyle, the specific anatomy of your knee and other medical conditions

What is the life of the implant?

Today, implants are available in a variety of designs and materials.  The life of an implant is approximately 10 to 15 years, although there are many patients whose implants have lasted more than 25 years.  Hospitals in India offer the latest in implants, including the Oxinium implant, which is constructed of oxidized zirconium metal, which provides smooth movement with extremely low wear and tear.

Preparing for your knee replacement procedure

During the period prior to your knee replacement, you will undergo:

• Overall medical evaluation to confirm that you do not suffer from any other medical conditions that might affect the outcome of the surgery, and to confirm that you are fit for surgery
• A review of your current medications (you may need to discontinue some medications such as blood thinners prior to surgery)

How exactly is this procedure done?

Knee replacement surgeries can be performed either under:

• General Anaesthesia (you will be asleep for the duration of your procedure)
• Spinal / Epidural Anaesthesia (while you will be awake during the procedure, your legs will be completely insensitive to pain.  This method is preferred by many surgeons because it provides relief from pain for about 72 hours following the surgery)

The total duration of the surgery will be approximately 60 to 75 minutes.

During the surgery an incision, approximately 6 to 8 inches long, is made along the front of the knee.  The quadriceps muscles are detached from the kneecap, which is then moved aside to expose the junction of the thighbone and the leg bone.  The ends of the bones are then cut away to very precise measurements using special tools.  The anterior cruciate ligament as well as affected cartilage tissue is removed.  The posterior cruciate ligament may also need to be removed.  The implant is then placed and aligned with the joint and the bones, often with the assistance of computer navigation.  The implant can be either a press-fit implant or a cemented implant.

After the surgery

You will be moved to a recovery room after your surgery is completed.  Your vital signs and recovery from anaesthesia will be monitored for two to three hours, after which you may be allowed to return to your hospital room.

Your physiotherapist will teach you to exercise your lungs to clear it of congestion following surgery.  You will also be asked to gently move your feet to enhance blood circulation to your knee joint and avoid formation of blood clots.

Physiotherapy of the knee joint will commence a day or two after surgery with gentle movement and bending exercises.

Stitches will be removed 10 days after surgery after which you can fly back home.  The hospital will provide you with medical documentation for your airline so that a wheelchair is made available to you for movement within the airport in India and at the destination airport.  You will also receive a medical dossier providing full reports of the investigations performed on you, medical details about the surgery performed, details of the implant that was used, medications to be taken, physiotherapy protocol and the list of do's and don'ts to ensure that you get the best out of your total knee replacement.

What will be the duration of my stay in India?

In the normal course, the total duration of stay in India will be approximately 12 to 14 days, of which the first 5-7 days would be in hospital, followed by recuperation stay in a hotel or apartment.

Do's and don'ts after Total Knee Replacement

• Do exercise your knee gently and regularly as advised by the physiotherapist at the hospital.
• Do watch your weight and keep it under control
• Do resume normal activities three to six weeks after surgery
• Do ensure that you do not suffer a fall, especially in the weeks and months following the surgery
• Do not stress your knee unduly through aggressive movement or physical exercise
• Do have your knee reviewed by an orthopaedic surgeon in your country one year after surgery
• Do contact us at any time should you have any doubts or any questions, even after you return to your country

What is a Total Hip Replacement?

A total hip replacement is a surgical procedure during which a degenerated hip joint is replaced using an artificial implant.  The hip joint primarily works as a junction between the hip and the thighbone, through a ball and socket arrangement.  During a total hip replacement procedure, the worn away cartilage and bone is removed and replaced with artificial implant components.

About the hip joint

The hip structure comprises of a ball and socket and is one of the largest joints in the body.  In this arrangement, the acetabulum constitutes the socket, while the upper end of the thighbone forms the ball.

A healthy hip has a smooth cartilage surface across the bone surface.  The cartilage has a cushioning effect when the bones are in motion.  The other bone surfaces of the hip are lined by a tissue called the synovial membrane which releases  a lubricating fluid.  It is this fluid that completes the mechanism for smooth functioning of the hip joint.  The ball and socket are held together by ligaments which also provide stability to the hip joint

What medical conditions cause hip pain and degeneration?

The primary cause of constant hip pain and malfunction of the hip joint is arthritis.

The most common forms of arthritis which affect the hip joint are the following:

• Osteoarthritis: This condition is primarily age-related and generally occurs in individuals over the age of 50, who have a family history of this condition.  Osteoarthritis causes the cartilage cushion in the hip to wear away, leading to bone friction and hip pain
• Rheumatoid arthritis: This condition causes inflammation of the synovial membrane, which produces the lubricating fluid for the hip joint.  The inflammation of this membrane causes excessive production of the lubricating fluid which fills the hip joint and damages the cartilage, resulting in pain and stiffness in the hip joint.
• Arthritis caused by hip fracture/trauma:  Fracture of the hip or severe damage to the ligaments in the hip joint can cause degeneration of the cartilage, resulting in hip pain.
• Avascular necrosis: Damage to the hip joint cost by trauma or by some diseases can result in reduced blood supply to the femoral head, resulting in the wearing away of the bone surface of the ' ball'.  This results in arthritis.
• Hip disease during childhood: Some hip diseases suffered during infancy or childhood can result in arthritis in adult life even if the diseases were treated and cured during childhood

Do I actually need a Total Hip Replacement?

Hip replacement is not necessary if:

• Pain is not acute
• Pain during movement is only intermittent and not constant
• Pain during rest is tolerable
• Pain is tolerable with mild, intermittent medication

Hip replacement is advisable if:

• Pain is chronic and intense during movement
• Pain is present even during periods of non-activity
• You have been on painkillers for a long time and are therefore at risk of side-effects

Your surgeon will evaluate you to correlate your symptoms with x-ray images of your hip to confirm degeneration of the hip joint and to verify that you will benefit from hip replacement.

How is the implant selected?

Selecting the right implant is important for a successful hip replacement surgery.  Some of the factors that will come into play while picking your implant will be the following: your age, lifestyle, nature of activity, the specific condition of your hip and other medical factors

What is the life of the implant?

Implants are available in a wide range of designs and materials of construction.  The average life of an implant is approximately 10 to 15 years. With progress in technology, there are many patients whose implants have lasted more than 25 years.  Hospitals in India offer the latest in implants, including the OXINIUM-on-XLPE implant, constructed of oxidized zirconium metal, which provides smooth movement with extremely low wear and tear.

Preparing for your hip replacement procedure

in preparation for your hip replacement, :

• Your surgeon will have you go through overall medical screening to confirm that you do not have any medical conditions that might affect the results of the hip replacement surgery,
• You will also undergo cardiac screening to confirm that you are fit enough to sustain the stress of the surgery
• Your current medication list will be reviewed and all contraindicated drugs will be suspended before surgery

How exactly is the hip replacement procedure performed?

Hip replacement surgeries can be performed either under

• General Anaesthesia (you will be asleep for the duration of your procedure)
• Spinal / Epidural/ Regional Nerve Block Anaesthesia:  While you will be awake during the procedure, your waist and lower limbs will be completely insensitive to pain.  This method is preferred by many surgeons because it provides relief from pain for about 72 hours following the surgery)

The total duration of the surgery will be approximately two hours.

There are many approaches to hip surgery.  The incision can be made on the back, the front or the side of the hip depending on the nature of the problem and the technique favoured by your surgeon.

In a stepwise procedure, the surgeon first removes the damaged cartilage and bone.  The upper part of the thighbone is cut and the ball is removed.  A special tool called a reamer is used to work on the hip socket - the damaged cartilage and bone is removed to leave an even rounded surface which can receive the new implant. The other component of the implant, containing the ball is inserted into the hollow portion of the thighbone and is fixed firmly in place.  The implant material is made of natural alloy or ceramics.

After the surgery

You will be shifted from the operating theatre to a recovery room where your vitals will be monitored for a few hours.  Generally speaking, most patients will be shifted to the hospital room after this monitoring period.  A physiotherapist will visit you the day following surgery and commence gentle exercises.  An important exercise involves your lungs to clear it of post-surgery congestion.

Stitches placed during surgery will be removed 10 days later. You should be free to fly home to your country after this.

At the time of your discharge, the hospital will provide you with a folder containing records of all investigations and a discharge summary which will describe your condition on admission to the hospital, the course of investigations and treatment as well as the doctor's advice to you upon discharge.  In addition, you will receive dietary advice as well as prescriptions for medication to be taken after your discharge from hospital.

You will also be provided with the surgeon's certificate that you are fit to fly - a requirement with most international airlines.

What will be the duration of my stay in India?

The total duration of your stay in India would be approximately 2 weeks, including five to seven days in the hospital. If you wish to have a recuperative holiday after your surgery, we will be happy to assist you with your plans.

What is a Hip Resurfacing Procedure?

A total hip replacement is a surgical procedure during which a degenerated hip joint is resurfaced or reworked to receive an artificial implant.  The hip joint primarily works as a junction between the hip and the thighbone, through a ball and socket arrangement.  The hip resurfacing procedure is a relatively conservative procedure that preserves the ball (femoral head).  The surface of the femoral head is prepared to receive a metallic cap and this helps to protect the cartilage. A matching metallic cup is placed in the socket. During hip movement the cartilage in the hip joint is protected by the metal implants.

About the hip joint

The hip structure comprises of a ball and socket and is one of the largest joints in the body.  In this arrangement, the acetabulum constitutes the socket, while the upper end of the thighbone forms the ball.

A healthy hip has a smooth cartilage surface across the bone surface.  The cartilage has a cushioning effect when the bones are in motion.  The other bone surfaces of the hip are lined by a tissue called the synovial membrane which releases  a lubricating fluid.  It is this fluid that completes the mechanism for smooth functioning of the hip joint.  The ball and socket are held together by ligaments which also provide stability to the hip joint.

What medical conditions cause hip pain and degeneration?

The primary cause of constant hip pain and malfunction of the hip joint is arthritis.

The most common forms of arthritis which affect the hip joint are the following:

• Osteoarthritis: This condition is primarily age-related and generally occurs in individuals over the age of 50, who have a family history of this condition.  Osteoarthritis causes the cartilage cushion in the hip to wear away, leading to bone friction and hip pain
• Rheumatoid arthritis: This condition causes inflammation of the synovial membrane, which produces the lubricating fluid for the hip joint.  The inflammation of this membrane causes excessive production of the lubricating fluid which fills the hip joint and damages the cartilage, resulting in pain and stiffness in the hip joint.
• Arthritis caused by hip fracture/trauma:  Fracture of the hip or severe damage to the ligaments in the hip joint can cause degeneration of the cartilage, resulting in hip pain.
• Avascular necrosis: Damage to the hip joint cost by trauma or by some diseases can result in reduced blood supply to the femoral head, resulting in the wearing away of the bone surface of the ' ball'.  This results in arthritis.
• Hip disease during childhood: Some hip diseases suffered during infancy or childhood can result in arthritis in adult life even if the diseases were treated and cured during childhood

Do I actually need a major procedure like Hip Replacement or Hip Resurfacing?

Hip replacement or resurfacing is not necessary if:

• Pain is not acute
• Pain during movement is only intermittent and not constant
• Pain during rest is tolerable
• Pain is tolerable with mild, intermittent medication

Hip replacement or resurfacing is advisable if:

• Pain is chronic and intense during movement
• Pain is present even during periods of non-activity
• You have been on painkillers for a long time and are therefore at risk of side-effects

Your surgeon will evaluate you to correlate your symptoms with x-ray images of your hip to confirm degeneration of the hip joint and to verify that you will benefit from the surgery.

Is Hip Resurfacing a better option for me compared to Total Hip Replacement ?

Hip Resurfacing is a better option for you if:

• You are relatively young (below 60)
• You are not very overweight
• You have a confirmed diagnosis of non-inflammatory degenerative joint disease
• You do not have an infection in the hip joint
• You do not have allergies to the metals used in the implants

Hip Resurfacing MAY not be for you if:

• The femoral head is not strong
• You have weak bones or suffer from osteoporosis
• Blood supply to the femoral head is inadequate
• You suffer from rheumatoid arthritis
• You are over 60

Advantages of hip resurfacing surgery

• Conservative surgical approach
• Minimal removal of bone mass from the hip joint, providing stronger support to the implant
• Smaller risk of dislocation of hip joint
• If the implant wears out after, say, 15 years then the new implant can be put in with a simple hip replacement procedure, instead of a complex hip revision procedure.
• Ideal for younger patients (below 60 years) with an active lifestyle

How is the implant type selected?

Selecting the right implant is important for a successful hip resurfacing surgery.  Some of the factors that will come into play while picking your implant will be the following: your age, lifestyle, nature of activity, the specific condition of your hip and other medical factors      

What is the life of the implant?

Implants are available in a wide range of designs and materials of construction.  The average life of an implant is approximately 10 to 15 years. With progress in technology, there are many patients whose implants have lasted more than 25 years.

Preparing for your Hip Resurfacing procedure

In preparation for your hip resurfacing:

• might affect the results of the hip resurfacing surgery,
• You will also undergo cardiac screening to confirm that you are fit enough to sustain the stress of the surgery
• Your current medication list will be reviewed and all contraindicated drugs will be suspended before surgery

How exactly is the hip resurfacing procedure performed?

Hip resurfacing surgeries can be performed either under:

• General Anaesthesia (you will be asleep for the duration of your procedure)\
• Spinal / Epidural/ Regional Nerve Block Anaesthesia:  While you will be awake during the procedure, your waist and lower limbs will be completely insensitive to pain.  This method is preferred by many surgeons because it provides relief from pain for about 72 hours following the surgery)

The total duration of the surgery will be approximately two hours.

There are many approaches to hip resurfacing.  The incision can be made on the back, the front or the side of the hip depending on the nature of the problem and the technique favoured by your surgeon.

During standard hip replacement surgery, the surgeon would remove the entire ball of the ' ball and socket joint' of the hip.  In the case of hip resurfacing surgery, the ball would be left intact and a metal cap is placed around the cartilage section that has worn away.  The top of the femoral head is re-shaped so that its profile is closely matched to the underside of the cap of the implant. This metallic cap protects the cartilage from further deterioration. This approach leaves a large amount of bone which supports the metal cap. The other component of the implant is a metal cup that becomes the socket of the joint. This component surface is designed to allow natural bone growth extends into the component, does integrating it into the hip bone structure and providing stability to the joint.  The implant used in hip resurfacing surgery is much smaller than the implant used in hip replacement surgery.

After the surgery

You will be shifted from the operating theatre to a recovery room where your vitals will be monitored for a few hours.  Generally speaking, most patients will be shifted to the hospital room after this monitoring period.  A physiotherapist will visit you the day following surgery and commence gentle exercises.  An important exercise involves your lungs to clear it of post-surgery congestion.

Stitches placed during surgery will be removed 10 days later. You should be free to fly home to your country after this.

At the time of your discharge, the hospital will provide you with a folder containing records of all investigations and a discharge summary which will describe your condition on admission to the hospital, the course of investigations and treatment as well as the doctor's advice to you upon discharge.  In addition, you will receive dietary advice as well as prescriptions for medication to be taken after your discharge from hospital.

You will also be provided with the surgeon's certificate that you are fit to fly - a requirement with most international airlines.

What will be the duration of my stay in India?

The total duration of your stay in India would be approximately 2 weeks, including five to seven days in the hospital. If you wish to have a recuperative holiday after your surgery, we will be happy to assist you with your plans.