Total Knee Replacement (TKR)

What is Total Knee Replacement?

A Total Knee Replacement (TKR) or Total Knee Arthroplasty is a surgical procedure in which those parts of the knee joint which are affected and destroyed by arthritis, are replaced with artificial metal or plastic parts called the ‘prostheses'. Total Knee Replacement may be recommended if you suffer from severe arthritis in the knee, to alleviate pain and to improve your ability to walk.

Where can I get a Total Knee Replacement?

Country	Cost with MedSolution
France	$17,004 - single (inquire)
France	$30,000 - both (inquire)
India	$6,725 - single (inquire)
India	$11,425 - both (inquire)

Cost of procedure performed in the US: $35,000 (single), $70,000 (double).

All prices are in US dollars and include the cost of the procedure and minimum hospital stay. Estimates and minimum hospital stay will vary depending upon individual needs and requirements.

Who is an ideal candidate for Total Knee Replacement?

People who suffer from arthritis of knee are candidates for Total Knee Replacement surgery. The most common forms of knee arthritis are osteoarthritis, also known as degenerative joint disease. This disease is also known as 'wear and tear' arthritis. In this condition the joint mechanics is altered, the knee becomes inflamed and irritated, and the damaged cartilage, inflamed tissues, and exposed bone can cause pain. You may be a candidate for Total Knee Replacement if you have a severely damaged, arthritic knee that limits your mobility and function, you are older than 55 and in generally good health, and conservative measures fail to improve your symptoms. Total Knee Replacement can improve knee problems associated with osteoarthritis, rheumatoid arthritis and other degenerative conditions such as osteonecrosis — a condition in which obstructed blood flow causes your bone tissue to die.

What is the procedure for Total Knee Replacement?

The procedure for Total Knee Replacement entails removal of damaged bone and cartilage from your thighbone, shinbone and kneecap and replaced with an artificial joint (prostheses) made of metal and plastic. A longitudinal skin incision, approximately 15 cm in length is made down the front of your knee. The arthritic surfaces are exposed by reflecting the kneecap out of the way. Special instruments are used to remove the bone in a specified manner so that Total Knee Replacement prosthesis can fit onto the bone with or without cement. The cement fixes the prosthesis and allows healthy bone to grow into it. Once the two metal components are fixed to the bone, a plastic insert is placed on the tibial surface. This plastic acts as the shock absorber. The plastic allows the low friction movement to occur. The plastic may either be fixed or mobile depending on the type of prosthesis. The worn out kneecap is resurfaced and cemented to keep it in place. Soft tissue releases are performed to balance the knee joint and after the prosthesis has been placed in the knee, the knee should appear straight and flex to over 110 degrees. A Total Knee Replacement will correct the mal-alignment of bow knees or flexed knees. Following the Total Knee Replacement surgery the wound is closed with absorbable sutures and a drain is inserted.

What happens after the Total Knee Replacement?

Post-operative re-cooperation consists of physiotherapy which is started 24 to 48 hours following Total Knee Replacement. It is important to do all the exercises as recommended by your physiotherapist as they will allow a quicker recovery. The most important are exercises to strengthen the quadriceps, knee extension and flexion. Some of these exercises can be done in the comfort of your home; others may require the use of weight machines, exercise bicycles or treadmills, which may mean visits to an athletic club, fitness center or clinic. After re-establishing full range of motion in your knee, you then progress to knee-, hip- and ankle-strengthening exercises combined with training to improve your stability and balance. You should expect to gain a range of motion from 0 - 110 degrees. Very stiff knees often do not regain this amount of movement.

What is the outcome of Total Knee Replacement last?

Total Knee Replacement implants can eventually wear out over time as they are made of metal and plastic. There is consistent clinical evidence that Total Knee Replacement implants function well in 90 - 95% of patients between 10 and 15 years after surgery. Most Total Knee Replacement operations last more than 20 years.

B . R . A . N . D . of Total Knee Replacement

Benefits of Total Knee Replacement

• Successful reconstruction and rehabilitation following Total Knee Replacement surgery can allow you to return to full activities with a healthy knee including participating in your favorite sports without the use of a brace. The pain and stiffness are completely alleviated. You do not experience any episodes of instability in which the knee gives away. In short, your independence returns and you can enjoy a better quality of life.

Risks of Total Knee Replacement

As with all other major surgical procedures, Total Knee Replacement has risks and complications that can occur, so careful pre-operative assessment is extremely important.

• Deep Vein Thrombosis - This risk of clot formation in leg veins can be minimized by giving blood thinning medication after Total Knee Replacement surgery.
• Infection - The risk of infection is less than 1% and pre-operative antibiotics are given to prevent this from happening.
• Pain and Stiffness - Occasionally this problem occurs if you are significantly overweight or have diabetes. This may require a manipulation under anesthesia or a revision surgery.
• Nerve and vessel damage - It is unlikely that any major nerve or vessel will be damaged the total knee replacement procedure. It is, however, very common to have a small area of numbness over the outer side of your knee where a superficial skin nerve is always cut during the surgery.
• Failure of plastic prosthesis - The prosthesis may fail due to the plastic wearing out and it may require revision.
• Excessive leeding and fluid build up around the joint - This may require drainage or may settle spontaneously.
• Excessive scarring - Some skin will scar up significantly at the site of incision.

Alternatives to Total Knee Replacement

• Pain and anti-inflammatory medications (NSAIDs) – Non-steroidal anti-inflammatory pain medications are available over-the-counter (e.g. Ibuprofen, Motrin, Aleve) or as a prescription (e.g. Celebrex, Bextra). NSAIDs are effective at pain relief (analgesia), and to reduce swelling (anti-inflammatory).
• Intra-articular injections – Two medications are commonly used for this purpose; cortisone and synvisc. These medications can be injected into the knee joint (intra-articularly). They provide temporary relief of pain and inflammation in the knee joint, thus helping through the delay and waiting period before Total Knee Replacement surgery.
• Knee Arthroscopy – Arthroscopic surgery of the knee is beneficial (as an alternative to Total Knee Replacement) to relieve mechanical symptoms such as a catching sensation, a giving way, or painful popping. Knee arthroscopy to treat isolated pain, with no other symptoms, can also be beneficial.
• Knee Osteotomy - The idea of an osteotomy is to shift the weight-bearing from the worn out side of the joint to the healthier side

Now or Never

• For a vast majority of patients having a total knee replacement surgery means enjoying a full range of activities pain free, without any fear or worry. However, you have to keep in mind that Total Knee Replacement surgery will not allow you to do more than you could before joint problems developed. Bottom line is that you do not have to live with knee joint pain mobility limitations that result from knee arthritis. If you have not obtained desirable results with medication and other conservative treatments, Total Knee Replacement may provide the pain relief that you deserve and long for

Decision to have Total Knee Replacement

• Your decision to have a Total Knee Replacement is based largely on to what extent the painful and damaged knee is significantly affecting your day-to-day activities. More than 250,000 Americans have Total Knee Replacement surgery each year. Sophisticated and modern surgical tools and procedures have led to joint replacement of the hip and knee as two of the most successful surgeries in the past decade. With proper post-operative care you can expect more than 95% chance of success for at least 15 years.