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Is it a replacement surgery or resurfacing surgery?
Total Knee Replacement Surgery is a surface replacement surgery as only worn out surfaces of the bones are removed and replaced with artificial materials (metal on one side and plastic on other side).
Is total knee replacement surgery different in different cetres or in different hands?
No. It is the same surgery all over the world. There can be different names like Robotic Surgery/ Robo Lense/ Patient Specific Implants / Navigation etc.
Can it be a stitchless knee replacement without cuts? No. Surgery can not be performed without cutting. The wound has to be closed after the surgery in all cases with sutures/ stitches. Your surgeon may use a nylon thread/ stainless steel staples or absorbable subcuticular thread to close the wound. But the surgery is same.
Can it be painless surgery? No. In the first 24 hours, the pain can be a bit more and usually walking is delayed till next day. Moreover, the patients who are ginen spinal anesthesia- for them walking in the first 24 hours is usually not recommended to avoid postural hypotension.
Can there be a differen technique for doing a painless knee replacement? As I mentioned above, the surgery is same all over the world. In the hands of an experienced and senior surgeon, the tissue handling is very fine so the pain is less. But there is no painless surgery. One may give different kind of drugs through different routes to suppress pain for the first 24 hours- but there is no technique of painless surgery.
Who is the right candidate for Total Knee Replacement:
Usually this surgery is performed in elderly people so that the life of the artificial joint should be more than the life of the person. Nowadays, we recommend the ideal patient to be older than 65 years. But if the pain is affecting the quality of life of patient, one can do it earlier also to improve the quality of life of the patient.
In medical terminology, it should only be done in grade 4 osteoarthritis – that means when the knee joint is degenerated in its 360 degrees surfaces.
Indian patients have the tendency to develop deformities in the degenerating joints apart from pain. The deformities alter the walking pattern (gait) of the patients. These deformities are corrected at the time of knee replacement surgery.
Who should perform this surgery?
A surgeon reasonably trained should perform this surgery. He should be well aquanticed with the surgical technique of knee replacement as well as the basic surgcal principles of orthopaedic surgery.
Ideally, the surgery should be performed in a center which is well equipped with the supporting specialties like cardiology/ ICU/ A good lab etc so that in case of exigencies the team from other specialties can give the best care to the patient.