What is Knee Replacement Surgery? - Types, Risks, What to Expect & Cost

Knee replacement surgery or arthroplasty is a common surgery where your damaged or diseased knee is replaced with an artificial joint. This surgery is necessary when your knee joint has worn out or damaged due to injury. This reduces your mobility, and you suffer pain while resting.

This article details all about knee replacement, types of surgeries and the average cost in India. If you have knee replacement surgery ahead of time, read this piece to gain information on the same.

For those who do not know what knee replacement surgery is called, it is known as arthroplasty. Knee replacement surgery helps to relieve knee aches and reimpose function in extremely damaged knee joints. The surgery involves removing the diseased bone and cartilage from your shinbone, thighbone and kneecap. This follows replacing it with a prosthesis. A prosthesis is an artificial implant made of acrylic resin, thermoplastics, silicone, carbon fibre, titanium and aluminium.

Knee Replacement surgery is suggested by physicians to treat the following diseases and damages in your knee:

• Rheumatoid arthritis: This disease is a long-term condition that causes extreme pain, stiffness and swelling in your knee joints. When symptoms worsen, it can cause flare-ups affecting your feet even more.
• Gout: It is a type of arthritis when you experience sudden severe pain in your joints, especially your big toe. You will notice hot and swollen skin in the affected joint area.
• Haemophilia: It is a rare disease when your blood's ability to clot is affected severely. This generally comes as an inheritance.
• Fibrous dysplasia: It is a condition that is caused due to abnormal and unusual bone growth. The swelling bone becomes enlarged and brittle.
• Avascular necrosis: This is a condition caused due to lack of blood supply, resulting in bone tissue death. This can also cause bones to collapse if there are minor fractures in these bones. 
• Knee injuries: Most common knee injuries include knee dislocation, fractures, and soft tissue sprains in ligaments. This causes extreme pain and swelling and can lead to arthroplasty if the condition worsens.
• Osteoarthritis: It is a type of arthritis when the flexible tissues or cartilage at the end of your bones wear down. Sometimes these bones grow thicker, resulting in more friction and severe pain.

The common types of knee replacement surgery in India offered by renowned hospitals are as follows:

1. Total Knee Replacement Surgery

Total knee replacement surgery involves the procedure when prosthetics replace both sides of your knee joints. To treat osteoarthritis, total knee replacement can be considered. This type of knee replacement is a traditional surgery that includes an 8-inch incision on your knees.

After the surgery, a patient needs to move with the help of a walker or a cane and rest for at least three to four months as prescribed by the doctor. Most of the patients have stated a complete recovery after a successful total knee replacement surgery. This knee surgery is most common in middle-aged and older people with arthritis in more than one knee compartment. 

• Benefits:
  • Considering total knee replacement allows for the reduction of pain completely
  • This surgery also enhances mobility and helps you can walk around independently
  • You do not require regular physiotherapy sessions after this surgery
• Survival Rate After Surgery
  • As per reports, more than 90% of patients who undergo total knee replacement surgery function well after 15 years
• Cost of Surgery
  • Approximately ₹ 1,80, 000 to ₹ 2,50,000

2. Partial Knee Replacement Surgery

Partial Knee Replacement or partial knee resurfacing is an effective surgical procedure conducted by doctors. This is for those patients who suffer arthritis in one section of their knees. 

Unicompartmental osteoarthritis in knees happens when it affects only one section of your knees, whereas the other sections remain not so damaged. In partial knee replacement surgery, the bone surfaces of only one knee section are replaced with the help of prosthetics.

• Benefits:
  • Preserves the healthy ligaments, tissues and bones in your knee 
  • Results in reduced blood loss and tissue trauma
  • You will not experience much pain post operation
  • Increased motion range of knee
• Survival Rate After Surgery
  • As per studies, more than 90% of partial knee surgeries perform well 10 years post-surgery.
• Cost of Surgery
  • Approximately ₹ 1,50,000 to ₹ 2,20,000

3. Bicompartmental Knee Replacement Surgery

When a section of the inner and kneecap compartment requires replacement, it is termed Bicompartmental partial knee replacement surgery. Surgeons conduct a 4-inch incision in the front section of your knee during this surgery. 

After this, the patient's kneecap is repaired, and prosthetics are implanted perfectly.

• Benefits:
  • There are lower rates of complications in this type of surgery
  • Patients experience quicker rehabilitation post the surgery
  • Almost no pain after the surgery is complete
  • Less blood loss and fewer side effects
• Survival Rate After Surgery
  • Almost 85% of patients who have undergone Bicompartmental partial surgery have been performing well
• Cost of Surgery
  • Approximately ₹ 3,20,000 to ₹ 4,50,000

4. Patellofemoral Knee Replacement Surgery

This surgery is conducted when your kneecap has been damaged due to continuous and natural wear and tear or arthritis. Doctors perform a 4-inch incision in the frontal section of your knee. 

After resurfacing the kneecap, cartilage is removed from the bone to implant. Prosthetics are then implanted between the thighbone and kneecap.

• Benefits:
  • Less blood loss and reduced surgical pain
  • Faster recovery, less pain and swelling
  • Absolutely no complications
  • Enhanced knee function and movement
• Survival Rate After Surgery
  • 85% to 90% satisfactory results have been reported for patients who have undergone this surgery
• Cost of Surgery
  • Approximately ₹ 1,80,000 to ₹  4,56,000

5. Knee Osteotomy

If you have arthritis damage in only one section of your knee, your doctor might recommend knee osteotomy. This surgery involves removing or adding bone to your femur or tibia. This will help shift your total body weight from the damaged section of your joint. 

People who are under sixty and active generally undergo this surgery.

• Benefits:
  • This surgery strengthens your quadriceps or thigh muscles
  • Enhances your knee’s range of motion
  • Improves balance and helps in mobility
• Survival Rate After Surgery
  • 96% satisfactory results at 5 years have been reported for patients who have undergone this surgery
• Cost of Surgery
  • Approximately ₹ 3,00,000 to ₹  5,84,000

6. Arthroscopic Debridement

A surgery that removes the broken bits of your cartilage, this surgery reduces pain and improves the movement of your knee. 

To reduce the symptoms of arthritis and remove the damaged tissue and regain the functioning of your knee, doctors perform this surgery.

• Benefits:
  • Less swelling and inflammation in the operated area
  • Reduced blood loss
  • Lower risks of complications
  • Better movement of your knees
• Survival Rate After Surgery
  • 88% success rate has been reported for patients who have undergone this surgery
• Cost of Surgery
  • Approximately ₹ 1,50,000 to ₹ 2,00,000

7. Mosaicplasty

Mosaicplasty is another knee surgery where defective knees are repaired by transplantation of healthy cartilage and bone from less or non-weight bearing areas of your knee. 

This is used to treat minor cartilage defects caused to people below 45 years of age. 

• Benefits:
  • Removes suffering caused due to osteochondral lesions
  • The condition never deteriorates and hence reduces any pain caused due to defective knees
• Survival Rate After Surgery
  • 89% success rate has been reported for patients who have undergone this surgery
• Cost of Surgery
  • Approximately ₹ 1,53,000 to ₹ 1,68,000

Once your surgery date is fixed, there are certain preparations you have to follow before the operation. Many of the patients are stressed out before this surgery. Following the below tips will help them to recover faster postoperative.

Medications

Certain medications interfere with your recovery, so you need to stop taking them until the surgery. According to AAOS (American Academy of Orthopaedic Surgeons), they are:

• Anticoagulants or blood thinners, NSAIDs or nonsteroidal anti-inflammatory drugs escalate bleeding risks and should be avoided. 
• Furthermore, specific antidepressants taken during monoamine oxidase inhibitors (MAOIs) can affect anaesthesia.
• It is beneficial to consult your doctor if you are taking any vitamins and whether you can continue taking them.

Food and Drinks

Anaesthesia is always better on an empty stomach. However, some doctors recommend patients have certain food and drinks, such as:

• You can have light food such as toast or oatmeal.
• Avoid eating fried food or meat which is high in fat.
• You can drink fruit juice without pulp, tea or coffee.
• Avoid taking yoghurt, milk or energy drinks.

Alcohol Consumption

It is essential to cut down your alcohol consumption during these days because of the following:

• Alcohol and tobacco increase the chances of complications during surgery.
• Tobacco increases the risk of blood clots and added complications during surgery.

Exercises to Follow Before Surgery

Doctors suggest certain exercises to strengthen your body.

• Perform exercises that strengthen the upper section of your body so that you can easily carry crutches or other assistive devices.
• Exercising to reduce weight loss and ease pressure on knees and joints is helpful.

Although most knee replacement surgeries are successful, there are risks associated with them as well. Most patients who undergo the operation do not have many risks and recover within a few months. However, here are some knee replacement surgery risks you may find:

• Reddened, painful areas due to deep vein thrombosis
• Pulmonary embolism or breathlessness
• Unexpected bleeding into knee joints
• Wound infection post-surgery
• Nerve, ligament or artery damage near the knee joint
• Bone fracture around the artificial joint during surgery or post-surgery
• Restriction of knee movement due to excess bone formation around the artificial knee joint area
• Formation of excess scar tissue restricting knee movement
• Numbness near the operated area
• Persistent knee pain post-surgery
• Sudden allergic reaction to the bone cement

You should immediately consult your doctor if you notice any of these symptoms. There may be specific cases where the knee joint is not properly placed. Doctors can correct this with further surgeries.

As soon as you go for a knee replacement surgery, the preparation process can take weeks and months, depending on your body condition. Before the surgery, a team of medical practitioners will analyse your condition and suggest a few tests. 

A medical team will refer you to an orthopaedic surgeon after that. Here are the evaluations you need to do:

• X-Ray to determine the condition of your knee joint
• CBC, ESR, Blood sugar fasting and PP
• Electrocardiogram (ECG/EKG)
• 2 D Echo
• Stress test
• Chest X-ray
• Hepatitis C
• Blood group and Rh factor
• Urine and stool tests

You can keep a note of what to ask before knee replacement surgery from your doctor. There will be further tests to analyse your condition before the surgery the next day.

On the surgery day, you are likely to reach 90 minutes before the operation. The total surgery time is normally two hours depending upon how complex the operation is. 

However, here are some pointers that you have to do on your operation day:

• For the surgeon to carry out a hassle-free operation, you will have to sign a consent letter.
• Before the surgery, they will take you in a wheelchair or bed to the operation theatre.
• After a sedative medication, you will be given anaesthesia. For most knee replacement surgeries, epidural or spinal anaesthesia is done.
• Then, your knee will be kept in a bent position to expose the joint surfaces.
• Your doctor will then make an incision of 6 to 10 inches, removing the kneecap and cutting away the damaged surfaces.
• After this, your surgeon attaches prosthetics and rotates your knee to ensure proper movement.

After knee replacement surgery, the medical team will take you to a recovery room for two hours. Doctors will prescribe certain medications to reduce swelling and pain post-operation. 

However, here is what to expect after surgery:

• Patient-controlled analgesia (PCA), where you can control your painkiller dose, can be prescribed
• Oxygen supply to a patient is mandatory and is given through a mask or nose
• You will have a catheter inserted to help drain out the urine and stool for a few days

Many hospitals encourage following ERP or enhanced recovery programmes. The focus is to get the patient moving and walking within 18 hours of surgery. This ERP system is beneficial before and after knee replacement surgery to ensure you are ready for surgery and faster recovery post-surgery. 

Although nurses will remove most of these systems two to three days post-operation, some painkillers will continue to reduce pain in your joints. As anaesthesia and strong antibiotics wear off, you will need painkillers to sustain. As you are discharged from the hospital after surgery, doctors will prescribe follow-up checks and supporting exercises. 

The more you move your ankle and foot, the more active you become as it increases blood flow into leg muscles. These are post-knee replacement surgery precautions to follow.

Most of the operations are successful in knee replacement surgery. However, certain patients suffer additional conditions for which they need to see a doctor. They are as follows:

• Blood clot or infection with severe pain
• Swelling and redness in the calf, foot or ankle
• Pulmonary embolism causes serious issues such as sudden chest pain, shortness of breath and coughing
• Fever higher than 100.4 degrees Fahrenheit
• Leakage from the incision area causing bleeding

If you have anxiety related to knee replacement surgery, you also have certain alternatives, thanks to advanced medical treatments. All these depend upon your medical condition. Here is a certain alternative to knee replacement surgery:

• Cartilage Regeneration

Doctors might suggest cartilage regeneration if you do not have severe arthritis and have a better bone condition. Here they will replace only the damaged cartilage instead of replacing the joint. Autologous chondrocyte implantation (ACI) is a new medical treatment where doctors take a sample of your cartilage, grow them in labs, and surgically replant them in your knees.

• Radiofrequency Ablation or RFA

Radiofrequency Ablation reduces the risks of osteoarthritis by destroying the sensory nerves. These nerves carry pain signals from your knee to the pain. Therefore, it is helpful to control severe knee pain due to osteoarthritis. 

• Hyaluronic Acid (HA) Injections

Cortisone shots or Hyaluronic acid injections help lubricate your knee's inner sections, relieving arthritis pain. These injections can temporarily relieve the pain and post your surgery for a few months only.

The cost of knee replacement surgery in India varies from city to city and depends on the type of surgery. Consider the approximate cost given to determine the cost of knee replacement surgery. You can also consult your medical practitioner to determine the one required for you.

Well, the cost of knee replacement surgery varies between ₹2,80,000 and ₹6,00,000, depending upon the type of knee replacement, the age of the patient, the location of the hospital, and the hospital chosen.

The good news is that insurance companies can cover this cost under a health insurance policy. However, the cost of expenses is only covered up to the sum insured in the health insurance. You must buy a higher sum insured policy with higher coverage to cover the cost of the surgery.