Know more

about your

knee

Revival Bone & Joint HospitalYojana, Off Gokhale Road, Behind IDBI Bank, Near Malhar Cinema, Thane (W), 400 0602.

Tel: 2537 2237 / 2537 6803. Email: drmilindpatil@yahoo.com

Total Knee Replacement Your Concerns & Questions

Dear Patient,

I welcome you to the Revival Bone and Joint Hospital and would like to assure you that our team of physicians, nurses and staff are committed to delivering the highest level of professional care possible. Our goal is to provide quality Orthopaedic care guided by evidence-based science using state-of-the-art surgical techniques and equipment.

As a recipient of an artificial joint, you represent an invaluable wealth of clinical information. Every time you are seen in our hospital, information is generated which may someday be used to improve existing prosthetic joint technology and to further enhance our knowledge of the disease processes involved in Arthritis. Any advancement in the science of joint replacement may someday help the millions of people who suffer from Arthritis in our country.

It is my hope to stay in touch with you and interact throughout your life. The hospital would like to be notified whenever you change your address, e-mail, so that we will be able to contact you to review the condition of your joint replacement. Also, it would facilitate our ability to notify you of new advances which could affect your own prosthetic joint.

This booklet is designed with you in mind. It is aimed at giving you the relevant information about your condition.

This information will help you in getting maximum out of your surgery.

Thanking You

Yours Sincerely,

Dr. Milind Patil

Q1: How is a normal knee joint made ?

A: Normal knee joint is made of three bones articulating with each other femur (thigh bone), tibia (leg bone) and patella (knee cap). The joint surface of these bones are covered by cartilage. Cartilage works like sunmica and is relatively less sensitive. The movements of joints is by muscles and gets its stability because of ligaments.

Q2: What happens in arthritis ?

A: In arthritis, articular cartilage is lost due to wear & tear or disease. Articular cartilage is not seen on the x- ray. Hence x-ray shows gap between two bones, once the cartilage is destroyed, the gap in the x-ray reduces.

Normal Knee

Arthritic Knee

Q3 : What is the treatment of early arthritis?

A: In early stages, weight reduction, physiotherapy is very important. Avoiding stairs climbing and floor activities can be useful. Life style modifications such as using commode, dinning table and lift may be necessary. Painkillers or injections in the joint may be used on doctor's advice.

Q4: What is the end stage arthritis?

A: In the end stage arthritis, cartilage is completely worn out and bone is touching bone. Because cartilage is relatively insensitive, there is not much pain in normal joint during movement. But underlying bone is very sensitive. Therefore in end stage arthritis after the whole thickness of cartilage is gone and underlying bone is rubbing on bone, there is severe pain.

Before After

Q7 : Who benefits by TKR?

A: In end stage arthritis, when patient gets rest pain, and walking distance is less than 20 minutes, limps or needs pain killers, will benefit by TKR. When activities of daily living starts suffering due to severe, unbearable pain, the patient requires TKR.

Q8: What is the pre-surgical preparation?

A: Blood investigation, X-Rays of the knee and chest, ECG, 2D Echo cardiography is done pre operatively. Fitness for surgery is obtained from physician and anaesthetist. If you are on any blood thinning drugs such as warfarin, clopidogrel & aspirin, inform the doctor about it. They may have to be stopped 5 days prior to surgery.

Q9: What is a high flex knee?

A: High flex knee TKR permits full flexion of the knee, if patient's muscles, ligaments are elastic enough. Even if full flexion (bending) is achieved, it is safer to sit cross legged on bed or chair only. It is advisable not to load the knee in the postion of full flexion.

Q5 : What is the treatment of end stage arthritis?

A: Cartilage can't regrow with medicines, hence, need to be replaced. TKR is the treatment for the end stage arthritis.

Q6 : What is TKR?

A: Replacing wornout cartilage with layers of artificial material is called as Total Knee Replacement (TKR).

Q10: What is All Poly TKR ?

A: In some patients, if the bone quality is good, a metal portion of tibial impiant is not required. This reduces the cost. But this is not suitable for all patients and the decision can be taken only during the surgery.

Q11: What is a navigated TKR?

A: Navigated TKR is done using computer navigation. Computer navigation machine has infra red camera, with which it picks up all the surgical actions. These are analyzed by computer and final results are projected on the screen. Computer navigation adds to the accuracy and perfection which surgeon wants to achieve. It helps in the surgeon's judgment in some cases. However, the surgeon's experience is the most important factor.

Q12 : What are the types of anesthesia?

A: Most surgeries are performed under spinal anesthesia or epidural anesthesia, where in only lower half of the patients body is anesthetized. However complete anesthesia (General Anesthesia) can also be given.

Q13 : What is the duration of the surgery?

A: The actual surgery time is 1 hour 15 minutes to 1 hour 30 minutes. However, due to the pre-surgery preparation and post surgery observations, the patient spends almost 3 hours in the operation theatre.

Q14: Do I need blood?

A: Surgery on a single knee generally does not require blood, if the patient's pre operation hemoglobin is normal. One bottle of blood may be required if both the knees have to be operated simultaneously or in quick succession.

Q15 : Do I need to arrange for blood?

A: Patient can donate a bottle of blood before surgery, if he/she is fit. The same can be used after the surgery, if required. Patient's relatives / friends can also donate blood prior to surgery. Alternatively, safe blood, available in licensed blood banks can also be used.

Spinal or Epidural Anesthesia

Q16: Will I get lots of pain after surgery?

A: Although TKR is a very painful operation, effective methods of pain control are in use for post op pain relief. Commonly countious epidural analgesia is used through epidural pumps and catheter. Oral, injectable analgesics and sedatives are given to keep the patient comfortable.

Q18: When can I go home?

A: Patients generally go home once they are independent i.e. they are able to go to commode on their own without taking anybody's help and are able to use a dinning chair etc. This generally happens in 5 days. At this time, the patients are discharged.

Q19: When will I climb stairs?

A: If only one knee is replaced, the patients are able to climb stairs in 5 days .If both knees are replaced, they can take as long as 3 weeks.

Q17: When will I walk?

A: The patient's physiotherapy starts on the next day of surgery. Attempts are made to bend the knee, stand with the walker and walk. Most patients walk on the next day after surgery and make gradual progress with exercises. Q20: Do I need any help at home?

A: Patients are independent, when they go home. They can go to toilet on their own. They are able to use basin for brushing / shaving etc. They are able to sit in chair for watching TV and use the dinning table.

Q21: Do I need physiotherapy at home ?

A: Patients need exercises at home for few days. This may be done under the supervision of a physiotherapist.

Q22: Do I need dressing at home?

A: No, only if the wound is soaking (it happens very rarely), it may require dressing.

Q23: When are the sutures removed?

A: The sutures are removed in 20 days after the surgery. Patients can come to OPD for the removal or it can be arranged at home.

Q25: When can I resume normal activities?

A: Activities like cooking, shopping, going to work etc can be started within 4 to 6 weeks.

Q24: When do I take bath?

A: The wound should not get wet for a month. If the patient wishes to take a bath before this, he /she should cover the wound with plastic or continue sponging for a month.

Q26: What activities are normally possible?

A: After full recovery, patients are able to walk, stand, climb stairs. Patients are able to drive two wheelers and four wheelers. Patients can also use public transport like rickshaws, bus, taxi, train and airplane like normal population. Swimming and light sports like golfing are possible.

Q27: Which activities are prohibited?

A: heavy sporting activities football, cricket, running, jumping are best avoided. sitting on the floor for indian toilet and sitting cross legged should be avoided, even if they appear possible.

Q28: What should I report immediately?

A: If there is

• Fever• Swelling of knee• Swelling of the calf / foot,• Severe pain in the knee• Severe pain in the calf• Soakage of wound• Stiffness of knee, • Difficulty in walking and • Any other untoward happening

Then the patient should immediately report on the following telephone numbers

+91 22 2537 2237 / 2537 6801 / 6802 / 6803

Or come to hospital.

Revival Bone and Joint hospital is a 25 bedded super specialty hospital, situated in the heart of Thane city, with major thrust on Orthopedic and Trauma surgeries.

It's equipped with special rooms for patients with facilities like TV, Fridge, AC Rooms.

TKR Patients - Pre & Post operation Revival Bone and Joints Hospital

Before After

It has an Intensive Care Unit of 6 beds which is supported by intensive care specialists, trained resident doctors and nurses, round the clock.

It also has monitors, ventilators and cardiac pacemakers.

It has a dedicated Joint Replacement Operation Theatre comprising of Laminar Air Flow (Clean Air Unit) with Hepa filters , which has an anti bacterial and anti fungal coating on walls. The Operation theatre is equipped with pulse separators, monitors and ventilators.

Dr. Milind Patil, is a leading Joint Replacement Surgeon at Thane. He is a pioneer in Total Knee Replacement surgery in Thane district, Maharashtra. He has founded the Revival Bone and Joint hospital in the year 2005 to provide specialized complete solution for joint replacement with his professional team to offer best care and satisfaction to patients. Today, he is one amongst the leading experts in India on knee replacement and super speciality joint surgeries .

Dr Patil always gives his patients better function (more ability to reproduce normal walking, and more ease & comfort in doing their day to day activities), more mobility (increased range of flexion of the knee) and more durability (longevity of the implant).

The patients from the region of Thane district and Maharashtra got immensely benefited in the last decade. These large numbers of satisfied patients had become referrals to their friends, family members to suggest them to benefit from his expertise and vast clinical experience in the field.

Today, patients are coming from abroad, UK, Canada, and African countries and these satisfied patients have put the Revival Hospital as well as Thane on the global map of medical tourism from India.

It also has a “state-of-the-art” Navigation system for computer assisted “Joint Replacement Surgery”.

The Arthroscopic equipment includes camera, shavers and image intensifier with instrumentation for advanced fracture as well as spine surgery.

The Outpatient Department is air conditioned, having Digital X-ray facilities. The X-ray can be digitized and these digital file image can be sent by LAN or email.

The primary and revision total joint replacement surgeries are routinely performed and all the modern equipment like calf pumps, air beds and supportive treatment like physiotherapy is routinely given.

There is a regular flow of patients from various parts of India as well as African / European countries including UK and USA. These foreign patients have also taken benefits of the facilities of Revival Bone and Joints Hospital.

Revival Bone and Joints Hospital

A patient from England for ACL reconstruction

A patient from Nigeria for bilateral knee replacement

He is on the panel of consultant surgeons of the leading corporate hospitals such as Wockhardt, Mulund (Mumbai ) and Lok Hospital and Jupiter Hospital at Thane. He has been operating at Cumballa Hill Hospital & other important hospitals in the Mumbai city & Western region.

Dr Milind Patil is one amongst the leading joint replacement surgeons in the field of computerized navigated TKR in India. In the period of emergence and evolution of joint replacement as a science 15 years back, Dr Milind Patil underwent extensive training in UK at Liverpool.

He is constantly enriching and enhancing his skills by regularly attending and participating in the workshops, conferences at national and international level. He is also training surgeons from India and abroad on a routine basis.

Due to his specialized and unique experience in the field of TKR and having performed over 2000 surgeries using a high performance knee system, he is one amongst the top few joint replacement surgeons in India.

He is routinely invited to attend the national and international orthopedic conferences as a faculty to share his rich experience.

He has many papers / reports to his credit, that got published in reputed orthopedic journals and major publications. He is also invited regularly for interviews in the print media and for talk shows in the electronic media.

Dr. Milind Patil