If you are experiencing persistent knee pain, here are six of the top questions to ask yourself and if the answer to one or more of these is yes, I recommend having a consultation with your doctor:

• Is knee pain habitually keeping you awake at night or do you wake up during the middle of the night with pain?
• Does your knee pain limit your ability to perform typical daily activities such as walking, climbing stairs, or getting up and down from a sitting position and in and out of your car?
• Are you afraid that your knee might give way when you pivot or step up or down from a curb?
• Does your knee pain limit leisure activities such as walking, exercising, dancing, golf, tennis, traveling, or even shopping?
• Are you experiencing increased frustration that you are losing your quality of life due to impaired mobility?
• Have you tried other treatments for a suggested period of time, such as exercise, physical therapy, a brace, anti-inflammatory medicines, or injections and still have no relief from pain, or you simply "can't trust" your knee

It is a surgical procedure in which an artificial joint is implanted to replace a damaged and arthritic knee joint.

Total Knee Replacement is an operation in which we do not remove the whole joint, only the damaged surface of thigh bone (femur) and shin bone (tibia) are shaved off. Often, underside of the kneecap (patella) is also removed and these surfaces are replaced with artificial parts. The new joint consists of a metal shell on the end of the femur, a metal plate covered with a plastic trough on the tibia, and if needed, a plastic button on the kneecap. It is an operation where one just resurfaces the damaged knee joint, as is done in capping a damaged tooth.

Besides conventional Total Knee implant, now High Flex Knees and Unicondylar Knees are also available. High Flex Knee gives full flexion to the patient thereby allowing sitting on the floor. Unicondylar Knees also known as half joint replacement are indicated for very early arthritis and when only one half of the joint is involved. You and your surgeon can discuss the most suitable implant for yourself.

Total Knee Replacement surgery is an elective procedure. Dr(Prof.) Anil Arora & Team has more than likely treated your condition with physiotherapy, pain medicines, anti-inflammatory drugs and injection in the knee or may be with minor surgeries. The circumstances vary somewhat, but generally you would be considered for total knee replacement if:

• You have daily pain.
• Your pain is severe enough to restrict not only work and recreations but also the ordinary activities of daily living.
• You have significant stiffness of your knee.
• You have significant instability (constant giving way) of your knee.
• You have significant deformity (knock knees or bow legs) causing pain and inability to walk.
• You besides Dr (Prof.) Anil Arora & Team are probably the best judge of when you will finally need total knee replacement surgery.

Yes you can, but your unstable joints may cause a fall and you may have fractures around the knees and the hips because of osteoporotic bones. Regular consumption of analgesics and anti inflammatory drugs may damage your kidneys and cause ulcers in your stomach.

Although knee joint replacement is recommended in older age group, it can be considered in younger patients who are severely crippled due to rheumatoid, ankylosing arthritis or post traumatic osteoarthritis of knees. As such, age is no bar to this operation depending on what is the root cause of pain.

Once your new joint has completely healed, you will reap the benefits of the surgery. These include:

• Reduced joint pain dramatically (may be no pain)
• Increased movement and mobility
• Correction of deformity
• Improved quality of life: ability to return to normal activities
• Running, jumping, jogging or other high impact activities are discouraged. But you can resume playing golf, walking, bicycling, swimming and other low impact sports.

As with any major surgery, there are potential risks involved in total knee replacement surgery. The most common complications are not directly related to the knee and usually do not affect the result of the operation. These complications include urinary tract infection, blood clots in legs or blood clots in lungs. Complications affecting the knee are less common, and in these cases the operation may not be as successful. These complications include:

• Some knee pain
• Loosening of the prosthesis
• Stiffness
• Infection in the knee
• A few complications such as infection, loosening of prosthesis and stiffness may require re-operation, if they do not respond to antibiotics, splintage or physiotherapy

Surgeons and manufacturers have made remarkable advances in joint replacement technology over the last few years. The materials are long lasting and durable. The surgical methods have been fine tuned and standardized. As a result, the chances for a successful outcome are excellent. The operation will provide pain relief for at least 10-15 years. The major long term problem is loosening of the prosthesis. By 15 years possibly 20% may require re-operation.

Yes, if both the knees are damaged, both can be replaced in the same sitting. It means one time anaesthesia, one time hospital stay, one time medicines and one time physical therapy. It means saving the cost too. Dr(Prof.) Anil Arora & Team can advise you for the need of replacing both the knees simultaneously, If physician, cardiologist and anaesthetist thinks you are fit enough for it.

You will be admitted a day before surgery. Surgeon, anaesthetist, physician and cardiologist will do a complete medical evaluation. X-ray images will be taken of your knees that help the surgeon plan your surgery. Chest X-rays, ECG, blood and urine test will be done prior to surgery to ensure that you are fit for surgery. You will be required to scrub the surgical area with antimicrobial solution 3-4 times a night before and on the day of surgery and after which your leg will be covered with a sterile drape. You will be transported to the operating room in the morning. You may have General Anaesthesia or Spinal Anaesthesia with sedation. The duration of surgery for one knee is about 90 minutes. Dr (Prof.) Anil Arora & Team will talk to your family after the surgery to report your progress. You will be kept in recovery room for few hours and then transferred to the room or in some cases to ICU for the monitoring of vital parameters.

The operative site and the whole limb will be covered with a large bandage. After 3-6 hours depending upon the type of anaesthesia given at the time of surgery, you will start with normal diet. Next morning, you will be transferred to the room and physical therapy usually begins with most of the patients. On 3rd day (48 hours after surgery) your dressing will be changed. In some cases a knee immobilizer will be worn. Walking with support & toilet training will be started from 2rd day onwards.

Rehabilitation and Exercises: The initial rehabilitation generally takes 5-7 days during your hospital stay. It is needed for your weak leg and thigh muscles which have not been used because of knee problem. The surgery can correct the knee problem, but the muscles will remain weak and need to be strengthened through regular exercises. The therapist also focuses on helping to increase the range of motion of knee with bending exercises.

Physical therapist along with you will work until you meet the following goals:

• Independence in getting in and out of bed
• Independence in walking with walker on a level surface
• Independence in your home exercise programme

Dr (Prof.) Anil Arora & Team and therapist may modify these goals somewhat to fit your particular condition. If there are no complications after surgery, most patients stay in our hospital approximately for 1 week or less.

It is not advised to sit on floor after conventional Total Knee Replacement . However, It is possible to sit cross leg or squat after High Flex Total Knee Replacement Surgery. It is important to realize that ability to squat does not only depends on the implant or the surgeon. To a large extent it depends on individual patients muscle strength and ones pre-disease functional status.

Medication: You will continue to take medicines as prescribed by Dr(Prof.) Anil Arora & Team.

Activity: Continue to walk with crutches / walker
Bear weight and walk on the leg as much as is comfortable

• Walking is one of the better kinds of physical therapy and is good for muscle strengthening
• The success of the operation depends to a great extent on how well you do the exercises and strengthen the muscles.
• Continue to wear your knee immobilizer as instructed
• Our ultimate aim is that you should be able to bend your knee to at least 900 (usually more) and be able to strengthen your knee.
• Within six weeks after surgery, most patients are able to walk with a cane.
• Other considerations: Do not wet the knee until after the stitches are removed
• You can usually return to work within 2-3 months or as instructed by Dr (Prof.) Anil Arora & Team.
• You should not drive a car until after the 3 months follow-up appointment.

Care of the wound: Keep the incision clean and dry. If there is any swelling, in case in pain, drainage from incision site, redness around the incision or fever, report this immediately to Dr (Prof.) Anil Arora & Team. The stitches are removed at about 2 weeks after the operation.

Your knee replacement should give you years of service. You can protect it by taking a few simple steps:

Watch for and prevent infection: Because your new knee is sensitive to infection, you must be diligent about preventing infection. If you suspect infection of any kind, contact Dr (Prof.) Anil Arora & Team right away.

Follow-up care: Your regular follow-up visits will ensure the long term success of your operation. Often, follow-up X-rays will confirm proper placement and alignment of the artificial joint.

Weight control: Keeping your weight under control. This will reduce the amount of pressure and stress on your new knee. Avoid high impact sports and participate regularly in low impact activities to strengthen your new knees and get the exercise you need to stay fit.

Do not attempt to squat or sit cross legged after conventional knee replacement.

Total Knee Replacement is an elective operation. The decision to have the operation is yours. The surgeon may recommend the operation, but your decision must be based upon you weighing the benefits of the operation against the risks. All your questions should have been answered before you decide to have the operation.