Articles on knee replacement

8 Ways To Avoid Knee Replacement

Dr. Brijbhushan Mahajan, Orthopedist
Undergoing a knee replacement for knee arthritis can be a very effective quality-of-life decision. Patients are able to get back to recreational activities and a severely reduced painful lifestyle.  Methods of avoiding the replacement with the arthritis.Weight loss – Over 65% of Americans & over 30% of Indians are either overweight or obese. The problem with this is that a lot of stress goes through the joint during ambulation. This excess weight can lead to increased pain and/or increased arthritis. Losing weight allows the patient to decrease joint pain by decreasing stress over joint, and an increased ability to perform activities of daily living, along with other substantial health benefits such as lower blood sugars and lowered blood pressure.Benign neglect – The patient is able to do most of the things that he or she wants to do, the most appropriate answer at that point may be to simply ignore the problem. One additional aspect to consider may be to modify one’s activities. This may include switching from jogging to fast walking, or shifting from skiing to an activity that is less stressful on the joints such as swimming. Physical therapy – Physical  therapy may have significant benefits. Therapy can strengthen up the muscles around the knee joint, which has  beneficial effect of unloading the pressure from the knee joint and dissipating it into the surrounding musculature. This can reduce pain.Acetaminophen and NSAIDS – These medications are predominantly available without prescription and they can be extremely beneficial for alleviating the pain. They have a low risk profile, as long as patients stick to the manufacturers dosing on the box, and don’t combine those medications that can have an additive effect and lead to a bleeding ulcer.Knee injections – Injections into arthritic knee can help substantially relieve the pain. Presently the bulk of these injections consist of cortisone, which is a hefty anti-inflammatory substance, but not one that is going to alter the course of the disease. There are some newer medications consisting of regenerative substances, which contain components such as stem cells, hyaluronic acid, and cytokines. These may in fact alter the course of the arthritis.Bracing  – Off-loading braces take pressure off of the arthritic area of the knee joint and promote pain relief. These braces are typically custom fit after seeing your doctor, and should be worn whenever the patient is up and about when the pain would typically be felt. Narcotic medications – These should not be used on a chronic basis. They should be utilized only for an acute type of situation where patients are having an exacerbation of their arthritis pain. Narcotic medication on a chronic basis has the risk of tolerance, addiction, constipation, etc. So it should be avoided. Utilizing them for exacerbations can however be very effective.Non-narcotic medications – Medications that are non-addictive such as Tramadol can be very effective for knee pain. In addition there are modulating medications such as gabapentin that can help a lot with decreasing the pain that is coming into the arthritic knee joint from the surrounding nerve endings.

Do I Need a Knee Replacement?

Dr. Mohan Puttaswamy, Orthopedist
Many patients have this question regarding their knee arthritis and ask us during their consultation. What is the right time to undergo a joint replacement surgery? The answer to this is determined by a couple of factors- age of the patient, severity of symptoms and most important how this has affected the quality of life.Each of the points mentioned have a bearing on the outcome of surgery. Total knee replacement is an excellent and cost effective way in managing knee arthritis. The satisfaction rates after knee replacement is around 80% and age at surgery has a bearing on the outcome. Generally, knee replacement in younger patients has been found to be less satisfying and has more complications. Even if though there is no cut-off age, generally knee replacement should be opted after the age of 55-60 years. In younger patients if all the options have been exhausted,then one can opt for a knee replacement. Some patients will have severe arthritis on the X-rays but clinically they are able to do their ADL (Activities of Daily Living) without much hindrance. When such a situation arises it is always the patient’s symptoms that dictate the timing of replacement and can be postponed till pain becomes severe. The pain in the knee should be continuous and not well controlled, pain should be limiting simple normal activities like stair climbing, walking or using the toilet. I am diabetic, is it OK to have a knee replacement?          The other factor to be considered during a joint replacement is the general health of the patient. If a patient has multiple medical problems-then those problems should be well controlled before undertaking a joint replacement surgery. Common medical problems like Diabetes, Hypertension, Thyroid problems, Anaemia all have a bearing on the ultimate outcome of a knee replacement. Many of our patients are obese and that can have serious repercussion regarding outcome after a replacement surgery. Weight reduction is generally difficult because patients are unable to exercise before knee replacement but when an individual’s BMI is more than 35 then the complications after a replacement increases. So, it is advisable to consult a dietician and reduce weight by dieting before going forward with a knee replacement.What pain medications are safe to treat mild arthritis?Medications like Paracetamol and Tramadol have a higher safety profile than Diclofenac or other NSAID’s (traditional pain killers). The problem with long term pain medication intake is the higher chance of kidney failure and stomach ulcer formation.  The duration of treatment necessary makes it important to take safer medications and opt for surgical treatment if pain management is not adequate.What injections are safe and effective in knee arthritis?Basically, there are 3 types of injections that are currently available in the treatment of OA knee. They are corticosteroids, Visco supplements and Platelet Rich Plasma (PRP). Corticosteroids are cheap and give good pain relief the problem with steroid injections is that they worsen the degeneration.  Visco supplements are expensive and need to be repeated and cost is a significant factor to consider when opting for Visco supplements. Visco supplements basically work by increasing the joint lubrication. Lastly, PRP is an exciting new option which is less expensive than visco supplements in some centers and is more effective than the visco supplements according to some studies. PRP reduces the inflammation in the knee joint and is patients own blood product injected into the knee joint. Please talk in detail with your surgeon regarding which is the best injection option for your knee arthritis.

10 Myths About Knee Replacement Surgery

Dr. Shreedhar Archik, Orthopedist
10 myths about knee replacement surgeryI see almost3 to 4 patients a day that desperately needs a knee replacement surgery. All these patients are grossly disabled but are reluctant to get operated. I haverealized that most of them refuse surgery because they have been scared bytheir relatives. Relatives and friends talk about the surgery very loosely i.ewithout much knowledge and most of it is hearsay. Unfortunately because ofclear cut information these patients get confused. Youngsters now days will goon the net and find out the facts but elderly generation is mostly not that techsavvy.Here are the10 0common myths I have discovered while talking to my patientsMyth 1: Iwill be in bed for a long time after the surgeryTruth: Dueto the new rapid recovery protocols the patient walks on the same day of hissurgery!Myth 2: Iwill not be able to bend my knee after the surgeryTruth: Onecan bend the knee fully after the surgery. Most of the new implants allownormal range of movement at the knee jointMyth 3:It is a foreign body inserted in my body, it will get rejected.Truth: Theseartificial joints are made up of a special metal which is compatible with ourbody and it can stay in the body forever without causing any side effects.Myth 4: Iwill need lots of physiotherapy after the surgery and recovery is very slowTruth: 99%patients do not need a physiotherapist at home. We teach patients all theexercises while they are in the hospital and all the patient needs to do ispractice the same exercises at home. 98% patients are walking without an aidafter 4 weeks.Myth 5: Doing2 knees in one sitting is very dangerousIt is theother way around. Two knees in one go has lot of advantages. You visit thehospital only once. The recovery is faster because both knees are pain freeafter the surgery. The stay is only one day extra i.e. after one knee thepatient goes home on 4th day whereas here he goes home on the 5thday. It also saves 30 to 40,000 rupees on the total cost which is another hugeadvantage.Myth 6: Iwon’t be able to sit on the floor ever again after the surgeryTruth: Mostof the patient scan squat or sit on the floor after surgery. However the kneegets extra loading while getting up and it is recommended that one sits on thefloor only in case of an emergency.Myth 7:Only joints form “A” company are good.Truth: Mostof the big companies have joints which are very similar in nature and thechoice of the company should be left to the surgeon. Every surgeon is familiarwith one a particular product which works well in his hands. Forcing a surgeonto use a certain product based on the knowledge gathered from the internet isthe worst thing to do.Myth 8:This surgery has high risk and fails most of the times.Truth: Theonly risk in the entire surgery is the risk of infection. This risk is around 2%. This risk is universally same in any center which is well equipped.Myth 9: Iam above 65 years and hence won’t be able to tolerate such a majo surgery90% ofpatients undergoing a knee replacement are above the age of 65 because this isan age related wear and tear issue. It is therefore safe surgery and all patientsare screened before they are taken up for a surgery.Myth 10:These artificial knees last only ofr 10 to 15 years therefore at age 60 I shouldnot get operated.Though it istrue that the artificial knees have a life, it is worth noting that the surgeryis offered to improve the “quality of life”. At age 60 if one cannot enjoy thedaily routine then it is not worth living that kind of painful miserable life.

7 Basic Queries About Total Knee Replacement

Dr Dewangan Ssunil Kumar
 Total Knee Replacement: The knee comprises the joint between the femur and the tibia but also the joint between the patella and the front of the femur. Either or all of these parts of the knee may be affected by arthritis to various degrees. The procedure of joint replacement includes removing the affected joint surfaces and replacing them with metal components with a high-density polyethylene-bearing surface between the metal components What is Total Knee Replacement? A total knee replacement involves replacing the damaged bone and cartilage of the knee joint, which provides articulating surfaces.The total procedure takes approximately an hour to hour and a half to perform and recovery time varies between patients which ranges from 2-3 weeks to 2-3 months. Correct rehabilitation following surgery significantly improves outcomes.In the total knee replacement procedure, each prosthesis is made up of four parts. The tibial component has two elements and replaces the top of the shin bone (tibia). This prosthesis is made up of a metal tray attached directly to the bone and a plastic spacer that provides the bearing surface. The femoral component replaces the bottom of the thigh bone (femur). This component also replaces the groove where the patella (kneecap) sits. The patellar component replaces the surface of the kneecap, which rubs against the femur. The kneecap protects the joint, and the resurfaced patellar button slides smoothly on the front of the joint. This may or may not be replaced depending on the condition of the patient.Advantages of Total Knee ReplacementThe most important advantage is that this operation produces very effective and long lasting relief from joint pain. It also gives a joint which functions normally. The recovery period from the operation is very short and the patient is able to walk from the second or the third day after the operation. Walking support that is needed can often be discarded by around 2-3 weeks or a month's time. The patient regains a normal lifestyle and mobility with significant improvement in quality of life.Frequently Asked Questions about Knee Replacement SurgeryWho is the candidate for a total Knee replacement? What are the risks of Total Knee Replacement? Should I have a total knee replacement? Who develops a more severe or an earlier arthritis? When can I return home? What measures should be taken after the surgery/operation (post operative instruction)? What activities should I avoid after knee replacement?Q 1 who is a candidate for a total replacement?Total knee replacements are usually performed on people suffering from severe arthritic conditions. Most patients who have artificial knees are over age 55, but the procedure can be performed in younger people if joint is already damaged. So criteria for surgery based on age is non dependent. The circumstances vary somewhat, but generally you would be considered for a total knee replacement if:You have daily pain which affects your ADL (Activities of Daily Living).Your pain is severe enough to restrict not only work and recreation 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 bowlegs).Q 2 what are the risks of total knee replacement?Total knee replacement is a major operation. The most common complications are not directly related to the knee and usually do not affect the result of the operations. These complications include urinary tract infection, blood clots in a leg, or blood clots in a lung. Complications affecting the knee are less common, but in these cases the operation may not be as successful. These complications include:some residual knee painloosening of the prosthesisstiffnessinfection in the knee jointA few complications such as infection, loosening of prosthesis, and stiffness may require reoperation. Infected artificial knees sometimes have to be removed. This would leave a stiff leg about one to three inches shorter than normal. However, your leg would usually be reasonably comfortable, and you would be able to walk with the aid of a cane or crutches, and a shoe lift. After a course of antibiotics the surgery can often be repeated to give a normal knee.Q 3 Should I have a total knee replacement?Total knee replacement is an elective operation. The decision to have the operation is not made by the doctor, it is made by you the (Patient). All your questions should be answered before you decide to have the operation. If you have any questions, please feel free to write to us.Q 4 who develops a more severe or an earlier arthritis?One who has family history (this having a strong hereditary influence), who has history of injury in the joint (e.g. a fracture or a ligament/meniscal injury in the knee), who has deformity of knees and the one who is overweight. Medicines are not the treatment for this form of arthritis. Weight reduction, regular exercises, and local heat therapy help in early stages. Physiotherapy is the mainstay of the treatment. Painkillers should be used only occasionally as they adversely affect our kidneys, cause intestinal ulcers and bleeding. Another form of Arthritis is inflammatory arthritis (Rheumatoid or its variants). This does need medical treatment (DMARD's), which changes the course of the disease and prevents further damage to joints. Surgical treatment is needed when structural joint changes have taken place. Before and after the surgery, the patient should remain under care of a Physician/Rheumatologist. Post Traumatic Arthritis can follow a serious knee injury. A knee fracture or severe tears of the knee's ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.Q 5 When can I return home?You will be discharged when you can get out of bed on your own and walk with a walker or crutches, walk up and down three steps, bend your knee 90 degrees, and straighten your knee.Q 6 What measures should be taken after the surgery/operation (Post operative instruction)The success of your surgery also will depend on how well you follow your orthopaedic surgeon's instructions at home during the first few weeks after surgery. Wound Care you will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed several weeks after surgery. A suture beneath your skin will not require removal. Avoid soaking the wound in water until the wound has thoroughly sealed and dried. A bandage may be placed over the wound to prevent irritation from clothing or support stockings. Diet some loss of appetite is common for few days after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Activity Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within three to six weeks following surgery. Some Pain with activity and at night is common for several weeks after surgery. Your activity program should include:A graduated walking program to slowly increase your mobility, initially in your home and later outside.Resuming other normal household activities, such as sitting and standing and walking up and down stairs.Specific exercises several times a day to restore movement and strengthen your knee. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery.Driving usually begins when your knee bends sufficiently so you can enter and sit comfortably in your car and when your muscle control provides adequate reaction time for braking and acceleration. Most individuals resume driving about two to four weeks after surgery.Q 7 What activities should I Avoid after Knee Replacement?Even though you may increase your activity level after a knee replacement, you should avoid high-demand or high-impact activities. You should definitely avoid running or jogging, contact sports, jumping sports, and high impact aerobics. You should also try to avoid vigorous walking or hiking, skiing, tennis, repetitive lifting exceeding 50 pounds, and repetitive aerobic stair climbing. The safest aerobic exercise is biking (stationary or traditional) because it places very little stress on the knee joint.

Things You Must Follow After Knee Replacement

Dr. Hrushikesh R.Saraf, Orthopedist
Knee replacement surgery is one of the specialised surgeries. For better results, after this procedure certain things patient must follow religiously.We can divide it in four categories: 1. Preoperative - Some changes at home like arrangement of commode/western toilet is must. If western toilet is not available then fold-able commode chair can be arranged. Also ,during immediate post operative period patient needs walker followed by  stick support for walking. So do arrange these things prior you get admitted for surgery. Medicines like clopitab /ecosprin must be stopped before one week of surgery or as per advised by your surgeon/physician .2. During admission and post operative period - Follow all instructions given by your doctor. Do exercise and physiotherapy as per schedule. Eat lots of water and keep yourself hydrated. Take soft diet and small feeds after 3-4 hrs. If you are diabetic then keep a watch on sugar levels. If you have fever then immediately contact your surgeon and follow their guidelines.3.Post operative at home - Physiotherapy exercises are important during post operative period to regain strength of thigh muscle. Also they help you to become independent from support of the walker. It trains you to climb chair and perform all your day to day activity at your own. Three months of physiotherapy after surgery not only makes you independent but help to regain maximum range of movement of your new joint.4.Follow up - Regular follow up with surgeon every month for first 6 months and then every year is mandatory. Excessive activity ,over-activity, jogging ,trekking, must be avoided after surgery. Swimming cycling can be started with instructions of your surgeon. Walking is good exercise and that is more than enough for all the patients of this age group. Sitting cross-leg and squatting must be avoided. Patients with high flexion joints can sit cross leg  with consent of their surgeon. 

Treatment of Arthritic Knee Pain

Dr. Samarjit S. Bansal, Orthopedist
Knee pain can be due to many reasons. The most common cause in elderly patient is arthritis (specifically osteoarthritis). It is very disabling and can be cause of severe agony and misery in elderly population. Patient will have difficulty in getting up from bed or chair, difficulty in sitting and squatting and climbing stairs . Few patients may hear crackling sound on bending the knees. Treatment depends upon the stage of the disease. Stage is decided by the x-rays predominantly and clinical examination.Various treatment methods are:EXERCISES:   Exercises help strengthen your muscles and improve/maintain the range of motion of the joint. It is very effective in the early stage of arthritis. There are specific exercises for muscle groups around the knees. These exercises decrease pain also. This can delay/prevent the need of surgery and also reduces the quantity of pain killers required. Proper exercises reduces the risk of injury. In case surgery is required, exercises before and after surgery helps in early recovery.MEDICINES: There are various medicines available for treatment of knee pain. These are important part of treatment of knee pain. NSAID's are commonly used in acute conditions . But these should be avoided for long term use as they have side effects also. There are few analgesics which are relatively safe and can be taken for longer period under the guidance of doctor. Treatment specific medicines are available for Gout , Rheumatoid arthritis. Steroids also sometimes used to decrease acute pain.OTHER MEDICINES: Glucosamine and chondroitin have shown to be effective in moderate to severe arthritis. But study results are mixed for these supplements. Newer products like rosehip extracts with collagen are also showing good results.KNEE INJECTIONS:  When oral medicines are not giving relief than knee injections can be taken before going for surgery. There are three types which can be injected into joint.HYALURONIC ACID: A thick fluid, similar to the fluid that naturally lubricates joints, hyaluronic acid can be injected into your knee to improve mobility and ease pain. Although study results have been mixed about the effectiveness of this treatment, relief from one or a series of shots may last as long as six months. These are given weekly for period of 3-5 weeks depending upon the product.CORTICOSTEROIDS:  Injections of a corticosteroid drug into your knee joint may help reduce the symptoms of an arthritis flare and provide pain relief that lasts a few months. While the injections bring targeted relief to the joint and lack many of the side effects of oral corticosteroid medications, they are not without risks.PLATELET RICH PLASMA (PRP): PRP contains a concentration of many different growth factors that appear to reduce inflammation and promote healing. These types of injections tend to work better in younger people and in people with mild arthritis.SURGERY: Surgery is the last option when all other treatments have failed and knee pain is very terrible and affecting the patient in activities of daily living.TOTAL KNEE REPLACEMENT:The most common knee surgery is total knee replacement, a procedure in which the damaged knee joint is removed and replaced with prosthesis of metal, high grade polymers and plastics. Healthy patients are made to walk the next day after surgery. Few patients take slightly longer time. ARTHROSCOPY: Depending on your injury, your doctor may be able to examine and repair your joint damage using a fiber-optic camera and long, narrow tools inserted through just a few small incisions around your knee. Arthroscopy may be used to remove loose bodies from your knee joint, remove or repair damaged cartilage (especially if it is causing your knee to lock), and reconstruct torn ligaments.OSTEOTOMY: If the damage to your knee is mostly limited to one section, your doctor may recommend a surgery called osteotomy. In an osteotomy, the surgeon reshapes the bones and repositions them to take the weight off of the damaged part of the knee. In doing so it can help relieve pain and improve function, particularly for someone who is not ready to have a total knee replacement.NOTE: This article for information purpose. Kindly consult your doctor for appropriate treatment.

What to Do When Planning for a Knee Replacement Surgery?

Dr. Deepak N Inamdar, Orthopedist
If you are planning to undergo a Knee Replacement Surgery, the following are some of the things that you should keep in mind:Build your muscles and range of movementsBefore the surgery, you're expected to do homework.People who strengthen the muscles around their knees have a faster, easier recovery than those who are weaker going into the surgery. If you reinforce the connections,especially of your inside quad muscle, it will be easier for them to reconnect.For the months or weeks leading up to your operation, try to get on a bicycle or work with a physical therapist to build your strength and expand your range of motion as much as possible.Build up the vital capacity of your lungsDeep breathing exercises like pranayamaIncentive spirometry - started much before surgery help your lungs/body cope and decreases chances of lung associated issues like ARDS Keep yourself clean - Infection anywhere is a strict no for replacement surgery. Treat any infections of urinary tract, skin, soft tissues and other areas .Build your endurance - Start long walks and exercise as much as you can, as ultimately it is needed post-surgery.Prepare yourself mentally to undergo the rigours of surgery and rehab, a mentally tough person is the one who does very well post-surgery.Have a buffer budget - for extras ifstay is prolonged.When to see your doctor if you are planning knee replacement?In a perfect world, I would love to see you a couple of months in advance. Then you're comfortable with the exercises, you know what you're supposed to feel, and the recovery goes more smoothly. 

Facts and Fallacies-Knee Joint Replacement Surgery

Dr. Purushottam Reddy Padala, Orthopedist
Knee Replacement Surgery- Who Needs It?Generally, but not always, joint replacement is done after the age of 50 yrs.  Having said that, no age should be exempted or delayed from surgery for want of a way out of the misery of pain from arthritis.Anybody who has end stage arthritis due to a variety of diseases-osteoarthritis, rheumatoid arthritis, joint damage due to injury etc should have joint replacement surgery.WHEN QUALITY OF LIFE IS AFFECTED TO AN EXTENT WHERE THE PATIENT IS DEPENDENT ON CRUTCHES, WHEELCHAIR OR IS UNABLE TO MOBILIZE AND ALMOST HOUSE-BOUND DUE TO PAIN, STIFFNESS AND DEFORMITY, THEN PERHAPS, JOINT REPLACEMENT IS MANDATED.What Is Available?Unless you need to squat due to religion or a job requirement, you require the usual knee- the one used for 80 % of people. The extra cost for marked knee bending provided by new knees( which is more expensive also) is possibly not required for you.Always ask your doctor to go for a reputed company. The money spent on quality is worth while in the long run.General Questions1. How long does it take after the surgery to be able to walk?Generally 2 days 2. How long before I get back to normal outdoor life?By 6 weeks you will be able to do most things like shopping, travelling etc.3. Period of stay in hospital?4-5 days.4. Do I need to do exercise?Physio is an integral part of joint surgery, to strengthen the muscles, so that normal balancing can take place. Physio for upto a month might be required.5. Can my father have surgery at the age of  seventy? No age is too old for surgery. As long as patient is fit for anaesthesia, which will be done by our anaesthetist, no age is bar from surgery.Where should I get it done?Some centres with no training are claiming 100% guarantee. Remember there is no 100 % in medical specialties. Out of the thousands that are done, a few are likely to get infected, loosen and become painful after surgery. It is recommended that you go to someone who has received advanced training abroad and practiced in Europe or the States, so that all or any eventualities are covered by that surgeon.Replace fear with confidence as joint replacement is now a well entrenched surgery, with very few complications and high success rate.Wish you all the best!Dr Purushotta Reddy 

Do I Require a Knee Replacement Surgery?

Dr. Ashok S Gavaskar, Orthopedist
This is a lingering question in the minds of a lot of elderly people with prolonged knee pain after consulting a lot of orthopedic surgeons. This article will provide some insight for patients before contemplating knee replacement. Total knee replacement has emerged as a highly successful surgery for management of endstage knee arthritis. 15 - 20% of patients undergoing knee replacement surgery continue to suffer and feel dis-satisfied with their surgery. Reasons could be manifold including poor surgical technique on part of the surgeon. The most important factor contributing to poor outcome is improper patient selection. So what are the risk factors for dis-satisfaction after a knee replacement?Wrong diagnosisVarious conditions may mimic arthritic pain from the knee and it is the responsibility of the surgeon to exclude these before attributing the knee as the source of pain. Disorders of the spine and hip can co-exist and if identified as a possible source of pain, may require treatment before addressing the knee.Ruling out other sources is an important part of the preoperative evaluation to avoid a major cause for dis-satisfaction after knee replacement surgery.Lack of symptoms and low demandsPatients with no, minimal or tolerable pain without need for medications tend to have inferior results with knee replacement irrespective of what is seen on their x-ray. Knee replacement is mainly performed to address pain due to arthritis and lack of pain pre-operatively will mean that patient will not benefit much after surgery. Similarly a very elderly patient with very low demands, home bound with medical issues and low motivation levels will not realize the entire benefits of knee replacement surgery.Extremes of ageThough no arbitrary age cut off could be defined, knee replacement is generally preferred in a slightly older patient with end stage arthritis. Knee replacement in a very active young patient places higher loads on the prosthesis increasing risk for early failure and may require multiple revision surgeries later. On the contrary young patients with severe arthritis due to rheumatoid conditions,preceding trauma or infections may actually do much better with a knee replacement than going through severe pain and disability during their productive age. Similarly the satisfaction rates can be low in very elderly patients with extremely limited mobility and cognitive impairment. We don’t define age limits and the decision is purely made based on functional demands of the patient, degree of pain and disability. After all age is just another number.Unrealistic expectations and poor preoperative counselingFailure to counsel the patient properly can result in unrealistic expectations, which can have a huge bearing on satisfaction rates following knee replacement. A patient undergoing a total knee arthroplasty needs extensive counseling and education regarding the outcome of the procedure in a personalized manner. The dos and don’ts, what to expect after surgery, time taken for recovery, degree of pain relief,amount of movement possible at the knee and any patient specific demands should be thoroughly addressed. Total knee replacement in an indicated patient tremendously improves pain relief and also improves function and mobility to a degree that is possible at that age. A good surgery by the surgeon and an expensive implant doesn't always guarantee a good outcome. A lot of patient specific factors like age, weight, activity level and other medical conditions can have a significant say in the outcome and needs to be discussed with the patient to keep expectations realistic.Pain management after total knee replacementTotal knee replacement is a painful procedure and poor pain management in the post-operative period can cause dis-satisfaction, muscle weakness and joint stiffness. We follow unique state of the art protocols for evaluating and preparing a smooth road map for surgery keeping patients well informed and counselled by a dedicated team of counselors. In my practice, pain management starts much before the surgery using preemptive analgesia (to control pain before surgery to smoothen the transition to surgery). Postoperative pain is well taken care off using patient controlled epidural pumps, nerve blocks and parenteral pain medications to enable faster recovery and expedite rehabilitation.We provide a dedicated supervised home physiotherapy program to enable patients to realize the ultimate benefits of knee replacement surgery.Who is an ideal patient to undergo knee replacement surgery?I follow stringent policies and protocols to screen and evaluate patients undergoing knee replacement at multiple levels to ensure successful results following knee replacement surgery. I consider an active person after their 50s suffering from intractable knee pain which is significantly hindering their daily routine making them either avoid their personal and social commitments or force them to take regular medications to overcome pain with x-rays showing advanced cartilage degeneration to be an ideal candidate for knee replacement. Special considerations are given to young patients with rheumatoid, psoriatic and severe post-traumatic or post-infective arthritis who may also benefit from knee replacement surgery with better mobility, pain relief and a superior quality of life.