Total Knee Arthroplasty Surgery in Indore

Hakimi Ortho Care. Dr. Murtuza Rassiwala. Relief from advanced knee arthritis. Designed around your life.

When a worn-out knee turns a short walk into an ordeal, keeps you awake at nite or forces you to plan your day around the nearest chair, it’s natural to ask yourself if a knee replacement might be the answer. Total knee arthroplasty (TKA), more commonly known as total knee replacement, resurfaces the damaged ends of the thigh bone and shin bone with precisely shaped metal components and a medical-grade plastic bearing. It is one of the most established operations in orthopedics for the right patients to relieve arthritic pain and improve day to day function.

Dr Murtuza Rassiwala, an orthopedic surgeon in Indore who has done DNB training in orthopedics and has a fellowship background in joint replacement, assesses each knee on a case-to-case basis. Some patients are advised to continue with non-surgical treatment for longer, some are more suited to a partial knee replacement and others, whose whole joint is affected, benefit from a total replacement. This page covers the entire pathway so you can come to your consultation armed with knowledge.

Quick answer: Total knee arthroplasty is a procedure to replace all the damaged surfaces of the knee joint with artificial parts. Generally intended for severe osteoarthritis, rheumatoid arthritis or post injury arthritis where pain and stiffness persist to limit everyday life even with medication, physiotherapy and lifestyle changes.

Total Knee Replacement at a Glance

These timelines are average ranges reported for knee replacement in general: Age, fitness, other health problems, the condition of the knee before surgery and your dedication to rehabilitation all influence your own recovery.

What is Knee Replacement Surgery?

The knee is a hinge joint that connects three bones: the lower end of the thigh bone (femur), the upper end of the shin bone (tibia) and the kneecap (patella). Articular cartilage is a smooth, slippery lining on your healthy knees that lets the bones slide over each other with no friction. When this cartilage wears away, bone grinds on bone. The result is pain, swelling, stiffness, grating sensations and, with time, a change in the shape of the leg.
In total knee replacement the surgeon doesn’t replace the knee as a single block. Rather, the damaged surfaces are shaved off in thin, measured slices and resurfaced with:

• Femoral component: a curved metal cap, normally made of a cobalt-chromium alloy, which sits on the end of the thigh bone.
• Tibial component: A flat metal tray that is fixed to the top of the shin bone.
• Polyethylene insert: This is a medical-grade plastic spacer that sits on the tibial tray and serves as the new gliding surface.
• Patellar button (a plastic dome which can be used to resurface the back of the kneecap, depending on its condition and the surgeon’s judgement).

The main ligaments that stabilize the knee from the sides are preserved and balanced during the operation. The goal is a well aligned, stable knee that is much less painful than it was throughout its range of motion.

The word “arthroplasty” simply means repair of a joint. You may hear total knee arthroplasty, total knee replacement and TKR used interchangeably; they all refer to the same operation.

Why is Knee Replacement Performed?

The goal of total knee replacement is to relieve pain and disability from severe damage to the joint surfaces. One does not treat a single episode of pain or a knee that is only mildly worn. The most common underlying conditions are listed below.

• Osteoarthrosis: Osteoarthritis is the number one cause for knee replacement surgery worldwide. It progresses slowly as the cartilage breaks down and degenerates, often over a long period of years. Age, weight, previous injury, family tendency, and the natural alignment of the leg all play a part. In many Indian patients osteoarthritis begins in the inner (medial) part of the knee and slowly leads to the leg becoming bow legged.
• Rheumatoid Arthritis and Other Inflammatory Arthritides: Rheumatoid arthritis is an autoimmune disease that causes inflammation of the lining of the joint and destruction of the cartilage throughout the knee, often in both knees at the same time. Modern medical treatment by a rheumatologist has reduced the need for surgery but when damage is advanced replacement can be useful. These patients require: Close coordination between the orthopedic surgeon and rheumatologist around the time of surgery, especially regarding medications affecting immunity.
• Post-Traumatic Arthritis: A fracture that goes into the knee joint or a serious ligament or meniscus injury may affect the joint surfaces and result in early arthritis years later. Some of these patients are younger than the typical knee-replacement candidate, and planning may need to account for old hardware, scarring or bone loss.
• Disfigurement: If the arthritis has been present for a long time, the leg may be bowed (varus), knock-kneed (valgus), or unable to fully straighten (flexion deformity). Deformity causes the joint to be loaded asymmetrically and increases wear. One of the key tasks of a total knee replacement is to correct alignment.
• Another reason: Other causes are less common and include avascular necrosis (loss of blood supply to part of the bone), post-infective arthritis and some bone tumors. Each of these needs specific evaluation.

Who May Need a Total Knee Replacement?

The decision is not based on any particular age or X-ray finding. Dr. Rassiwala looks at the big picture: how bad your symptoms are, how much they interfere with your life, what the X-rays show and how well you’ve responded to other treatment. If several of the following are true, you may be a candidate.

• Knee pain that wakes you up at nite almost every day.
• Trouble walking even a few steps, climbing stairs, or getting up out of a chair or the floor.
• Stiffness prevents full bending or straightening of the knee.
• Observable increase in bow-leg or knock-knee deformity.
• X-rays that show loss of joint space, bone spurs, and bone-on-bone contact.
• Little or no sustained benefit from medicines, physiotherapy, weight management, walking aids or injections.
• Good general health to undergo anesthesia and surgery safely.

The decision to replace a knee is largely a matter of quality of life. A patient with moderate x-ray changes but severe disabling pain may do better than one with dramatic x-rays who is still walking comfortably. The talk is always about you, not the image alone.

Symptoms That Lead Patients to Consider Surgery

The symptoms of advanced knee arthritis usually develop gradually and many people adapt without realizing how much they have changed their routine. Patients have reported common patterns including:

• Pain That Has Changed Its Nature: In the early stages of arthritis pain is often only felt after a long walk. In advanced disease, pain starts with the first few steps, returns quickly after sitting, and may ache at rest or at nite. Many patients describe a deep grinding pain on the inside of the knee.
• Stiffness upon Sitting and Morning Stiffness: The knee is “rusty” in the morning or after a long car journey, and needs a few minutes of movement to loosen.
  Swelling and Heat: Worn cartilage rubs against the lining of the joint. The lining makes excess fluid. The knee can look puffy, particularly at the end of the day.
• Grinding, Crunching or Clicking Noise: Crepitus, a rough, grating feeling when bending the knee, indicates that the joint surfaces are irregular.
• Yielding and Lack of Confidence: Pain can cause the thigh muscles to shut off suddenly and the knee may give way. Patients often start holding onto railings or walls and avoid crowded places.
• Loss of Independence: People in Indore often seek an opinion because they find it difficult to sit on the floor for prayer or meals, use an Indian-style toilet, climb into a bus or visit homes on upper floors.

Preoperative Diagnosis for Hip Replacement:

Good decisions are based on a thorough evaluation, not one report.

• Physical examination: Dr Rassiwala observes your walk, the positioning of the leg, your mobility, the stability of the ligaments, the state of the kneecap joint, the tone of the thigh muscles and the condition of the skin surrounding the knee. They also look at the hip and spine, because hip arthritis and back nerve problems can cause pain that feels like it is coming from the knee.
• X-ray, Weight Bearing: Standing X-rays show how much joint space is left when the knee is supporting the weight of the body, where the wear is, and how severe the deformity is. Additional views of the kneecap and, if required, a complete leg x-ray will help plan the alignment.
• MRI: Advanced arthritis that is obvious on X-rays usually doesn’t need an MRI. It can be useful in cases of diagnostic uncertainty, such as suspected avascular necrosis, or when deciding between partial and total replacement.
• Blood Tests & Medical Evaluation: Before surgery routine blood tests, a urine test, an ECG, a chest X-ray and other investigations depending on age and medical history are performed. Diabetes control, blood pressure, heart and kidney function, anemia and any active infection (including dental or urinary infection) are assessed. A doctor or anesthetist will assess your fitness for surgery.

When Surgery is Recommended?

Total knee replacement is usually recommended when three things converge: the arthritis is advanced enough on imaging, the symptoms are substantially limiting your daily life, and appropriate non-surgical treatment has been attempted without adequate relief. It’s all about timing. “If you wait too long and the knee is badly deformed and the muscles have wasted away, the surgery can be technically more difficult and the recovery slower. Patients are put at unnecessary surgical risk when conservative treatment can still help, by operating too early.

Dr Rassiwala asks patients to think about what they want to be able to do – walk to the temple or mosque, play with grandchildren, go back to a job that requires standing, travel – and weigh it against the effort and risks of surgery and rehabilitation.

When Knee Replacement May Not Be Suitable

In some cases surgery can be delayed or avoided:

• Active infection of the knee or elsewhere in the body, such as skin ulcers, urinary tract infection or dental abscess, until fully treated.
• Uncontrolled medical conditions like poorly controlled diabetes, unstable heart disease or severe lung disease until optimized.
• Poor skin condition/circulation around the knee which may affect wound healing.
• Severe weakness or paralysis of the thigh muscles, so that the knee would not function even after replacement.
• Pain in another location, such as the hip or spine, with little knee change.
• Unrealistic expectations eg expecting to return to running or high impact sport.
  Getting told “not yet” is not a denial of care. That usually means there is a better or safer first step to take.

Non-Surgical Options to Try First

Many people with knee arthritis will not need surgery for years. Usually the following are considered before recommending replacement

• Weight Control: Each kilo of body weight is amplified several fold across the knee during walking and stair climbing. Even a modest weight loss can help reduce pain in overweight patients.
• Physical therapy and exercise: Strengthening the quads, hamstrings and muscles in the hip area helps absorb load and improves stability. In general, activities that are low impact—such as cycling, swimming, and walking on flat ground—are better tolerated than running or deep squatting.
• Medications: Pain may be eased with paracetamol, short courses of anti-inflammatory tablets or gels, or other medicines. They are prescribed according to kidney function, stomach health and heart conditions.
• Walking Aids & Supports: Carrying a walking stick in the hand opposite the painful knee can relieve the joint load noticeably. Unloader braces can help some patients who have arthritis on one side of the knee.
• Injections: Steroid injections can give temporary relief during flare-ups. Some doctors use hyaluronic acid and other injections. These help some people but not others and do not rebuild worn cartilage.
• Activity Modification: Avoiding long periods of squatting, sitting cross-legged and frequent stair climbing may relieve symptoms. Raised seating, a Western-style commode and handrails at home can often make a real difference.

When the above measures are no longer keeping you comfortable and active, a total knee replacement is a reasonable consideration.

Types of Knee Replacement and Alternative Approaches

Total knee replacement is one of several surgical options for knee arthritis. Choosing the right one depends on where the damage is and how healthy the ligaments are.

If you have arthritis in only one compartment, you might want to read about partial knee replacement. This removes less bone and may allow for a quicker early recovery for selected patients.

• Implant Design Choices: There are design variations within total knee replacement . Posterior-stabilized implants substitute for the function of the posterior cruciate ligament, whereas cruciate-retaining designs preserve it. The components may be fixed with bone cement, the most common method, or they may be designed to allow bone to grow onto them. The choice depends on the ligaments, bone quality and deformity and is explained at planning.
• Unilateral or bilateral operations: If both knees are very bad, they can be replaced at the same time (simultaneous bilateral) or a few days or months apart (staged). Doing both at once means one anesthetic and one recovery period, but is harder on the heart and lungs and is usually done only for fitter patients. Your health condition is the basis for this decision.

Surgical Technique

Dr. Rassiwala designs each operation specifically for your knee deformity, bone quality, and ligament balance. The main technical goals of any total knee replacement are:

• Proper alignment to ensure body weight is distributed evenly over the new joint.
• Ligaments balanced to provide stability of the knee in extension and flexion.
• Correct component size and rotation to enable smooth tracking of the kneecap.
• Solid anchoring of the implants in healthy bone.
• Gentle handling of soft tissues for wound healing and early mobilization.

These goals are reached by means of precision instruments, cutting guides and intra-operative controls.

Step-by-Step Procedure

Knowing what happens on the day can take some of the anxiety away. Here’s how a typical total knee replacement works.

• Arrival and Getting Set Up: You are admitted to hospital, usually the evening before or the day of your surgery. The team checks your identity, which side to operate on and that you agree. The operated leg is marked. An IV is started and antibiotics are given before the incision to help prevent infection.
• Anesthetics: Most knee replacements are performed under spinal anesthesia which numbs the body from the waist down while you breathe on your own. Light sedation helps you relax. A nerve block may be added around the thigh to reduce pain after surgery. If spinal anesthesia is not suitable, then general anesthesia is used.
• Preparation and Positioning: The leg is cleaned with antiseptic and draped with sterile drapes. During part of the operation a tourniquet may be applied to the thigh to reduce bleeding.
• Exposure and Incision: An incision is made in the front of the knee. The surgeon moved the kneecap out of the way to get at the joint.
• Preparation of Bones: Thin layers of worn cartilage and bone are removed from the end of the femur and top of the tibia using measured cutting guides. Bone spurs that interfere with movement are removed. If it is to be resurfaced, then the back of the kneecap is shaped.
• Trial Components and Ligament Balancing: Trial implants are inserted and the knee is cycled through the full range. The surgeon assesses for stability, alignment, patellar tracking, and range of motion and corrects soft tissues as necessary.
• Final Fixation of Implant: The final components are then fixed to the bone (usually with bone cement) and the plastic insert is secured to the tibial tray.
• Conclusion: The joint is flushed out the layers are closed with sutures the skin is closed with stitches or staples. Apply a sterile dressing. A drain may or may not be placed depending on the judgment of the surgeon.
• Recovery Room: You are monitored as the anesthetic wears off and then transferred to the ward.

Anaesthesia and Pain Control

The most common concern for patients is whether the surgery will be painful. Modern knee replacements employ a range of techniques, called multimodal pain management, to keep pain under control and allow early movement. This may include spinal anesthesia, nerve block, local anesthetic injected around the joint during surgery, regular oral pain relief and cold therapy. Some pain is to be expected, especially in the early physiotherapy sessions but should be controlled enough for you to exercise. Let the nursing team know if pain is preventing you from moving.

Technology and Implants

The long-term performance of knee replacement depends on good surgical technique, appropriate implant selection and patient factors such as weight and level of activity. The implants are made of materials that have a history of successful use in joint replacement, cobalt-chromium or titanium alloys for the metal components and either highly cross-linked or conventional polyethylene for the bearing surface. Your discharge papers contain information about your implant – the manufacturer and batch – keep these in a safe place in case you need to reference them in the future.

Benefits of Total Knee Replacement

Potential benefits for selected patients include:

• Reduced arthritis pain. This is the most common benefit reported in published research.
• Better walking ability, including longer distances, fewer rests.
• Improved sleep once nite pain from the arthritic knee settles down.
• Correction of deformity, with a straighter leg and gait.
• More independence in daily activities such as climbing stairs, shopping and traveling.
• Better overall health as patients can remain active and control weight.

A replaced knee is not like a young, natural knee. Most patients will not be able to kneel comfortably for long periods and deep squatting or sitting cross-legged may be limited depending on the range of motion achieved. It is common to feel the implant, hear clicking or experience mild stiffness.

Preparing for Surgery

Proper preparation leads to smoother recovery.

Medical Preparation:

• Complete all pre-operative tests and be cleared by the physician or anesthetist.
• Work with your doctors to optimize diabetes, blood pressure and anemia.
• Treat any dental problems, skin infections or urinary symptoms in advance.
• Give a complete list of medicines. Some diabetes medicines, blood thinners and some anti-rheumatic drugs may need to be stopped or adjusted – on medical advice only.
• Stop smoking, preferably a few weeks before the surgery.

Physical Activity:

Learning and practising your post-operative exercises before surgery, strengthening the thigh muscles and getting to know what a walker is all about makes the early days easier.

Home Prep:

• Get a bed of the right height and an armchair ready.
• Use a commode of the Western type or a raised toilet seat.
• Remove loose rugs and clutter; install nite lights and handrails as needed.
• Have a family member come help out for the first two to three weeks.
• Keep frequently used items at waist level.

Admission and Hospital Stay

You will be instructed to fast for a number of hours before your operation. Bring your reports, medicines, loose comfortable clothes and non-slip footwear.

During your hospital stay your priorities are pain control, clot prevention, wound care and getting you moving safely. Physiotherapists will teach you to stand, walk with a walker, bend and straighten the knee, and walk up a few stairs. Most patients are discharged when they are safe to walk with support, can use the toilet, have enough knee movement and their pain is controlled with tablets.

Recovery After Total Knee Replacement

Swelling and warmth around the knee can persist for several months and are part of the normal healing process. Sleep may be disrupted in the first few weeks.

Post-Operative Care

Wound Care

Keep the dressing clean and dry and follow instructions about when you can take a bath. Report spreading redness, pus-like drainage, increasing pain or fever.

Exercises

Physiotherapy will usually include quadriceps tightening, straight-leg raises, heel slides to improve bending and straightening of the knee, and practice at walking. It’s more a question of frequency than intensity.

Medications

Follow the directions on your prescription for pain relievers and blood clot prevention medication.

Warning Signs – Contact the Clinic if you Notice:

• Fever or chills or drainage from the wound.
• Calf pain, swelling of the whole leg, or new breathlessness or chest pain (seek urgent medical attention).
• Sudden inability to bend the leg or put weight on it.
• Fall on the knee operated on.

Follow up

Dr. Rassiwala will see you at the follow up appointments to look at the wound, range of motion in the knee, your gait and X-rays. Long-term periodic checks help to detect wear or loosening in time.

Caring for Your Implant

Tell any doctor or dentist that you have a joint replacement before you have surgery. In some cases, you may need to take antibiotics. Treat any infection in the body as soon as it occurs.

Returning to Work, Driving and Daily Activities

• Desk or office work: Usually 4–6 weeks
• Standing or walking work: often 8-12 weeks
• Heavy manual work: May take longer and some positions may need to be adapted.
• Driving: When you can safely operate the pedals and you are not on strong painkillers, usually 4 to 6 weeks or longer. Right knee replacements usually take longer.
• Travel: You may often be able to take short trips after a few weeks. Long flights should be discussed as clot prevention is important.
• Sex: Usually possible when comfortable, usually after several weeks.

Exercise and Activity After Knee Replacement

Keeping active is good for the new knee and your overall health. Activities generally encouraged are walking, stationary cycling, swimming post-wound healing and gentle exercise classes. After full recovery some patients can participate in low impact sports such as golf or doubles badminton. Running, jumping and contact sports place high loads on the implant and are usually not recommended. Prolonged kneeling and deep squatting can be uncomfortable. Talk about your specific goals with Dr. Rassiwala.

Cost of Total Knee Replacement in Indore

The cost of total knee replacement in Indore varies because each patient has different requirements. The main factors are:

• One or both knees.
• Implant type and brand.
• Hospital and type of room chosen.
• Duration of hospital stay.
• Medical clearance and pre-operative testing.
• Additional medical care for conditions like diabetes or heart disease.
• Physiotherapy post-discharge.

Insurance & Cashless Treatment

Many health insurance policies cover knee replacement with conditions like waiting periods, sub-limits, co-payments and implant caps as stated in the policy. Before surgery, check your policy terms and whether the hospital is empaneled with your insurer or TPA for cashless treatment. The clinic can assist with the paperwork.

Dr. Murtuza Rassiwala’s Expertise in Knee Replacement

Dr Murtuza Rassiwala is an joint replacement surgeon in Indore. He practices at arthroscopy, joint replacement and trauma. Qualifications: MBBS (Baroda University, 2013), DNB – Orthopedics (National Board of Examinations, 2018), MNAMS, F.I.A.S.M, F.I.A.J.R. (Fellowship)

Academic Title: Associate Professor
His experience in both arthroscopy and joint replacement allows him to consider the whole spectrum of options for a painful knee from joint preserving procedures to partial or total replacement and recommend the one appropriate for your stage of disease.

Why Dr. Rassiwala for Knee Replacement in Indore

• Individual assessment: The X-ray alone does not determine the decision, your symptoms, examination and goals all play a part.
• Range of options: Non-surgical treatment, partial replacement and total replacement are all considered.
• Open discussion: Risks as well as the expected recovery and limitations are discussed prior to consent.
• Focus on rehabilitative: Pre-surgery recovery planning.
• Clinics available: Two Hakimi Ortho Care clinics in Indore for consultation and follow-up.

Book a Knee Replacement Consultation in Indore

If you are experiencing knee arthritis symptoms that affect your sleep, walking or independence, a comprehensive evaluation can help determine if total knee arthroplasty, partial knee replacement or continued non-surgical treatment is the best option for you. Take your X-rays and list of medicines with you to the appointment.

Book an Appointment with Dr. Murtuza Rassiwala at Hakimi Ortho Care – 106 Badshah Chambers, Jawahar Marg or 6 Phadnis Colony, Manik Bag Road, Indore. Call +91-7224888071, 0731-4981538 or 0731-3695285 or Book Online.

Medically reviewed by: Dr. Murtuza Rassiwala, MBBS, DNB (Orthopaedics)

This page provides general information about knee replacement and is not a substitute for a personal medical consultation.