Knee Replacement

KNEE REPLACEMENT SURGERY WITH A DIFFERENCE

Tissue Preserving Total Knee Replacement (TPTKR)

Knee Replacement

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Tissue Preserving Knee Replacement

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Revision Knee & Complex Knee Replacement

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Partial Knee Replacement Or Unicompartmental Knee Replacement

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Patellofemoral Knee Replacement

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The arrows in the picture show the cartilage layer over the knee joint surfaces


Understanding arthritis

Cartilage is the cushion, which covers the knee joint surfaces like the rubber on your car tyre. Movement in the absence of cartilage leads to a grinding of bone on bone and production of debris, which causes swelling, pain and destruction. This is what happens in knee arthritis.
“This grinding process in the knee joint continues in spite of medications, which only reduce swelling and pain but do not restore the lost cartilage.” This process can be slowed down by weight reduction, activity modification, muscle strengthening exercises with judicious use of anti-inflammatory medication.. The time to consider surgical intervention comes when the patient is functionally incapacitated or in danger due to severe bone destruction.

About Conventional Total Knee Replacement

Total knee replacement surgery is one of the most cost effective ways of treating severe knee arthritis. This surgery simply involves removing the damaged bone surfaces and replacing them with metal and plastic.

Total knee replacement is a good established operation for end stage knee arthritis. Knee Replacement surgery has advanced significantly with the use of high bending implants, gender specific implants (special implants for women) and computer assisted surgery, but, the operation continues to be done through a mid line muscle and tendon cutting approach as shown in the diagram below on the right. The red line depicts the conventional approach to expose the knee joint.

Less attention has been given to preserving soft tissues during this operation. The bone work is done satisfactorily but the soft tissue damage that occurs during the operation is often not given due importance. The conventional technique damages the quadriceps muscle ( muscle in front of thigh and knee) and other normal tissues. It causes more bleeding and post operative pain. The damage to the muscle is slow to recover and in a lot of cases the muscle may never come back to full potential. This leads to slower rehab inspite of very intensive physiotherapy. Knee bending is slower and often incomplete.


Tissue Preserving Total Knee Replacement (TPTKR)

TPTKR is an attempt to make a good surgery better. It goes beyond the general scope of conventional knee replacement surgery. It allows satisfactory knee replacement with minimal tissue damage.
The quadriceps muscle is one of the most important muscles around the knee. It therefore does not make good sense to damage this quadriceps muscle. This is even more important in older patients whose tissue reserve is already low. The specialized TPTKR technique uses a Muscle preserving exposure.
The muscle preserving technique we use does not cut the QUADRICEPS muscle (muscle in front of knee and thigh) and damage it. It allows entry into the joint along the side of the muscle by simply flipping it to the side and not cutting through it. It gives satisfactory exposure with standard instruments. It is minimally invasive in the true sense.

The Quadriceps muscle and tendon

Advantages of tissue preserving surgery
⦁ Less post surgery pain
⦁ Less bleeding (We rarely transfuse blood including patients who undergo both knee replacement in one sitting)
⦁ Faster return of knee function – muscle strength and control comes back more quickly – allows faster rehabilitation. Patients can walk on day of surgery in most cases
⦁ Shorter hospital stay
⦁ Recovery time is less than one third of that with conventional technique.

A good knee replacement happens when we remember that not only do we have to execute the bone work properly but at the same time preserve the tissues that are going to stabilize and move these bones. Good function as seen in the picture below is more than simply well aligned knee implants.

Recently we demonstrated the power of this technique when a 94 yr old pt. underwent TPTKR on both knees in a single sitting and was able to walk 4 hrs. after surgery. This technique has been quoted in the LIMCA book of records for quicker recovery following surgery.

Patients Speaks

George Benz

Dr. Kaushal Has Been Extremely Helpful Throughout The Entire Treatment Process. His Care And Attention To His Patients Is Excellent. I Have Made A Full Recovery And My Life Is Back On Track