Knee Replacement

Know a bit about your knee

Your knee joint is the largest joint in your body and also a very complex one. Because it is very important for your daily activities and you use it a lot, it can get injured and damaged.


Your knee joint is made up of:

Knee joint bones

Bones: the lower end of the thigh bone (femur), upper end of the shinbone (tibia) and the knee cap (patella).

Cartilage covering the bones
Cartilage: This is a thin, white covering on the bone ends which keeps them bones and provides a smooth, slippery surface for painless, free movement of your knee.
Knee joint ligaments
Ligaments: 4 thick rubberband-like structures that hold the two bones together and provide stability.
The 2 collateral ligaments (MCL, Medial and LCL, Lateral) are on the inner and outer side of the knee.
The 2 cruciate ligaments (ACL, anterior cruciate ligament, and PCL, posterior cruciate ligament) are in the centre of the knee.
C-shaped cushions
Menisci: These are 2 C-shaped cushions between the femur and tibia which act as shock absorbers. The one on the inner side is called the Medial meniscus and is injured more often than the Lateral meniscus which is on the outer side of the knee.

The 3 Compartments of the knee

orthopedic doctor in mumbai
Know your knee
The end of your thigh bone (femur) can be compared to a rocking chair. It has two distinct surfaces called condyles, which rest on the shin bone (tibia), forming two ‘compartments’, the inner (or medial) and the outer (or lateral compartment). A third compartment is in the front of the knee behind the knee cap (patello-femoral compartment).
What is Arthritis?

Osteoarthritis, commonly called ‘arthritis’, is the most common cause of chronic knee pain and typically affects people over the age of 50 years, being 3 times more common in women than men.

The end of your thigh bone (femur) can be compared to a rocking chair. It has two distinct surfaces called condyles, which rest on the shin bone (tibia), forming two ‘compartments’, the inner (or medial) and the outer (or lateral compartment). A third compartment is in the front of the knee behind the knee cap (patello-femoral compartment). The bones in each compartment are covered by a thin layer of cartilage which prevents the bones from touching each other.

The exact cause of arthritis is not known but it results when the slow loss of cartilage exceeds the rate at which the body is able to repair it. Once the cartilage covering is completely worn out, the bones touch each other, causing pain.

Noraml knee joint healthy cartilage
Xray of normal knee joint showing gaps
Loss of cartilage covering treatment
Arthritic knee joint xray
Gaps between bones xray

Xray showing severe arthritis with almost complete loss of ‘gap’ between bones

Arthritis results in pain, stiffness, swelling and difficulty in performing your daily activities such as walking, standing for long, getting up from a chair, climbing stairs and sitting cross-legged. When the full thickness of cartilage is worn away due to osteoarthritis, there is no treatment available to make it grow back.

What is Total Knee Replacement?
cartilage covering the bones

The end of your thigh bone (femur) can be compared to a rocking chair. It has two distinct surfaces called condyles, which rest on the shin bone (tibia), forming two ‘compartments’, the inner (or medial) and the outer (or lateral compartment). A third compartment is in the front of the knee behind the knee cap (patello-femoral compartment). The bones in each compartment are covered by a thin layer of cartilage which prevents the bones from touching each other.

Arthritis means damage and wear of the cartilage covering the bone ends. It can be of different types - Osteoarthritis, Rheumatoid Arthritis, and Post-traumatic Arthritis (after previous injury, fracture or dislocation) being the common ones. It causes pain, stiffness, swelling and difficulty in performing your daily activities such as walking, standing for long, getting up from a chair, climbing stairs and sitting cross-legged.
When the cartilage in all 3 compartments of your knee is severely damaged, results in pain, swelling, stiffness and deformity, and affects your daily activity, you should start thinking about knee replacement. It should be considered only after all other standard treatment (lifestyle modifications, medicines, exercises and physiotherapy) has failed to improve your quality of life. Through examination, x-rays and possibly scans, we will help you decide which is the best option for you – replacement or resurfacing (in which only the diseased cartilage in one compartment is resurfaced leaving normal tissues, ligaments, and cartilage intact).

'Knee Replacement' is actually misleading as your whole knee is not replaced! It only involves resurfacing the entire cartilage on the 3 bones where they move against each other. The new surfaces are made of metal and polyethylene and are fixed to your bones with special bone cement. The implants we use are imported, have been well tested, and have been used successfully for many years.

Total Knee Repalcement
resurfacing arthroplasty knee
What are the different types of Total knee replacement?
cartilage covering the bones

Yes, there are hundreds of different designs and models. In fact, we have helped design implants (such as the Attune Knee System, made by DePuy Johnson & Johnson) that are used worldwide by other surgeons. We decide what is best for each person based on a thorough assessment of several patient factors (age, weight, activity level, bone quality, deformity, ligament integrity, etc.). Do let us know if you have any specific design in mind. Also let us know if you are allergic to nickel, chromium or cobalt.

Mobile bearing, cruciate-retaining

Mobile bearing, cruciate-retaining

Fixed bearing, cruciate-retaining

Fixed bearing, cruciate-retaining

Fixed bearing, cruciate-substituting

Fixed bearing, cruciate-substituting

Mobile bearing, cruciate-substituting

Mobile bearing, cruciate-substituting

Cementless prosthesis

Cementless prosthesis

Fixed bearing, all-poly cruciate-substituting

Fixed bearing, all-poly cruciate-substituting

Fixed bearing, oxinium cruciate-substituting

Fixed bearing, oxinium cruciate-substituting

Constrained, mobile bearing, cruciate-substituting

Constrained, mobile bearing, cruciate-substituting

Hinged, rotating platform

Hinged, rotating platform

Tumour prosthesis

Tumour prosthesis

Total knee Replacement or Resurfacing?

Arthritis usually starts in only one compartment, while the other two remain healthy. Most surgeons use implants to replace all 3 compartments (Total Knee Replacement) as it is a technically easier operation. Patients who have osteoarthritis in only one compartment may not need a total knee replacement.

Total knee resurfacing
knee resurfacing

In Resurfacing, only the diseased cartilage in one compartment is removed and resurfaced with metal and polyethylene leaving normal ligaments, meniscus, and cartilage intact. By Resurfacing one compartment at the right time, the knee joint can be preserved and knee replacement can be avoided or delayed for over 15 years.

The benefits of resurfacing include a smaller incision, less pain, little swelling and faster recovery. Your knee will be as similar to your normal knee as possible, will feel normal, and will be as flexible so that you can lead a normal life. The operation removes less bone than a total knee replacement because only damaged cartilage is removed. The wear rate of unicompartmental resurfacing is exceptionally low, allowing them to last long. Results from around the world show that those who have had resurfacing are more satisfied than those with a knee replacement. It is also very likely that there will be no need for any further operations on your knee. However, should you require knee replacement after many years, it will be an easier operation as the remaining knee had been preserved, and the results will be equally satisfactory and long-lasting.

However, knee resurfacing is a more difficult operation and few surgeons are trained to perform it well. We are among the few centres in the world that perform it regularly in large numbers since nearly 20 years. We have published our technique and results in scientific papers in journals and as chapters in textbooks. We also are involved in designing the implants that are used for resurfacing and run training courses to teach other surgeons the technique of resurfacing.

Common questions about knee resurfacing

How is your knee joint special?

Your knee joint is the largest joint in your body and also a very complex one.Because it is very important for your daily activities and you use it a lot, it can get injured and damaged.

Your knee joint is made up of:

  • 3 bones - Thigh bone (femur), shinbone (tibia) and knee cap (patella).
  • Cartilage - Thin covering which keeps the bones apart and provides a smooth, slippery surface for painless, free movement of your knee.
  • 4 Ligaments - Thick rubber-bands like structures that holds the two bones together and provide stability.
  • 2 Menisci - C - shaped cushions between the femur and tibia which act as shock absorbers.

Noraml Knee

Normal Knee

Knee Joint Specialist

Knee Joint Speciality

What is arthritis?

Arthritis means damage and wear of the cartilage covering the bone ends. It can be of different types - Osteoarthritis, Rheumatoid Arthritis, and Post-traumatic Arthritis (after previous injury, fracture or dislocation) being the common ones. It causes pain, stiffness, swelling and difficulty in performing your daily activities such as walking, standing for long, getting up from a chair, climbing stairs and sitting cross-legged.

knee replacement surgeon

What is knee replacement?

'Knee Replacement' is actually misleading as your whole knee is not replaced! It only involves resurfacing the cartilage on the 3 bones where they move against each other. The new surfaces are made of metal and polyethylene and are fixed to your bones with special bone cement. The implants we use are imported, have been well tested, and have been used successfully for many years.

Total Knee Replacement

Total Knee Replacement Animation

When do I require knee replacement?

When the cartilage in all 3 compartments of your knee is severely damaged, results in pain, swelling, stiffness and deformity, and affects your daily activity, you should start thinking about knee replacement. It should be considered only after all other standard treatment (lifestyle modifications, medicines, exercises and physiotherapy) has failed to improve your quality of life.


Total Knee Replacement

What is CAS (Computer-Assisted Surgery) and how is it helpful?

We are pioneers in using computer technology for knee surgery, have helped develop software for it, and were the first in the world to use an iPod for knee replacement. Our extensive research and published papers have shown that you are likely to have superior results, quicker recovery, less pain and tong-lasting results with our CAS techniques which involve the use of reflected infra-red beams to add precision and accuracy to knee surgery.



CAS machine

CAS

Computer assisted surgery for knee replacement

CAS (Computer-Assisted Surgery)

How will your bespoke technique benefit me?

Our 'Bespoke' technique of surgery enables us to treat your knee in a customized fashion as your knee is somewhat different from that of others. We use CAS which helps us to individualize our technique to your needs as well as to the specific condition of your knee. Our pain control methods, anesthesia techniques, and fast recovery programme after the operation are also tailored to your specific requirements. This patient-specific approach will enable you to recover more quickly and regain full movement and activity more speedily and without effort.

resurfacing knee replacement

Bespoke Technique
 

total knee replacement

Total Knee Replacement of both knees with severe deformity

total knee replacement in mumbai

Total Knee Replacement of both knees with severe deformity

Knee Replacement

Climbing a steep ladder after Total Knee Replacement of both knees

How successful is knee replacement?

Success depends on the surgeon and his team's experience, skills and technique in performing it, and the implant design. We have been pioneers in is operation, are involved in designing implants for worldwide use by other surgeons, and have extensive experience over 20 years. We have treated over 10,000 patients who are very satisfied with their results and which last for 15 years or more in over 95%.

Can both my knee replacements be done at the same time?

Yes, if your tests done beforehand are normal and both your knees are affected, knee replacement can be safely done in both knees at the same sitting. Your hospital stay (2-3 days) and pain will be the same as when knee replacement is done only for one side. The advantages are that both legs will be of the same length, your knees will recover together, you will walk correctly from the first day, and you will not need to return to hospital for the second knee.

resurfacing arthroplasty knee

Total Knee Replacement of both knees with severe deformity

Knee Replacement

Total Knee Replacement of both knees with severe deformity

Knee Replacement

Climbing a steep ladder after Total Knee Replacement of both knees

Location

Kemps Corner

mullaji knee clinic in kemps corner
     101, Cornelian, Kemps Corner, Cumballa Hill, Mumbai-400036.
    Call us: +91 22 2385 6161
    Call us: +91 9820811536
     Monday - Friday, 10am to 8 pm.
    (By prior appointment only).

Khar

mullaji knee clinic in khar
 Marbella, 2nd Floor, 11th Road, Khar (W), Mumbai-400052.
Call us: +91 22 23856161
Call us: +91 9820811536
 Only Saturday, 1pm to 7 pm.
(By prior appointment only).

Powai

mullaji knee clinic in powai
 301 A, Galleria, 3rd Floor A Wing, Opp KFC, Hiranandani Gardens, Mumbai-400076.
Call us: +91 22 4013 0019
 Monday to Saturday, 2pm to 8 pm.
(By prior appointment only).

Ghatkopar

mullaji knee clinic in ghatkopar
 903, G Square, Jawahar Road, Above Kalyan Jewellers, Ghatkopar (E), Mumbai-400077.
Call us: +91 22 2508 1200
  Monday to Friday, 2pm to 8 pm.
(By prior appointment only).

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