Knee Resurfacing

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:

total knee replacement in mumbai

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
C-shaped cushions
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 Knee Resurfacing?
knee joint resurfacing surgery

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

There are 3 types of resurfacing depending on the compartments that are involved:
  • UKR : Unicompartmental Knee Resurfacing of the medial compartment.
  • PFR : Patellofemoral Resurfacing of the patello-femoral compartment.
  • BKR : Bicompartmental Resurfacing of medial and patello-femoral compartments.

Unicompartmental knee resurfacing (UKR) is a minimally invasive procedure where only the inner (medial) compartment of the knee joint is resurfaced when the cartilage there gets completely worn out.

Bones rubbing treatment

Xray showing bones rubbing against each other

Bicompartmental knee resurfacing

Diagram showing UKR of one compartment

Xray after UKR

Xray after UKR

Patellofemoral Resurfacing

Xray showing bones rubbing against each other

Patellofemoral Resurfacing (PFR) is a minimally invasive procedure where only the front (patellofemoral or behind the knee cap) compartment of the knee joint is resurfaced when the cartilage there gets completely worn out.

Bicompartmental knee resurfacing (BKR)

Bicompartmental knee resurfacing (BKR)

Bicompartmental knee resurfacing (BKR) is a minimally invasive procedure where both the inner (medial) and front (patellofemoral) compartments of the knee joint are resurfaced when the cartilage there gets completely worn out.

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

What is resurfacing?

Arthritis usually starts in only one compartment, while the other two remain healthy. In Knee Resurfacing, only the diseased cartilage in one or two compartments is removed and resurfaced with metal and polyethylene leaving normal ligaments, meniscus, and cartilage intact. By Resurfacing one or two compartments at the right time, the knee joint can be preserved and total knee replacement can be avoided or delayed for over 15 years.

What are the types of Knee Resurfacing?

  • UKR: Unicompartmental Knee Resurfacing of the medial compartment
  • PFR: Patellofemoral Resurfacing of the patello-femoral compartment
  • BKR: Bicompartmental Resurfacing of medial and patello-femoral compartments

Unicompartmental knee resurfacing (UKR) is a minimally invasive procedure where only the inner (medial) compartment of the knee joint is resurfaced when the cartilage there gets completely worn out.

Bones rubbing xray
UKR resurfacing
UKR xray

Patellofemoral resurfacing (PFR) is a minimally invasive procedure where only the front (patellofemoral) compartment of the knee joint behind the knee cap is resurfaced when the cartilage there gets completely worn out.

Knee Resurfacing

When is resurfacing required?

Resurfacing is very successful when there is loss of cartilage only in one or two compartments that causes knee pain, swelling, stiffness, and affects your daily life, and only when other treatment (lifestyle modification, exercises, medicines and physiotherapy) has failed. Through examination, x-rays and possibly scans, we will help you decide if this is the best option for you.

Is resurfacing painful?

By using the latest techniques, minimally-invasive approach (small cuts) and our fast recovery protocol, you will have very little or no pain, and you will be surprised by the speed of your recovery.

Can resurfacing be done in both my knees at the same time?

Yes, if all your tests done beforehand show that you are medically fit, resurfacing can be safely done in both knees on the same day.

Will I need physiotherapy after surgery?

No, there is little or no need for physiotherapy! There are six simple exercises which will be shown to you to regain full movement, strengthen the muscles, walk normally, and perform daily activities. You will be able to get up and walk right away, returning home within 24 hours.

How successful is resurfacing of the knee?

Success depends on the surgeon and his team's experience in selecting the correct patient for the operation, skill and technique in performing it, and the implant design. This operation is more technically difficult compared to a total knee replacement and is therefore performed only by few surgeons in India and around the world. We have been pioneers in this operation and have considerable experience (nearly 20 years). In fact, we are involved in designing resurfacing implants for worldwide use by other surgeons. Like most of our patients who are very satisfied with their results, your operation too has an over 90% likelihood of lasting for 15-20 years. Most patients can lead a normal, active life after resurfacing. Patient of Mullaji Knee Clinic performing yoga after unicompartmental knee resurfacing surgery Patient of Mullaji Knee Clinic enjoying life after unicompartmental resurfacing of both knees Cycling after Unicompartmental Knee Resurfacing

Success depends on the surgeon and his team's experience in selecting the correct patient for the operation, skill and technique in performing it, and the implant design. We have been pioneers in this operation, are involved in designing resurfacing implants for worldwide use by other surgeons, and have the longest experience. Like most of our patients who are very satisfied with their results, your operation too has an over 90% likelihood of lasting for 10 - 15 years.

total knee replacement

Taking the bus or train after Total Knee Resurfacing of both knees

knee joint resurfacing surgery

Cycling after Unicompartmental Knee Resurfacing

Why is resurfacing preferred over replacement?

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. Also by not replacing the knee, we are able to preserve the bone, ligaments, menisci and cartilage in the remaining compartments. 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.

How long will it last?

The rest of the joint will last for over 15 years in most patients and the implant itself has a wear rate that is exceptionally low, allowing them to last as long.

Are there any complications of resurfacing?

Complications are almost unheard of after resurfacing. In general, risks are very low if your medical condition is satisfactory.

How often will I need to come for a check-up after surgery?

As artificial materials have been inserted in your body (of the best available quality), you must accept the need for regular check-ups and xrays to ensure that all is well. You should visit us every year once a year with new xrays (AP standing and lateral views of both knees).

In case you are from another city/country and cannot come in person, you can email (drarunmullajiclinic@gmail.com) or send by WhatsApp (9820811536) your annual xrays and drop by whenever you are in town. We will also inform you if one of us is visiting your city.

Annual check-ups will enable us to modify your medication, suggest specific exercises, advise any precautions, and recommend any latest treatment that can help enable you to enjoy the full benefits of your operation.

What is High Tibial Osteotomy?

When the legs are bow-legged because the bones are bent, an operation called osteotomy is used to make them straight by cutting across the bone. After this there may be a plaster cast, a plate applied internally or a device applied from outside (external fixator) to hold the two parts together till it heals.



High Tibial Osteotomy

High Tibial Osteotomy

Osteotomy

Osteotomy

wedge of bone

After removal of a wedge of bone

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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