In this approach, no muscle it cut to reach the knee and hence there is no weakening of the muscle, there is minimal pain and bleeding and the need for physiotherapy is drastically reduced or eliminated altogether. This approach was described in the German language over 100 years ago but was described first in the English language in 1999. We have been using this approach since the year 2005 and have the experience of over 12000 knees operated by this method.
We perform all our operations ( even partial knee replacements ) without using a tourniquet . A tourniquet is an inflatable circular band that is traditionally applied to the thigh during a Knee Replacement and the pressure in the tourniquet is raised above the patients” blood pressure . This stops the blood flow to the leg and allows the operation to be performed in a bloodless field. However, the current research shows that the tourniquet is associated with more post-operative pain and delayed recovery and paradoxically even a higher blood loss after its release.
We have devised special methods to reduce bleeding during the operation and afterwards and published papers on strategies too reduce blood loss during a Knee Replacement . The cornerstone of this strategy is the use of Tranexamic acid , a drug that we have been using since 2008 . How this drug can be used for Knee Replacements has been a subject of intense international research and we have published acclaimed papers in inter-national journals on this subject and are continuing our research. A lot of the current world literature (2015 onwards till today ) of fast track Knee Replacements and day care Knee Replacements , are also advising to abandon the use of tourniquet and use Tranexamic acid.
Saline Adrenalin infiltration
This is a combination that when injected in tissues to be operated on , can reduce bleeding and we routinely inject first and then operate .
Use of Cruciate Retaining Implants
Use of these implants are believed to be more physiological and associated with lesser blood loss.
Adductor Canal Blockade for pain relief
We were the first ones in India to start using this technique post-operatively to reduce pain associated with the operation and have published international papers on this .
Now that you have decided for the Knee Replacement
The operation is performed so that you can have a pain- free knee for a long time – probably for ever. But as we know , most things in life can take time . Hence despite all the advances , in surgical technique , pain control , understanding of the biomechanics of the joint , the kinematics , the advanced nature of the implant , the replaced knee can still take a long time to settle in some patients , even as long as a year ! Obviously all patients do not take that long. As to which patients would take longer to recover is also a subject of scientific research. It is known that the personality of the patient ( i.e. is the patient anxious , depressed or cheerful and forward looking ), and the personality of the knee ( how stiff is the knee , how much is it bending , has been there any injury to the knee previously , what is the state of the muscles , what is the state of the remaining joints and general health , presence or absence of comorbidities etc . ) can also play a role in the recovery. For best recovery , it is better to get operated at the right time ( when the knee is still supple ), in the right frame of mind , not too anxious or depressed ,without the presence of other major health diseases and hopefully at reasonable weight and nutrition and fitness.