Successful Right Total Knee Replacement for Grade 4 Osteoarthritis in a 82 Y.O. Female

PACE Hospitals’ expert Orthopaedic team successfully performed a  Right Total Knee Replacement surgery in an 82-year-old female patient diagnosed with Bilateral Knee Grade 4 Osteoarthritis and Left Ankle Bursitis. The procedure was carried out to relieve severe knee pain, restore joint function, and improve the patient’s mobility and overall quality of life.

Chief Complaints

A 82-year-old female patient with a body mass index (BMI) of 23 presented to the Orthopaedic Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of pain in both knee joints and the left ankle, along with difficulty performing daily activities such as walking and standing. She also reported difficulty while climbing and descending stairs.

The patient had no significant past medical history and no previously known chronic illnesses. There was no history of trauma or prior surgery to the affected joints. The patient also reported no known drug allergies.

On examination, the patient was conscious and oriented with stable vital signs and was afebrile. Respiratory system examination revealed normal bilateral air entry. Cardiovascular examination showed normal heart sounds with no murmurs. Abdominal examination was soft and non-tender with normal bowel sounds. Neurological examination revealed no focal neurological deficits.

Local examination revealed abnormal findings in both knees, including deformity, swelling, fixed flexion deformity, crepitus, tenderness over the medial joint line and suprapatellar region, ligament laxity, and restricted painful range of motion. Distal neurovascular status was intact. Examination of the left ankle showed abnormal fullness over the anterolateral aspect with tenderness and restricted painful movements, while distal neurovascular status remained normal.

Following the clinical evaluation, the Orthopaedics team at PACE Hospitals conducted a detailed assessment focusing on the patient’s complaints of pain in both knee joints and the left ankle, associated with difficulty in performing routine daily activities such as walking, standing, and climbing or descending stairs.

A comprehensive clinical and systemic examination was carried out to determine the severity of the condition. Examination of both knees revealed deformity, swelling, tenderness over the medial joint line and suprapatellar region, palpable crepitus, ligament laxity, and grossly restricted and painful range of motion. The left ankle examination showed fullness over the anterolateral aspect with associated tenderness and restricted movements. The distal neurovascular status of the lower limbs was found to be intact. Radiological evaluation further supported the presence of advanced degenerative changes consistent with severe osteoarthritis.

Based on these findings, the patient was advised to undergo Grade 4 Osteoarthritis Treatment in Hyderabad, India, under the care of the Orthopaedic Department, to relieve pain, correct deformity, restore knee joint function, and improve mobility and quality of life.

After a detailed consultation with Dr. Anand Agroya, Senior Orthopaedic Consultant, a comprehensive evaluation was performed to determine the most appropriate diagnostic and therapeutic approach. Considering the patient’s history of bilateral knee pain, left ankle pain, difficulty walking, standing, and climbing stairs, along with clinical findings of deformity, swelling, tenderness, and grossly restricted range of motion, a focused local examination and radiological assessment were undertaken to formulate an optimal treatment strategy.

Based on the clinical findings and imaging, which confirmed Grade 4 osteoarthritis of both knees and left ankle bursitis, it was determined that Right Total Knee Replacement Surgery was identified as the most suitable intervention to relieve pain, correct deformity, restore knee function, and improve mobility. Future management of the left knee and left ankle has been planned, including either Left Total Knee Replacement for the left knee, and conservative management for the left ankle, with the goal of relieving pain, improving joint function, and enhancing mobility.

The patient and family members were thoroughly counselled regarding the diagnosis, need for surgery, procedure details, risks, and recovery process. Informed consent was obtained, ensuring their understanding and involvement in the treatment plan.

Following the diagnosis, the patient was scheduled to undergo Right Total Knee Replacement surgery in Hyderabad at PACE Hospitals, under the supervision of the expert Orthopaedic Department.

The surgical procedure involved the following steps:

• Preoperative Preparation and Exposure: The patient was placed in a supine position under general anesthesia with tourniquet control. The right limb was flexed to 90 degrees, painted, and draped in a sterile fashion. A midline skin incision was made, the subcutaneous tissue was dissected, and the musculotendinous junction was exposed. A medial para-patellar arthrotomy was performed, and the patella was everted to expose the knee joint. Grade 4 osteoarthritis with gross osteoporosis was observed, and osteophytes were removed.

• Soft Tissue Release and Joint Preparation: Medial and lateral soft tissue releases were performed to balance the joint. The anterior cruciate ligament was excised, and both medial and lateral menisci were removed. Intercondylar osteophytes were excised, and the knee was dislocated using medial and lateral spikes along with a central spike to allow better exposure. Extension and flexion gaps were assessed to prepare the joint for proper implant alignment.

• Bone Cutting and Alignment: A tibial jig was used to perform the proximal tibial cut, and alignment was carefully checked. Distal femoral entry was made, and a distal femoral jig was positioned at 5 degrees of valgus angulation to guide the distal femoral cut. Extension and flexion gaps were re-checked to ensure proper balance. The distal femur was sized, and anterior, posterior, and chamfer cuts were performed to allow precise fitting of the femoral component.

• Trial Implantation and Cementation: Trial implants were inserted, and the knee was checked for stability, alignment, and patellar tracking. Tibial preparation and placement of the extension rod were completed. A thorough wash was performed using Pulsavac, and the final components, including the tibial, femoral, and polyethylene inserts, were implanted using cement.

• Closure: Synovectomy was performed, and patellar osteophytes were excised. The soft tissues were closed in layers, and skin closure was completed using staplers. A compression bandage was applied to minimize swelling and support postoperative healing.

The patient’s postoperative period was uneventful. She was started on treatments for infection prevention, pain management, prevention of blood clots, and antiplatelet therapy. On Postoperative Day 1, the surgical dressing was checked and changed; mild soakage was noted, and physiotherapy was initiated to maintain joint mobility.

On Postoperative Day 2, she began mobilization with a walker, experienced mild giddiness, and continuous monitoring of vital signs was performed. The epidural catheter was removed on this day. By Postoperative Day 3, the patient was hemodynamically stable and discharged with advice for ongoing care, including pain management, blood clot prevention, wound care, and continuation of physiotherapy exercises.

At the time of discharge, the patient’s general condition was fair. Her vitals were stable, and she was hemodynamically and neurologically stable. The right knee range of motion was 10 to 40 degrees, painless, with a flexion deformity of 10 degrees due to postoperative swelling and pain. She was discharged with medications for infection prevention, pain and inflammation management, stomach protection, and blood clot prevention, with instructions to take them for the prescribed duration and use additional pain relief as needed for severe pain.

The patient was instructed not to wet the surgical dressing. She should avoid sitting cross-legged or using an Indian-style toilet. She should continue physiotherapy as advised, including exercises for the knee, calf, ankle, toes, and chest, and follow the standard TKR rehabilitation protocol.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, knee pain, and vomiting.

The patient was advised to return for a follow-up visit with the Orthopaedic Doctor in Hyderabad at PACE Hospitals. The dressing should be checked in the outpatient department after 5 days if any soakage is noted, and the staples are to be removed 14 days after surgery.

This case highlights the successful management of right knee osteoarthritis with total knee replacement surgery. The procedure was uneventful, and postoperatively the patient remained hemodynamically and neurologically stable. At discharge, the operated knee had a painless range of motion of 10–40 degrees, and the patient was advised on medications and rehabilitation for continued recovery.