Successful Total Knee Replacement (TKR) for Right Knee Osteoarthritis in a 63 Y.O. Female

PACE Hospitals’ expert Orthopaedic team successfully performed a Right Total Knee Replacement on a 63-year-old female patient diagnosed with osteoarthritis of the right knee. The aim of the procedure was to relieve chronic knee pain, restore joint function, improve mobility, and enhance the patient’s overall quality of life.

Chief Complaints

A 63-year-old female patient with a body mass index (BMI) of 21 presented to the Orthopaedics Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of pain and swelling in the right knee for the past few months.

Past Medical History

The patient was a known case of rheumatoid arthritis (RA) and had been on regular medical treatment for the condition. There was no documented history of diabetes mellitus, hypertension, cardiac disease, respiratory illness, or other major chronic medical conditions. The patient had previously undergone a left total knee replacement (TKR), as noted on imaging studies.

On Examination

On general examination, the patient was conscious, cooperative, and clinically stable, with no pallor, icterus, lymphadenopathy, clubbing, or cyanosis, all of which were normal. Systemic examination was largely within normal limits. Local examination of the right knee revealed abnormal findings, including the presence of joint effusion, medial joint line tenderness, and a fixed flexion deformity. The range of motion of the right knee was painfully restricted. There were no distal neurovascular deficits, and distal pulses and sensations were normal.

Diagnosis

Following the clinical examination, the Orthopaedics team conducted a comprehensive assessment, including a detailed review of the patient’s medical history and a focused evaluation of the right knee.

To confirm the diagnosis and evaluate the extent of joint involvement, a comprehensive clinical and systemic examination was performed. The patient exhibited swelling, tenderness along the medial joint line, and a limited range of motion in the right knee due to pain, while distal neurovascular status remained intact, and systemic examination revealed no significant abnormalities.

Initial X-rays of both knees were obtained to assess the severity of degenerative changes. Radiographic findings revealed moderate osteoarthritis in the right knee, with reduced medial tibiofemoral and patellofemoral joint spaces, along with marginal condylar and patellar osteophytes. The left knee demonstrated a status post-total knee replacement with normal implant positioning and bone density. These clinical and radiological findings established the diagnosis and guided the treatment plan.

Based on the confirmed diagnosis, the patient was advised to undergo Osteoarthritis Treatment in Hyderabad, India, under the care of the Orthopaedic Department, ensuring effective pain relief, joint stabilization, and optimal functional recovery.

Medical Decision Making (MDM)

After a detailed consultation with Dr. Raghuram, Senior Orthopaedic Consultant, a comprehensive evaluation was performed to determine the most appropriate diagnostic and therapeutic approach. Considering the patient’s history of rheumatoid arthritis (RA) and osteoarthritis of the right knee, along with clinical presentation of pain, swelling, medial joint line tenderness, effusion, and restricted range of motion, a focused local examination of the right knee was undertaken to formulate an optimal treatment strategy.

Based on the clinical and radiological findings, which confirmed moderate osteoarthritis of the right knee, it was determined that total knee replacement (TKR) was identified as the most suitable surgical intervention to achieve pain relief, restore joint alignment and stability, improve functional mobility, and prevent long-term complications such as progressive deformity, loss of joint function, or disability.

The patient and family members were counselled about the severity of the knee disease, the need for surgery, potential risks, and the expected recovery with physiotherapy and gradual mobilization.

Surgical Procedure

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

The surgical procedure involved the following steps:

• Anesthesia and Positioning: The patient was positioned supine and administered spinal and epidural anesthesia. A tourniquet was applied to control intraoperative bleeding and provide a bloodless surgical field.

• Surgical Approach: A midline incision was made over the right knee, and a subvastus approach was used to expose the joint while preserving the quadriceps mechanism.

• Joint Preparation: The knee joint was opened, and osteophytes along with inflamed synovial tissue were carefully removed. Bony cuts were made on the distal femur and proximal tibia to prepare for the prosthetic components.

• Implant Placement: After achieving proper gap balancing, a total cemented knee replacement was performed using Biorad Gold implants (femur size E, tibial tray size 3, and a 9mm polyethylene spacer). Patellar osteophytes were also excised to ensure smooth articulation.

• Wound Closure: Hemostasis was achieved, and the wound was closed in layers using Vicryl 2-0 sutures and skin staples. The procedure was completed successfully with stable knee alignment.

Postoperative Care

The postoperative period was uneventful. The patient was gradually mobilized and encouraged to walk during the hospital stay. Appropriate measures for pain management, infection prevention, and overall supportive care were provided. Wound dressings were regularly performed and remained clean. The patient was discharged in a hemodynamically stable condition with prescribed medications and detailed discharge instructions.

Discharge Medication

Upon discharge, the patient was prescribed medications for infection prevention, gastric protection, acid suppression, blood thinning to prevent clot formation, bone and joint health support, and vitamin supplementation to aid recovery and healing.

Advice on Discharge

The patient was advised to undergo physiotherapy, including walking and staircase training for one week, and to continue a normal diet.

Emergency Care

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

Review and Follow-Up

The patient was advised to return for a follow-up visit with the Orthopaedic Doctor in Hyderabad at PACE Hospitals after one week for a change of dressings.

Conclusion

This case highlights a patient with right knee osteoarthritis and a history of rheumatoid arthritis who underwent a successful total knee replacement. The surgery and postoperative period were uneventful, with early mobilization and physiotherapy. The patient recovered well and was discharged in a stable condition with appropriate supportive care and follow-up advice.

Orthopaedic Department | Orthopedic Hospital in Hyderabad