Can patients with diabetes undergo knee replacement surgery?
Patients with diabetes can indeed undergo this surgery provided their blood sugar is maintained within acceptable limits. Such patients may need to be put on insulin injections immediately before and after surgery to achieve better control of their blood sugar levels. Patients with diabetes have a slightly higher risk of infection and wound healing problems. However when appropriate preventive measures are taken such complications can be avoided.
Is it necessary to give blood transfusion to a patient during or after surgery?
The need for blood transfusion depends upon the patient’s pre-operative hemoglobin and the amount of blood loss occurring during and after surgery (through the drainage tube). The patient’s hemoglobin is checked after surgery to assess the amount of blood loss and decide on the need for giving blood. Generally speaking, for most patients with a normal hemoglobin undergoing unilateral (one side) knee replacement and an average blood loss, there is no need to give blood transfusion. Patients undergoing bilateral (both sides) knee replacement at the same time or within a space of a few days may need one or more blood transfusions.
Can both knees be replaced at the same time?
When patients have severe pain in both the knees requiring surgery, this can be done at the same time (simultaneous TKR) or after an interval time between two surgeries (staged TKR). Patients who are in good health and medically fit can be considered for bilateral simultaneous TKR at the same sitting. Patients who are older or those with co-existing medical conditions may have to be operated with some time interval between the two surgeries. This time interval may vary from a few days to few weeks depending on individual circumstances.
What is subvastus approach in TKR?
This refers to a method of exposing the knee joint from the overlying quadriceps muscle. The conventional mid-rectus approach involves cutting through the quadriceps tendon. The mid-vastus approach involves cutting through the muscle rather than the tendon. The sub-vastus approach involves reflecting the muscle without cutting through it. The sub-vastus approach is said to violate the quadriceps muscle the least, and supposedly helps in faster rehabilitation of patients after surgery. However a number of studies comparing these three approaches have not shown any significant advantage in the medium to longer term recovery after surgery. Majority of the surgeons prefer the conventional mid-rectus approach.