Dr. Harish Chandran

M.S.ORTHO , FASM, FAA ( ITALY ). Fellowship in Arthroscopy & Sports Medicine ( ITALY )

Shoulder Surgery & Joint Replacement


About arthritis

There are two common types of knee arthritis, osteoarthritis and rheumatoid arthritis.


OA or the degenerative joint diseases, is the most common type of arthritis(also known as synovial disease).OA is a chronic condition characterized by the breakdown of the joints cartilage. The breakdown of the cartilage causes the bones to rub against each other ,causing stiffness, pain and loss of movement of the joint. It is associated with again and most typically begins among people aged 50 years or older. A young person develops OA ,typically has had an injury to the knee or may have other pathological conditions.

Characteristics / symptoms of knee OA

  • Pain in and around the knee joint
  • Morning stiffness
  • Swelling of joint
  • Occasional night pain
  • Restrict continuous walking for just a few step also
  • Unable to stand for long

   Rheumatoid Arthritis (RA)

Rheumatoid arthritis, Which generally affects people at a younger age than OA, is an autoimmune disease. This means occurs as a result of the immune system attacking its own cartilage of the body. RA generally attacks all joints of the body. This disease is commonly known as the crippling disease.

Treatment options at different stages

  • Medication:

If u suffer from mild to moderate OA pain, your doctor may recommend you a group of medicines called non –steroid anti inflammatory drugs(NSAIDs) based on your diseased condition while NSAIDs can reduced symptoms, they do not stop or improve underlying condition of the disease.

  • Exercise:

As your OA advances, your doctor may recommend a change in your physical activities to help  reduce the  pain and inflammation in your joints.

Some of the suggestions he might give are:

  • Physiotherapy aims to restore function to the maximum possible degree
  • Obesity aggravates the symptoms of OA. You may be recommended weight loss as a way to relieve some of the stress of your joints and reduce pain and inflammation.
  • You may also be suggested prescription medications or injections

However, these treatment options provide symptomatic relief from pain but cannot cure or arrest the progression of the disease.

  • Surgical options:

When you can no longer manage the pain through non- surgical treatments or deal with loss of mobility caused by your severe OA, Surgery is the final option. Below are the two most common surgical interventions recommended to OA sufferers.


When OA sets in joints, small pieces of cartilage tend to wear away from the joint surface and float around inside the joint. This debris causes inflammation and pain. In certain cases of OA, arthroscopy is used to remove some of the debris and provide temporary pain relief and improving mobility.

This does not involve any blood loss and offers a temporary relief of symptoms for some where between 6 months to 2 years.


Joint replacement

When medication, physical therapy and other conservative methods of treatment no longer relieve pain, you and your orthopaedic surgeon will decide if the degree of pain, deterioration and loss of movement is severe enough to qualify you as a candidate for joint replacement.

Unicompartmental Knee Arthroplasty

In this procedure, only a part of the knee joint is resurfaced. It is recommended for patients with moderate to severe pain and functional impairment where only one part of the knee is affected.


  • Minimally invasive
  • Short hospital stay
  • Rapid recovery


  • Complex surgical procedures.
  • Long-term result (>15 years) unknown
  • Not recommended for heavy manual work

Total Knee Arthroplasty

When the disease progresses further and deformity continues to increase, you and your orthopaedic surgeon have to evaluate the other medical condition to decide to  go for a resurfacing of called Total Knee Arthroplasty(TKA).

During total joint  replacement surgery, the worn-out surfaces of the joint are  removed  and replaced with implants called prosthesis.

The components are fixed by mechanical and biological means.

Benefits of TKA

  • TKA can permanently relieve pain that does not respond to other treatment options
  • Straightens the knee to the orginal position
  • Brings back the walking ability
  • Improved alignment of deformed joints

TKA is one of the most successful long-term surgical procedures in the world. With the current technology, the implant survivorship is 15-20years in 97% of the patients worldwide.

Preparing for a Knee Replacement

There are several things that you can do before your surgery to make your recovery successful, easier and safer.

Commit to the success of the surgery: Working as team, you, your doctor, your physiotherapist and your family must adopt a  positive attitude towards the success of your surgery.

Remain as active as possible: Remaining active before the operation will help in a quicker recovery and more flexibility after the operation.

Stop Smoking: This will help reduce the risk of complications during and after your surgery.

Make sure all infections are cleared up prior to the surgery: These include tooth abscesses ,bladder infections, infections such as leg ulcers, cold and the flu. This is to ensure that the infection does not spread through the body during the operation and infect the newly replaced joint.

On the day of the operation, it is usual that the doctor will ask you not to drink or eat anything. The area around your knee may shaved to reduce the risk infection.

Approximately, an hour before the operation you may be given tablets or an injection to relax you.

What to expect after surgery?

Your surgeon will recommend and supervise  your knee rehabilitation program, which typically begins 24hours after surgery Isometric exercises (tightening muscles without moving the joint )will begin while you are still in bed .You will be instructed to do these exercises a number of times per day. The day after surgery, you will probably begin walking and exercising your knee joint.

Range of motion exercises typically begin on your first day after surgery. Through progressive daily exercises, you may achieve a good degree of bend in the knee joint by the time you leave the hospital.                                                                                                                                


Physiotherapy  is an essential part of recovery following a total hip replacement. Physiotherapy aims to:

  • Provide an exercise program to improve the joints movement, strength and flexibility
  • Improve your mobilization and confidence
  • Educate you on how to protect your new knee

Your commitment to follow the exercise program recommended by your physiotherapist is essential for your post recovery rehabilitation. Remaining active and practicing the prescribed exercises are the quickest ways to full recovery.

Home care

It is normal for you to have some discomfort which gradually disappears over a period of time(may be 6 months). However, contact your surgeon if you develop any of the following:

  1. Any discharge from the operative site during the 1st
  2. Fever (temperature nearly 101 degree F or 38 degree C) for two days.
  3. Increased swelling, tenderness, redness and/or pain at the operative site.

Myths & realities about Knee Replacement

Myth No. 1: Arthritis pain is just part of aging. It’s just something you learn to live with

Reality: OA is the most common form of arthritis today, but still many people choose years of conservative care(physical therapy, drugs, injections)to lessen, but not eliminate, their joint pain. If regular pain is interfering with your daily activities, you may benefit from a consultation with an orthopaedic surgeon.

Myth No .2: A knee Replacement won’t feel natural

Reality: They have been significant advances in materials, designs, and surgical procedures for knee Replacement. Today’s implant designs offer many types of knee implants that closely mimic the feel and movement of a natural knee.

Myth No. 3: I’m too young for knee Replacement

Reality: Candidacy for a knee replacement is not based on age, but on the person’s level of pain and immobility. As a result of advances in implant technology, patients may benefit from knee replacement options such as the rotating platform(RP)knee, which is designed to help patients move more naturally.

Myth No. 4: I should wait as long as possible to undergo knee Replacement surgery                                               

Reality: Delaying surgery lowers a patient’s quality of life and leads to complications like severe deformity, which may require special prosthesis due to this delay.

OA is a degenerative disease that continues to damage the joint and delaying surgery makes both surgery and return to activity more difficulty.

Myth No.5: All knee implants are the same

Reality: Today, Knee Replacement patients have a choice of various types of knee  implant as well as a variety of implant shapes and sizes designed to accommodate specific needs and different lifestyles. Talk to your orthopaedic surgeon about your individual needs and the clinical history of the implant your surgeon  recommends for you.


When to visit an orthopaedic surgeon?

If you have difficulty  performing  the movements  below, it may be time to talk with your doctor. For each activity, rate your level of discomfort from one (mild or no pain)to five (extreme discomfort).Share the results with your healthcare provider.

Activity  1: Pretend to drive a car, pushing an imaginary accelerator and then break with the right foot. Repeat  the procedure for the left  foot.

Activity  2: Bend at the hips and knees as if you were watering flowers.

Activity  3: Walk several steps, leading with the left foot.

For each exercise, rate your level of discomfort  from 1 (mild or no pain)to 5 (extreme discomfort). If your rating is more than 3 in any of the 3 activities, it is recommended to share your results with the orthopaedic surgeon.