The good news: most patients start walking with help, usually a walker, on the day of surgery or the next day. And in large national joint registries, more than 9 in 10 total knee replacements are still working after 15 years.
You do not have to choose the type yourself. Dr Imran Salim Malik, orthopedic and trauma surgeon, recommends the type that suits the knee after examining it and looking at the X-ray.
WhatsApp your X-ray or MRI to +92 300 4890692 to book a consultation. Clinic, Monday–Saturday: Omar Hospital & Cardiac Centre, Johar Town, 7–9 PM.
What is a total knee replacement?
In a knee replacement (arthroplasty), the damaged bone and cartilage are replaced with artificial parts (implants). This eases pain, straightens a bent knee and helps the joint move smoothly. Replacing the whole joint is called a total knee replacement.
If only one part of the knee is worn, a partial knee replacement may be enough. When most of the knee is damaged, a total replacement is usually advised.
Dr Malik chooses these for you, based on the knee damage, age, bone strength and activity:
- How the operation is done: a standard or a smaller cut
- The implant design: whether a knee ligament is kept
- The material: most often metal on plastic
- How the implant is held: with or without bone cement
More detail on each part is near the end of this page.
Types by how the operation is done
Traditional knee replacement
The surgeon uses a standard-length cut to see the whole knee. It suits severe arthritis or a badly misshapen knee, and has a long track record.
Minimally invasive (smaller-cut) knee replacement
The surgeon uses a smaller cut and disturbs less muscle. Long-term results are similar to the traditional method, and it is not right for everyone.
Robotic-assisted knee replacement
A robotic system aims to help the surgeon place the implant precisely. Whether this makes the knee work better or last longer is still being studied. Not every hospital offers it. Ask Dr Malik whether it is available and whether it would help your knee.
What to expect before and after surgery
Before surgery, you have a full check-up, X-rays or scans, and a medical fitness check. The operation usually takes one to two hours. Physiotherapy and walking start soon after.
Signs it may be time for a knee replacement
Surgery may be worth considering if:
- Knee pain continues despite medicines and physiotherapy
- Standing, walking or climbing stairs has become hard
- Stiffness stops the knee from bending or straightening
- The X-ray shows the joint is badly worn
Dr Malik looks at all of this, and at your general health, before recommending surgery.
Does this sound like your mother or father? WhatsApp their knee X-ray to +92 300 4890692 to book a consultation. Dr Malik will need to examine them before advising on surgery.
Already been told you need an operation? A second opinion is your right. Bring your reports and Dr Malik will go through your options with you, including non-surgical ones.
Benefits of smaller-cut surgery
For suitable patients, smaller-cut surgery may mean:
- A smaller wound and less damage to muscle
- Less blood loss and a slightly quicker early recovery
- A shorter hospital stay
- Getting up and moving sooner, which can help older patients
Whatever the method, you can usually still have MRI scans later. Just tell the scan team about your implant.
Questions families often ask
Types of knee implant: the parts Dr Malik chooses for you
- Design: A posterior-stabilized (PS) implant has a built-in support that replaces a ligament at the back of the knee. A cruciate-retaining (CR) implant keeps that ligament, if it is strong enough.
- Material: Most knees are metal on plastic, which is long-lasting and moves smoothly. A ceramic-surfaced part may be chosen for some people, for example with a metal allergy.
- Bearing: In most knees the plastic insert is fixed. In a mobile bearing it can move a little, but this has not been shown to work better.
- Fixing: Bone cement holds the implant firmly straight away and often suits older patients. Without cement, the bone grows into the implant, so strong bone is needed.
About Dr Imran Salim Malik
Dr Malik is a consultant orthopedic and trauma surgeon in Lahore, with more than 20 years of experience in orthopedic surgery. He plans each knee replacement individually. If you need a knee replacement, Dr Malik performs it himself.
Sources: Evans JT, et al. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports. The Lancet, 2019.
Questions families ask
How many days will my parent stay in hospital?
Usually about 3 days, depending on how they recover and their general health.
Is it safe for an older parent with sugar or blood pressure?
Many people who need a new knee are older and have these conditions. Before surgery, your parent has a full check-up and a medical fitness check. Sugar and blood pressure should be well controlled first. Dr Malik explains the options, risks and costs, including not operating.
What are the risks?
Like any operation, a knee replacement has risks. The main ones are infection, blood clots, a stiff knee and some pain that does not go away. Rarely, a nerve or blood vessel is injured. Over the years the implant can wear or loosen, and another operation may be needed.
Before surgery, Dr Malik checks your parent's health and explains their own risks. Antibiotics around the operation lower the risk of infection. Blood-thinning medicine and early walking lower the risk of clots. You may be given blood-thinning medicine to take at home for some weeks. Take it exactly as prescribed.
Stop smoking and all tobacco, including naswar and chewing tobacco. It slows bone and wound healing.
How long does recovery take?
Everyone heals at their own pace. This is a general guide; Dr Malik will give you your own plan.
- Day of surgery to discharge: standing and walking with a walker. The physiotherapist shows you how to manage stairs before you go home.
- Weeks 1–2: at home with a walker, doing gentle knee exercises.
- Weeks 3–6: walking further each day, and stairs get easier. Many people move to a walking stick.
- Around 6 weeks: many people manage most daily tasks. Driving is usually possible around 6 weeks, and only when Dr Malik agrees. You need to be off strong painkillers and able to press the brake hard without pain. After a right-knee operation it often takes longer.
- Several months: full recovery, with regular physiotherapy.
What warning signs should we watch for at home?
Call +92 300 4890692 the same day if:
- the wound is red, hot, swollen or leaking, or there is a fever
- the calf is painful or swollen (this can be a blood clot)
If the clinic is closed or you cannot reach it, go to the nearest emergency department.
If there is chest pain or sudden breathlessness, go to the nearest emergency department now or call Rescue 1122.
Go to the nearest emergency department now, or call Rescue 1122, if your parent falls onto the knee and cannot stand on the leg, or if the wound opens.
Can my parent pray, sit on the floor or use a squat toilet afterwards?
At first, pray seated on a chair and use a raised toilet seat or a commode. Kneeling, squatting and sitting cross-legged on the floor may stay difficult after a knee replacement. Many people pray on a chair. It is wise to keep the raised toilet seat too. Dr Malik will tell you what is safe for you.
How much does it cost?
The consultation fee depends on the hospital you visit. We tell you the exact fee on WhatsApp before you book, so there are no surprises. A follow-up visit within 5 days of your first consultation is free to go through your reports and scans.
The cost of surgery depends on the operation, the implant, the room and the nights in hospital. It is explained to you before you decide.
Can both knees be done together?
Sometimes. It depends on overall health and fitness. Dr Malik will advise whether one knee at a time or both together is safer.
How long does a knee replacement last?
In large national joint registries, more than 9 in 10 total knee replacements are still working after 15 years, and about 8 in 10 after 25 years.
Is smaller-cut surgery right for everyone?
No. It depends on the knee damage, general health and bone strength.
Does the choice of surgeon and hospital matter?
Yes. Training, how often a surgeon does the operation and the hospital's facilities all affect results. You can check that any surgeon is registered with the PMDC, and ask how often they operate on knees.
From the clinics of Dr Imran Salim Malik, orthopaedic and trauma surgeon. MBBS (Allama Iqbal Medical College) · MS (Trauma & Orthopaedics) · PMDC Reg. 39646-P. Every patient is different: Dr Malik will tell you what applies to you.
