Total knee replacement — the complete patient guide

When replacement is the right call — and when it isn't

Surgery is indicated when two things are simultaneously true: the arthritis is radiologically advanced, and it restricts your life despite adequate conservative care. A patient who can walk their routine with tolerable discomfort should usually wait; a patient whose world has shrunk to their home should usually not. This practice tells you which you are, plainly.

Arthritis severity is judged partly on how far the cushioning gap between the bones has narrowed on X-ray — early narrowing may not need surgery at all, while advanced, bone-on-bone change is what replacement addresses.

What the operation involves

The damaged surfaces of the thigh bone and shin bone are removed in measured cuts and capped with metal components, separated by a medical-grade polyethylene bearing. Wherever anatomy permits, Dr. Srivastava uses the muscle-sparing subvastus approach — lifting rather than cutting the quadriceps.

Computer-assisted knee replacement: navigation, robotics and augmented reality

The single biggest surgeon-controlled factor in how a knee replacement feels and lasts is accuracy of alignment and soft-tissue balance. A family of technologies now helps achieve it more reproducibly:

• Navigation — infra-red trackers give the surgeon real-time feedback on bone cuts and alignment, like GPS for the operation
• Robotic assistance — a robotic arm executes a patient-specific 3D plan within tightly controlled limits; the surgeon directs it throughout
• Augmented reality — the surgical plan is projected into the surgeon's field of view, merging plan and anatomy

Dr. Srivastava's background as a robotic joint replacement consultant means these tools are used as instruments of precision — never as substitutes for judgement. The technology serves the plan; the surgeon owns it.

Alignment strategy — and why assistive technology matters

How the new knee is aligned is a deliberate choice, not an accident:

• Mechanical alignment — the long-proven neutral leg axis; reliable and durable
• Kinematic alignment — reproducing your own pre-arthritic alignment for a more natural-feeling knee
• Functional alignment — fine-tuning implant position to your individual soft-tissue balance

The more individualised strategies (kinematic, functional) demand precision that is hard to achieve by eye — which is exactly where navigation and robotics earn their place: they make a chosen strategy reproducible. The strategy is selected for your knee, and the right tool is used to deliver it accurately.

Recovery, milestone by milestone

• Day 0–1: standing and walking with a walker; knee bending exercises begin
• Week 1–2: staples/sutures reviewed; walking indoors independently with support; stairs with assistance
• Week 3–6: stick replaces walker; most household activity resumes; driving typically cleared around week 6
• Month 2–3: unaided walking, longer distances, return to work for most occupations
• Month 6–12: the knee progressively feels less like a replacement and more like your own; improvement continues to a year

Hospital stay

Typically 1–2 days for a single knee, and 3–4 days when both knees are replaced together. Stay is individualised to your recovery, pain control and support at home.

One knee or both?

When both knees are worn, replacing them in one sitting spares one hospitalisation and one recovery — but demands cardiac and general fitness that not every patient has. The fitness workup makes this decision objectively; both paths are routine here.

The questions of cost and longevity

Cost varies with implant choice, whether assistive technology is used, hospital and room category, and bilateral versus single surgery; an itemised written estimate follows your assessment. Longevity of 15–25 years is common with modern implants — and the surgeon-controlled share of that longevity is alignment accuracy, which this practice treats as the entire point.