Painless Total Knee Replacement
Bilateral Grade IV Osteoarthritis with Severe Varus Deformity
Patient Background & Presentation
The patient was a 67-year-old female from Kanpur, Uttar Pradesh. She had been suffering from progressively worsening bilateral knee pain for over three years and had tried multiple conservative treatments at various centres without success. Her quality of life had declined significantly — she was unable to walk more than 50 metres, could not climb stairs, and had stopped using an Indian-style toilet entirely due to the pain and instability.
She was referred to Dr. Kamal Kishor Gupta at Apollomedics Super Speciality Hospital, Lucknow after repeated failure of medications, physiotherapy, and steroid injections at her previous treating centre.
- Severe bilateral knee pain for 3+ years, worse on the right side
- Inability to walk more than 50 metres without rest
- Difficulty climbing stairs, using Indian-style toilet, or sitting cross-legged
- Significant reduction in quality of life and daily independence
- Failed response to pain medications, physiotherapy, and steroid injections
🩻 X-Ray
Bilateral Grade IV osteoarthritis with severe varus (bow-leg) deformity of 12°
🧲 MRI
Bone-on-bone contact in the medial compartment, complete loss of cartilage
🩸 Blood Profile
Fit for surgery; no uncontrolled diabetes or cardiac risk
⚖️ BMI
27.4 — acceptable surgical risk with no contraindications
| Patient Detail | Clinical Information |
|---|---|
| Age | 67 Years |
| Gender | Female |
| City | Kanpur, Uttar Pradesh |
| Duration of Symptoms | 3+ Years |
| Affected Knees | Bilateral (Both Knees) |
| Deformity | 12° Varus (Bow-Leg) |
| Previous Treatment | Medications, Physiotherapy, Steroid Injections |
| Main Concern | Pain Relief & Restoration of Daily Function |
Diagnosis
The patient was diagnosed with bilateral end-stage osteoarthritis (Grade IV) of the knee with severe varus malalignment. In simple terms, the cartilage inside her knee joint had completely worn away — causing the bones to grind directly against each other. The 12° bow-leg deformity was further accelerating joint damage and contributing to her pain and instability.
- Grade IV osteoarthritis means no cartilage remains — non-surgical treatments cannot regenerate bone-on-bone damage
- 12° varus deformity required surgical correction to restore normal alignment
- Three years of pain with failed conservative treatment confirmed surgery as the only meaningful option
- Patient's overall health (BMI 27.4, no cardiac risk) made her an excellent candidate for TKR
Treatment Plan — Painless TKR Protocol
Dr. Kamal Kishor Gupta is known in Lucknow for performing Total Knee Replacement with a specialised painless, zero-opioid protocol that enables patients to walk within hours of surgery. This approach significantly shortens recovery time and reduces post-operative complications.
Pre-Operative Evaluation
A thorough pre-operative workup was completed before the surgery:
- Standing X-rays and weight-bearing MRI to assess deformity and bone quality
- Cardiology clearance — ECG, Echo, and physician review
- Anaesthesia assessment — spinal anaesthesia selected over general for lower risk
- Implant selection: cemented posterior-stabilised implant chosen for long-term durability
- Patient counselling on the painless protocol, expected outcomes, and recovery timeline
Multimodal Pain Management (Painless Protocol)
The cornerstone of Dr. Gupta's approach is a zero-opioid multimodal pain protocol:
- Adductor canal nerve block — targeted local anaesthetic that numbs the knee without affecting leg movement
- Periarticular infiltration — local anaesthetic, anti-inflammatory agents, and adrenaline injected around the joint
- Pre-emptive oral analgesia — anti-inflammatory medications given before surgery to reduce pain signalling
- Allows same-day walking, reduces hospital stay, and eliminates opioid side effects
Total Knee Replacement Surgery
Performed under spinal anaesthesia. Key surgical steps:
- Skin incision and careful exposure of the knee joint preserving tendons and soft tissue
- Removal of damaged bone and cartilage from the femur and tibia
- Intraoperative correction of the 12° varus deformity to restore normal limb alignment
- Implantation of cemented posterior-stabilised knee prosthesis — metal and high-grade polyethylene
- Kneecap (patella) resurfaced where required for optimal movement
- Total OT time: approximately 75 minutes
Recovery & Rehabilitation
- 6 hours post-op: Patient walked with a walker — pain score 2/10 (vs 7–8/10 conventional)
- Day 1: Physiotherapy begun — active range of motion, quad sets, ankle pumps
- Day 2: Discharged home with home physiotherapy instructions and oral medications
- Week 2: Wound review, staples removed, walking without walker indoors
- Week 6: Patient climbed stairs independently — milestone typically reached at 3 months
- Month 12: Follow-up confirmed no complications, implant well-positioned, patient pain-free
Surgical Procedure — In Detail
| Parameter | Details |
|---|---|
| Procedure | Bilateral Total Knee Replacement |
| Implant Type | Cemented Posterior-Stabilised Prosthesis |
| Implant Components | Metal + High-Grade Polyethylene |
| Deformity Correction | 12° Varus — Fully Corrected Intraoperatively |
| Patella | Resurfaced Where Required |
| Anaesthesia | Spinal Anaesthesia |
| Pain Protocol | Zero-Opioid Multimodal (Adductor Canal Block + Periarticular Infiltration) |
| Total OT Time | ~75 Minutes |
| First Walk Post-Op | 6 Hours (Pain Score 2/10) |
| Discharge | Day 2 Post-Surgery |
Post-Operative Rehabilitation — Phase by Phase
Dr. Gupta's protocol focuses on early mobilisation, rapid strength recovery, and minimising the risk of stiffness or complications.
Hours 0–24: Immediate Post-Op & First Walk
Day 1–2: Active Physiotherapy & Discharge
Week 2: Wound Review & Walker-Free Walking
Week 6: Independent Stair Climbing
Month 3 & Month 12: Full Recovery
Clinical Outcomes & Follow-Up
- ✅Surgery: Successful — deformity fully corrected, implant well-aligned on post-op X-ray
- 💊Pain: Reduced from 9/10 pre-operatively to 1–2/10 at 6-week follow-up
- 🚶Function: Independent stair climbing at 6 weeks — 3× faster than standard outcomes
- 🏥Discharge: Day 2 — 3 days shorter than typical TKR hospital stay
- 🔬Complications: None at 12-month follow-up
- ⭐Patient Satisfaction: Complete satisfaction; contralateral (left) knee surgery subsequently scheduled
| Timeline | Outcome |
|---|---|
| 6 Hours Post-Op | Walked with walker — pain score 2/10 |
| Day 1 | Physiotherapy begun — active ROM, quad sets, ankle pumps |
| Day 2 | Discharged home with oral medications and home physio plan |
| Week 2 | Walking without walker indoors; staples removed |
| Week 6 | Independent stair climbing — pain score 1–2/10 |
| Month 3 | Full daily activity restored; no walking support required |
| Month 12 | No complications; implant well-positioned; patient pain-free |
Key Clinical Decisions That Made the Difference
This case reflects several evidence-based decisions that contributed to the exceptional outcome — each grounded in Dr. Gupta's international training and patient-first philosophy.
Free Remote MRI Review
By reviewing the patient's MRI via WhatsApp before she travelled, Dr. Gupta planned the surgery precisely, counselled the family, and ensured a smooth admission.
Implant Selection
A cemented posterior-stabilised implant was chosen for its proven long-term durability and excellent functional outcomes in elderly patients with significant deformity.
Zero-Opioid Pain Protocol
The multimodal painless protocol eliminated opioid side effects entirely — no nausea, no confusion — allowing earlier physiotherapy and a faster discharge.
Precise Deformity Correction
Intraoperative correction of the 12° varus deformity restored normal limb alignment — protecting the implant from uneven loading and ensuring long-term durability.
Same-Day Mobilisation
Walking at 6 hours post-surgery reduces blood clot risk, prevents muscle wasting, and significantly accelerates the entire rehabilitation timeline.
Early Discharge Planning
Structured home physiotherapy instructions and clear follow-up milestones meant the patient continued progressing without prolonged hospitalisation.
About Dr. Kamal Kishor Gupta
Dr. Kamal Kishor Gupta
MS Ortho, FIAA, MRCS, FIFA · Senior Consultant Orthopedic Surgeon
Apollomedics Super Speciality Hospital, Lucknow
| Qualification | Institution |
|---|---|
| MS Orthopaedics | King George's Medical University (KGMU), Lucknow |
| FIAA — Fellowship in Arthroplasty & Arthroscopy | Singapore General Hospital, Singapore |
| MRCS — Member of Royal College of Surgeons | Royal College of Surgeons, Edinburgh, UK |
| FIFA Medical Diploma | Barcelona, Spain |
| Clinical Experience | 12+ Years |
| Google Reviews | 580+ Reviews | 4.9-Star Average |
Apollomedics Super Speciality Hospital, Lucknow
Dr. Gupta practices at Apollomedics Super Speciality Hospital — one of North India's most advanced tertiary care centres. Patients from Delhi, Kanpur, Varanasi, Gorakhpur, Agra, and across India travel to Lucknow for treatment.
Dedicated Orthopaedic OT
Purpose-built laminar flow operating theatre for bone and joint surgery
Robotic Surgery Suite
Advanced robotic assistance available for joint replacement procedures
Digital Imaging & MRI
On-site high-resolution MRI and digital X-ray for rapid diagnosis
Physiotherapy Unit
Dedicated post-operative rehabilitation unit on site
Rapid Recovery Ward
Same-day mobilisation protocol for eligible patients
Outstation Coordination
Dedicated support for patients from Kanpur, Varanasi, Delhi, and beyond
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