What has to be managed before a knee replacement in a patient with heart disease, diabetes and several earlier operations?
Dr. Mahajan is Chairman Orthopaedics, Joint Replacement & Chief Robotic Joint Replacement at Max Smart Super Speciality Hospital, Saket.
A man in his sixties, who had already tried injections and keyhole cleaning of his knees, done through small cuts with a camera and fine instruments, came to Dr Ramneek Mahajan with all of these.
Why did the patient need surgery?
The patient says he had constant pain in his joints. Dr Mahajan says that earlier, the knees had been cleaned out through keyhole surgery and injections had been given into them, and by then the patient had tried everything.
Which operation was chosen, and why?
Dr Mahajan says the decision was a robotic knee replacement, in which the surgeon uses a robotic arm to guide the cuts. It was chosen because the major bones are not disturbed and the canal, the hollow centre of a long bone such as the thigh bone, is not opened. The soft tissues, the muscles, ligaments and other tissues around a joint, are cut less, and there is no drilling into the thigh bone.
What made the operation harder, and how was it handled?
Dr Mahajan says the patient has high blood pressure and diabetes, has had a heart attack, and has stents, small tubes placed inside the heart's blood vessels to keep them open. The patient was also very overweight and had a weight-loss operation, called bariatric surgery, and then plastic surgery around the abdomen to tighten the muscles.
The patient's conditions were managed with the help of a physician and heart specialists, and the anaesthetist, the doctor who keeps a patient asleep and steady through an operation, reviewed him, to bring his risk down as far as possible.
How did the patient recover?
The patient says the operation was done by the robotic method, and he is now in good health.
What should a patient with heart disease or diabetes ask?
This is one man's story, not a promise: what an operation can do for you depends on your own case.
Ask who will check and manage your heart, blood pressure and diabetes before a knee replacement.
Tell your surgeon about every earlier operation, including a weight-loss operation or surgery on the abdomen.
What this case teaches
Surgeons consider replacement when medicines, injections or earlier knee surgery no longer help, the American Academy of Orthopaedic Surgeons says.
Before a knee replacement, a physical exam checks you are healthy enough for surgery and an electrocardiogram checks the heart, Cleveland Clinic says.
People with diabetes were 28% more likely to return to hospital after a knee replacement, a 2025 overview of reviews found.
An earlier weight-loss operation brought no clear benefit to knee replacement results, a 2025 review of 18 studies found.
