Can a knee replacement go ahead when the tests before surgery find blood pressure out of control?
Dr. Mahajan is Chairman Orthopaedics, Joint Replacement & Chief Robotic Joint Replacement at Max Smart Super Speciality Hospital, Saket.
A woman who could no longer stand faced that question before her operation with Dr Ramneek Mahajan.
Why did the patient need surgery?
The patient says she had a lot of knee pain for three or four years. Dr Mahajan says she arrived in a wheelchair, unable to go to the toilet or to stand.
What made the operation harder, and how was it handled?
Dr Mahajan says that after the patient's X-rays and tests, she also had a blood pressure problem on the heart side, and when she went for her heart test, her blood pressure was not under control. A heart specialist saw her, medicines were given, and the dose of her blood pressure medicine was adjusted. The operation was put off once, and she was admitted only when her blood pressure was properly steady.
How was the operation done?
Dr Mahajan says navigation, a computer system that guides the surgeon in placing the parts of a new knee, was used during the operation to get a proper fit, alignment and balance for the new knee: alignment means it lines up straight with the leg, and balance means the tissues on each side of the knee are equally tight.
How did the patient recover?
The patient says she was operated on in the morning, was helped to stand that same evening, and walked two or three steps.
Dr Mahajan says that on the day after the operation she was asked to walk with a walker and to exercise, and she started exercising and bending her knee quickly. At 24 hours after the operation she used the walker only once, for balance, then put it aside and took a stick.
A family member says that, on the day of speaking, the patient is on the stairs with the physiotherapist, walking with a stick.
Dr Mahajan says a better result depends on how active and determined the patient is: the surgeon cannot do it alone, and the patient's part matters as much.
What should a patient ask before a knee replacement?
This is one woman's story, not a promise: what an operation can do for you depends on your own case.
If the tests before the operation find high blood pressure, ask whether the operation should wait until it is steady.
Ask what you will be expected to do yourself, such as walking and exercises, from the day after the operation.
What this case teaches
High blood pressure was linked to more blood clots in the leg after knee replacement, a 2026 study of 257,319 patients in Japan found.
Long-term illnesses may raise the chance of complications, the American Academy of Orthopaedic Surgeons says, and advises talking them through before surgery.
Computer navigation and robotic help lined up the new knee about equally well, a 2025 review of 16 studies found.
Walking within 12 hours of a hip or knee replacement may shorten hospital stays without adding harm, a 2026 review suggests.
Doing the physiotherapist's exercises early helps the knee's long-term strength and movement, the NHS says.
