Do I need surgery?
Knee replacement (also known as knee arthroplasty), is a surgical procedure to replace a damaged or worn-out knee joint with an artificial joint.
The procedure is recommended only to those who are experiencing severe pain, stiffness or instability, limited mobility and a reduced quality of life for conditions such as osteoarthritis, rheumatoid arthritis and post-traumatic arthritis.
Everybody is different and your treatment plan will be tailored to you based upon your quality of life, your medical history and your expectations.
What are the alternatives to surgery?
- Painkillers
- Weight loss
- Physiotherapy
- Steroid injections
- Walking aids
What are the advantages of knee replacement?
Knee replacement will improve your pain.
You will have better mobility.
Your exercise tolerance will be better.
Your overall quality of life will be improved.
What are the disadvantages of knee replacement?
1 in 5 patients still have some pain in their knee following surgery. This is particularly the case when surgery was performed for early stage osteoarthritis. If you have only the early stages of osteoarthritis, alternatives to surgery should be explored first.
The knee replacement is never as good as a “normal knee”. Patients rate a knee replacement at three-quarters that of a normal knee.
The knee replacement can clunk and click. This is normal but can take time to get used to.
The majority of patients will have some numbness on the outer aspect of their knee following surgery. They may also not be able to flex (bend) the knee as a normal knee and therefore have difficulty kneeling.
How long does a knee replacement last?
Mr Brock uses the Stryker triathlon knee replacement. This can be utilised using a manual technique or by using robotic surgery. The implant has an excellent track record and survivorship in National Joint Registries.
Most knee replacements will last 20 years or more. This number is decreased if you are (i) younger (ii) overweight (iii) participate in manual labour or heavy exercise.
If a knee replacement wears out, revision (re-do) surgery is possible but is more complicated and can carry more risk.
What is the process like?
Mr Brock will see you in clinic. He will take a detailed history about your symptoms and medical history. He will perform a physical examination and request x-rays of your knee. If you are having a robotic procedure you will also need a CT scan of your knee.
The benefits and the risks of knee replacement will be discussed in clinic. You will also have a pre-assessment appointment where your fitness for surgery will be assessed.
You will come in on the day of your procedure fasted. Mr Brock will see you that morning and make sure you are happy to procede with surgery. The anaesthetist will also talk to you.
You will receive a spinal anaesthestic and sedation prior to your surgery. The procedure takes between 45 minutes and 2 hours depending on the complexity.
You will then be transferred to the ward for rehabilitation and monitoring.
How long am I in hospital?
Patients are usually in hospital between 1 and 3 days. You are seen by physiotherapists and occupational therapists to determine that you are safe to go home prior to discharge.
You are seen at two weeks by a nurse to check your wound. On certain occasions, clips need to be removed from your skin.
You will then be seen back in clinic at six weeks. If you are doing well you will be discharged at that point but on some occasions you will be seen at 3, 6 and 12 months.
When can I return to work?
Whilst everyone is different, most people with desk-based jobs will be back at work after six weeks. People who do a lot of standing or manual work may need three months off work.
Some people that do heavy manual work will need to discuss with their employer doing less vigorous work on a long-term basis.
Looking after your knee replacement
Your knee replacement will continue to improve for upto two years as the muscles in your leg strengthen and scar tissue heals.
It is important that during the first six weeks after surgery your pain is under control so that you can participate in rehabilitation. Stiffness is common but you need to work through this with the physiotherapy in the first six weeks to get a good result.
The knee and lower leg will be swollen for around two months following surgery. Ice packs, walking and elevation when resting are all helpful for this.
You will start mobilising with sticks and usually by six weeks the majority of people can walk unaided again.
You will be safe to drive when you are able to perform an emergency stop. This is generally at around six weeks following surgery. It is important to check with your insurance company that you are covered during your recovery.
Can I still exercise after knee replacement?
Recreational sports such as golf, tennis and walking are recommended. Cycling is excellent for building up strength in the knee following surgery.
Heavier impact sports such as running must be performed with caution as this may reduce the longevity of the implants.
What are the risks of knee replacement?
Most operations are successful. However, 1 in 20 patients may have complications. Fortunately, most complications are minor and can be successfully treated.
Blood clots affecting the leg (deep vein thrombosis) and lung (pulmonary embolism) can occur following surgery as a result of the changes to the way the blood flows and clots during and after surgery. We try to minimise the risk of this by fitting special compression stockings to the other leg during surgery and by giving you medication to thin the blood for the first 10-14 days following surgery. Blood clots can be treated effectively with medication. In rare cases a blood clot on the lung (pulmonary embolism) can be fatal.
Infection in the knee replacement can occur in 1 in 100 patients. This can occur early following surgery or at a later date. Treatment involves an operation to wash the knee out and antibiotics. In some instances revision (re-do) surgery is required. In rare cases where infection cannot be cleared despite multiple attempts, amputation is required.
Nerve and vessel damage is uncommon. A nerve injury occurs in less than 1 in 100 patients and is usually temporary. A blood vessel injury occurs in 1 in 1000 patients and usually needs further surgery to repair.
Fracture to the bone during surgery is rare but is normally associated with patients who have weak bones (osteoporosis).
Pain after surgery is common but usually improves. 10-20% of patients will have ongoing pain (usually better than prior to surgery) and no obvious cause is determined for this.
Stiffness is uncommon. It is more likely to occur if pain is not controlled. On rare occasions, patients need to go back to theatre to have their knee manipulated in the first three months after surgery.
The knee replacement can wear out over time and require more surgery. At 10 years, approximately 3% of patients need more surgery, at 20 years, approximately 15% of patients do.