Total knee replacements are a very successful procedure, but before operating other measures are usually tried first. These include rest or reduced activity, pain-relieving medication, anti-inflammatory medication (if no contra-indications), physiotherapy and weight loss. A steroid injection can give temporary relief and a limited number of people can benefit from more minor arthroscopic (keyhole) procedures.
An X-ray may reveal a number of issues, including bone touching bone with no remaining cartilage, extra bone lumps around the joint (osteophytes), cavities or cysts in the bone (geodes) or the hardening of arthritic bone (sclerosis).
If you experience any of the symptoms listed below and you are not treated, you run the risk of the following problems:
For many people, only a knee replacement can provide good pain relief.
If you experience any of the following symptoms you may need knee replacement surgery:
Knee replacements are called knee arthroplasty and are a resurfacing procedure. In osteoarthritis, trauma and inflammatory arthritis, the smooth, low-friction, cartilage that cushions the joint is lost. In knee replacement surgery the damaged surfaces are removed and the thigh bone surface is covered with a smooth metal dome. The shin bone surface is covered with a metal tray into which fits a medical-grade plastic spacer that then functions as the smooth bearing surface on which the thigh bone glides. The patella can also be resurfaced with a plastic button.
Surgery can take between one and two hours and is usually carried out with a spinal anaesthetic. Patients can also have a short-lasting intravenous sedative, so they snooze during the procedure, but recovery is enhanced having avoided a full general anaesthetic.
We practice the Enhanced Recovery Pathway (ERP), which is a modern, evidence-based approach that helps people recover more quickly after having major surgery. Our physiotherapists begin working closely with patients within hours of joint replacement surgery, getting them up on their feet and growing their confidence. The length of stay at our hospital can be significantly shorter as a result. Early mobilisation and a return home reduces the risk of deep vein thrombosis and infections, as well as making patients feel more comfortable. With this support you will be mobile enough to go home two to four days after your operation. You will be given exercises and instructions on how to use mobility aids such as crutches and sticks.
You will need to rest when you return home and you are likely to feel tired in the first six weeks. Pain relief (analgesia), icepacks, elevation and a programme of rehabilitation are normal. By 10 to 12 weeks most patients are doing well, though knee replacements often improve for up to 18 months after surgery.
With any major surgery it must be remembered that there is a small risk of complication, but these are always discussed in detail with you beforehand. Programmes of care and hospital routines are regularly revised to minimise these occurrences, which mean that issues such as pulmonary embolism and deep infection are rare.
After a total knee replacement the knee will always feel a little mechanical. Proprioception (natural stability) can be reduced in some situations but a good functional range of movement is the norm. For the vast majority of patients a knee replacement is the most effective procedure for providing pain relief for an arthritic knee.
A pre-operative assessment is our opportunity to ensure that the procedure for which you have been referred is right for you. We’ll explain your treatment to you and make sure that you are well enough to go ahead with it. It is also your opportunity to meet the team who will care for you and to ask any questions.
We carry out all the necessary tests and examinations in one outpatient session. While this may take several hours, everything is done in one go to save frequent visits before surgery.
Where knee replacement surgery is not available on the NHS, or where the number of NHS procedures available has been reduced and has resulted in a longer waiting time, you can choose to pay for your treatment yourself via our self pay option.You may also want to explore privately funding your treatment for other reasons which are personal to your circumstances.
Self pay is available if you find you are not eligible for NHS-funded care and do not have private medical insurance.
You will need an open referral letter from your GP (we can help you with this). Because we don’t include all of the costly extras you may associate with private hospital treatment, paying for yourself could cost you considerably less than you might imagine too. There are also financing options available, to help you spread the cost.
Mike, April 2017
Orthopaedic patient, May 2017
Patient, May 2017