Total knee replacement involves removing the damaged joint surfaces at the end of the thigh bone (femur) and the top of the shin bone (tibia) and replacing them with a prosthetic joint consisting of metal and plastic.
Partial knee replacement involves replacing only part of the knee joint whilst preserving as much of the native joint as possible. This can be used if the knee joint has limited degenerative joint disease in only one area.
More than 90% of people who have total knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. Knee replacement will not allow you to do more than you could before you developed arthritis.
If you have arthritis of the knee you will have a rapid clinical assessment eliciting details of your difficulties and level of discomfort. You will require confirmatory X-rays and sometimes an MRI scan to confirm the diagnosis and assess for damage to other structures. You will be taken through all the available treatment options and your treatment will be tailored to your individual case and needs.
The decision to carry out surgery is only made after a thorough consideration of the symptoms you are suffering, the likely risks and benefits of surgery and an evaluation of whether other treatment modalities would be appropriate.
Other treatments include: exercise, applying heat to inflamed and swollen joints, taking pain killers including non-steroidal anti-inflammatories (NSAIDs), physiotherapy with muscle strengthening,corticosteroid injections and hyaluronic acid injections. Self-help measures such as losing weight can also be beneficial.
Total or partial knee replacement is carried out under general or spinal anaesthetic.
The operation lasts from 90 to 120 minutes. An incision at the front of the knee is used to access and replace the damaged surfaces of the joint.
The latest techniques are used to reduce pain and discomfort and enhance your rapid recovery from surgery.
Most patients will be able to leave after 2-5 days.
During this time you will be seen by a physiotherapist who will guide your early recovery and rehabilitation. In the early phase you will concentrate on getting the knee straight – extension exercises. This will improve quadriceps (front of thigh muscle) function and promote a good recovery.
You will be walking after surgery but may require walking aids for the first few days until the quadriceps are working well.
You will initially have a bandage on the knee. Your bandage will support the leg firmly but will allow considerable movement. This may be taken down fairly early to allow you to ice the knee (to help reduce swelling).
Mr Jennings will review you in hospital after surgery and then in the outpatient clinic at two weeks after your surgery to check your progress.
The critical part of the surgery is the rehabilitation which will be guided by your specialist physiotherapist.
Most of the discomfort subsides within 6 weeks and most patients can mobilise without the need of any crutches or sticks. By 3 months, almost all patients are pain free and very happy with the results. Occasionally it can take up to 18 months for the knee to fully settle. You will probably always find kneeling uncomfortable.
This is variable and depends on the nature of your work. Most patients return to work 6 weeks after their operation. Some more physically demanding jobs may require longer off work.
You can usually drive 6 weeks after knee replacement surgery. Your knee should bend sufficiently so that you can enter and sit comfortably in your car and your muscle strength and control can coordinate braking and acceleration.
Always check with your car insurance company before getting back on the road. It is important that in an emergency you are able to stop the car safely.
Repetitive loading and impact such as running may be possible, but is more likely to wear out your joint more rapidly. After 3 months most activities should be fine, but it is sensible to discuss your expectations and limitations prior to surgery.
Realistic activities following total knee replacement include unlimited walking, swimming, cycling, golf, driving, light hiking, biking, ballroom dancing, and other low-impact sports.
For up to 6 weeks following major knee surgery there is an extra risk of blood clots in the legs (DVT or deep vein thrombosis). During this time long haul flights should be avoided.
Shorter flights may be contemplated with much less risk. You should always consider using sensible precautions including good hydration, regular movement or exercise and the use of compression stockings when flying.